Caring for Ryan White : The Fundamentals of HIV/AIDS Treatment Policy

This background paper provides an overview of the HIV/ AIDS epidemic in the United States and discusses how treatment of the disease and the populations most affected by it have changed over time. The federal government’s domestic and global efforts in prevention, research, and treatment of the disease are highlighted. The paper outlines the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act, a set of programs that fund treatment services for uninsured and underinsured individuals living with HIV/AIDS, and places it in the context of other federal programs that fund treatment for HIV/AIDS. Policy issues for Ryan White’s potential congressional reauthorization are also discussed

Don\u27t Bring Me Your Tired, Your Poor: The Crowded State of America\u27s Emergency Departments

If the time comes, people expect that the emergency department (ED) will have the resources necessary to treat them in a timely, high-quality manner. Increasingly, however, EDs may not be able to meet that expectation. Hospitals in urban areas with large populations, high population growth, and higher-than-average numbers of uninsured are particularly crowded: ambulances are often diverted to other hospitals and patients are frequently forced to “board” in the hallways (while they wait to be transferred to another facility or part of the hospital). This issue brief places EDs in the context of the U.S. health care system and its economics, discusses existing ED capacity and utilization, where crowding is happening and ways of measuring it, what is causing crowding in EDs, and the consequences of crowding. It highlights a number of potential ways to alleviate crowding at both the health system and the individual hospital level

The Ryan White HIV/AIDS Program

This publication describes the basics of the Ryan White HIV/AIDS Program, the largest federal program solely focused on treating people living with HIV/AIDS in the United States. The program funds cities, states, and community-based organizations to provide primary care, prescription drugs, and support services to low-income, uninsured, and underinsured people living with HIV/AIDS

Updating the WIC Food Packages: It\u27s About Time

This issue brief reviews key revisions to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program proposed by the USDA, which are based substantially on recommendations by the Institute of Medicine. Should the changes become regulation, they will be the most significant revision of the WIC food packages in over 25 years. This brief describes the changes, the impetus for their consideration, and possible implementation issues from the perspectives of vendors, state and local WIC agencies, and participants

Changes in Latitudes, Changes in Attitudes: FQHCs and Community Clinics in a Reformed Health Care Market

The Patient Protection and Affordable Care Act of 2010 and the Supreme Court’s related decision have significantly shifted the health care landscape for safety net providers. Federally qualified health centers (FQHCs) are a mainstay of primary care for the uninsured and those with limited access to care. This paper focuses on the impact of health reform on FQHCs given the significant federal investment in them through grants, Medicaid, and Medicare reimbursement. Where noteworthy, the effect on non-FQHC community clinics is also discussed. The implications of Medicaid coverage expansions (or lack thereof in states that choose not to expand), Medicaid disproportionate share hospital program cuts, discretionary budgets and sequestration, Medicare payment changes, contracting with qualified health plans in state health insurance exchanges, and delivery system reforms are explored

The Primary Care Safety Net: Strained, Transitioning, Critical

This background paper examines the primary care safety net. It describes key primary care safety net providers, including federally qualified health centers, free clinics, local health departments, and safety net hospital outpatient departments and clinics, among others. The paper also explores the changing role of the primary care safety net in a post–health reform marketplace

The Coopetition Model: Caring for San Diego\u27s Low-Income Population

This site visit explored aspects of health care delivery for Medicaid beneficiaries and the uninsured in a California county marked by a diverse population, dominant managed care, and stakeholder dedication to solving problems in a spirit of coopetition. The program looked at the impact of California\u27s Bridge to Reform (the state\u27s Medicaid section 1115 waiver) on federally qualified health centers and the people they serve. Eligibility and enrollment expansions in the Low Income Health Program and Medi-Cal, health information technology adoption and its use to improve care delivery and health, and patient-centered medical homes and care coordination were discussed. The group learned about efforts to integrate behavioral health and social services into primary care and the identification of heavy health care users and system improvements to better serve them. Participants visited three community health centers, conversed with government officials, providers, a health plan representative, consumer advocates, leaders in health information technology, a hospital executive, and experts on the San Diego market. A report on participants\u27 impressions was published on May 15, 2013

LA Story: Improving Care Management for the Chronically Ill and Chronically Underserved

This Los Angeles-based site visit examined safety net and private sector efforts to improve care coordination for underserved and vulnerable populations, including the homeless, the uninsured, the undocumented, and individuals with chronic conditions like diabetes, asthma, and severe mental illness. The visit highlighted challenges and innovations in the use of disease management programs, information systems, performance incentives, and managed care as tools for improving care coordination

Tending to Richmond\u27s Children: Community Strategies to Bridge Service Gaps

The National Health Policy Forum sponsored a site visit to Richmond, Virginia, in October 2008 to explore social and environmental determinants of children’s health, including the impacts that poverty and exposure to lead-based paint have on birth outcomes, child development, and school readiness; and the community\u27s efforts to address them. Though not large in population terms, Richmond faces many of the social and economic problems often common in larger urban areas—concentrated poverty, migration of wealth and services to the surrounding counties, a high infant mortality rate, and troubled schools. The site visit explored community strategies to improve birth outcomes and early childhood development, such as home visiting programs. Efforts to serve children with special behavioral and physical health care needs were discussed as were community-level efforts to bridge service fragmentation and gaps. Site visitors learned about issues faced by community-based organizations serving children and families, including problems with federal funding streams, state and local politics and bureaucracies, and perennial budget challenges

Rocky Mountain Highs and Lows: Efforts to Improve Health and Reduce Costs in Denver

In late May–early June 2011, the Forum sponsored a site visit to Denver, Colorado, to observe innovative efforts to improve the health of Coloradans and reduce the cost of health care. The three-day agenda was designed to convey the breadth and interconnectedness of the efforts underway in Denver and to highlight both successes and challenges. The exploration concentrated on how three themes of national interest are unfolding in Denver: building and sustaining a robust and effective safety net in an evolving health care market; improving the health of people and their communities to prevent and reduce the need for health care; and interprofessional education, training, and practice to foster the development of the teams of health professionals envisioned for the future. The site visit also examined the intersections among and disconnects between these critical aspects of a comprehensive approach to a healthy city. The agenda included visits to several communities in the Denver Metro Area; a variety of health care delivery sites ranging from a small school-based clinic to a large academic medical center under expansion; and the new interprofessional Anschutz Medical Campus which houses the University of Colorado schools of medicine, nursing, dentistry, pharmacy, and public health. The agenda also included several panels convened in the hotel and at various other sites