A managed-care approach to treating people with AIDS in Los Angeles County has earned a $1.25 million federal grant.
The Los Angeles-based AIDS Healthcare Foundation's project will provide capitated payments for the care of California's Medicaid patients who have AIDS.
"We're capitating a catastrophically ill population that is publicly supported," said Marie Flores Clarke, director of managed care at AIDS Healthcare Foundation. "Typical prepaid plans need tens of thousands of enrollees, and they try to spread the risk over mostly healthy people. We're doing it with people that have full-blown AIDS."
Initially, about 1,000 AIDS patients from California's Medicaid program, Medi-Cal, are expected to participate in the model plan. The effort hopes to attain fewer hospitalizations, better care and longer lifespans for people with AIDS.
Total costs haven't been projected.
The foundation's effort could become a national model for care of Medicaid patients with AIDS, according to the Bureau of Resources Development, which awarded the grant over a five-year period. Nationally, Medicaid pays for more than 45% of AIDS care, according to the Washington-based AIDS Action Council.
The foundation expects to sign an initial contract with the California Department of Health Services by the end of the year to care for Medi-Cal patients. Since the effort is a pilot project, the foundation's effort didn't have to pass traditional licensing requirements for health plans.
The state, however, is mandating the foundation's plan save at least 5% of costs when compared with traditional fee-for-service care of Medi-Cal patients with AIDS. Rate and cost structures have yet to be established.
Costs for treating patients range from $120,000 to $200,000 for treating a person from the time of AIDS virus infection until death, Ms. Clarke said.
"Unlike a lot of other efforts, we already have a network of clinics in place," Ms. Clarke said. "This has been in the works for three years."
AIDS Healthcare Foundation is a not-for-profit organization with $13.5 million in revenues. It owns and operates five outpatient clinics and two 25-bed residential AIDS hospices for people with AIDS and HIV, the virus that causes AIDS.
The clinics are all located on hospital campuses in Los Angeles County. The affiliated hospitals are 299-bed Queen of Angels-Hollywood Presbyterian Medical Center, 924-bed Cedars-Sinai Medical Center and 301-bed California Hospital Medical Center, all in Los Angeles; 105-bed Sherman Oaks (Calif.) Hospital and Health Center; and 403-bed Daniel Freeman Memorial Hospital, Inglewood.
The foundation is discussing the addition of two other clinics, but executives weren't ready to release the details.
Patient enrollment in the plan is voluntary. Enrollment could exceed 2,500, based on the number of participating clinics and affiliated hospitals.