3 Site interviews (site administrators)

R WHAP Outcomes Study - Site Visit Interview Guide

Attachment A: Ryan White HIV/AIDS Program Outcomes and Expanded Insurance Coverage - Site Interview Guide

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Site Visit Overview

Introduction and Background

The healthcare landscape has changed over the past few years and continues to change. Some individuals who had only access healthcare through the Ryan White HIV/AIDS Program (RWHAP) now have additional healthcare coverage.

These healthcare coverage categories represent a complex array of client profiles to which RWHAP sites have had to adapt in order to meet the need of clients. Although the HIV population is experiencing additional care options, the experience of individuals varies dramatically from person to person and depends significantly on the state where they live and the number and type of plan offerings available to them. It also depends upon the extent to which RWHAP grant recipients and providers have adapted their service offerings to effectively assist persons to navigate the new insurance system and compliment the insurance benefits offered. The focus of this evaluation will be to assess whether and how the chaning healthcare landscape has affected overall health outcomes, service utilization, and gaps in care of HIV positive individuals. We will also assess how RWHAP provider sites meet the needs of clients with various healthcare coverage types across the country.

This document presents the study site interview questions organized by general line of inquiry. To achieve the Health Resources and Services Administration (HRSA), HIV/AIDS Bureau’s (HAB) objectives for this evaluation, we will include questions on clinic context and background, client healthcare outcomes, RWHAP services, and pharmaceutical coverage, as they relate to clients’ healthcare coverage types.

Date(s) of Interview __In-Person __Telephone
Facility Name and Location
Participants (full name credentials)	Title	Organizational Affiliation

1. Background/Clinic Context

Before we begin,we’d like to gain a clearer understanding of the larger context in which your clinic/facility operates.

1. COMMUNITY CONTEXT: Since January 2014 have there been any changes regarding the unique socio-economic and cultural characteristics of the community in which your clinic/facility operates?

1. If yes, how have these changes influenced services, program and operations at your clinic/facility?

2. Currently, how widely available are medical and support services (including Ryan White HIV/AIDS Program and non-Ryan White HIV/AIDS Program funded services) for people living with HIV/AIDS within your community?

2. CLINIC CONTEXT: We’d like ask some questions about services offered by your clinic and those available in your community for HIV positive clients.

1. What insurance types does your site accept?

• Medicaid?

• Marketplace insurance?

• Private insurance?

• High risk insurance pools (if there are any currently operating in the state)

2. Have there been any additions or deletions regarding the Ryan White HIV/AIDS Program-funded services offered by your site? [NOTE: Review previous list with respondent]

3. With which other community organizations do your clinic partner with most actively to provide services to clients?

1. What role do they play?

2. Have there been any significant changes since January 2014?

3. CLIENT CONTEXT: Since January 2014 have there been any changes regarding the demographic characteristics of your clinic population? [NOTE: Validate the estimates provided in the next three questions against the RSR data provided in your pre-site visit materials.]

1. Approximately how many HIV positive clients does your facility/clinic currently serve?

• What proportion of these clients receive Ryan White HIV/AIDS Program funded services?

• What proportion of these clients receive Ryan White HIV/AIDS Program funded medical services?

2. Overall, has your caseload of HIV-positive clients increased or decreased since January 1, 2014?

• By how much?

• How much of that increase or decrease was inRWHAP clients?

3. Have/how have the characteristics of your client caseload changed January 2014 (overall, specifically Ryan White HIV/AIDS Program clients)?

• Demographics

• Socioeconomic status

2. Overall Healthcare Outcomes & Insurance Coverage

In this section, we will ask about changes in health outcomes and healthcare coverage factors based on insurance type.

1. Impact on all client health outcomes, for RWHAP clients receiving coverage through since January 2014: Medicaid compared with private insurance

1. Have the overall health outcomes for RWHAP?

• Changes in HIV outcomes?

• Changes in overall primary health outcomes?

2. Are there any differences in changes in health outcomes by insurance type?

• Medicaid?

• Marketplace insurance?

• Private insurance?

2. Health insurance-related factors contributing most to a RWHAP client’s health outcomes

1. What insurance-related factors have faciliated or challenged sufficient access to care for clients with different coverage types?

• Medicaid?

• Marketplace insurance?

• Private insurance?

2. What insurance-related factors have faciliated or challenged client health outcomes? Please note any significant difference between HIV outcomes and overall primary health outcomes.

• Medicaid?

• Marketplace insurance?

• Private insurance?

3. What healthcare coverage gaps still remain (by insurance type)? Please note any significant difference between HIV outcomes and overall primary health outcomes.

4. Has your site’s model of care changed for RWHAP clients based on insurance type? (e.g. Infectious Disease (ID) only, ID + primary care, ID +primary care elsewhere).

5. What have been the challenges and successes working with insurers?

6. Please describe your experience contracting with insurers.

• Are there insurers with which you do not contract that have caused you to stop serving previous cleints?

• Are your providers designated as PCPs under your contracts?

• How has contracting with insurers impacted client care (HIV care and overall primary healthcare)?

3. Clients receiving greatest number and variety of RWHAP services and experienceng poorest health outcomes

1. Please describe the types of clients that receive the greatest number and variety of RWHAP services and experience the poorest health outcomes (new to care, stable/virally supressed, unsuppressed/non-adherent, multiple comorbities)?

2. Please describe the types of clients that receive the fewest number and variety of RWHAP services and experience the poorest health outcomes?

3. Please describe the types of clients that receive the greatest number and variety of RWHAP services and experience the best health outcomes?

4. Please describe the types of clients that receive the fewest number and variety of RWHAP services and experience the best health outcomes?

5. Can you describe the role that differing types of healthcare coverage play in the level of services and outcomes we’ve discussed?

3. RWHAP Services Provided

In this section, we will ask about the RWHAP services available to your clients.

1. CORE MEDICAL SERVICES: Please tell us about Ryan White HIV/AIDS Program funded core medical services your clinic/facility offers.

1. What core medical services did clients access most frequently from your site prior to January 2014?

• Clients with healthcare coverage?

  • Medicaid clients?

  • Private insurance clients?

• Uninsured clients?

2. What core medical services have clients accessed most frequently from your site after January 2014?

• Medicaid clients?

• Marketplace insurance clients?

• Private insurance clients?

• Uninsured clients?

3. Can you describe the facilitators and challenges in providing these medical services i since January 2014? For example, are there challenges in engagement, retention, and coordination of care? Is it easier to get clients into care for non-HIV-related conditions? Please describe and tell us why.

4. Are clients experiencing any gaps in the core medical services provided? If so, which kinds of services and why?

1. Are any of these gaps related to their type healthcare coverage?

• Medicaid?

• Marketplace insurance?

• Private insurance?

• Uninsured clients?

5. Do you think there are certain core medical services that RWHAP clients need most for retention and suppression? If yes, what are these services?

1. What are the facilitators of and/or barriers to clients receiving these services based upon the type of healthcare coverage?

• Medicaid?

• Marketplace insurance?

• Private insurance?

• Uninsured clients?

6. Have clients experienced difficulties with appointment availability? Does this vary by insurance type?

2. SUPPORT SERVICES: Please tell us about the Ryan White HIV/AIDS Program funded support services your clinic/facility offers.

1. What support services did clients access most frequently from your site before January 2014?

• clients with healthcare coverage?

  • Medicaid clients?

  • Private insurance clients?

• Uninsured clients?

2. What support services have clients accessed most frequently from your site after January 2014?

• Medicaid clients?

• Marketplace insurance clients?

• Private insurance clients?

• Uninsured clients?

3. Can you describe the facilitators and challenges in providing these support services after January 2014? For example, are there challenges in engagement, retention and coordination of care? If so, which and why?

4. Are clients experiencing any gaps in support services provided? If so, which kind of services and why?

1. Are any of these gaps related to their type of healthcare coverage?

• Medicaid?

• Marketplace insurance?

• Private insurance?

• Uninsured clients?

5. Do you think there are certain support services that RWHAP clients need most for retention and suppression? If yes, what are these services? What are the facilitators of and/or barriers to clients receiving these services based upon the type of healthcare coverage?

• Medicaid?

• Marketplace insurance?

• Private insurance?

• Uninsured clients?

6. Have clients experienced difficulties with appointment availability? Does this vary by insurance type?

7. If RWHAP support services were not available, what impact would it have on clients?

4. Pharmaceutical Outcomes

In this section, we will ask you about the pharmaceutical coverage options and health outcomes among your clients.

1. Changing healthcare landscape’s impact on client’s experience related to pharmaceutical coverage

1. Prior to January 2014, did RWHAP clients experience any challenges or barriers to accessing pharmacy services or HIV medications? If yes, what challenges or barriers did they face?

• Medicaid clients?

• Private insurance clients?

• Uninsured clients?

2. After January 2014, did RWHAP clients who were new to healthcare coverage experience any challenges or barriers to accessing pharmacy services or HIV medications?

• Medicaid clients?

• Marketplace insurance clients?

• Uninsured clients?

2. Degree to which clients change insurance versus ADAP/LPAP pharmaceutical/Impact of “switching” on client health outcomes/Degree of “churning”

1. For clients who experienced a change their HIV medication coverage, can you describe the changes regarding [NOTE: Change does not necessarily mean they compleltely discontinued their previous medication coverage]

• What they changed from (Medicaid, QHP, ADAP, LPAP)?

• What they changed to?

• Whether they changed more than once?

• Why they changed?

2. Any perceived positive or negative effects on their ability to maintain medication adherence and health outcomes

3. Impact of ADAP/LPAP on health outcomes compared to newly covered clients-contributing factors

1. How does changing insurance coverage for medications impact client health outcomes?

• Medicaid

• Marketplace

• ADAP

• LPAP

2. Are certain drugs covered by one type of insurance and not another?

3. Are there certain drugs that are covered, but not sufficiently? If so, how does this vary by coverage type?

• Medicaid

• Marketplace

• ADAP

• LPAP

4. Closing

For this last question, I’d ask for you to reflect back on the discussion we just had on client health outcomes, RWHAP services, and pharmaceutical coverage.

1. TOP THREE: If you had to summarize the top three impacts that changing healthcare landscape has had your clients’ health outcomes over the past year, what would they be?

2. TOP THREE: If you had to summarize the top three impacts the changing healthcare landscape has had on RWHAP over the past year, what would they be?

3. TOP THREE: If you had to summarize the top three impacts that changing healthcare landscape has had on pharmaceutical coverage over the past year, what would they be?

FINAL THOUGHTS: Thank you very much for your time today. We are at the end of our time/site visit/interview. Are there any additional thoughts you’d like to share before we conclude?

OMB Number (0906-XXXX) 15

Expiration date XX/XX/201X