|
|
|
|
Medical Case Management — Treatment Adherence
|
|
|
HRSA/HAB Category Definition:
|
|
Medical case management services (including treatment adherence) are a range of client-centered services that link clients with health care, psychosocial, and other services. The coordination and follow-up of medical treatments is a component of medical case management. These services ensure timely and coordinated access to medically appropriate levels of health and support services and continuity of care, through ongoing assessment of the client and other key family members’ needs and personal support systems.Medical case management includes the provision of treatment adherence counseling to ensure readiness for, and adherence to, complex HIV/AIDS treatments. Key activities include (1) initial assessment of service needs; (2) development of a comprehensive, individualized service plan; (3) coordination of services required to implement the plan; (4) client monitoring to assess the efficacy of the plan; and (5) periodic reevaluation and adaptation of the plan as necessary over the life of the client. It includes client-specific advocacy and/or review of utilization of services. This includes all types of case management including face-to-face, phone contact, and any other forms of communication.
|
|
|
Source: Definition provided by the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), HIV/AIDS Bureau (HAB). 2009. Ryan White HIV/AIDS Treatment Modernization Act of 2006 Definitions for Eligible Services. Rockville, Md.: HRSA HAB, August 20, 2009.
|
|
|
Category Notes:
|
Clarifications
For the purposes of this service category, adherence will be defined as “the act or quality of sticking to something; steady devotion; the act of adhering. Adherence is best achieved through a collaborative process that facilitates acceptance and integration of a medication regimen into an individual’s daily life” (NYHD 2001). Adherence may also be defined as keeping appointments and following through on the agreed-upon multidisciplinary care plan.
The following definition clarifications are a result of a conference call involving representatives of the grantee (BCHD), Greater Baltimore HIV Health Services Planning Council (PC), PC support office (IGS) and HRSA on May 28, 2008.
• Adherence activities performed solely by peers is a support service.
• Involvement of family in the services being provided to the infected client is left to the professional judgment of the case manager.
The following clarification was distributed by HRSA on April 8, 2010 (HRSA 2010a).
Medical Case Management services must be provided by trained professionals, including both medically credentialed and other health care staff who provide a range of client-centered services that result in a coordinated care plan which links clients to medical care, psychosocial, and other services. These services ensure timely and coordinated access to medically appropriate levels of health and support services and continuity of care, through an ongoing assessment/reassessment of the client and other key family members’ needs and personal support systems. Medical case management may also include the provision of treatment adherence counseling to ensure readiness for, and adherence to, complex HIV/AIDS treatments. Key activities include: (1) initial assessment of service needs; (2) development of a comprehensive, individualized care plan; (3) coordination of services required to implement the care plan; (4) continuous client monitoring to assess the efficacy of the care plan; and (5) periodic reevaluation and adaptation of the care plan, at least every six months, as necessary during the enrollment of the client.
The following clarification was distributed by HRSA on April 8, 2010 (HRSA 2010a).
Benefits and Entitlement Counseling
Funds awarded under Ryan White HIV/AIDS Program may be used to refer or assist eligible clients to obtain access to other public and private programs for which they may be eligible, e.g. Medicaid Medicare Part D, State Pharmacy Assistance Programs, Pharmaceutical Manufacturer’s Patient Assistance Programs, and other state or local health care and supportive services. Such benefits/entitlement counseling and referral activities may be provided as a component of three allowable Ryan White HIV/AIDS Program support service categories: Medical Case Management, Case Management (non-medical) and/or Referral for Health Care/Supportive Services.
History
Medical Case Management
The service definition for medical case management changed with the authorization of the Treatment Modernization Act of 2006. The category became a core-medical service that included treatment adherence services. The Baltimore EMA moved treatment adherence services into medical case management; some programs providing adherence services were also moved from psychosocial support services.
This subcategory was previously under the Early Intervention Services category in FY 2008, but funding was absorbed into the supportive service category of psychosocial counseling effective FY 2009.
The Baltimore EMA has funded case management since the EMA’s first grant.
Treatment Adherence
Throughout the Baltimore EMA, service providers experience the failure of clients to keep appointments and/or to follow through with planned medical regimens. The rate of no-shows for appointments varies across the EMA, but some treatment services may have nearly 50 percent of their scheduled appointments not kept. Since failure to keep scheduled appointments, especially HIV medical care appointments, has a serious impact on the state of wellness of the individual and causes a serious waste of limited staff and financial resources, the planning council has designated funds to address adherence issues.
The goal of the service is to provide intensive services directed toward identification and remediation of barriers that interfere with the client’s adhering to the needed medical services or following the planned medical treatments. The service is intended to help clients develop the habits and techniques necessary to keep medical appointments, follow complex medication regimens and comply with agreed-upon multidisciplinary action steps. One of the key principles in developing a successful treatment adherence program is the cooperation and collaboration between the person requiring adherence support and the primary care provider and the multidisciplinary care team.
Clients with co-morbid conditions as primary barriers should be served through the primary care co-morbidity service category. Clients who have multiple service needs should be served through the case-management service category.
Current Directives
At the time of publication, there were no current directives for this service category.
|
|
|
|
|
|
|
|
|
|
|
|