Managed care and HIV.

In order to control costs, a transition from fee-for-service plans to managed care for people with HIV infections and AIDS is developing in the United States. The question arises whether a cost-conscious, competitive environment can deliver quality care to people with a disease that is complex and expensive to treat. Several options can be used to keep managed care from removing incentives for treating too many HIV and AIDS patients. Approaches include increasing capitation fees for patients who require more resources, and utilizing a carve-out approach from the State-managed Medicaid plans to separate HIV from the mainstream plans. However, rate determination under either option is problematic and may entail analyzing the cost of care under the fee-for-service system as a benchmark, including cost variations at various stages of HIV disease. This analysis also includes developing accurate adjustments for changes in treatment and assessing the quality of care that is received. Quality of care can be assessed through an analysis of outcomes, processes, and structures of care.