What Is The "Centers Of Excellence" Project?

Eligibility of the uninsured population of TennCare created a unique situation. The diagnosis of HIV infection automatically qualifies an individual for TennCare. As a result, the vast majority of HIV infected persons in Tennessee are enrolled in the TennCare program. However, 32 months after its initial implementation, the TennCare program continued to experience problems often encountered when serving vulnerable populations in a managed care environment. It thus became apparent patients, providers, and managed care organizations (MCO) would benefit from more structure and coordination in the delivery of services to HIV positive patients enrolled in TennCare.

Under the TennCare system, not all patients were referred to a provider that had experience in treating HIV/AIDS. MCOs had identified problems concerning the quality of care these patients received. Provision of prevention therapy and appropriate use of antiretrovirals were particular concerns. In addition, providers had expressed frustration with the time-consuming prior authorization procedures that the MCOs implemented to ensure quality and control costs. Finally, primary care providers were unsure of their ongoing responsibilities and their ability to perform them following the referral of a patient to an HIV/AIDS specialist.

The development of an AIDS Centers Of Excellence model, consisting of a coordinated network of clinics and private practices across the state, provided a comprehensive approach to HIV and AIDS treatment and addressed the problems previously cited.

Under the center of excellence model, all HIV positive patients enrolled in TennCare have the option of referral to a Center Of Excellence for medical care management. All designated Centers Of Excellence use uniform treatment protocols developed by experts in the treatment of HIV and are endorsed by the MCOs. Staff of the centers, while not exempt for all MCO prior authorization procedures, have manage to simplify the prior authorization process provided that they operate in accordance with the established protocols. The centers use a centralized data collection system that facilitates outcome monitoring in association with treatment and demographic variables, making the model extremely attractive for clinical trials and other research projects.

The MCOs benefit from the use of protocols that focus on the prevention of opportunistic infection and from clinical trials that fund lab tests for treatment of their enrollees. Inappropriate treatment has been reduced or eliminated when patients' medical care is managed by a Center Of Excellence. Patients experience the obvious benefits of having their care coordinated by experts and further, benefit directly and indirectly from the increased focus on research and evaluation. Additionally, patients benefit from a system that is designed to respond quickly in changes in technology.

The development of an AIDS Centers Of Excellence model requires a significant amount of planning and evaluation. Robert Wood Johnson Foundation funds were received through the Center For Health Care Strategies for the planning and implementation of the AIDS Centers Of Excellence Project in Tennessee.