Dr Stella Safo on Challenges With Managing HIV Costs in Shift to Value-Based Care

It's important to have different metrics when it comes to cost containment because some patients are just sicker than others, explained Stella A. Safo, MD, assistant professor of Medicine at the Icahn School of Medicine at Mount Sinai.

With people living with HIV having significantly higher medical costs compared with people without infection, what challenges exist in the shift to value-based care in trying to lower costs while improving quality of care?

It is a very important area as we think about risk for certain patient populations and population health management to not have the same metrics when it comes to cost containment because some patients are just sicker than others and will always be sicker than others no matter what you do, short of cutting services. It’s specifically very true of our HIV population, who as they age, even if they’re being treated with antiretrovirals, still have higher incidences of cancer, still have higher incidences of certain acute infectious diseases, and so one of the first benchmarks is that we have to understand and we have to allocate more resources to this population that’s naturally sicker.

I think we also have to, as part of that, educate our system executives and leaders, that as they’re looking at their dashboards and looking at certain clinics and looking at certain patient populations, that they understand that the clinic outcomes of certain patients, even with the best and most proactive population management with team-based care and all of the things that we’ll do, that certain patients will always have a little bit more of a challenge meeting those cost and quality metrics just because of the nature of their disease. I see it as someone who does health system design, administrative work, and also as a clinician, I see it as my job to really help with the translation of that for all of the individuals involved in this. I think the question is a good one: how do we make sure that we don’t end up hurting a population like HIV-positive patients by requiring them to meet the same metrics, the same cost metrics as patients who might not be as acutely ill as they are? So, I think it’s a challenge we really need to figure out how to deal with.