Unity's Response to the HIV Epidemic

Andrew Catanzaro, MD Unity Health Care, Inc.

Overview

• Unity Health Care, Inc.o History, Mission, Visiono Patient demographicso Unity Healthcare Structure

• HIV Groupo Comanagement Modelo Structure

• Dr. Catanzaroo Role in the organizationo Personal challenges

• Successful management traits

Mission

To offer a citywide network of quality health and human services to the medically underserved regardless of race, ethnic background, or ability to pay.

Vision

To become the preeminent health care delivery system for the medically undeserved of Washington DC, and to be recognized by them as the provider of choice.

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Unity Health Care: History

1985 - Unity founded as Health Care for the Homeless Project (HCHP)

1996 – The Federal Government requesed that HCHP become the emergency grantee for the Community Health Center Program in the District of Columbia

Unity Health Care: History

2001 – Unity Health Care joined the DC Health Care Alliance

Partners: Hospital, Two Insurance organizations, Children's Hospital, University Partner

HMO Insurance for coverage up to 200% poverty line

2006 - Unity start to provide health services to the DC Jail

1,500 Inmates 6% HIV infection rate

Unity Health Care Fee Structure

Medicaid, MedicareUnison Health Plan*DC Alliance*Health Right HMOChartered HMO

*Complete coverage up to 400% poverty line

Health Right Alliance Coverage2007

User and Visit in 2007

• Total Users 80,803• Total Visits 433,450

• HIV+ Patients: 2,974o Male 1,829o Female 1,134o Transgender 11

Income and Insurance Status

Structure to Deliver Health Care

• Eleven Community based centers• Nine Medical sites in homeless centers• Four Specialized Health Centers• Two Health Services Sites in DC Jails• Two Mobile Outreach vans• Seven Pharmacies• Home Visit Programs

Unity's Approach to HIV Medicine

• Co-management with a primary care provider (nurse practitioner, Family Medicine Physician, or Internal Medicine Physician)

• Comprehensive care

Unity's Medical Staff

• Health Care Providers 170• HIV Specialists 4

Unity's HIV Comprehensive Medical Care: Goals

• To offer comprehensive care to Unity patients infected with HIV within a primary health care network

• Services in:o Medical Careo Mental Healtho Social Serviceso Primary Careo Preventive health

Nutrition Dental Opthalmology OB/GYN

Unity's HIV Care Model: Co-management of HIV with Primary

Care

Primary Care Provider

HIV Specialist

Primary Care Provider HIV Specialist

HIV Therapy: AIDS Drug Assistance program

• Free to qualified applicants• Administered at the State level• Prescription medications including

o Antiretroviralso Prophylactic Medicationso Antidepressantso Pain medication

Prescription Coverage:AIDS Drug Assistance Program

Federal Budget 2007• $1.4 billion• Covering 344,000 prescriptions for 101,000

patients nationally

DC 2007• $14 million• Covering 2,100 prescriptions for 740 patients• Surpluses • Full coverage in less than 72 hours

My role in Unity

• One of three physician providing infectious diseases consultations to Unity patients

• My 800 patientso Five medical siteso DC Jail 20% time

• Team Approacho Nursingo Medical Assistantso Primary Care Providers

• Teaching Responsibilities

Evaluation of our Success

• Audit by the DC Government • HRSA tools• Ryan White Data

Structure of the HIV Group

• Four core HIV providers traveling to sites providing clinical care

• Four full time nurse case managers• Five full time medical assistants• Social Services on site funded for outreach

services• Grant writers: Federal, CDC, NIH grants,

Robert Wood Johnson for medical care • Monthly meeting to disseminate policy

changes

Successful leadership traits in Unity Manager

• Working in the health centers - on site

• Listen carefully regarding concerns

• Experience: seasoned, but not jaded

• Come up with solutions and systems in response to real problems

• Minimal paperwork, drama and politics

Unity Health Care, Inc.

“The medicine is easy, its the other stuff that is difficult.”

Challenges at Unity

• To care for patients for whom HIV is one of many difficult problems

Solution

• ICMP “the 50”o Take 50 of the most difficult patients and organize

the data in one location (Excel Spreadsheet)o Organize by CD4 count, viral loado Prioritize so that time and energy is focused on

these 50 patientso Revisit this list regularly with nursing/medical

assistant