SOUTHERN HOSPITALITY

Tony Braswell, Executive Director
AID Atlanta

The unprecedented success of AIDS therapies and treatments has focused a new attention on the field of case management. Today, professionals trained primarily in the field of social work coordinate health, social and support services in an atmosphere of scarce and sometimes non-existent resources. The success of this work leads to a healthier client who is better able to benefit from advances in clinical AIDS treatment. Quite simply, when a client doesnt have to worry about housing, transportation, food, insurance, family, and finance issues, that individual has a much greater opportunity to succeed with their HIV treatment.

Located in Atlanta Georgia, AID Atlanta is one of the largest AIDS Service Organizations in the southeast, serving over 7000 infected men women and children. AID Atlanta also provides education, counseling, and support to over 80,000 persons across our state. The Ryan White Care Act designated AID Atlanta as a coordinating body for a centralized system of case management in the twenty-county Atlanta service area. In this role, we work with over 30 other service providers across our city to reach clients and case manage their care so that they can achieve optimal benefit from their medical support.

Our agency operates with a case-management staff of 45 persons who provide services at 18 different sites across the city. Last year, 3300 clients were intensively case-managed, many on a weekly and sometimes daily basis. Another 4000 persons received episodic services over the same period. The coordination of care has demonstrated cost effective access to a complex and constantly changing set of resources needed by clients to maintain their health. It has also provided an opportunity to invest fully in the health of our clients, and to lower their overall healthcare expensesa large savings to the state and federal funding sources who in turn can extend resources to a larger number of clients.

Our case-management programs ability to save precious resources and continue to assist clients is validated through a recent study completed for AID Atlanta by Bain and Company et al. Health indicators, including T-helper cell count, viral load, and other clinical tests, were 30% to 40% better in our clients who had been case managed one year or longer. Obviously, this can have a significant positive financial impact on community resources. Our research repeatedly shows that most of properly case-managed clients (over 80%) progress to a level of better health and lower social service need. Further, we have demonstrated the cost benefit of case management in our community. Our research has shown that the annual expenses (including medications) for clients with lower health and social service needs average $19,624. Lower health and social service needs would imply T-cells >200, and less than five social service intervention per year. For those in our client base with an average level of health and service needs, we realize and annual cost of $27,419 per year. For those in our client base with high levels of social service and health care needs (T-cells <50 and more than ten social service interventions per year) we average $41,580 per year in expenses.

Clearly, a solid plan to case-manage the entire spectrum of a clients service and health needs can improve health and move the client toward a lower need category. This in turn frees up resources that can be applied to other client needs or that can be extended to new clients. For sake of argument, assuming a ten-year lifespan of service need, costs of care can be reduced if the most expensive care can be delayed through effective case management. In our study, total lifetime costs (over ten years) could be reduced from $308,000 to $222,000 with effective case management. When repeated over hundreds of clients, this represents a potentially substantial savings to any organization.

In our current healthcare environment, case management is one of the most misunderstood and misinterpreted efforts we undertake. In fact, for many, case management continues to be defined in terms of cost containment, service coordination, or social service provision. It is our hope that readers will be able to learn from our experience and that this will help their organizations effort. And please note, we dont have all the answers. We truly value feedback that can help us make our agencys model even more effective.

Tony Braswell is the Executive Director of AID Atlanta, and an adjunct professor in the University System of Georgia. He lives in Atlanta,Georgia and has worked for almost 20 years in HIV/AIDS and Public Health.