Linking HIV Surveillance Data with Medicaid Data to Improve Outcomes in Louisiana

Background:  In 2014, the Louisiana Office of Public Health (OPH) and Bureau of Health Services Financing (BHSF) signed a data sharing agreement allowing the agencies to exchange Medicaid and public health data. In Louisiana, only 50% of persons living with HIV (PLWH) were virally suppressed in 2014, and approximately one-third of PLWH were enrolled in Medicaid. In order to improve outcomes among Medicaid recipients, an incentive-based performance measure for HIV viral load suppression was included in the 2015 contracts with the five Medicaid managed care organizations (MCOs). HIV surveillance data were linked to Medicaid claims data to measure viral suppression using lab data reported to OPH.

Methods:  Medicaid claims data from October 2014 to September 2015 were linked to HIV surveillance data. Viral suppression was calculated separately for each plan for PLWH who had an HIV-related claim.  Individual-level data were provided back to each MCO so they could determine if they met the target viral suppression rate set by Medicaid.  Each quarter OPH receives a new Medicaid file for the previous 12 months.

Results:  Of the 1,505,833 persons enrolled in Medicaid in Louisiana, 5,288 had an HIV-related claim and matched to a case in the HIV surveillance database; 3,467 of these PLWH (65.6%) were virally suppressed. The viral suppression target set by BHSF was 54.3%, so the plans as a whole met the target, although the percentage varied by plan.

Conclusions:  Linking Medicaid claims data and HIV surveillance data allows the MCOs to better monitor HIV-related outcomes among their enrollees. The HIV viral suppression data have already been used to justify increasing the viral suppression target.  The same Medicaid claims data file has also been linked to reported primary and secondary syphilis cases to determine the proportion of cases enrolled in Medicaid in order to help the MCOs with syphilis reduction efforts.