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Talk to George Washington University Masters's Students.covering Unity's Health Care's Response to the HIV epidemic in Washington DC

Talk to George Washington University Masters's Students.covering Unity's Health Care's Response to the HIV epidemic in Washington DC

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Gw unity feb_09 Gw unity feb_09 Presentation Transcript

  • Unity's Response to the HIV Epidemic
      • Andrew Catanzaro, MD
      • Unity Health Care, Inc.
  • Overview
      • Unity Health Care, Inc.
        • History, Mission, Vision
        • Patient demographics
        • Unity Healthcare Structure
      • HIV Group
        • Comanagement Model
        • Structure
      • Dr. Catanzaro
        • Role in the organization
        • Personal challenges
      • Successful management traits
  • Mission To offer a citywide network of quality health and human services to the medically underserved regardless of race, ethnic background, or ability to pay.
  • Vision To become the preeminent health care delivery system for the medically undeserved of Washington DC, and to be recognized by them as the provider of choice. Homelessness: The Family Portrait Across Region, Economy Pulls Rug From Under More and More 2-Parent Households By Chris L. Jenkins Washington Post Staff Writer Monday, February 16, 2009; A01
  • Unity Health Care: History 1985 - Unity founded as Health Care for the Homeless Project (HCHP)‏ 1996 – The Federal Government requesed that HCHP become the emergency grantee for the Community Health Center Program in the District of Columbia
  • Unity Health Care: History
    • 2001 – Unity Health Care joined the DC Health Care Alliance
        • Partners: Hospital, Two Insurance organizations, Children's Hospital, University Partner
        • HMO Insurance for coverage up to 200% poverty line
    • 2006 - Unity start to provide health services to the DC Jail
        • 1,500 Inmates
        • 6% HIV infection rate
  • Unity Health Care Fee Structure Medicaid, Medicare Unison Health Plan* DC Alliance* Health Right HMO Chartered HMO *Complete coverage up to 400% poverty line
  • Health Right Alliance Coverage 2007
  • User and Visit in 2007
      • Total Users 80,803
      • Total Visits 433,450
      • HIV+ Patients: 2,974
        • Male 1,829
        • Female 1,134
        • Transgender 11
  • Income and Insurance Status
  • Structure to Deliver Health Care
      • Eleven Community based centers
      • Nine Medical sites in homeless centers
      • Four Specialized Health Centers
      • Two Health Services Sites in DC Jails
      • Two Mobile Outreach vans
      • Seven Pharmacies
      • Home Visit Programs
  • Unity's Approach to HIV Medicine
      • Co-management with a primary care provider (nurse practitioner, Family Medicine Physician, or Internal Medicine Physician)‏
      • Comprehensive care
  • Unity's Medical Staff
      • Health Care Providers 170
      • HIV Specialists 4
  • Unity's HIV Comprehensive Medical Care: Goals
      • To offer comprehensive care to Unity patients infected with HIV within a primary health care network
      • Services in:
        • Medical Care
        • Mental Health
        • Social Services
        • Primary Care
        • Preventive health
          • Nutrition
          • Dental
          • Opthalmology
          • OB/GYN
  • Unity's HIV Care Model: Co-management of HIV with Primary Care Primary Care Provider HIV Specialist Primary Care Provider HIV Specialist
  • HIV Therapy: AIDS Drug Assistance program
      • Free to qualified applicants
      • Administered at the State level
      • Prescription medications including
        • Antiretrovirals
        • Prophylactic Medications
        • Antidepressants
        • Pain medication
  • Prescription Coverage: AIDS Drug Assistance Program
    • Federal Budget 2007
      • $1.4 billion
      • Covering 344,000 prescriptions for 101,000 patients nationally
    • DC 2007
      • $14 million
      • Covering 2,100 prescriptions for 740 patients
      • Surpluses
      • Full coverage in less than 72 hours
  • My role in Unity
      • One of three physician providing infectious diseases consultations to Unity patients
      • My 800 patients
        • Five medical sites
        • DC Jail 20% time
      • Team Approach
        • Nursing
        • Medical Assistants
        • Primary Care Providers
      • Teaching Responsibilities
  • Evaluation of our Success
      • Audit by the DC Government
      • HRSA tools
      • Ryan White Data
  • Structure of the HIV Group
      • Four core HIV providers traveling to sites providing clinical care
      • Four full time nurse case managers
      • Five full time medical assistants
      • Social Services on site funded for outreach services
      • Grant writers: Federal, CDC, NIH grants, Robert Wood Johnson for medical care
      • Monthly meeting to disseminate policy changes
  • Successful leadership traits in Unity Manager
      • Working in the health centers - on site
      • Listen carefully regarding concerns
      • Experience: seasoned, but not jaded
      • Come up with solutions and systems in response to real problems
      • Minimal paperwork, drama and politics
  • Unity Health Care, Inc.
      • “ The medicine is easy, its the other stuff that is difficult.”
  • Challenges at Unity
      • To care for patients for whom HIV is one of many difficult problems
  • Solution
      • ICMP “the 50”
        • Take 50 of the most difficult patients and organize the data in one location (Excel Spreadsheet)‏
        • Organize by CD4 count, viral load
        • Prioritize so that time and energy is focused on these 50 patients
        • Revisit this list regularly with nursing/medical assistant