New Hampshire: Quality Improvement Project Reduces the Stress of Living with HIV

For the more than 1,200 New Hampshire residents who are living with HIV, life can be a daily struggle of paperwork, appointments, and insurance claims. Managing the details of daily HIV care can add to the stress. Many low-income New Hampshire residents with HIV depend on the Ryan White Comprehensive AIDS Resources Emergency (RW CARE) program for life-saving medications, quality medical care, and support services.

The RW CARE team noticed that many of their 600+ clients were missing appointments, having difficulty getting medications, and facing financial burdens to receiving care. Historically, many medical providers caring for RW CARE clients have had trouble processing insurance payments on time, causing clients to receive collection notices. The New Hampshire Division of Public Health Services (DPHS) used a portion of its Preventive Health and Health Services (PHHS) Block Grant funds to provide quality improvement (QI) training to the RW CARE team to help solve billing problems for patients, medical providers, and DPHS staff.

In 2015, the RW CARE team created the Quality Improvement Committee, whose members learned how to use proven QI tools to help them handle the billing process step by step. Medical providers discovered that clients did not always report their RW CARE coverage for services. The providers were also billing for services incorrectly, causing insurance payment delays. The Committee developed the NH CARE Program—Guidance for Submission of Medical Copay and Deductible Bills and delivered it to 85 medical offices. The guidance provides information about how to bill appropriately for RW CARE medical services. Staff also created a billing template for patients to help them understand how providers bill insurance for medical care and prescriptions.

In 2016, the use of QI training supported by funds from the PHHS Block Grant led to healthier clients and fewer provider complaints about the payment system. Through the changes brought about by the Committee, the RW CARE team increased the efficiency of billing and payment processes. Billing error rates decreased from more than 50% to about 25%, and medical provider knowledge about correct billing increased by 80%. The Committee’s efforts also resulted in a decrease in payment lag time to providers. Other plans include developing a client satisfaction assessment, which will gather information about how these billing improvements directly affected RW CARE clients.

With improvements supported by PHHS Block Grant funding, more than 600 clients who receive HIV healthcare and support services through the RW CARE program are now better served.

Story year: 2017

Photo: The NH Ryan White CARE Team poses in front of their improved billing case management outcomes poster.

The NH Ryan White CARE Team poses in front of their improved billing case management outcomes poster.

Page last reviewed: May 24, 2018