Coordinating HIV Treatment in a Changing Healthcare Landscape

Published Feb 6, 2012

By: Liza Behrendt

This piece originally appeared at here.

Jewish law obliges us to look out for the health of others, even at considerable sacrifice. One rabbi in Babylonian Talmud Nedarin advises us to visit the sick 100 times a day, a symbolic call to keep their needs front and center in our minds. But how does U.S. policy hold up to these ideals? As an AVODAH Corps member working with Gay Men’s Health Crisis, the world’s first HIV/AIDS service provider, I see people with chronic health conditions battling to obtain the life-saving services that they deserve. Federal healthcare policy is at a crucial turning point with the Affordable Care Act (ACA), President Obama’s landmark healthcare legislation passed last year.

People with HIV are living longer, but their medical needs are increasingly complicated. Many experience additional chronic conditions like asthma, diabetes, and cardiac problems, and depend on a wide array of social services. HIV advocates work to ensure that clients receive the complete care that they need with minimal stress, while also considering severe budget constraints on Medicaid programs. Through the ACA, the federal government is pushing “coordinated care” as a strategy for increasing communication among providers and cutting down on administrative healthcare costs.

Coordinated care is organizational collaboration, focused on managing a chronic condition between a range of medical providers. Ideally, coordinated care services means coverage for the whole individual, taking all of a person’s needs into account, rather than isolated treatment for symptoms as they arise. Therefore coordinated care programs, in order to be successful, must prioritize the client’s own voice in all healthcare decision making.

The U.S. Department of Health and Human Services sees coordinated care as a cost-saving strategy because it means a more cohesive system. The rapid rise in U.S. healthcare over the past several decades has resulted less from higher quality care than from higher profits and administrative costs, as well as a remarkably disorganized system where providers maintain little contact with each other. Our healthcare system still functions on a profit-driven model that prioritizes short-term payment over the long-term well-being of patients. How are people with HIV supposed to manage their complex chronic conditions if neither they nor their doctors know the full picture of their health? Faulty referrals and incomplete background information make people with HIV more likely to be unnecessarily hospitalized or institutionalized, which can raise costs, stress, and even stigma. This lack of coordination can perpetuate and intensify health disparities, leaving the most vulnerable populations without adequate health support.

A more collaborative approach, where clients work with a single provider to anticipate long-term needs and oversee the delivery of all services, could streamline care, lessen wasteful bureaucracy, prevent duplicated services, and intervene early and prevent problems before they become dangerous and expensive. Yet we must be wary of the challenges that coordinated care can bring, especially when cost-saving is the driving force behind new policies. Clients value flexibility in choosing their healthcare providers, and an increasingly networked system could minimize their options. The transition into coordinated care could disrupt current client-provider relationships.

At Gay Men’s Health Crisis, I’ve come to understand that people affected by HIV/AIDS must have full control over their own healthcare if medical and social services are to succeed. Clients who feel a sense of ownership over their own health will personally commit to adhering to care. Saving Medicaid dollars is essential, but the voices of people affected by healthcare cannot be forgotten. You can start to amplify their voices by learning more: for information on what coordinated care will look like in New York, click here.

Liza Behrendt is from Durham, NH, and attended Brandeis University. As a New York AVODAH Corps member, she is a Community Organizer at Gay Men’s Health Crisis, which is committed to national leadership in the fight against AIDS. GMHC works hard to reduce the spread of HIV disease, helps people with HIV maintain and improve their health and independence, and keeps the prevention, treatment, and cure of HIV an urgent national and local priority.

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