Washington Blade - September 12, 2003
Laurel Faust

Felicia Lynch, HAA's director of health and support services, said that, with the old system - which is still in place in a few locations - clients have to go through separate intake procedures each time they change providers. With XPRES, there will be a unifying database so providers can pull up the health history of each client.

Lynch said that HAA began implementing XPRES in pilot programs around the region beginning in March. Now 98 percent of service providers have the program and are being trained on how to use it.

Clients are issued a white plastic card with a key code and a four or five digit number. The cards are swiped in the same manner as a credit card. The client's complete medical history shows up on the provider's computer screen.

Lynch said the cards can be used by people receiving federal Ryan White CARE Act Title I and Title II funds. The Ryan White legislation funds primary care and support services for people living with HIV disease who have no other health care or the financial ability to pay for their care. Title I provides grants in metropolitan areas where the epidemic has hit the hardest. Title II provides funding for states.

"Clients have the choice to receive case management from one provider, primary medical from another, and complementary therapy from yet another," Lynch said. "Because an individual is living with HIV/AIDS and receiving treatment and care supported by Ryan White dollars does not mean they have given up their right to choose where, how and from whom they can receive services. Utilizing the card insures autonomy and choice."

AIDS Coalition to Unleash Power spokesperson Wayne Turner testified to the difficulties with the old system. He said that his partner, Steve Michael, who died on May 25, 1998, went through several case managers and had to get re-tested for HIV when he saw a new provider.

"He had three new appointments just to go through the intake. There is excessive red tape. It's just nightmarish," Turner said.

The Women's Collective, a community-based organization run by and for women living with and at risk for HIV/AIDS, was one of the first to implement XPRES.

Women's Collective case manager Diana Kenlow said that the new system is quicker and less "tedious" than the old one.

"When a person comes into care for a specific service, we're able to track that person in terms of other services provided," Kenlow said.

She said under the old system, people were able to "agency hop" and receive duplicate services from many providers. She said the new system should prevent this from happening. Kenlow added that the case managers can follow up to see if their clients follow through with their referrals.

Concern over stigma

Dr. Pat Hawkins, associate executive director for policy at the Whitman-Walker Clinic, is also a member of the Ryan White Planning Council and its Quality Insurance Committee. She said there is mixed information and confusion about XPRES.

She said that some people with HIV and AIDS are concerned about what will happen if people find out what the cards are for. They're afraid, because of the stigma surrounding the illness, that people might use the cards to somehow target people with AIDS and HIV.

Lynch said this won't happen because there is no identifying information on the cards.

"It can only identify the individual once it is swiped in a card reader," Lynch said.

Hawkins expressed concern about the confidentiality of the clients. She said that under the Health Insurance Portability & Accountability Act of 1996, patients are given the option to not disclose certain medical information.

Hawkins gave the example of a person who has a substance abuse or a mental health problem. She said the person might not want this information revealed to their general practitioner.

"We support the concept of a unified database, but we don't support it without the protections in place," she said.

Lynch insisted that despite confusion about the XPRES card, that the program is "totally HIPAA compliant." Lynch said the Health Resources & Services Administration requires that all the Ryan White Title programs provide reports on services provided and utilization of services.

"We felt if we were going to be revamping the entire system that we ought to have improved access for the clients," Lynch said.

She said there are no additional costs for XPRES - that the same funds that were used to fund the old program will be used for the new one.

More than 13,000 people with HIV/AIDS in the metropolitan area are eligible to receive local funds and federal funds through the Ryan White Emergency CARE act. In D.C. alone, 9,000 clients receive primary medical care, case management and other support services including medications.

MORE INFO

D.C. HIV/AIDS Administration

717 14th St., NW, 10th Floor - Washington D.C. 20002

202-727-2500

Whitman-Walker Clinic

1407 S St., NW - Washington, DC 20009

202-797-3500 - www.wwc.org

Women's Collective

1436 U St., Suite 120 - Washington, DC 20002

www.womenscollective.org

030912
WB030906

Always watch for outdated information. This article first appeared in 2003. This material is designed to support, not replace, the relationship that exists between you and your doctor.

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