Ricardo Colon and Sebastian Branca of the Philadelphia AIDS Activities Coordinating Office presented on Client Services and Quality Management in Philadelphia at the March 2017 meeting of the Ryan White Planning Council.

1. Philadelphia Department of Public
Health
AIDS Activities Coordinating Office
Ryan White Planning Council Meeting
March 9, 2017

2. Client Services Unit
(CSU)

3. 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

4. Key Point of Entry
 Intake services to HIV positive
individuals requesting case
management services

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

6. 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

7. 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
months
HIV/AIDS Bureau Policy 16-02

8. 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

9. 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

10. CSU Responsibilities
 Information and referral services for all
other AACO funded programs
 Process individuals’ requests for
subsidized housing
 Feedback about funded providers
 Local Case Management Coordination
Project

11.  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 & French
◦ Other languages available through PDPH
translation services
CSU Information

12. CSU Wait List
 21people as of 3/7/17
 Followed by CSU Intake Workers
 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

13. Intake Data

14. 2016 Intake Demographics
65%
33%
2%
Client Gender
Male
Female
Transgender
14%
71%
1%
0%
0%
14%
Client Race
White
Black
Asian
Hawaiian
Native
American
Hispanic/Latino

15. 2016 Intake Demographics
27%
11%
40%
1%
4% 17%
Risk Factor/Mode of Transmission
MSM
IDU
Hetero
Blood
Perinatal
Not Identified
6%
11%
61%
0% 21%
0% 1%
Insurance Type Private
Medicare
Medicaid
VA or Other Military
No Insurance
Other
Unknown

16. Calendar Year 2016: Client Needs at Intake (N=1887)
All Clients Male Female
Afr. Amer.
MSM
Latino 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%

17. Calendar Year 2016: Client Needs at Intake (N=1887)
All Clients Male Female
Afr. Amer.
MSM
Latino
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%

18. Housing Services
Program
(HSP)

19. HSP Funding
 The 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

20. What is HSP
 Centralized 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

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

22. HSP Scope
 8 housing sponsors
 686 housing slots
◦ 494 HOPWA
◦ 192 S+C
 72% tenant based
 28% project based

23. Wait List
 400 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

24. 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

25. Quality Management and
MCM Services

26. 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

27. QM and the Continuum
 In 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

28. 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

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

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

31. 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

32. 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 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

33. Average Improvement QIP vs.
No QIP

34. Retention and VL
Suppression in Philadelphia
EMA
85.3% 85.4%
75.0%
70%
72%
74%
76%
78%
80%
82%
84%
86%
88%
2011 2012 2013 2014 2015
Retention in Care
VL Suppression
Retention in Care: Percent with two or more OAMC visits > 90 days apart for patients with one or more
visits in 2015
VL Suppression: Percent with last VL test in year < 200 copies/mL

35. Philadelphia EMA
 Philadelphia 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

36. 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
 AACO is currently developing a process to
enhance systems-level consumer participation

37. Questions or Comments