The Philadelphia Department of Public Health held a meeting on April 14, 2016, focusing on medical case management (MCM) services for HIV/AIDS, which aim to improve health outcomes through client-centered activities. Key activities include initial assessments, care plan development, and ongoing client monitoring, with an emphasis on quality improvement initiatives to enhance service delivery. The meeting also highlighted funding details and demographic information of clients benefitting from these services in the region.

1. Philadelphia Department
of Public Health
AIDS Activities Coordinating Office
Planning Council Meeting
April14, 2016

2. Agenda
 Overview of MCM services
 CSU
◦ Data
◦ HSP
 QI
 MCM Measures

3. Medical Case Management (MCM)
Services in the Philadelphia EMA

4. 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

5. HIV/AIDS Bureau Policy 16-02
MCM Key Activities
 Initial assessment of service needs
 Development of a comprehensive, individualized
care plan
 Timely and coordination access to medically
appropriate levels of health and support services
and continuity of care
 Continuous client monitoring to assess the
efficacy of the plan
 Re-evaluation of the care plan at least every six
months
 Ongoing assessment of client’s needs
 HIV treatment adherence counseling
 Client-specific advocacy

6. 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

7. MCM Services in the EMA
 Approximately $8.6 million allocated to medical case
management in RW Part A/B and MAI funding
◦ 8, 856 unduplicated clients received MCM services
in CY 2014, includes all RW (Part A-D) for AACO
funded agencies
◦ 2015 intakes completed through the Client
Services Unit in CY 2015
 21 providers funded throughout the EMA
◦ CBOs/ASOs
◦ Hospital outpatient infectious disease clinics,
including pediatric sites
◦ Stand alone HIV clinics

8. Slide Courtesy of Karen Robinson and David Heal, Washington State DOH

9. Client Services Unit
(CSU)

10. 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

11. CSU Responsibilities
 Intake services to HIV positive
individuals requesting medical case
management services
 Information and referral services for all
other AACO funded programs
 Process individuals’ requests for
HOPWA and SPC housing subsidies
 Feedback about funded providers
 Local Case Management Coordination
Project

12. CSU Information
 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
◦ Other languages available through PDPH
translation services

13. CSU Wait List
 33 people as of 4/12/16
 Followed by CSU Intake Workers
◦ Emergency
◦ Urgent
 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

14. Intake Data

15. 2015 Intake Demographics
68%
30%
2%
Client Gender
Male
Female
Transgender
14%
14%
70%
1%
0%
0%
1%
Client Race Hispanic/Latino
White
Black
Asian
Hawaiian
Native
American

16. 2015 Intake Demographics
28%
12%
41%
2%
3% 14%
Risk Factor/Mode of Transmission
MSM
IDU
Hetero
Blood
Perinatal
Not Identified
5%
12%
55%
1%
25%
0% 2%
Insurance Type Private
Medicare
Medicaid
VA or other Military
No insurance
Other
Unknown

17. Calendar Year 2015: Client Needs at Intake (N=2015)
All Clients Male Female
Afr. Amer.
MSM
Latino MSM
Number of
Intakes
2015 1364 614 470 88
Percent of Total
Intakes
100% 67.7% 30.5% 23.3% 4.4%
Service Category
Benefit
Assistance
41.4% 41.9% 41.0% 35.5% 46.6%
Housing
Assistance
50.0% 48.6% 51.6% 53.6% 42.0%
Transportation
Assistance
25.3% 24.2% 27.5% 18.7% 18.2%
Mental Health
Treatment
29.7% 29.4% 29.3% 28.1% 26.1%
Medical
Insurance
22.0% 26.0% 14.3% 25.5% 33.0%
Medical Care 28.9% 29.5% 27.2% 28.7% 37.5%

18. Calendar Year 2015: Client Needs at Intake (N=2015)
All Clients Male Female
Afr. Amer.
MSM
Latino
MSM
Number of
Intakes
2015 1364 614 470 88
Percent of Total
Intakes
100% 67.7% 30.5% 23.3% 4.4%
Service Category
Medications 23.9% 25.6% 19.5% 23.6% 35.2%
Rental
Assistance
11.2% 10.6% 12.4% 15.7% 13.6%
Food
Bank/Home
Delivered Meals
26.9% 26.0% 28.8% 27.0% 28.4%
Support Groups 10.0% 9.2% 11.9% 9.1% 6.8%
Dental Care 7.0% 7.7% 5.5% 8.9% 9.1%

19. Calendar Year 2015: Client Needs at Intake (N=2015)
All Clients Male Female
Afr. Amer.
MSM
Latino
MSM
Number of
Intakes
2015 1364 614 470 88
Percent of Total
Intakes
100% 67.7% 30.5% 23.3% 4.4%
Service Category
Medications 23.9% 25.6% 19.5% 23.6% 35.2%
Rental
Assistance
11.2% 10.6% 12.4% 15.7% 13.6%
Food
Bank/Home
Delivered Meals
26.9% 26.0% 28.8% 27.0% 28.4%
Support Groups 10.0% 9.2% 11.9% 9.1% 6.8%
Dental Care 7.0% 7.7% 5.5% 8.9% 9.1%

20. Housing Services
Program
(HSP)

21. HSP Funding
 The AACO Housing Services Program
(HSP) is 100% funded by the Philadelphia
Office of Housing & Community
Development (OHCD)
 The HSP receives $0 from Ryan White
funds
◦ RW funding can not be used to provide
permanent housing
◦ Federal funding for housing continues to decline

22. What is HSP
 Centralized intake for applicants
seeking permanent rental assistance
(subsidized housing)
 The main referral source for housing
sponsors providing Housing
Opportunities for People With AIDS
(HOPWA) or HIV/AIDS Shelter Plus
Care (S+C) housing

23. What HSP Does
 Process and evaluate individual
applications for housing
 Maintain the waiting list
 Provide training to southeastern PA
service providers
 Provide ongoing TA to providers
 All services at no cost
 Do not provide emergency housing

24. HSP Scope
 8 housing sponsors
 653 housing slots
◦ 522 HOPWA
◦ 131 S+C
 89% tenant based
 11% project based

25. Wait List
 376 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
7 years or more

26. Feedback
 All AACO funded
agencies must have
a grievance process
 MCM agencies must
share this process
with all clients
 Clients have the
option of calling the
Health Information
Helpline
 Helpline handles
DEFA appeals

27. Quality Management and
MCM Services

28. 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 is about knowing if clients are clinically
better off today than yesterday, and making
improvements for the HIV care system to be
better tomorrow

29. QM and the Care Continuum
 In accordance with NHAS, initiatives are
being directed at all stages of the care
continuum to promote retention and viral
suppression
 CDC-funded prevention providers are
doing QIPs on diagnosis and linkage
 QIPs for MCM and O/AMC target Gap in
Medical Visits and VL suppression
 Performance measure portfolios for both
O/AMC and MCM were updated in 2014
to focus on the continuum of care

30. 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

31. Outcome Monitoring in the
EMA
 Performance Measures
 System Measures
◦ Appointment Availability
 Disparities in Care

32. Performance Measures
 23 measures for medical (O/AMC)
services
 7 MCM measures
 3 oral health measures
 Measures for all other services
collected through PDE
◦ VL Suppression
◦ Gap in Medical Visits

33. Medical Case Management
(MCM) Measures
 Linkage to HIV Medical Case
Management
 Linkage to HIV Medical Care
 Medication Assessment and Counseling
 Prescription of Antiretroviral Therapy
 HIV Medical Visit Frequency
 Gap in HIV Medical Visits
 Medical Case Management Care Plan

34. MCM Performance Measures
Performance Measure 2014 2015
Linkage to HIV MCM 79% 78%
Linkage to HIV Medical Care 94% 94%
Medication Assessment &
Counseling
84% 89%
Prescription of ART 92% 94%
HIV Medical Visits Frequency 58% 59%
Gap in Medical Visits 23% 20%
MCM Care Plan 50% 62%

35. 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

36. MCM Performance Feedback Reports
Program A Performance Trend
Performance Measure December 2014 December 2015 Comparison
CSU01 Linkage to HIV Medical Case Management 80% 83% 3%
CSU02 Linkage to HIV Medical Care 100% 100% 0%
MCM01 Medication Assessment and Counseling 89% 93% 4%
MCM02 Prescription of Antiretroviral Therapy 96% 96% 0%
MCM03 HIV Medical Visit Frequency 59% 49% -10%
MCM04 Gap in HIV Medical Visits 43% 23% -20%
MCM05 Medical Case Management Care Plan 60% 75% 15%
Comparison of Regional Aggregate to Program A in Current Measurement Period
Performance Measure 2015 Region 2015 Program A Comparison
CSU01 Linkage to HIV Medical Case Management 78% 83% 5%
CSU02 Linkage to HIV Medical Care 94% 100% 6%
MCM01 Medication Assessment and Counseling 89% 93% 4%
MCM02 Prescription of Antiretroviral Therapy 94% 96% 2%
MCM03 HIV Medical Visit Frequency 59% 49% -10%
MCM04 Gap in HIV Medical Visits 20% 23% 3%
MCM05 Medical Case Management Care Plan 62% 75% 13%
Program A Regional Ranking by Measure
Performance Measure December 2014 December 2015
CSU01 Linkage to HIV Medical Case Management 10 8
CSU02 Linkage to HIV Medical Care 1 1
MCM01 Medication Assessment and Counseling 12 5
MCM02 Prescription of Antiretroviral Therapy 6 8
MCM03 HIV Medical Visit Frequency 15 19
MCM04 Gap in HIV Medical Visits 20 13
MCM05 Medical Case Management Care Plan 12 9

37. Quality Improvement Projects
• Expanded to Medical Case Management in
2012
• Grantee provides feedback to providers on
all plans and requires revisions as needed
• In 2015-16, AACO reviewed 73 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

38. 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
 MCM programs have been particularly effective at
incorporating consumers into QI

39. Questions or Comments