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