Upload
office-of-hiv-planning
View
55
Download
0
Embed Size (px)
Citation preview
Philadelphia Department of Public Health
AIDS Activities Coordinating Office
Ryan White Planning Council Meeting March 9, 2017
Client Services Unit(CSU)
CSU Mission Help HIV infected and at-risk individuals understand
their needs and make informed decisions about possible solutions
Advocate on behalf of those who need special support
Reinforce clients’ capacity for self-reliance and self-determination through ◦ education ◦ collaborative planning ◦ problem solving
Key Point of Entry Intake services to HIV positive
individuals requesting case management services
Medical Case Management (MCM) Services in the Philadelphia EMA
HRSA MCM Definition
The provision of a range of client-centered activities focused on improving health outcomes in support of the HIV care continuum
Activities may be prescribed by an interdisciplinary team that includes other specialty care providers
Includes all types of encounters (e.g. face-to-face, phone contact and any other forms of communication)
HIV/AIDS Bureau Policy 16-02
MCM Key Activities Initial assessment of service needs Development of a comprehensive,
individualized care plan Timely and coordinated access to
medically appropriate levels of health and support services
Continuous client monitoring to assess the efficacy of the plan
HIV treatment adherence counseling Client-specific advocacy Assessment of client needs is ongoing Re-evaluation of the care plan at least
every six monthsHIV/AIDS Bureau Policy 16-02
MCM vs. Non-MCM “Medical Case Management services have as their objective improving health care outcomes whereas Non-Medical Case Management Services have as their objective providing guidance and assistance in improving access to needed services.”
HIV/AIDS Bureau Policy 16-02
MCM Services in the EMA Approximately $8.45 million allocated to medical
case management in RW Part A/B and MAI funding ◦ AACO funded subrecipients provided MCM
services to 8,196 unduplicated clients in CY 2015
◦ 1,887 intakes completed through the Client Services Unit in CY 2016
21 subrecipients funded throughout the EMA ◦ CBOs/ASOs◦ Hospital outpatient infectious disease clinics,
including pediatric sites ◦ Stand alone HIV clinics
CSU Responsibilities
Information and referral services for all other AACO funded programs
Process individuals’ requests for subsidized housing
Feedback about funded providersLocal Case Management
Coordination Project
Health Information Helpline is open 8 a.m. to 5:30 p.m. Monday through Friday
800/215-985-2437Staffing:
◦ Manager ◦ SW Supervisor◦ Housing Coordinator ◦ 4 City Social Workers ◦ Training Coordinator
Staff speak Spanish & French◦ Other languages available through PDPH translation services
CSU Information
CSU Wait List21people as of 3/7/17Followed by CSU Intake WorkersEmergencies and other priority
populations are immediately referred to MCM providers ◦ SCI Clients
CSU workers facilitate HIV medical appointments for all clients reporting no HIV medical care in last six months
Intake Data
2016 Intake Demographics
65%
33%2%Client Gender
Male
Female
Transgender
14%
71%
1%0%0%
14%
Client Race WhiteBlackAsianHawaiianNative Amer-icanHispanic/Latino
2016 Intake Demographics
27%
11%40%
1%4% 17%
Risk Factor/Mode of TransmissionMSMIDUHeteroBloodPerinatalNot Identified
6%10%
61%
0% 21%
0%1%
Insurance Type PrivateMedicareMedicaidVA or Other Mili-taryNo InsuranceOtherUnknown
Calendar Year 2016: Client Needs at Intake (N=1887)
All Clients Male Female Afr. Amer.
MSMLatino MSM
Number of Intakes 1887 1226 623 407 79
Percent of Total Intakes 100% 65.0% 33.0% 21.6% 4.2%
Service Category
Housing Assistance 51.5% 52.1% 49.0% 58.0% 46.8%
Benefit Assistance 46.0% 46.2% 44.9% 39.8% 49.4%Food Bank/Home Delivered Meals
26.8% 26.7% 26.8% 26.3% 35.4%
Mental Health Treatment 25.5% 22.4% 31.1% 24.3% 25.3%
Transportation Assistance 25.2% 23.8% 28.1% 20.9% 27.8%
Medical Care 23.9% 24.3% 23.4% 22.9% 32.9%
Calendar Year 2016: Client Needs at Intake (N=1887)
All Clients Male Female Afr. Amer.
MSMLatino MSM
Number of Intakes 1887 1226 623 407 79
Percent of Total Intakes 100% 65.0% 33.0% 21.6% 4.2%
Service Category
Medications 22.7% 24.3% 19.9% 21.1% 35.4%
Medical Insurance 18.3% 21.5% 12.2% 19.4% 22.8%HIV Education/Risk Reduction
13.4% 13.4% 13.0% 14.0% 22.8%
Rental Assistance 7.5% 7.4% 8.0% 9.8% 8.9%
Support Groups 6.9% 6.3% 7.9% 7.9% 11.4%
Substance Abuse 6.0% 5.3% 7.5% 3.9% 2.5%
Dental Care 3.4% 4.0% 2.4% 5.4% 6.3%
Housing Services Program
(HSP)
HSP FundingThe AACO Housing Services Program
(HSP) is 100% funded by the Philadelphia Division of Housing & Community Development (DHCD)
The HSP receives $0 from Ryan White funds◦ RW funding can not be used to provide
permanent housing◦ Federal and State funding for housing
continues to decline
What is HSPCentralized intake for applicants from
Philadelphia and Delaware Counties seeking permanent rental assistance (subsidized housing)
Bucks, Chester and Montgomery Counties (Bensalem EMA)
The main referral source for housing sponsors providing Housing Opportunities for People With AIDS (HOPWA) or HIV/AIDS Shelter Plus Care (S+C) housing
What HSP DoesProcess and evaluate individual
applications for housingMaintain the waiting list Provide ongoing TA and training
to service providersAll services at no costDo not provide emergency
housing
HSP Scope8 housing sponsors686 housing slots
◦494 HOPWA◦192 S+C
72% tenant based28% project based
Wait List400 applicants
on the wait list as of 4/12/16 ◦Wait time for
homeless individuals is 18 months or more
◦Wait time for all other applicants is 8 years or more
Feedback All AACO funded
subrecipients must have a grievance process
Subrecipients must share this process with all clients
Clients have the option of calling the Health Information Helpline
Helpline handles DEFA appeals
Quality Management and MCM Services
What is Quality Management
The QM process includes: ◦Quality assurance ◦Outcomes monitoring and evaluation ◦Continuous quality improvement
The goal is to use high quality data to continually improve access to high quality clinical HIV care
QM and the ContinuumIn accordance with National Goals
(NHAS), initiatives are being directed at all stages of the care continuum to promote retention and viral suppression
AACO is updating its prevention QI process to place greater focus on systems-level interventions around diagnosis and linkage
QIPs for MCM and O/AHS are targeting Gap in Medical Visits and VL suppression
All RW service categories have outcomes focusing on the continuum of care
The AACO Quality Improvement (QI)
Process Collect and monitor data to assess client
outcomes◦Local and HAB performance measures◦Other available data
Use data to improve client outcomes ◦Ongoing feedback to providers
Benchmarking Trends
◦QIPs◦Regional QI Meetings◦ Individual TA
Outcome Monitoring in the EMA
Performance MeasuresSystem Measures
◦Appointment Availability Disparities in Care
Performance Measures25 measures for medical
(O/AHS) services7 MCM measures3 oral health measuresMeasures for all other services
collected through PDE◦VL Suppression◦Gap in Medical Visits
Monitoring and FeedbackStrong emphasis on feedbackQuickly highlights trends, strengths
and needsData visualization is critical in getting
attention of program leadershipBenchmarking contextualizes dataAssists in prioritizing QIPs
Quality Improvement Projects
• Focuses on MCM and O/AHS• Grantee provides feedback to
providers on all plans and requires revisions as needed
• In 2016, AACO reviewed 84 QIPsEMA has defined key measures and
set automatic thresholds for QIPsPrograms may still select other
measures for improvement in addition to any required QIPs
Average Improvement QIP vs. No QIP
Retention and VL Suppression in Philadelphia EMA
2011 2012 2013 2014 201570%72%74%76%78%80%82%84%86%88%
85.3%
85.4%
75.0%
Retention in CareVL Suppression
Retention in Care: Percent with two or more OAMC visits > 90 days apart for patients with one or more visits in 2015VL Suppression: Percent with last VL test in year < 200 copies/mL
Philadelphia EMAPhiladelphia ranks 5th among all EMAs
for retention in care (85.4%)◦Among large EMAs, Philadelphia had
the 2nd highest outcome on retention Philadelphia ranks 6th among all EMAs
for VL suppression (85.4%)◦Among large EMAs, Philadelphia had
the highest outcome on viral suppression
Philadelphia was one of only two EMAs with high performance on both outcome measures
Consumers and CQIPDPH emphasizes consumers in the QI
process◦Consumers on QI teams or committees◦Obtain input from Consumer Advisory
Boards during key stages of a QI process◦Consumer focus groups◦Client surveys to obtain client input
relating to causes for low performance or proposed action steps
AACO is currently developing a process to enhance systems-level consumer participation
Questions or Comments