Case Study: Transforming HIV Care Through Centralized Eligibility
Overview:
The Ryan White HIV Health Insurance Program plays a critical role in providing healthcare access to people living with HIV. However, complex eligibility requirements, outdated technology, and changing regulations created significant barriers to care.
These challenges resulted in obstacles to care, administrative burden, and reduced program effectiveness. Recognizing the need for a comprehensive transformation, program leadership engaged InTegrity Partners Consulting and our pillars of InTegrity, InnovaTion, and ImpacT to design and implement a centralized eligibility system that would enhance access to care, improve stakeholder collaboration, and position the program as a national leader in HIV service delivery.
The Challenge
The program’s goal was to increase the number of people receiving care and achieving viral suppression by removing barriers in the eligibility process. However, multiple challenges stood in the way:
- Complex and Burdensome Application Process – Participants were required to complete a 15-page application twice a year, creating unnecessary administrative hurdles.
- Stakeholder Misalignment – State agencies, county health departments, and service providers had numerous priorities and did not have the resources required to redesign program, compliance, and eligibility processes.
- Outdated Technology – Existing legacy systems lacked integration capabilities, leading to inefficiencies and inconsistencies in eligibility determinations.
Transforming this system required a deep understanding of healthcare policy, regulatory compliance, technology integration, and stakeholder engagement to create a solution that was both effective and sustainable.
Our Approach
At InTegrity Partners Consulting, we applied our Human Factor methodology, ensuring that technology, policy, and human-centered design worked together seamlessly. Grounded in our core values of InTegrity, InnovaTion, and ImpacT, we focused on removing barriers, fostering collaboration, and delivering measurable, sustainable results.
Aligning Stakeholders to a Common Vision
- Conducted stakeholder interviews with state health agencies, county public health departments, and statewide service providers to identify pain points and operational challenges.
- Facilitated collaborative discussions to align stakeholders on the need for centralized eligibility and the anticipated benefits of modernization.
- Developed a change management strategy to ensure smooth adoption across all participating entities.
Designing and Implementing a Centralized Eligibility System
- Conducted a comprehensive technology assessment, selecting and integrating the most effective platform for eligibility centralization.
- Simplified the eligibility application process from 15 pages to a single page, eliminating unnecessary administrative barriers.
- Established standardized workflows for eligibility verification across agencies, reducing redundancies and improving efficiency.
- Provided extensive training and support to agency staff to ensure effective system adoption.
Addressing Barriers to Care Beyond Technology
- Developed clear and accessible communication materials to build trust among stakeholders and encourage engagement.
- Integrated social determinants of health services, including transportation assistance, mental health resources, and food support, to create a comprehensive care model.
- Ensured policy alignment with federal and state regulations to streamline program compliance.
Managing Change, Risk, and Compliance
- Strengthened data security measures to ensure compliance with HIPAA and federal privacy laws.
- Utilized our Human Factor methodology to mediate historical conflicts between stakeholders, fostering collaboration and improving program governance.
- Implemented real-time reporting tools to track progress and measure the program’s impact over time.
The Results
The transformation led by InTegrity Partners Consulting reflects what’s possible when InTegrity, InnovaTion, and ImpacT drive public health solutions. By prioritizing The Human Factor, we ensured this initiative was not just about process efficiency but about real, lasting change for those who need care most.
Key Outcomes
- Eligibility application streamlined from 15 pages to 1 page, removing a key barrier to care.
- A significant increase in the number of PLWH receiving regular care within 18 months.
- Marked improvement in viral suppression rates, advancing public health goals and reducing transmission risks.
- Stronger inter-agency collaboration, leading to more effective service delivery and program oversight.
- National recognition, positioning the program as a model for other states seeking to modernize their HIV care infrastructure.
Conclusion
At InTegrity Partners Consulting, we don’t just implement solutions—we partner with organizations to create meaningful, lasting change. This initiative was more than a systems upgrade; it was a transformation in how healthcare is delivered, ensuring that people living with HIV can access the care they need without unnecessary obstacles.
For the Ryan White HIV Health Insurance Program, we combined strategic vision, technical expertise, and a commitment to excellence to turn challenges into opportunities. Today, this program stands as a testament to what’s possible when InnovaTion and InTegrity come together to make a meaningful ImpacT. At InTegrity Partners Consulting, we are proud to lead transformations that don’t just optimize systems but empower people. We look forward to helping your organization achieve its full potential through the same principles that define our work.
We are proud to have played a role in shaping this success, and we are ready to bring the same transformative impact to your organization.
Let’s start the conversation. Contact us today to learn how InTegrity Partners Consulting can help you drive real results.
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Call: 952.240.3859
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