February 6, 2013

Wisconsin Receives Federal Approval for AIDS/HIV Medical Home Model of Care

MADISON-The Department of Health Services and AIDS Resource Center of Wisconsin (ARCW) announced the U.S. Centers for Medicare and Medicaid Services (CMS) has given final approval for the Wisconsin Health Home for Individuals with AIDS/HIV. The action by CMS is the culmination of more than four years of work in securing approval for the specialized health care system.

"We brought together staff with expertise in mental health and substance abuse, public health, and Medicaid to develop this benefit. We collaborated with the largest single provider of services to individuals diagnosed with AIDS/HIV, ARCW, to ensure that care is coordinated to ensure cost effectiveness while improving the overall quality of care," said Deputy Secretary Kitty Rhoades. "This is a great example of what can happen when we work together with the focus of helping people live better lives."

"ARCW has developed an innovative HIV Medical Home that is a national model for caring for HIV patients," said ARCW President and Chief Executive Officer Mike Gifford. "The approval by CMS of our model of care is an endorsement of the effective care that we offer to HIV patients throughout Wisconsin and sets the stage to assure that everyone with HIV receives excellent and comprehensive care."

Medical homes offer patients individualized, patient centered and coordinated health care that accomplishes the goals of saving costs across the health care system - typically by avoiding duplicative or unnecessary care and treatment - and enhancing patient health care outcomes by making sure patients receive the right care, at the right time. In support of these important goals, the ARCW HIV Medical Home is eligible to receive additional Medicaid reimbursement rates provided it meets a strict set of requirements outlined in Wisconsin Statutes.

"At ARCW, our patients have access to medical, dental, mental health and pharmacy services that are delivered in a coordinated fashion and supported by housing, food, legal and case management services," Gifford said. "Combined, our model of care is identifying the most pressing health and socio-economic needs of our patients and overcoming them, leading to health care outcomes that are among the best in the nation for HIV patients."

Today, 76% of ARCW patients on HIV medications have an undetectable viral load, meaning the patients are managing their HIV as effectively and successfully as possible. Unfortunately, only about 25% of the more than one million HIV patients in the United States are achieving this success.

"In securing federal approval for this innovation in care, Wisconsin has once again put people with HIV before politics. We are deeply grateful for the Walker Administration's leadership to secure federal support for this important HIV public policy based on legislation originally approved unanimously by the Wisconsin State Legislature," said Gifford.

Medical homes are a key part of the Department of Health Services' overall goal of changing Medicaid's service delivery and reimbursement structure from a volume based system to one based on value and health outcomes. The Benefit is available to eligible members who are enrolled in the BadgerCare Plus Standard Plan, BadgerCare Plus Benchmark Plan, BadgerCare Plus Core Plan or Wisconsin Medicaid.