IMPROVING ADAP DATA COLLECTION
A
ND
M
ANAGEMENT
ADAP TECHNICAL ASSISTANCE CONFERENCE CALL
HELD FEBRUARY 25TH, 1998
Arranged jointly by:
Division of Service Systems HIV/AIDS Bureau
Health Resources and Services Administration U.S. Department of Health and Human Services
and
National Alliance of State and Territorial AIDS Directors
Report prepared by:
National Alliance of State and Territorial AIDS Directors 444 N. Capitol Street, N.W., Suite #339
Washington, D.C. 20001 (202) 434-8090
EXECUTIVE SUMMARY
Introduction
This report summarizes the information presented in “Improving ADAP Data Collection and Management,” the eleventh in a series of nationally broadcast technical assistance telephone conference calls focusing on state operated AIDS Drug Assistance Programs (ADAPs), which was broadcast on Wednesday, February 25, 1998. This ADAP teleconference series has been arranged by the Division of Service Systems (DSS), Health Resources and Services Administration (HRSA) in collaboration with the National Alliance of State and Territorial AIDS Directors (NASTAD).
The teleconference began with statements from DSS and NASTAD staff regarding current issues of importance to grantees. Summaries of these statements are found in Appendix I. Following these statements, the teleconference topic was presented by grantee faculty from the States. A question and answer (Q & A) session with call faculty and listeners followed the grantee presentations. A list of teleconference faculty is presented in Appendix II. Basic information describing each presenting State ADAP is found in Appendix III.
Teleconference Topic: Improving ADAP Data Collection and Management
Recent trends in ADAP growth and the desire for increased accountability have led many ADAPs to reexamine their data collection and management systems. Efficient data collection and management systems are necessary in order for ADAPs to accurately forecast program growth and demand. This report profiles recent improvements in the ADAP data collection and management systems of three jurisdictions: the Commonwealth of Pennsylvania, the State of Alaska and the Commonwealth of Virginia.
The Pennsylvania ADAP recently improved its data collection and management system by contracting with a claims processor. The claims processor maintains a point-of-sale database that includes unique client identifiers, date of service, national drug code (NDC) numbers, quantity and days supply of drug dispensed, and cost information. The contractor provides the ADAP with weekly and/or monthly reports on program utilization and expenditures that the ADAP can merge with its in-house client database, enhancing reporting capabilities. The new system has improved the ADAP’s ability to provide required reports, track utilization/expenditures and assess the number of clients utilizing combination antiretroviral therapies.
The Alaska ADAP recently contracted the management of its ADAP, including data management services, to a pharmacy benefits manager (PBM). Alaska is a relatively low-prevalence jurisdiction for HIV/AIDS, with a historically small Ryan White budget. The State has found that contracting ADAP services to a PBM has been highly-cost effective and has reduced the administrative burden on limited program staff. Enhanced data analysis is possible in-house since the PBM provides the State with ADAP utilization data on diskette. The ADAP received invaluable assistance in the development of an RFP for PBM services from other State ADAPs, as well as assistance throughout the contracting process from the State Medicaid Pharmacy Liaison.
The Virginia Department of Health recently contracted with a local State university to greatly improve its ADAP data management system. The ADAP software, developed in a collaboration between the ADAP, the State Pharmacy and Virginia Commonwealth University has proven to be efficient, user-friendly and affordable. Benefits of the new data management system include enhanced ability to analyze utilization data and predict program growth, greater ability to identify clients who may be eligible for Medicaid, and a quality assurance component.
TELECONFERENCE PRESENTATIONS:
IMPROVING ADAP DATA COLLECTION AND MANAGEMENT
Pennsylvania: Initially, the state ADAP was operated through the state Medicaid office and limited access to AZT and other early anti-HIV therapies to state Medicaid clients who did not have drug coverage through Medicaid. When ADAP transferred into the state Division of Pharmacy and Ancillary Services, the program had to develop its own data collection capabilities.
During the transition period, Pennsylvania ADAP maintained a “paper” system to track clients; however, the program eventually developed a computerized data management system using PowerBase, a commercially available database program, that included client demographic and claims information. While this system was augmented over time to include additional data elements, it was relatively labor-intensive, as information had to be entered into the system and processed manually. Throughout the transition period from paper to a more automated data collection system, ADAP maintained links with the state Medicaid information system in order to monitor client Medicaid eligibility status.
In February 1997, the ADAP began using a contracted claims processor to collect and manage data. The claims processor maintains a point-of-sale database that includes a unique client identification number (ID), date of service, national drug code (NDC) number of the drug, quantity dispensed, day’s supply and the pharmacy provider’s usual charge for the drug. The contractor provides the ADAP with weekly and/or monthly reports on program utilization and expenditures that the ADAP can merge with its in-house database, providing for enhanced reporting capabilities. Some of the advantages that the ADAP has realized since initiating the use of the contracted claims processor include:
CEnhanced ability to track/monitor utilization and expenditure trends.
CAbility to monitor numbers of clients utilizing combination therapies, and the drugs included in each client’s drug “cocktail.”
CAbility to track where program dollars are being spent, thereby highlighting geographic areas and/or populations that may be under-served.
CEnhanced ability to comply with program reporting requirements and to respond to additional requests for information.
The integration of a point-of-sale claims processing contractor into the existing Pennsylvania ADAP data management system has greatly increased the scope of information that the program is able to monitor internally and the ease with which it can respond to external requests for program data.
Alaska: The State has a relatively low HIV/AIDS prevalence, a small HIV/AIDS program, a small Ryan White grant award, and few program staff. Alaska did not establish a formal ADAP until earmarked funds became available for ADAP services under Ryan White Title II in FY 1996. Given the recent initiation of the program, the State was able to benefit from the previous experience of other States in developing its ADAP.
Based upon several concerns, including limited program staffing and lack of pharmaceutical program experience, the State decided contract with an outside entity to manage the ADAP. Both the Minnesota and Washington State ADAPs provided invaluable assistance to Alaska in developing an RFP for a pharmacy benefits manager (PBM). Additionally, the Alaska AIDS program also benefited greatly from the input of the State Medicaid Pharmacy Liaison in establishing its ADAP, especially in the area of information management.
The State determined that it had two main information needs. The first was the need for program management information, allowing it to monitor program utilization and expenditures in order to track program costs, pay vendors, and provide data to the manufacturers for rebates. Secondly, the program had to fulfill grantee reporting requirements and respond to additional, external requests for program data. The State delineated the data elements and reporting necessary to meet these information needs in its RFP and subsequent contract, and selected a PBM through a competitive bidding process.
Alaska identifies four key benefits of its current ADAP system:
C Cost management/savings: The contractor has an extendable, fixed-price contract, and must closely monitor costs and provide services within the established budget, preventing cost over-runs. Utilization of the contractor also has resulted in administrative cost-savings for the ADAP. For example, the contractor already had an existing infrastructure and a data management system, avoiding development costs to the ADAP. The contractor has considerable experience and has been able to negotiate favorable drug prices on behalf of the ADAP.
C Administrative review: The contractor submits an invoice for the previous month’s expenditures, allowing State staff to review pharmacy expenditures before payment.
C Enhanced reporting: The contractor provides State staff with client and pharmacy level data, including: client and provider IDs; NDC numbers; date of service; prescription number, units and cost of drugs dispensed; client demographic information; and, client insurance/other benefit information. The contractor provides this information to the State in Excel format, and State staff translate the data into their existing database software (Microsoft Access) to allow for any needed further analysis. This allows the program to comply with grantee reporting requirements and to respond more easily to special requests for information.
C Additional benefits: The contractor also provides other services, such as coordination of client benefits, and participates with consortium case managers and State staff in considering ADAP issues such as eligibility requirements. Additionally, the ADAP and the contractor have a collegial relationship that allows them to work closely together on issues that impact on the ADAP, including formulary management, special client needs and special reporting requests.
The Alaska ADAP identifies four major lessons learned from its recent experience that other states may wish to consider:
C The development of the RFP is critical to selecting an appropriate contractor and establishing expectations.
C A collegial relationship with a PBM contractor is an invaluable asset to the program as it works through the initial “bugs” of a new/modified system.
C Utilize all existing and new information resources at the program’s disposal. For example, the State Medicaid Pharmacy Liaison has been an invaluable resource for the ADAP.
C Expect a learning curve when developing or modifying data collection systems. Non-technical program staff may need time/training in using a new data management system.
In summary, the Alaska ADAP has worked with a PBM to develop an effective information management system at little cost to the program—an important asset for a relatively small program with a small budget.
Virginia: Unlike Pennsylvania and Alaska ADAPs, which use a pharmacy reimbursement drug distribution model, Virginia ADAP uses a centralized state pharmacy distribution system through its State Bureau of Pharmacy Services. Drug are purchased through the PHS/602 program by the State pharmacy, then distributed to ADAP clients state-wide via 117 local health departments.
Initially, the ADAP tracked only program expenditures on HIV/AIDS medications. However, when funding for ADAP services was subsumed under Title II of the CARE Act, the program began tracking client-level data using the HRSA Toolbox software. Recently, the ADAP took additional steps to upgrade its data collection/management capabilities in order to better track its expanding enrollment, increasing expenditures and client utilization of combination therapies.
Using Title II administrative dollars, the Virginia Health Department contracted with the Virginia Commonwealth University (VCU) Survey, Evaluation and Research Lab to develop an ADAP data management system. VCU was chosen because it is a State entity and, since 1992, it had been managing the State’s Ryan White Title II service data. VCU also assists the State’s community planning group (s?) in their surveying and data collection efforts. The project to develop an ADAP data management system eventually became a collaboration between the State Health Department, VCU and the State pharmacy.
The final product of this collaboration was the development of a confidential, efficient, user-friendly and affordable ADAP information management system; the ADAP began using this program in early 1997. The software program was refined and modified as needed throughout the year. Five regional trainings—focusing on the use of this new software and targeting local health department ADAP managers—were also conducted.
Highlights of the ADAPs new information management system include:
C More sophisticated analysis of client utilization data, including the ability to unduplicate pharmacy claims, have led to an enhanced ability to generate necessary reports in a more timely and efficient manner.
C Drug utilization information is now available at the local level, increasing the ability of the program to analyze local trends in utilization and expenditures, and the ability to more accurately predict program growth. The ability to make cost projections and forecast growth is further augmented through the use of a contracted VCU economist.
C Ability to identify Medicaid-eligible clients.
C Enhanced program quality assurance.
Virginia ADAP has benefited greatly from this cost-efficient and user-friendly system, developed through the cooperation of several State agencies. The program hopes to augment the system’s capabilities in the future by strengthening the system’s quality assurance mechanism, improving the client intake process, increasing coordination with the Medicaid program and developing state-wide HIV-related demographic and epidemiological profiles.
SUMMARY OF Q & A SESSION
Following the presentations by the call faculty, listeners were invited to ask questions of the call faculty, DSS and NASTAD staff, or to make comments on the information presented. Highlights of this Q & A session are presented below.
Michigan reported that it contracted with a software developer to create a data
management program for its ADAP. The software program tracks pharmacy level and client level data. It also enables the ADAP to track program expenditures on a weekly basis. For more information regarding this software program, please contact Mary Gastambide at the Michigan ADAP.
Wisconsin ADAP recently began using Microsoft Access (a commercially-available
database) to manage the program’s data and produce reports. The ADAP is able to link this system to the HIV/AIDS Reporting System (HARS), the HIV surveillance system developed by the Centers for Disease Control and Prevention (CDC). The database also allows the ADAP to more easily produce quarterly utilization reports for submission to drug manufacturers for rebates. For more information on this issue, please contact Richard Albertoni at the Wisconsin ADAP.
Mississippi ADAP reiterated the importance of having the ability to develop cost projections and budget forecasts. These are invaluable tools, especially when approaching State legislatures regarding state funding for ADAP.
DSS, in collaboration with Lanny Cross of the New York ADAP, is currently working on an ADAP budget forecasting pilot project. DSS will be sharing the budget forecasting models developed through this effort with Title II grantees/ADAP directors upon completion of the project.
Rhode Island ADAP is currently developing an RFP for ADAP pharmacy services. Anyone with RFP model language to share with Rhode Island should contact Mary Marinelli at the Rhode Island ADAP.
Several listeners requested information regarding the HHS Office of Inspector General’s (OIG’s) recently released report, Audit of State AIDS Drug Assistance Programs’ Use of Drug Price Discounts (January 1998). The report is available for downloading through the OIG website at www.hhs.gov/progorg/oas/index.html. The report may also be obtained by calling HHS at 202-619-3370, and referencing report number A-01-97-01501.
APPENDIX I
DSS/NASTAD UPDATES
DSS Statements
Steven Young, Acting Director
Anita Eichler, DSS Director, has accepted a position as the Associate Administrator for Alcohol Prevention and Treatment Policy with the Substance Abuse and Mental Health Services Administration (SAMHSA). Anita will be leaving her current position at DSS in mid-March, and will be working on a number of issues in her new position at SAMHSA, including mental health and alcohol, as well as continuing work on HIV-related issues. Many thanks for her years of hard work, insight and dedication as Director of DSS.
Myatech is preparing a mailing for the grantee Annual Administrative Report (AAR) contacts. This mailing will include an updated drug pick list to be used in reporting drug data in the AIDS Pharmaceutical Assistance AAR component. The mailing is expected to go out in early March.
The Department of Health and Human Services broadcast the first in a series of satellite broadcasts on HIV/AIDS-related issues on February 27, 1998, from 1:00 to 3:00 p.m. (ET).
The topic for this first broadcast was the HHS publication, Guidelines for the Use of Antiretroviral Agents in HIV-infected Adults and Adolescents. The discussion was led by Anthony Fauci from the National Institute of Allergy and Infectious Disease, John Bartlett, of Johns Hopkins University, and Eric Goosby, Director of HIV/AIDS Policy at HHS.
Annette Byrne
As of the date of this teleconference, DSS has received ADAP Monthly Reports (AMRs) from 34 grantees. States that have not yet submitted an AMR will be contacted by their DSS project officer for follow-up, and to assess the need for technical assistance. The next deadline for AMR submission is March 10, 1998. In addition, quarterly pricing information will be due along with the AMR submission on April 10, 1998. Many thanks to those states that have submitted their AMRs.
Grantees are reminded that part of the statutory requirement of the 602/PHS program, implemented by HRSA’s Office of Drug Pricing, is the creation of a prime vendor program.
As this is an ongoing HRSA initiative, it is a conflict of interest for HRSA to officially endorse any other independent purchasing system or program.
Grantees are also reminded that there will be a National ADAP Forum held in Washington, DC, from April 5-7, 1998. The Forum, organized by ParExel SF & A, will include presentations by DSS and NASTAD staff, along with presentations by State ADAP representatives.
NASTAD Statement
Arnie Doyle
The National ADAP Monitoring Project Interim Technical Report is scheduled to be released in mid-March. Draft preview copies of the report are being mailed to State AIDS Directors with March 1998 edition of the NASTAD News. Final copies will be distributed to AIDS Directors, ADAP and Title II coordinators upon publication.
Recent reports from Idaho indicate that the State legislature has appropriated $200,000 in state general revenue funds for their ADAP in FY 1998. Congratulations to our colleagues in Idaho.
APPENDIX II
TELCONFERENCE PARTICIPANTS
From the Division of Systems Services, Health Resources Services Administration:
C Steven Young, Acting Director
C Annette Byrne, AIDS Drug Assistance and Program Support Branch Chief
C Erica Buehrens, Consultant
C Tracy Carson, Consultant
C Paul Mahanna, Program Analyst
C Miguel Gomez, Teleconference Moderator
From the National Alliance of State and Territorial AIDS Directors:
C Arnold Doyle, Research Associate
State Grantee Faculty Presenters:
C John Folby, Special Pharmaceutical Benefits Manager, Pennsylvania Department of Public Welfare
C Wendy Craytor, AIDS/STD Coordinator, Alaska Department of Health
C Anne Elam, ADAP Coordinator, Virginia Department of Health
Other State Grantee Faculty:
C Mary Gastambide, ADAP Coordinator, Michigan Department of Public Health
APPENDIX III
