HAB HIV Performance Measures: 

Medical Case Management 

Performance Measure: Medical Case Management: Medical Visits 

Percentage of HIV-infected medical case management clients1 who had two or more medical visits in an HIV care 

setting in the measurement year. 

Numerator: 

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

with prescribing privileges2

 two or more times at least three months apart in the measurement year 

that is documented in the medical case management record3 

. 

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, did the medical case manager document in the medical case management record3 

that the client had two or more medical visits at least three months apart in an HIV care 

setting in the measurement year? (Y/N) 

1. If yes, list the dates of these medical visits. 

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 

Medical case management record3

 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 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 clientMedical Case Management Final | November 23, 2009 | Page 3 of 4 
 

 

 

 

HAB HIV Performance Measures: 

Medical Case Management 

Performance Measure: Medical Case Management: Medical Visits 

centered services that link clients with health care, psychosocial, and other services. The coordination and 

follow-up of medical 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 clientspecific advocacy and/or review of utilization of services.” 4 

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

Reduce cost of care by decreasing hospitalization5 

Clients enrolled in case management are 1.5 times more likely to follow drug regimens6 

Improve chances of newly diagnosed HIV-infected persons entering care.6 

US Public Health Service Guidelines: 

None 

References/Notes: 

1

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

2

A “provider with prescribing privileges” is a health care professional who is certified in their 

jurisdiction to prescribe ARV therapy.

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

medical record. 

4

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

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

Beach County, Florida. Journal of Health & Human Resources Administration, 16, 96-110. 

6

 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. 

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