Thursday, July 21, 2016

Finding the right doctor can be challenging—this new service can help

By: Carine Carmy, Head of Marketing, Amino

When you need to find a doctor, how do you find the right one? If you have health insurance, you might start with your insurance plan, and check which doctors are in-network. You might look at online resources, and Google which doctors are located nearby. You might look at Yelp or other review sites to see what people say about the doctors (and if you’re lucky, those reviews might be relevant to your condition or to the procedure you need). If you have a friend or family member with your condition, or know someone with a medical background, you might be able to ask one of them for a recommendation.

Even if you went through all that to find a doctor, would you feel confident that you made the right choice? With all the resources available for health care decision-making, you might still be missing a crucial piece of information: how much experience does this doctor have with what you need?

Research shows that when it comes to doctors, experience matters—not necessarily years of experience practicing medicine, but rather the volume of patients a doctor has treated with your condition. That’s the philosophy behind Amino, a free website that launched in October 2015, which lets you find and book doctors and estimate health care costs for medical procedures. With Amino, you can get matched with a doctor based on his or her experience with the condition you have or the treatment you need. Amino measures a doctor’s experience by analyzing data from health insurance claims (the records doctors send to insurance companies to get paid for what they do) to uncover what they focus on and how they treat their patients.

Below, you can use the embeddable Amino search to see how the product works and find doctors who have experience with HIV-related care and treatment—you can also change any of the search filters to look up other conditions or procedures (Amino has over 800 topics to choose from).

Here are five quick guidelines for using Amino:

1. If you’re looking for doctors who have experience with HIV-related care and treatment, you would first enter in some information about yourself or the patient you’re taking care of.

Screenshot showing a location finder.
Photo Source: Amino

2. Then, enter your location and insurance (if you have it—it’s optional to enter in your insurance).

Screenshot showing a physician/provider locator.
Photo Source: Amino

3. You’ll get a list of doctors who have the most experience with testing people like you—of the same age and sex, and with the same insurance—for HIV-infection. Amino will search its database of 893,000 doctors to provide this list. You might see a variety of doctors in your match list, and depending on your preferences you can filter by a doctor's specialty.

Screenshot showing GPS map with physician/providers nearby.
Photo Source: Amino

4. When you click on the doctor’s profile, you can see what they treat patients for and which services, tests, and procedures they provide, along with other important information like their credentials.

Screenshot showing search results.
Photo Source: Amino

5. From there, you can book an appointment via email or text message at no cost to you.

Amino also offers cost estimates for 49 medical services and procedures for dermatology, diagnostics, men’s health, orthopedics, preventative care, surgeries, and women’s health—and you can view those cost estimates for individual doctors as well as research costs in your area and insurance network.

Health care is not one-size-fits-all—what’s right for you can change depending on your health and your preferences. Your search for a doctor should be customized to your condition or the procedure you need, and you should be able to see as much information about a doctor as possible before making the time commitment to see them in-person.

Using Amino, you get a data-driven and personalized experience, which can help you choose care with confidence. If you have any feedback or questions, please don’t hesitate to reach out to the team at feedback@amino.com.


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Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.



Thursday, July 14, 2016

Combatting the Dual Epidemic of Substance Use and HIV-Infection

By: Brandon M. Macsata, CEO, ADAP Advocacy Association

Since the earliest days of the AIDS epidemic, there has been a significant link between substance use, abuse, and dependence and HIV-infection. Aside from injection drug use ("IDU") -- which can cause direct exposure to the virus -- substance use, abuse, and dependance "can affect people’s overall health and make them more susceptible to HIV infection and, in those already infected with HIV, substance use can hasten disease progression and negatively affect adherence to treatment."[1]

Man resting his head on the table, with an alcoholic drink near his hand
Photo Source: We Do Recover
According to the CDC, some of the populations most vulnerable populations include people who live in disadvantaged neighborhoods, gay, bisexual and transgender men, people with mental illness, and people who have experienced sexual, physical, or emotional abuse. Among some of the most common substances used are alcohol, crack cocaine, heroin, Methamphetamine ("Meth"), and poppers.[2]

Unfortunately, many prevention strategies -- otherwise known has Harm Reduction -- often fall victim to the political kickball because many right wing conservatives view them as condoning drug use. Also, often the scarcity of available funding in public health can push these programs to the back burner. The lack of prevention dollars has long plagued the fight against the AIDS epidemic, and it is one that continues today (though some progress has been achieved over the last decade in this area).

To that end, earlier this month the National Alliance of State & Territorial AIDS Directors (NASTAD) released a Fact Sheet on ADAP Formulary Coverage of Substance Use Treatment. The fact sheet demonstrates how AIDS Drug Assistance Programs (ADAPs) cover substance use treatment medications, related client services, as well as drug-specific information for medications.[3]

It includes the following sections:

  • Substance Use Treatment Needs among PLWH
  • Use of Ryan White Part B and ADAP Funds to Expand Access to Substance Use Treatment
  • Substance Use Treatment Medications: Drug-Specific Information
NASTAD summarized the important role played by ADAPs: "When used in combination with behavioral therapy, substance use treatment medications allow individuals to manage addiction or dependency by reducing their risk for overdose, cravings, and/or symptoms of withdrawal.  For PLWH who use substances, these treatments bolster multiple “bars” within the HIV care continuum, including adherence to ARV treatment and viral load suppression."[4] 


There is no one-size-fits-all to the prevention and treatment of substance use, abuse, and dependence. One thing is certain though, there isn't enough being done in this area. Resources and tools -- such as the one made available by NASTAD -- are important to community leaders trying to tackle the dual epidemic of substance use and HIV-infection.



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[1] U.S. Centers for Disease Control & Prevention (CDC), "HIV and Substance Use in the Unite," March 2013; available online at http://www.cdc.gov/hiv/pdf/risk_HIV_Substance.pdf.
[2] U.S. Centers for Disease Control & Prevention (CDC), "HIV and Substance Use in the Unite," March 2013; available online at http://www.cdc.gov/hiv/pdf/risk_HIV_Substance.pdf.
[3] National Alliance of State & Territorial AIDS Directors (NASTAD), "ADAP Formulary Coverage of Substance Use Treatment," July 5, 2016; available online at https://www.nastad.org/resource/adap-formulary-coverage-substance-use-treatment.
[4] Bowes, Amanda, National Alliance of State & Territorial AIDS Directors (NASTAD), "AIDS DRUG ASSISTANCE PROGRAMS’ (ADAPS) SUPPORT OF SUBSTANCE USE TREATMENT FOR THE CLIENTS THEY SERVE," July 5, 2016; available online at https://www.nastad.org/blog/aids-drug-assistance-programs-adaps-support-substance-use-treatment-clients-they-serve.

Friday, July 8, 2016

Access to HIV/AIDS Medicines in Exchange Plans

By: Brandon M. Macsata, CEO, ADAP Advocacy Association

The ADAP Advocacy Association earlier this week announced the framework for its 9th Annual Conference, which includes seven (7) town-hall style panel discussions about various issues impacting access to care and treatment for people living with HIV/AIDS. Among them, a discussion on the access to HIV/AIDS medicines (and other services) in exchange plans.

The panel on the "Affordable Care Act: Marketplace Cost Sharing & Barriers to Healthcare" will be moderated by Scott Evertz, former Director for the Office of National AIDS Policy, and current board member for the Community Access National Network (CANN). It is an opportunity to dig deeper into the ongoing discriminatory practice by insurance companies, requiring inordinately high co-payments and co-insurance for medications used in the treatment of HIV and AIDS.

This ongoing issue has routinely been covered by the ADAP Blog, because it is one of the most commonly expressed concerns by the patient community. View previous blogs on the topic here, here, and here, as well as here.

The Pharmaceutical Research and Manufacturers of America® (PhRMA) recently released several new fact sheets, which provide an in-depth, state-by-state look at coverage and access in the 2016 exchange plans. In a statement released by PhRMA, they are summarized as follows: "From deductibles and cost sharing to prescription drug coverage and formulary data, each fact sheet lays out the specifics for a given state compared to the national average, according to research analyzing 2016 silver health insurance exchange plans. Based on the data and information gathered, the fact sheets also include suggestions for improving exchange coverage in each state."

The fact sheets are available online at AccessBetterCoverage.org.

Access to HIV/AIDS Medicines in Exchange Plans
Photo Source: AccessBetterCoverage.org









Of particular interest to our readers is the fact sheet on HIV/AIDS medications, outlined in the Formulary Access for Patients with HIV/AIDS. A troublesome finding is approximately 10% of the plans use high tier placement or coinsurance for all single source HIV medicines.[1]

An excellent patient-centric resource available at AccessBetterCoverage.org is the "In Your State" tool. It allows patients to learn more about the marketplace plans in each state, including important fact sheets.

For example, in Alabama the following actions are recommended:[2]

  • Enforcing non-discrimination requirements, which apply to benefit design and provider networks; 
  • Establishing stronger rules regarding exceptions and appeals processes, which help enrollees get the medicines and care their doctors recommend; and  
  • Enhancing the state's marketplace website or advocating for a Healthcare.gov page that allows for easier plan comparisons, including searchable formularies and estimates of total out-of-pocket costs.

To utilize this tool, CLICK HERE.

The rising share of patient cost-sharing is widely viewed as the next frontier in the healthcare reform battle. It is one that disproportionately impacts people living with chronic conditions, such as HIV/AIDS.

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[1] Avalere, "Formulary Access for Patients with HIV/AIDS," page 9, 2016.
[2] AccessBetterCoverage.org, "In Your State: Alabama," 2016; available online at http://accessbettercoverage.org/states/alabama.

Thursday, June 23, 2016

HIV-Related Belly Fat: More Than Just an Appearance Issue

By: Brandon M. Macsata, CEO, ADAP Advocacy Association

Excess belly fat, known in medical circles as VAT (visceral adipose tissue), is a type of hard fat that can affect people living with HIV-infection. Research has shown that between 20% and 30% of HIV-positive patients are experiencing excess VAT. For years, there’s been a common misconception that this belly fat is just a physical cosmetic issue that is a side effect of earlier HIV treatments – something that must be accepted as a reality of now living longer with HIV-infection. Recent research dispels that myth so that even with newer anti-retro viral regimens this condition continues to exist.

Man looking in mirror at his excessive belly fat, with the caption "Object in mirror may be more important than it appears"
Photo Source: Don't Take VAT
"Don’t Take VAT" is an educational initiative supported by the ADAP Advocacy Association, that is shedding light on excess belly fat and the medical complications it can potentially create in order to help people living with HIV-infection learn about the condition, how to identify it, and what questions to ask their doctor. Since VAT is a type of hard fat that can surround a person’s organs and make it difficult for people to do things like bend over to tie their shoes or breath normally, the ramifications of this type of belly fat go far beyond the emotional strain caused by the stigma of carrying VAT. Excess abdominal VAT is also associated with a variety of health concerns, including diabetes and cardiovascular disease, which is why it’s important for patients to talk to their doctor about it.

Far too often, people with HIV believe the doughy fat around one’s midsection can be addressed by a healthy diet and exercise alone. But VAT doesn’t work that way. It can be challenging to reduce VAT with exercise and healthy living alone. The "Don’t Take VAT" website – www.DontTakeVAT.com – includes fact sheets about VAT and healthy living with HIV, as well as a video that provides a deeper look at VAT and tips about what to ask your doctor.

A doctor can determine if a person has excess abdominal VAT by assessing the individual’s medical history and HIV therapy regimen and by measuring around a patient’s waist and hips and calculating waist-to-hip ratio. But this often requires a patient’s willingness to make such a request, as often even doctors mistake VAT for regular belly fat and don’t always conduct this type of assessment during routine medical appointments.

While having excess HIV-related belly fat can cause physical, medical and emotional difficulties, nobody should feel ashamed or embarrassed about it. It is important that you take ownership of your own health and take the first step toward talking to your doctor and examining your treatment option.

Thursday, June 16, 2016

Taking STEPS (Social, Treatment, Education, Physical, Spiritual)

By: Darnell Ferrell, STEPS Coordinator, Priority Health Care

Priority Health Care’s (PHC) “STEPS” (Social, Treatment, Education, Physical, and Spiritual) program is a new initiative in Louisiana, assisting young men living with HIV/AIDS. The program provides participants obtainable resources to enhance their quality of life through linkage to job readiness and employment training. This approach enables participants to become self sufficient by means of gainful employment.

STEPS
The Office of Minority Health is funding STEPS it for a term of three years. It is being carried out through the Louisiana Public Health Institute with eleven collaborative partners – including PHC.

In Louisiana, underserved communities have faced numerous challenges among young racial and ethnic minority men ages 20-29. In response, STEPS focuses on five strategy areas:
  • Corrections
  • HIV stigma reduction
  • Employment creation/protection
  • Housing discrimination
  • Asset building 
STEPS provides holistic support and guidance through linkage to job readiness and employment training, thereby enhancing the program participant’s quality of life in these areas:
  • Social – Psychosocial and mental health counseling/treatment. 
  • Treatment – Primary medical care services to address chronic diseases, STI’s, and general preventive healthcare services.
  • Education – Educate participants on preventive health; assist with personal goals in educational attainment, job readiness training, and financial planning (Life Skills).
  • Physical – Promoting healthy eating habits/diets for specific illnesses conditioning of the body.
  • Spiritual – Motivate and encourage participants to have a positive attitude and outlook on life by helping them find their purpose despite any health disparities
Person walking up steps
PHC has leveraged relationships with community stakeholders and other partners to guarantee the program participants job interviews. STEPS project partners include: Job One Career Center (Resume Building, Employment Referrals), Goodwill Industries (Culinary Arts, C-Tech Broadband Communications, Hospitality), STRIVE NOLA (Job Readiness Training), Adult Literacy Learning (GED), and Delgado Community Collage.

After only one-year into the program, STEPS has already demonstrated its successful bridge to better link participants to their communities. For example, take the experience with John Doe (name changed for privacy), who is an African-American male. At age 24, John Doe was homeless for 6 months living under the New Orleans Bridge with his seven-year old son. The Movement at Crescent Care (NOAIDS Task Force) referred him to STEPS.

After two months, John Doe obtained employment at a local restaurant. A local housing program secured transitional housing for three months; followed by assistance with identifying an apartment for him and his son to receive permanent supportive housing. He was subsequently promoted to shift manager at his job, and also transitioned into more permanent housing.

Equally important, John Doe remains virally suppressed, healthy, compliant, and self sufficient by means of gainful employment. STEPS allowed him to create a pathway of opportunities for himself by way of hard work and dedication to being proactive in his progress in every way.

Throughout the AIDS epidemic, local community programs have provided the building blocks for successfully combatting the disease, and the stigma surrounding it. Programs, such as STEPS, leverage resources, relationships, and partnerships within the community to better serve people otherwise underserved. STEPS helps to create a community of people living healthy lives through education, treatment, and support.    

Learn more at http://priorityhealthcare.org/main/?#steps.

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Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.




Thursday, May 19, 2016

Foul Called; Weak Patient Protections Offered by HHS

By: Brandon M. Macsata, CEO, ADAP Advocacy Association

The U.S. Department of Health & Human Services ("HHS") dropped the ball when it recently defined discrimination in plan benefit design under the Affordable Care Act ("ACA"); that statement is plainly put because it is true! Absent clearer guidelines, HHS basically issued a green light for insurance carriers to potentially discriminate against people living with chronic illnesses, including HIV/AIDS. Stakeholder groups have cried foul over the regulations, characterizing them as weak.

The ACA's Section 1557 is the nondiscrimination provision of the law. It law prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in certain health programs or activities. Section 1557 builds on long-standing and familiar Federal civil rights laws: Title VI of the Civil Rights Act of 1964, Title IX of the Education Amendments of 1972, Section 504 of the Rehabilitation Act of 1973 and the Age Discrimination Act of 1975.[1]

Insurance Claim Form with the words, DENIED
Photo Source: Class Action News
The "I Am Essential" coalition sent a letter to HHS signed by 197 organizations on the proposed rule. The letter outlined numerous concerns. Among them:[2]

  • placing all or nearly all medications to treat a certain condition on the highest cost-sharing tier;
  • not covering certain medications or not following treatment guidelines;
  • imposing excessive medication management tools such as unreasonable prior authorization, step therapy requirements, and switching medications midyear;
  • charging high cost-sharing to beneficiaries with chronic or serious conditions;
  • and having narrow and exclusionary provider networks.

To read the letter, CLICK HERE.

There is plenty of evidence to suggest that marketplace plans are already engaged in discriminatory practices, which in many cases have adversely impacted patients living with HIV/AIDS. High deductibles, high co-insurance, and high co-payments are a few tactics being used by insurance carriers to shift the cost of care to patients living with chronic illnesses. To read last week's blog on this trend, CLICK HERE.

HHS, however, did leave the door open to review alleged discrimination on a case-by-case basis. Albeit welcome news, there has to be a better approach to potential barriers that may arise.

Carl Schmid, Deputy Executive Director, The AIDS Institute, characterized some of the concerns, "We are disappointed that HHS did not do a better job at specifically defining discrimination in plan benefit design. Despite the many benefits of the ACA and its prohibition on denying coverage to beneficiaries with a pre-existing condition, some insurance plans are finding ways to discriminate against patients, particularly those with chronic and serious health conditions.  Those practices should be defined and clearly prohibited. However, we are pleased that HHS reiterated they will review plans for discriminatory practices on a case-by-case basis through their enforcement activities, and identified a number of examples of possible discriminatory plan design.  We urge the Administration to rigorously use their oversight and enforcement tools."[3]

Even the pharmaceutical industry's trade association expressed caution over the regulations issued by HHS, acknowledging that they neglect to define discrimination. The Catalyst, which is the Pharmaceutical Research and Manufacturers of America's (PhRMA) blog, said:

"Protecting patients from discriminatory benefits is particularly important when it comes to plan formularies. For many patients with chronic conditions, it is relatively easy to predict their prescription drug needs. This means plans may be able to discourage enrollment by certain higher cost individuals simply by not covering the medicines they need or placing them on a high formulary tier. Unfortunately, we have seen many marketplace plans placing all medicines for certain conditions on the specialty tier or on a tier with coinsurance above 40 percent. In some cases, this is even happening in classes where generics are available. This leaves patients with no lower cost alternative and goes against the very nature of insurance by punishing individuals who happen to need a particular class of medicine."[4]

It is crucial that the public health community continue to monitor these glitches with the Affordable Care Act and collaborate on solutions to better assist patients living with chronic illnesses. Left unchecked, insurance carriers have demonstrated a history of pushing the envelope when it comes to discriminating against HIV/AIDS.
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[1] U.S. Department of Health & Human Services, Office of Civil Rights, "Section 1557 of the Patient Protection and Affordable Care Act," 2016.
[2] I Am Essential, "Patient Groups React to Final ACA Nondiscrimination Rule," May 13, 2016.                                 
[3] I Am Essential, "Patient Groups React to Final ACA Nondiscrimination Rule," May 13, 2016. 
[4] Pharmaceutical Research and Manufacturers of America, The Catalyst, "New non-discrimination rule neglects to define discriminatory benefits," May 19, 2016.

Friday, May 13, 2016

Are ACA Exchange Plans Fair to People Living with HIV/AIDS?

By: Brandon M. Macsata, CEO, ADAP Advocacy Association

On April 25th, Avalere Health published a comprehensive study on marketplace exchange plan formularies offered under the Affordable Care Act ("ACA"); it includes a cross-condition analysis addressing formulary coverage, cost sharing and access. The study, which was prepared for the Pharmaceutical Research and Manufacturers of America® (PhRMA), suggests that certain disease classes -- including HIV/AIDS -- experience bias under many of the plans.

Most of the law’s major provisions were phased in by January 2014, with other provisions phased in by 2020. The ACA has numerous implications generally on the United State’s health care delivery system, but more specifically on the access to healthcare afforded to people living with HIV/AIDS, as well Viral Hepatitis. What’s more, ongoing Medicaid expansion and the implementation of insurance exchanges will also impact nearly all health care providers, as well as their patients.

According to the Avalere study, formulary access for patients with HIV/AIDS has expanded though other barriers remain. The study included the following summary:[1]

Classes Included:

  • Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs), Nucleoside and Nucleotide Reverse Transcriptase Inhibitors (NRTIs), Protease Inhibitors (PIs), and HIV-Other

Coverage for Key HIV Classes:

  • In high-enrollment states, the average exchange plan covers at least 43 of 51 HIV/AIDS medications
  • Single-source products in the therapeutic area appear on formulary at least 65% of the time in all states other than Utah, which has coverage 25% of the time

Utilization Management for HIV Classes:

  • Exchange plans have continued to reduce their use of UM for HIV/AIDS medications. Now, exchange plans use UM less frequently than employer plans for these medicines

Tiering and Cost Sharing for Key HIV Classes:

  • Preferred placement has increased for HIV/AIDS medications in 2016 exchange plans, though employer plans still use the specialty tier far less often than exchange plans do. And, a portion of plans continue to place all HIV drugs on the specialty tier
  • Copays are common across HIV classes, with an average copayment of $66. When used, coinsurance is 35% on average
Many Insurers Still Placing All Medicines to Treat Chronic Conditions on Highest Cost-Sharing Tier PERCENTAGE OF 2016 SILVER PLANS PLACING ALL COVERED DRUGS IN THE CLASS ON A SPECIALTY TIER
Photo Source: PhRMA

One of the more alarming findings demonstrates that many of the marketplace exchange plans require high cost sharing, which could be discriminatory. In 2016, about 1 in 10 health plans are placing all HIV medicines in certain classes on the specialty tier.[2]

This discriminatory practice took center stage in 2014, when four insurance carriers were sued by the National Health Law Program (NHeLP) and the AIDS Institute. The complaint charged “inordinately high co-payments and co-insurance for medications used in the treatment of HIV and AIDS" against Coventry Health Care Inc., Cigna Corp., Humana Inc. and Preferred Medical.[3]

Additional findings include:[4]
  • In states with high exchange enrollment, average plans cover at least 43 of 51 drugs.
  • Across classes, plans cover HIV/AIDS innovators at least 76% of the time, except Utah.
  • In 2016, exchange plans use Prior Authorization for HIV meds less often than before, but still more than employer plans.
  • Exchange plans’ placement of HIV/AIDS drugs on the preferred tier rises to more than half of the time in 2016.
  • Copays are more common than coinsurance, though when used, coinsurance averages 35%.
  • Exchanges have lower coverage for STRs than for other single-source NTRIs.
  • Ten percent or fewer plans in 44 states and D.C. require coinsurance above 30% for all covered NNRTIs.
  • New Jersey has the highest proportion of plans requiring coinsurance of 30% or more for all covered NRTIs.
  • Alaska, Minnesota, and New Jersey have the highest percentage of plans requiring coinsurance above 30% for all protease inhibitors.
  • Coinsurance above 30% for all covered therapies in HIV-other class is most common among plans in Alaska, New Jersey, Utah.
The ACA has largely benefited patients living with HIV/AIDS by expanding access to care, and lowering the ranks of the uninsured and under-insured. That said, despite some marked improvements in many exchange plans there remain ongoing barriers facing too many patients. Among them, higher deductibles, co-payments and co-insurance.

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[1] Avalere Health, "PlanScape® Review of Patient Access to Medicines in Exchange Plans, By Condition," p. 62, April 2016.
[2] Pharmaceutical Research and Manufacturers of America®, "New Avalere Study: Health plan formularies continue to suggest bias against individuals with certain health conditions," April 2016.
[3] Insurance Business Magazine, "Insurers accused of HIV discrimination in ACA marketplace," June 3, 2014.
[4] Avalere Health, "PlanScape® Review of Patient Access to Medicines in Exchange Plans, By Condition," p. 63-73, April 2016.