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Sustainable Services, A Guide for Contracting with Payers

HIV-focused community based organizations (HCBOs) have seen dramatic changes in federal spending for HIV prevention and treatment over the past decade. Federal domestic spending on the treatment and prevention of HIV indicates that while overall spending has been steadily increasing, the Ryan White HIV Program’s finances have become smaller. In FY2017, Medicaid and Medicare programs accounted for 61% of federal HIV expenditures, up from 53% in FY2012.

Health coverage plays an increasing role in the HIV arena, including HCBOs contracting directly with Managed Care Organizations (MCOs) and other health insurance entities. Establishing successful and lasting contracts with these payers can and should benefit both organizations. These partnerships allow HCBOs to replace lost revenue from the Ryan White Program. Many HCBOs are aware of the opportunity, but don’t know where to begin.

This online learning module is designed to assist HCBOs in establishing contracts with MCOs. The learning module toolkits have been designed by The Menges Group, through funding by AIDS United’s Sector Transformation program, generously supported by Johnson & Johnson. The learning module will take HCBOs step-by-step through the process of establishing contracts and managing relationships with MCOs.

The webinar recording below provides additional context and information. We strongly suggest watching the recording prior to using the toolkit. Register for the next webinar in this series here.

Download the webinar slides.

  • Sustainable Services: A Guide for Contracting with Payers


  • Tool A. Medicaid Costs and Utilization of HIV Drugs


  • Tool B. Medicaid Managed Care Model Contracts


  • Tool B1. Florida HIV Specialty Plan Contract


  • Tool B2. New York HIV Specialty Plan Contract


  • Tool C. Medicaid MCOs by State and Enrollment


  • Tool D. Medicare Advantage Enrollment March 2017


  • Tool E. List of Blue Cross and Blue Shield Companies by State


  • Tool F. Sample Introduction Letter to a Payer


  • Tool G. Cost and Pricing Derivation Worksheets


  • Tool H. Milliman Cost Derivation


  • Tool I. Cost of HIV AIDS Care


  • Tool J. Bibliography of Selected Articles


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