Unity Health Care Inc. was established in 1985 to provide quality health and human services to the medically underserved in Washington D.C., particularly focusing on the HIV epidemic. The organization employs a co-management model for HIV care, integrating primary care providers and specialists to offer comprehensive services, including medical, mental health, and social support. Unity's approach also involves outreach and support programs, focusing on the most challenging patient cases to ensure effective treatment and management of their health needs.

1. Unity's Response to the HIV Epidemic Andrew Catanzaro, MD Unity Health Care, Inc.

2. 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

3. 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.

4. 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

5. 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

6. 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

7. Unity Health Care Fee Structure Medicaid, Medicare Unison Health Plan* DC Alliance* Health Right HMO Chartered HMO *Complete coverage up to 400% poverty line

8. Health Right Alliance Coverage 2007

9. 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

10. Income and Insurance Status

11. 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

12. Unity's Approach to HIV Medicine Co-management with a primary care provider (nurse practitioner, Family Medicine Physician, or Internal Medicine Physician)‏ Comprehensive care

13. Unity's Medical Staff Health Care Providers 170 HIV Specialists 4

14. 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

15. Unity's HIV Care Model: Co-management of HIV with Primary Care Primary Care Provider HIV Specialist Primary Care Provider HIV Specialist

16. HIV Therapy: AIDS Drug Assistance program Free to qualified applicants Administered at the State level Prescription medications including Antiretrovirals Prophylactic Medications Antidepressants Pain medication

17. 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

18. 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

19. Evaluation of our Success Audit by the DC Government HRSA tools Ryan White Data

20. 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

21. 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

22. Unity Health Care, Inc. “ The medicine is easy, its the other stuff that is difficult.”

23. Challenges at Unity To care for patients for whom HIV is one of many difficult problems

24. 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