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New York State Health Home Impact on HIV Treatment Cascade

Award Number: R01DA038193
ORGANIZATION: NATIONAL INSTITUTE ON DRUG ABUSE
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 07/01/2014
PERIOD OF PERFORMANCE END DATE: 06/30/2020

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New York State Health Home Impact on HIV Treatment Cascade - DESCRIPTION (provided by applicant): In order to slow the spread of HIV and improve health outcomes for persons living with HIV/AIDS (PLWHA), the Affordable Care Act greatly expands access to health care for low-income PLWHA. Further, the Office of National AIDS Policy has created a strategy to improve the current system of care by closing gaps in the HIV care continuum. The HIV care continuum outlines a series of steps in addressing infection: a) HIV testing, b) engagement in HIV care, c) participation in antiretroviral therapy (ART), and d) the ultimate target-viral suppression. Surveillance data paint a dismal picture of the continuum of care in the United States, with less than 25% of PLWHA having undetectable viral load. Given the fragmented, crisis-driven nature of the current health care system, individuals who are homeless or unstably housed may continue to receive low quality care or no care at all. The high prevalence of substance use disorders, mental illness, and other chronic illnesses among unstably housed, HIV-positive individuals increases the difficulty in engaging this group in care. The Affordable Care Act includes a number of important healthcare system restructuring provisions for chronic illness management, among which are Health Homes (HH) for Medicaid recipients. New York (NY) Department of Health (DOH) has created one of the country's earliest and most ambitious implementations of HHs. NY HH's are newly formed integrated healthcare networks of medical and behavioral health providers that contract to provide integrated care through shared care managers and common technology platforms. Additionally, NY DOH has a pilot program to provide 544 units of supportive housing (SH) for homeless PLWHA enrolled in HHs. This study will test 1) whether SH combined with HHs improves quality of care for 544 homeless PLWHA HH enrollees and 2) whether New York HH improve quality of care and costs to 8,250 Medicaid homeless PLWHA enrolled in HHs. The primary aims will be addressed in two ways. First, we will compare HIV continuum and other quality metrics and Medicaid costs between homeless PLWHA in SH and those who did not receive supportive housing using nonparametric difference-in-difference methods. Second, we will implement a longitudinal design using administrative data from 2009 through 2016 to examine changes in quality of care and Medicaid costs for homeless PLWHA in Medicaid. The project comes from an academic- public sector partnership to address high priority questions of healthcare system redesign. Data will come from surveillance data on all HIV lab tests conducted in NY, Medicaid encounters/claims, and from HHs reporting on client functioning and care manager contacts. These data will be merged to create DE identified analytical datasets by DOH. Additional qualitative research methods will be employed to elucidate the HH factors associated with outcomes. If aims are achieved, the study is likely to have a major impact on improving knowledge about evidence-based approaches to address homeless PLWHA. In addition, because the study intervention is part of ACA, the policy impact of the study findings on national healthcare may be substantial.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2022 ( Subtotal = -$28,294 )
2022	2018	PARTNERSHIP TO END ADDICTION	711 3RD AVE FL 5	NEW YORK	NY	10017	NEW YORK	USA	Drug Use and Addiction Research Programs	000	5	12/1/2021	NON-COMPETING CONTINUATION	-$28,294
														Subtotal = -$28,294

Issue Date FY: 2021 ( Subtotal = $0 )
2021	2018	PARTNERSHIP TO END ADDICTION	711 3RD AVE FL 5	NEW YORK	NY	10017	NEW YORK	USA	Drug Use and Addiction Research Programs	001	5	7/21/2021	NON-COMPETING CONTINUATION	$55,253
2021	2018	PARTNERSHIP TO END ADDICTION	711 3RD AVE FL 5	NEW YORK	NY	10017	NEW YORK	USA	Drug Use and Addiction Research Programs	000	5	1/27/2021	NON-COMPETING CONTINUATION	-$55,253
														Subtotal = $0

Issue Date FY: 2018 ( Subtotal = $654,128 )
2018	2018	NATIONAL CENTER ON ADDICTION AND SUBSTANCE ABUSE, THE	633 3RD AVE FL 19	NEW YORK	NY	10017	NEW YORK	USA	Drug Use and Addiction Research Programs	000	5	6/5/2018	NON-COMPETING CONTINUATION	$654,128
														Subtotal = $654,128

Issue Date FY: 2017 ( Subtotal = $653,990 )
2017	2017	NATIONAL CENTER ON ADDICTION AND SUBSTANCE ABUSE, THE	633 3RD AVE FL 19	NEW YORK	NY	10017	NEW YORK	USA	Drug Use and Addiction Research Programs	000	4	6/5/2017	NON-COMPETING CONTINUATION	$653,990
														Subtotal = $653,990

Issue Date FY: 2016 ( Subtotal = $647,245 )
2016	2016	NATIONAL CENTER ON ADDICTION & SUBSTANCE ABUSE	633 THIRD AVE	NEW YORK	NY	10017	NEW YORK	USA	Drug Use and Addiction Research Programs	000	3	6/17/2016	NON-COMPETING CONTINUATION	$647,245
														Subtotal = $647,245

Issue Date FY: 2015 ( Subtotal = $643,805 )
2015	2015	NATIONAL CENTER ON ADDICTION & SUBSTANCE ABUSE	633 THIRD AVE	NEW YORK	NY	10017	NEW YORK	USA	Drug Use and Addiction Research Programs	000	2	6/18/2015	NON-COMPETING CONTINUATION	$643,805
														Subtotal = $643,805

Issue Date FY: 2014 ( Subtotal = $671,616 )
2014	2014	NATIONAL CENTER ON ADDICTION & SUBSTANCE ABUSE	633 THIRD AVE	NEW YORK	NY	10017	NEW YORK	USA	Drug Use and Addiction Research Programs	000	1	6/2/2014	NEW	$671,616
														Subtotal = $671,616

Grand Total All Awards = $3,242,490

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New York State Health Home Impact on HIV Treatment Cascade

Award Number: R01DA038193

ORGANIZATION: NATIONAL INSTITUTE ON DRUG ABUSE

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 07/01/2014

PERIOD OF PERFORMANCE END DATE: 06/30/2020

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