AACO Annual Client Services Unit (CSU) Report
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At the April 16th, 2016 meeting of the Philadelphia Ryan White Planning Council, Evelyn Torres and Sebastian Branca of the AIDS Activities Coordinating Office (AACO) presented their annual Client Services Unit (CSU) report.
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AACO Annual Client Services Unit (CSU) Report
- 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
- 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%
- 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