3. Utilization and Demand of Use The Planning Council considers how a service category is being used in the Denver TGA, and the demand for what it provides. Utilization of services informs how well a category is funded. Service Categories that are underspent may not be utilized as much as those with consistent overspending, indicating high demand. Examples: Oral health has a significant impact on overall health and the ability of PLHIV to thrive and it is consistently overspent and in high demand. Medical Nutrition Therapy can greatly benefit PLHIV—especially those managing other conditions like diabetes or gastrointestinal issues and utilization in the Denver TGA has historically been low. This may be due to a limited number of trained providers, lack of patient awareness, or a perception that nutrition support is less urgent than other clinical needs. Low demand also reflects broader changes in the health trajectory of PLHIV. As medical advancements have improved, overall wellness, many will no longer face the same nutritional challenges common in the early days of the epidemic. Despite its lower utilization, MNT remains essential for certain populations and warrants consideration based on targeted demand. It should also be noted that, while MNT is a core medical service, it is currently supported through other funding sources.

4. Provision Availability by Payor Source Ryan White Part A is the payor of last resort—meaning it only covers services when no other funding source is available. Priority Setting takes into account whether a service is already paid for by another payor, such as Medicaid, private insurance, or other public programs. This ensures Ryan White Part A funds are used efficiently and directed toward services that cannot be covered elsewhere. Examples: Initial Intake Appointment: For someone newly diagnosed who does not yet have insurance coverage, Ryan White Part A may fund the initial medical visit to ensure immediate linkage to care. Medical Transportation Services (MTS): If Medicaid or other public transportation benefits are not available or applicable, Ryan White Part A may step in to cover transportation costs for medical appointments. However, if another payor is available, that source must be used first.

5. Cost and Value of the Provided Service When setting priorities, the Planning Council considers whether the cost of providing a service is reasonable and sustainable within the available Ryan White Part A budget. Even if a service is in high demand, it must be weighed against how far the funds can stretch and the overall value it brings to PLHIV in the Denver TGA. Cost-effectiveness is a key factor—services that provide broad, sustained impact for a reasonable cost may be ranked higher than more expensive services that serve fewer people or duplicate efforts already funded elsewhere. Examples: Residential Substance Use Services: While important, these services come with a high per-person cost. In the Denver TGA, funding this category through Ryan White Part A would quickly lead to overspending, limiting available dollars for other high-impact services. Housing Services: The need for housing support is critical, but the scale of investment required often exceeds what Ryan White Part A can reasonably provide. As a result, funding housing at a meaningful level would compromise the program’s ability to maintain essential core medical services.