Arizona College of Emergency Physicians

Long-acting cabotegravir plus rilpivirine (CAB + RPV LA) administered monthly or every 2 months is recommended by treatment guidelines for maintenance of virologic suppression in people with human immunodeficiency virus type 1 (HIV-1). In clinical trials, CAB + RPV LA demonstrated noninferiority versus United States (US) Food and Drug Administration-approved daily oral therapy, and outcomes in real-world settings can supplement these results. We present month 12 results of BEYOND. BEYOND is an ongoing, 2-year, multicenter, prospective, observational real-world study of adults initiating CAB + RPV LA in the US. Key outcomes included reasons for initiating, virologic outcomes, adherence, and patient-reported outcomes related to treatment satisfaction and treatment challenges at baseline and month 12. In total, 308 participants (median age, 45 years; 83% identified as male; 39% identified as Black) initiated CAB + RPV LA most commonly because of treatment fatigue, adherence anxiety with daily oral therapy, and/or convenience. Of participants with baseline viral load data, 97% (194/200) had a viral load <50 copies/mL for their most recent test reported at month 12. Mean treatment satisfaction scores increased significantly from baseline to month 12 and 97% (223/229) of participants preferred LA versus oral treatment at month 12. Proportions of participants reporting "always" or "often" experiencing challenges related to HIV-1 treatment (fear of disclosure, adherence anxiety, reminder of HIV-1 status, and feeling stigmatized) decreased from baseline to month 12. Month 12 results from the real-world BEYOND study support the effectiveness of CAB + RPV LA for maintenance of virologic suppression and as a preferred treatment option for people with HIV-1.

More opportunities exist to evaluate theories on cost savings in health care delivery as increasing numbers of Americans enroll in managed health care plans. Arizona has jumped into second place (behind Minnesota) as the state with the most patients per capita enrolled in managed care plans. Our private practice of otolaryngology is conducted in a physician-directed, multispecialty group in Phoenix, Ariz. Our group has contracts with 37 of the more than 50 managed care plans in place including the capitated Arizona Health Care Cost Containment System, which is the state's prepaid alternative to Medicaid. Several of these managed care plans have placed restrictions on referrals to specialists through "gate-keepers." The primary care providers acting as gatekeepers are motivated, to some degree, by economic incentives. The cost of referrals can be subtracted from the primary care provider's monthly capitated payment or can be deducted from the referral risk pool that is