Tools for Monitoring HIV Care: HIV Clinical Quality Measures

April 2015

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This issue brief describes available HIV-related quality measures1 and how they are currently being used to monitor the delivery of HIV care by federal programs. This information is intended to support the implementation of HIV quality measures across public and private insurers and health care systems.

1. Why Are Clinical Quality Measures Important for Health Care Reform and the National HIV/AIDS Strategy?

Uptake and utilization of HIV-related clinical quality measures is important for promoting standards of health care coverage that support adherence to current HIV clinical guidelines and federal guidelines. As more patients enroll in health insurance it is critical to track a standardized set of quality measures across patient populations and public and private insurers to monitor access to high quality HIV care.

In July 2013, President Obama announced the HIV Care Continuum Initiative. The goal of the initiative is to leverage federal resources to improve outcomes along the HIV care continuum, from testing, to linkage to and retention in care, to viral suppression. A key component will be to establish and deploy standard core indicators for monitoring federally funded HIV prevention, treatment, and care services. Clinicians should expect to see increased focus among key federal agencies, including the Centers for Medicare and Medicaid Services (CMS), the Health Resources and Services Administration (HRSA), and the Centers for Disease Control and Prevention (CDC), on aligning and coordinating their efforts to maximize outcomes along the HIV care continuum.

2. What HIV-Related Clinical Quality Measures Are Available?

Several federal programs are utilizing HIV-related clinical quality measures in their reportable measure portfolios. The chart below tracks seven core indicators that the Department of Health and Human Services (HHS) identified to track across federally funded HIV programs. To see definitions of the measures, follow the links to each measure set included in the column headings of the chart.

The U.S. Preventative Services Task Force now recommends routine HIV screening for all people between the ages of 15 and 65, which means most health plans will be required to cover routine HIV screening at no cost to the patient. A routine HIV screening measure is expected to soon be nationally endorsed, and will be an important tool for monitoring implementation of this screening.

Quality MeasureHHS HIV/AIDS Core IndicatorsNational Quality Forum (NQF) Number2014 Medicare PQRS Number2015 Medicare PQRS HIV Measures Group1CMS Final Stage II EHR Meaningful Use RuleHRSA/HAB HIV Clinical Performance Measure Portfolio (2013)62014 HHS Proposed Core Set of Health Quality Measures for Medicaid Eligible Adults
Late HIV Diagnosis1999------1999--
Linkage to HIV Medical Care----------*
Retention in Care (Medical Visit Frequency, Gap in Medical Visits)2079, 20802340, 341340--2079, 2080--
HIV Viral Load Suppression20823338338040720822082
Adolescents/Adults Prescribed ART20834339339--2083--
CD4 Cell Count--0404159--------
PCP Prophylaxis--040516016004050405--
HIV Positivity----------*
Housing Status----------*
Care Plan--0326047047------
Screening for Clinical Depression--0418134134--0418--
STD Screening--0409205205----*
Tobacco Use Screening and Cessation--0028226226--0028--
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This article was provided by HIV Medicine Association. Visit HIVMA's website to find out more about their activities, publications and services.

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