Delivering the Mountain

The HMO Kaiser Permanente provides care to nearly 10,000 people with HIV in California. For Kaiser, says Michael Allerton, HIV operations policy leader for the Permanente Medical Group, the California legislation was important because it 'gave us a template of how to define a specialist. We were defining our own specialist and what experience meant.' What is most challenging for an HMO, Allerton says, is providing quality care in areas with a small HIV-positive population. And in Hawaii, where Kaiser treats 428 HIV-positive patients, the HMO has developed a creative means of addressing this problem. In the past, people with HIV were flown to Oahu to see the HIV team. Now that has changed. 'Instead of taking the patients to the clinic,' Allerton says.' the HIV team goes out to each island on certain days.' This model, he notes, may be useful in other rural areas where the population of people with HIV is small but the need for HIV specialists is great.