HEALTH
How HIV Special Needs Plans Bring Care to Patients
Tailored health initiative focuses on prevention and treatment
BY MATT TRACY
One of the prime challenges
in the continuing
fi ght against HIV/AIDS
is establishing specialized
care around the needs of individuals
living with HIV or those at
risk of HIV — including transgender
people and folks experiencing
homelessness.
The importance of tailored care
is perhaps most evident when evaluating
the typical approach to primary
care in the general population.
Not all primary care providers
are equipped to offer care that is
inclusive to LGBTQ individuals or
those at risk of or living with HIV,
which ultimately impacts health
outcomes and can make a difference
in the willingness of patients
to be forthright with their doctors.
One way those issues are confronted
in New York City is through
HIV Special Needs Plans, which
provide eligible Medicaid patients
living with HIV or are homeless
or transgender with case management
services and coordinated
care from their doctors in a way
that it is intended to best serve
their unique needs — whether that
includes accessing HIV prevention
medication such as PrEP or connecting
to HIV treatment in an inclusive
environment.
Among the leaders of HIV Special
Needs Plans in New York City
include MetroPlus Health Plan,
which is the presenting sponsor of
this year’s Gay City News Impact
Awards. Two key areas of emphasis
for Special Needs Plans are prevention
and treatment, meaning
not everyone enrolled in the plans
is necessarily living with HIV, but
might be at risk.
“That is really one of the great
things about the Special Needs
Plan,” said Todd Canning, the director
of clinical services for the
Partnership in Care Program at
MetroPlus Health Plan, which is
a wholly-owned subsidiary of NYC
Health + Hospitals.
The customized nature of the
HIV Special Needs Plans translates
into different approaches to
Todd Canning, the director of clinical services for the Partnership in Care Program at MetroPlus Health Plan, said HIV Special Needs Plans look to work around
the needs of patients.
patients depending on whether
they are living with HIV or HIVnegative.
The goal is to cater to the
needs of patients rather than employing
a one-size-fi ts-all outlook.
“We have the option to provide
primary care at a place of our
members’ choosing,” Canning said.
“That could be any provider in the
MetroPlus network; it could be a
provider in the shelter system.”
More than 9,000 individuals
with Medicaid in New York City
have an HIV Special Needs Plan,
Canning said, though some of the
people who are enrolled in the plan
struggle to maintain their care
due to a range of factors such as
housing instability. That’s part of
why the plan is intended to work
around those issues.
“It’s always a challenge of ‘how
do you connect to individuals who
don’t have a home?’” Canning
said.
Canning said his team has also
taken on other unique obstacles
this year — including the ongoing
drive to vaccinate the community
against COVID-19 — as it contends
with existing efforts to take on the
HIV/AIDS epidemic.
Between emerging, evolving
healthcare hurdles ranging from
HIV-related care to COVID-19 prevention,
communication is essential
in ensuring that patients are in
the best position to navigate their
own well-being in the future. Canning
noted that the plan allows for
partnerships with providers, provides
information and feedback
to providers around the needs of
members, and “helps providers
connect with members wherever
they are.”
“Whatever problem people are
having — a bill is not getting paid
or someone can’t get an appointment
— how can you connect with
someone to cut through the red
tape, cut through the bureaucracy,
and get someone to say, ‘Hi, how
can I help you?’” he said. “That’s
what is very unique about this. We
do that with members and we also
do that with providers.”
Canning said this allows the
DONNA ACETO
MetroPlus Health Plan team to
establish a connection with members
on a fi rst-name basis, while
also bringing expeditious service
to make sure folks are not waiting
for their care. On the other side of
the healthcare equation, MetroPlus
Health Plan works to assist doctors
who are confused about complex
rules pertaining to healthcare or
need assistance fi nding the right
specialist for their patient.
“We have time to work with
providers to help them, which improves
member care, the member
experience, and provides services
quickly,” Canning explained.
To help spread the word about
the plans in the LGBTQ community,
MetroPlus Health Plan is
embarking on a social media campaign.
The campaign is geared
towards informing potential members
about MetroPlus Health Plans’
longstanding work with LGBTQ
New Yorkers and notes that they
can connect members to a primary
care provider who focuses on LGBTQ
specifi c health needs.
NOVEMBER 4 - NOVEMBER 17, 2 20 021 | GayCityNews.com
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