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Primary care is just the first step
Housing Works Inc. of New York City fulfills a major part of its mission through three health care facilities that provide a wide variety of health care services.
In addition to its primary care and mental health care for HIV/AIDS patients, the organization has developed some subspecialties and soon will expand these, says Errol A. Chin-Loy, senior vice president for health services.
For example, Housing Works is involved with the New York State Department of Health’s comprehensive managed health care initiative for Medicaid-eligible New Yorkers with HIV/AIDS. Called Special Needs Plans (SNPs), the program is a national model to provide comprehensive care to HIV-infected clients. The SNPs include VidaCare, which is partly owned by Housing Works, he explains.
"The goal is to have a managed care program that is inclusive of all services for people with HIV/AIDS," Chin-Loy says. "We felt that many of the existing managed care companies have a lot of inflexibility. VidaCare, which was opened in July 2003, is open to everyone with HIV."
Here are some additional details about Housing Works’ health care program:
HIV/AIDS patients have to meet certain requirements that are the same for all primary care services with some additions.
Patients are required to meet with a primary care physician for a physical exam, complete follow-up appointments, and see a psychologist or mental health specialist.
VidaCare also requires patients to have a full-scale orientation to the program within 15 days, meeting with social workers and providers. After the physical exam, they must undergo a series of other assessments within 28 days, Chin-Loy says.
"The beauty of the VidaCare network is to build a substantial subspecialty program so clients who come into VidaCare will come into the providers at Housing Works and also be able to access services for gynecology, gastrointestinal, etc.," he explains. "And these providers all are top-notch in the field of HIV/AIDS."
Medicaid provider specialists who also have experience with HIV/AIDS patients already have agreed to see patients referred to them through VidaCare, Chin-Loy says.
"We make appointments for patients, and the ultimate goal is to have the client come into the system and refer within the system, and they receive the same services any of us would receive when we have insurance," he notes. "If clients run into problems after hours, they can call an essential number to the VidaCare line and can be directly connected to a physician."
Under VidaCare, the hotline physician will assess the patient’s medical needs and either refer the person to the hospital or have them wait until the next day for a medical appointment at the clinic, he explains.
"We also have to keep in mind that a good portion of our population has not been good at negotiating the health care system," Chin-Loy notes. "So these are the people who end up in emergency rooms, where they get frustrated and leave, receiving incomplete care or no care."
Reducing ED visits
The on-call VidaCare system will reduce the high rate of emergency department visits while making certain patients receive appropriate care and follow-up. "It provides good, cost-effective care to clients," he says.
Housing Works has physicians, nurse practitioners, physician assistants, nurses, and other health care professionals at its three facilities, which operate under the AIDS Adult Day Health Care program.
"Patients are treated just like patients at any other doctor’s office," Chin-Loy says. "There’s minimal waiting because we recognize the concerns of the population we serve."
The clinics have some subspecialty providers on site, including a gynecological nurse practitioner, he explains. "Our goal is to build subspecialties on site, including podiatry and gastrointestinal. All of the physicians are board-certified in internal medicine and are required to be HIV-certified."
A community advisory board oversees the day treatment program, and a residential advisory group (RAG) handles housing at the site of two of the clinics, Chin-Loy says. "We treat RAG as a co-op board. They work with us with all clients who may want to move into one of our facilities."
Anyone who is in residency must go through the day treatment program first so the boards and staff may see what they need and how they behave. Then if the client is interested in the residency program, he or she must be interviewed by members of the facility and RAG, he explains.
"They make a recommendation, and if that person is selected, they are put on a waiting list, and they can move in and stay for as long as they want until they’re stable," Chin-Loy says. "Until they’re ready to be independent, we will allow them to stay — it’s like the harm reduction model, we feel that if you push someone to do something before they’re ready, then they will fail."