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AACO Client Services Presentation

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Ricardo Colon and Sebastian Branca of the Philadelphia AIDS Activities Coordinating Office presented on Client Services and Quality Management in Philadelphia at the March 2017 meeting of the Ryan White Planning Council.

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AACO Client Services Presentation

  1. 1. Philadelphia Department of Public Health AIDS Activities Coordinating Office Ryan White Planning Council Meeting March 9, 2017
  2. 2. Client Services Unit (CSU)
  3. 3. 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
  4. 4. Key Point of Entry  Intake services to HIV positive individuals requesting case management services
  5. 5. Medical Case Management (MCM) Services in the Philadelphia EMA
  6. 6. 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
  7. 7. 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 months HIV/AIDS Bureau Policy 16-02
  8. 8. 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
  9. 9. 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
  10. 10. CSU Responsibilities  Information and referral services for all other AACO funded programs  Process individuals’ requests for subsidized housing  Feedback about funded providers  Local Case Management Coordination Project
  11. 11.  Health Information Helpline is open 8 a.m. to 5:30 p.m. Monday through Friday  800/215-985-2437  Staffing: ◦ Manager ◦ SW Supervisor ◦ Housing Coordinator ◦ 4 City Social Workers ◦ Training Coordinator  Staff speak Spanish & French ◦ Other languages available through PDPH translation services CSU Information
  12. 12. CSU Wait List  21people as of 3/7/17  Followed by CSU Intake Workers  Emergencies 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
  13. 13. Intake Data
  14. 14. 2016 Intake Demographics 65% 33% 2% Client Gender Male Female Transgender 14% 71% 1% 0% 0% 14% Client Race White Black Asian Hawaiian Native American Hispanic/Latino
  15. 15. 2016 Intake Demographics 27% 11% 40% 1% 4% 17% Risk Factor/Mode of Transmission MSM IDU Hetero Blood Perinatal Not Identified 6% 11% 61% 0% 21% 0% 1% Insurance Type Private Medicare Medicaid VA or Other Military No Insurance Other Unknown
  16. 16. Calendar Year 2016: Client Needs at Intake (N=1887) All Clients Male Female Afr. Amer. MSM Latino 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%
  17. 17. Calendar Year 2016: Client Needs at Intake (N=1887) All Clients Male Female Afr. Amer. MSM Latino 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%
  18. 18. Housing Services Program (HSP)
  19. 19. HSP Funding  The 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
  20. 20. What is HSP  Centralized 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
  21. 21. What HSP Does  Process and evaluate individual applications for housing  Maintain the waiting list  Provide ongoing TA and training to service providers  All services at no cost  Do not provide emergency housing
  22. 22. HSP Scope  8 housing sponsors  686 housing slots ◦ 494 HOPWA ◦ 192 S+C  72% tenant based  28% project based
  23. 23. Wait List  400 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
  24. 24. 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
  25. 25. Quality Management and MCM Services
  26. 26. 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
  27. 27. QM and the Continuum  In 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
  28. 28. 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
  29. 29. Outcome Monitoring in the EMA  Performance Measures  System Measures ◦ Appointment Availability  Disparities in Care
  30. 30. Performance Measures  25 measures for medical (O/AHS) services  7 MCM measures  3 oral health measures  Measures for all other services collected through PDE ◦ VL Suppression ◦ Gap in Medical Visits
  31. 31. Monitoring and Feedback  Strong emphasis on feedback  Quickly highlights trends, strengths and needs  Data visualization is critical in getting attention of program leadership  Benchmarking contextualizes data  Assists in prioritizing QIPs
  32. 32. 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 QIPs  EMA has defined key measures and set automatic thresholds for QIPs  Programs may still select other measures for improvement in addition to any required QIPs
  33. 33. Average Improvement QIP vs. No QIP
  34. 34. Retention and VL Suppression in Philadelphia EMA 85.3% 85.4% 75.0% 70% 72% 74% 76% 78% 80% 82% 84% 86% 88% 2011 2012 2013 2014 2015 Retention in Care VL Suppression Retention in Care: Percent with two or more OAMC visits > 90 days apart for patients with one or more visits in 2015 VL Suppression: Percent with last VL test in year < 200 copies/mL
  35. 35. Philadelphia EMA  Philadelphia 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
  36. 36. Consumers and CQI  PDPH 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
  37. 37. Questions or Comments

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