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Unity's Response to the HIV Epidemic
Andrew Catanzaro, MD Unity Health Care, Inc.
Overview
• Unity Health Care, Inc.o History, Mission, Visiono Patient demographicso Unity Healthcare Structure
• HIV Groupo Comanagement Modelo Structure
• Dr. Catanzaroo Role in the organizationo Personal challenges
• Successful management traits
Mission
To offer a citywide network of quality health and human services to the medically underserved regardless of race, ethnic background, or ability to pay.
Vision
To become the preeminent health care delivery system for the medically undeserved of Washington DC, and to be recognized by them as the provider of choice.
Homelessness: The Family PortraitAcross Region, Economy Pulls Rug From Under More and More 2-Parent Households
By Chris L. JenkinsWashington Post Staff WriterMonday, February 16, 2009; A01
Unity Health Care: History
1985 - Unity founded as Health Care for the Homeless Project (HCHP)
1996 – The Federal Government requesed that HCHP become the emergency grantee for the Community Health Center Program in the District of Columbia
Unity Health Care: History
2001 – Unity Health Care joined the DC Health Care Alliance
Partners: Hospital, Two Insurance organizations, Children's Hospital, University Partner
HMO Insurance for coverage up to 200% poverty line
2006 - Unity start to provide health services to the DC Jail
1,500 Inmates 6% HIV infection rate
Unity Health Care Fee Structure
Medicaid, MedicareUnison Health Plan*DC Alliance*Health Right HMOChartered HMO
*Complete coverage up to 400% poverty line
Health Right Alliance Coverage2007
User and Visit in 2007
• Total Users 80,803• Total Visits 433,450
• HIV+ Patients: 2,974o Male 1,829o Female 1,134o Transgender 11
Income and Insurance Status
Structure to Deliver Health Care
• Eleven Community based centers• Nine Medical sites in homeless centers• Four Specialized Health Centers• Two Health Services Sites in DC Jails• Two Mobile Outreach vans• Seven Pharmacies• Home Visit Programs
Unity's Approach to HIV Medicine
• Co-management with a primary care provider (nurse practitioner, Family Medicine Physician, or Internal Medicine Physician)
• Comprehensive care
Unity's Medical Staff
• Health Care Providers 170• HIV Specialists 4
Unity's HIV Comprehensive Medical Care: Goals
• To offer comprehensive care to Unity patients infected with HIV within a primary health care network
• Services in:o Medical Careo Mental Healtho Social Serviceso Primary Careo Preventive health
Nutrition Dental Opthalmology OB/GYN
Unity's HIV Care Model: Co-management of HIV with Primary
Care
Primary Care Provider
HIV Specialist
Primary Care Provider HIV Specialist
HIV Therapy: AIDS Drug Assistance program
• Free to qualified applicants• Administered at the State level• Prescription medications including
o Antiretroviralso Prophylactic Medicationso Antidepressantso Pain medication
Prescription Coverage:AIDS Drug Assistance Program
Federal Budget 2007• $1.4 billion• Covering 344,000 prescriptions for 101,000
patients nationally
DC 2007• $14 million• Covering 2,100 prescriptions for 740 patients• Surpluses • Full coverage in less than 72 hours
My role in Unity
• One of three physician providing infectious diseases consultations to Unity patients
• My 800 patientso Five medical siteso DC Jail 20% time
• Team Approacho Nursingo Medical Assistantso Primary Care Providers
• Teaching Responsibilities
Evaluation of our Success
• Audit by the DC Government • HRSA tools• Ryan White Data
Structure of the HIV Group
• Four core HIV providers traveling to sites providing clinical care
• Four full time nurse case managers• Five full time medical assistants• Social Services on site funded for outreach
services• Grant writers: Federal, CDC, NIH grants,
Robert Wood Johnson for medical care • Monthly meeting to disseminate policy
changes
Successful leadership traits in Unity Manager
• Working in the health centers - on site
• Listen carefully regarding concerns
• Experience: seasoned, but not jaded
• Come up with solutions and systems in response to real problems
• Minimal paperwork, drama and politics
Unity Health Care, Inc.
“The medicine is easy, its the other stuff that is difficult.”
Challenges at Unity
• To care for patients for whom HIV is one of many difficult problems
Solution
• ICMP “the 50”o Take 50 of the most difficult patients and organize
the data in one location (Excel Spreadsheet)o Organize by CD4 count, viral loado Prioritize so that time and energy is focused on
these 50 patientso Revisit this list regularly with nursing/medical
assistant