HAB HIV Performance Measures: 

Medical Case Management 

Performance Measure: Medical Case Management: Care Plan 

Percentage of HIV-infected medical case management clients1 who had a medical case management care plan 

developed and/or updated two or more times in the measurement year. 

Numerator: 

Number of HIV-infected medical case management clients who had a medical case management 

care plan developed and/or updated two or more times which are at least three months apart in the 

measurement year. 

Denominator: Number of HIV-infected medical case management clients who had at least one medical case 

management encounter in the measurement year. 

Patient 

Exclusions: 

1. Medical case management clients who initiated medical case management services in the last 

six months of the measurement year. 

2. Medical case management clients who were discharged from medical case management 

services prior to six months of service in the measurement year. 

Data Element: 

1. Is the client HIV-infected? (Y/N) 

a. If yes, did the client have a medical case management encounter in the measurement year? 

(Y/N) 

i. If yes, is there a case management plan developed and/or updated two or more times at 

least three months apart during the measurement year? (Y/N) 

1. If yes, list the dates of these care plans and/or care plan updates. 

Data Sources: 

Data reports required by HRSA/HAB, such as the Ryan White Data Report (RDR) and Ryan 

White HIV/AIDS Program Services Report (RSR), may provide useful data regarding the number 

of clients identified as receiving medical case management. 

Electronic databases, such as CAREWare, Provide, ARIES, Lab Tracker, Electronic Medical 

Record/Electronic Health Record. 

Case management record2

 chart abstraction by grantee of a sample of records. 

National Goals, 

Targets, or 

Benchmarks for 

Comparison: 

None available at this time. 

Outcome 

Measures for 

Consideration: 

Percent of patients who are retained in medical care in the measurement year. 

Percent of patients on antiretroviral therapy for whom it is indicated in the measurement year. 

Percent of patients who are adherent to their treatment regimen in the measurement year. 

Basis for Selection: 

The Ryan White HIV/AIDS Treatment and Modernization Act of 2006 (P.L. 109-415) indicates that medical case 

management is a core medical service. Additionally, medical case management services increase access to and 

retention in medical care. 

Definition: “Medical Case management services (including treatment adherence) are a range of client-centered services 

that link clients with health care, psychosocial, and other services. The coordination and follow-up of medical 

Medical Case Management Final | November 23, 2009 | Page 1 of 4 
 

 

 

HAB HIV Performance Measures: 

Medical Case Management 

Performance Measure: Medical Case Management: Care Plan 

treatments is a component of medical case management. These services ensure timely and coordinated access to 

medically appropriate levels of health and support services and continuity of care, through ongoing assessment of the 

client’s and other key family members’ needs and personal support systems. Medical case management includes the 

provision of treatment adherence counseling to ensure readiness for, and adherence to, complex HIV/AIDS treatments. 

Key activities include (1) initial assessment of service needs; (2) development of a comprehensive, individualized 

service plan; (3) coordination of services required to implement the plan; (4) client monitoring to assess the efficacy of 

the plan; and (5) periodic re-evaluation and adaptation of the plan as necessary over the life of the client. It includes 

client-specific advocacy and/or review of utilization of services.”3 

Case Management is beneficial in dealing with complex needs of people living with HIV/AIDS: 

Reduce cost of care by decreasing hospitalization4 

Clients enrolled in case management are 1.5 times more likely to follow drug regimens5 

Improve chances of newly diagnosed HIV-infected persons entering care.5 

US Public Health Service Guidelines: 

None 

References/Notes: 

1

 “Clients” includes all medical case management clients regardless of age. 

2 The client’s medical record may be used if case management documentation is located in the client’s medical record. 

3

 “Ryan White HIV/AIDS Program Services Report Instruction Manual, Version 1.3, page 6. 

4 Cruise, P.L. & Liou, K.T. (1993). AIDS Case management: a study of an innovative health service 

5

 Gardner, L.I. Metsch, L.R., Anderson-Mahoney, P., Loughlin, A.M. Et al. Efficacy of a brief case management 

intervention to link recently diagnosed HIV-infected persons to care. AIDS 2005 Mar 4; 19(4): 423-31. 

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