Philadelphia Department of Public Health

AIDS Activities Coordinating Office Planning Council Meeting April14, 2016

Agenda Overview of MCM services CSU

◦Data◦HSP

QIMCM Measures

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

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

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 $8.6 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

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

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

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 providersLocal Case Management

Coordination Project

CSU Information 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◦ Other languages available through PDPH translation services

CSU Wait List33 people as of 4/12/16Followed 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

Intake Data

2015 Intake Demographics

68%

30%2%

Client GenderMale

Female

Transgender

14%14%

70%

1% 0%0% 1%

Client Race Hispanic/LatinoWhiteBlackAsianHawaiianNative Amer-icanOther

2015 Intake Demographics

28%

12%41%

2%3% 14%

Risk Factor/Mode of TransmissionMSMIDUHeteroBloodPerinatalNot Identified

5%12%

55%1%

25%0%2%

Insurance Type PrivateMedicareMedicaidVA or other MilitaryNo insuranceOtherUnknown

Calendar Year 2015: Client Needs at Intake (N=2015)

All Clients Male Female Afr. Amer.

MSMLatino 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%

Calendar Year 2015: Client Needs at Intake (N=2015)

All Clients Male Female Afr. Amer.

MSMLatino 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%

HIV Education/Risk Reduction

15.8% 15.8% 14.8% 17.2% 14.8%

Substance Abuse 7.8% 7.8% 7.3% 6.2% 8.0%

Calendar Year 2015: Client Needs at Intake (N=2015)

All Clients Male Female Afr. Amer.

MSMLatino 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%

HIV Education/Risk Reduction

15.8% 15.8% 14.8% 17.2% 14.8%

Substance Abuse 7.8% 7.8% 7.3% 6.2% 8.0%

Housing Services Program

(HSP)

HSP FundingThe 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

What is HSPCentralized 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

What HSP DoesProcess and evaluate individual

applications for housingMaintain the waiting list Provide training to southeastern

PA service providersProvide ongoing TA to providersAll services at no costDo not provide emergency

housing

HSP Scope8 housing sponsors653 housing slots

◦522 HOPWA◦131 S+C

89% tenant based11% project based

Wait List376 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

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

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

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

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 Measures23 measures for medical

(O/AMC) services7 MCM measures3 oral health measuresMeasures for all other services

collected through PDE◦VL Suppression◦Gap in Medical Visits

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

MCM Performance Measures

Performance Measure 2014 2015Linkage 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%

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

MCM Performance Feedback ReportsProgram A Performance Trend

Performance Measure December 2014 December 2015 ComparisonCSU01 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 8CSU02 Linkage to HIV Medical Care 1 1MCM01 Medication Assessment and Counseling 12 5MCM02 Prescription of Antiretroviral Therapy 6 8MCM03 HIV Medical Visit Frequency 15 19MCM04 Gap in HIV Medical Visits 20 13MCM05 Medical Case Management Care Plan 12 9

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 QIPsEMA has defined key measures and

set automatic thresholds for QIPsPrograms may still select other

measures for improvement in addition to any required QIPs

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

MCM programs have been particularly effective at incorporating consumers into QI

Questions or Comments