WELCOME! 1 PLANNING COUNCIL MEETING January 10, 2019 - - PowerPoint PPT Presentation

WELCOME!

PLANNING COUNCIL MEETING January 10, 2019

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INTRODUCTIONS

Please state your name for the record.

Please note: You do NOT have to disclose your status during the introduction if you do not want to.

*Moment of Silence*

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APPROVE MEETING MINUTES (H-1) December 6, 2018

Steps in approving minutes:

• 1. Review Minutes
• 2. Make a first and second motion to approve minutes
• 3. Vote

All in Favor: Yes, approve minutes Opposed: No, do not approve minutes Abstention: Absent from previous meeting/ Decline to vote

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GROUND RULES

Be on time No Side Conversations Silence cell phones Presenters represent agencies- no personal attacks Participate Don't ask questions that accuse or assume where someone is coming from. Stick to asking questions regarding information. Be respectful Respect the option for presenters to come back with additional information or answers. Agree to disagree Send questions with more detailed explanations to the Executive Committee or PCS Ask questions Whenever possible, enjoy yourself Speak up so everyone can hear you Don’t assume everything is public knowledge Raise your hand and wait to be acknowledged by the Chair Step up, step back Don't interrupt

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COMMITTEE REPORTS (H-2)

Each month, the Committee Chairs will provide a summary of their committee's activities.

You can also refer to a handout in your packet for written updates.

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Presenter: Marcos Palmarin, Senior Program Coordinator, BPHC

FY19 HIV Services RFP Update

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UPDATE ---

FY 2019 HIV Services RFP

Ryan White Services Division Boston Public Health Commission

Marcos Palmarin

Senior Program Coordinator, RWSD

FY 2019 RFP Update

• The HIV Services RFP was released in October 2018
• Services open for bid:

Core Medical Services

• AIDS Drug Assistance
• Medical Case Management (MAI)
• Medical Nutrition Therapy
• Oral Health

Support Services

• Emergency Financial Assistance
• Housing
• Food Bank/Home Delivered Meal
• Non-Medical Case Management (MAI)
• Psychosocial Support (MAI)
• Substance Abuse Residential
• Health Education and Risk Reduction
• Medical Transportation

FY 2019 RFP Update

• 12 service categories up for bid
• 33 proposals were submitted and 110 different services

proposed

• One new agency submitted a proposal for funding
• Total amount requested: $ 15,191,271.00
• Total available: $ 12,393,727.00 (Level Funding Scenario)

FY 2019 RFP Update

• An external community review was held in

December

• Internal BPHC reviews are currently being

conducted

• Award letters will be sent to bidders by

1/31/2019

• A follow-up presentation of the RFP results is

scheduled for 2/7/19

FY 2019 RFP Update

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Rank # Service Category Planning Council Allocation Actual Requested Difference % Over/Under (Pre) 1 Medical Case Management $ 4,125,133.00 $ 5,089,774.00 $ (964,641.00) 23% Medical Case Management (MAI) $ 520,015.00 $ 274,887.00 $ 245,128.00

• 47%

2 AIDS Drug Assistance $ 150,215.00 $ 300,215.00 $ (150,000.00) 100% 3 Non-Medical Case Management $ 1,063,059.00 $ 1,972,052.00 $ (908,993.00) 86% Non-Medical Cade Management (MAI) $ 134,197.00 $ 35,824.00 $ 98,373.00

• 73%

4 Housing $ 970,620.00 $ 1,506,311.00 $ (535,691.00) 55% 6 Medical Transportation $ 242,655.00 $ 277,062.00 $ (34,407.00) 14% 7 Oral Health Care $ 1,386,599.00 $ 1,386,599.00 $ - 0% 9 Psychosocial Support $ 1,050,350.00 $ 1,192,946.00 $ (142,596.00) 14% Psychosocial Support (MAI) $ 184,521.00 $ 33,840.00 $ 150,681.00

• 82%

10 Food Bank/ Home Delivered Meals $ 762,630.00 $ 964,972.00 $ (202,342.00) 27% 12 Substance Abuse Residential $ 231,100.00 $ 231,103.00 $ (3.00) 0% 14 Emergency Financial Assistance $ 100,000.00 $ 173,119.00 $ (73,119.00) 73% 15 Medical Nutrition Therapy $ 1,194,159.00 $ 1,239,146.00 $ (44,987.00) 4% 16 Health Education/Risk Reduction $ 278,474.00 $ 513,421.00 $ (234,947.00) 84% Total $ 12,393,727.00 $ 15,191,271.00 $ (2,797,544.00) 23%

FY 19 RFP Update

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$- $1,000,000.00 $2,000,000.00 $3,000,000.00 $4,000,000.00 $5,000,000.00 Medical Case Management Medical Case Management (MAI) AIDS Drug Assistance Program Treatments Non-Medical Case Management Non-Medical Cade Management (MAI) Housing Medical Transportation Oral Health Care Psychosocial Support Psychosocial Support (MAI) Food Bank/ Home Delivered Meals Substance Abuse Residential Emergency Financial Assistance Medical Nutrition Therapy Health Education/Risk Reduction

Request vs. Level Funding Allocation

Actual Requested Planning Council Allocation

ADAP

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Agency FY 19 Request

CRI $ 150,215.00 NHDHHS $ 150,000.00

FY 19 PC Allocation FY 19 RFP Request Variation

$ 150,215.00 $ 300,215.00 $ (150,000.00)

Medical Case Management

Agency FY 19 Request

AIDS Response Seacoast (NH) $ 130,073.00 Beth Israel Deaconess - Plymouth $ 71,767.00 Boston Medical Center $ 242,283.00 Boston Health Care for the Homeless $ 382,760.00 Cambridge Health Alliance $ 425,463.00 Codman Square Health Center $ 475,596.00 Dimock Community Health Center $ 439,450.00 East Boston Neighborhood Health Center $ 172,226.00 Edward M. Kennedy CHC $ 137,311.00 Fenway Health $ 222,376.00 Greater Lawrence Family Health Center $ 743,296.00 Harbor Health Services $ 327,249.00 Lynn CHC $ 359,552.00 MGH - Boston $ 307,618.00 MGH - Chelsea $ 75,186.00 Merrimack Valley Assistance Program (NH) $ 155,690.00 Southern NH Task Force $ 214,346.00 Upham's Corner $ 135,732.00 Whittier Street Health Center $ 162,637.00

FY 19 PC Allocation FY 19 RFP Request Variation

$ 4,125,133.00 $ 5,089,774.00 $ (964,641.00)

Non-MCM (MAI)

Agency FY 19 Request

Dimock Community Health Center $ 90,837.00

Upham's Corner Health Center $ 16,042.00 Whittier Street Health Center $ 14,330.00 Boston Children’s Hospital $ 35,345.00

FY 19 PC Allocation FY 19 RFP Request Variation

$ 134,197.00 $ 35,824.00 $ 98,373.00

Medical Nutrition Therapy

Agency FY 19 Request Boston Children’s Hospital $ 35,345.00 Community Servings $ 1,194,159.00 MGH - Boston $ 9,642.00

FY 19 PC Allocation FY 19 RFP Request Variation

$ 1,194,159.00 $ 1,239,146.00 $ (44,987.00)

Oral Health

Agency FY 19 Request Ryan White Dental Program $ 1,386,599.00

FY 19 PC Allocation FY 19 RFP Request Variation

$ 1,386,599.00 $ 1,386,599.00 $ -

Emergency Financial Assistance

Agency FY 19 Request

AIDS Project Worcester $ 5,500.00 Boston Medical Center $ 4,125.00 Catholic Chartities of Boston $ 44,000.00 Codman Square Health Center $ 5,505.00 Fenway Health $ 29,128.00

Greater Lawrence Family Health Center $ 29,935.00

Multicultural AIDS Coalition $ 6,000.00 Massachusetts Alliance of Portuguese Speakers $ 13,951.00 MGH Chelsea $ 2,475.00 Montachusett Opportunity Council $ 22,000.00 Upham's Corner Health Center $ 5,000.00 Whittier Street Health Center $ 5,500.00

FY 19 PC Allocation FY 19 RFP Request Variation

$ 100,000.00 $ 173,119.00 $ (73,119.00)

Food Bank/Home Delivered Meals

Agency FY 19 Request

AIDS Project Worcester $ 127,455.00 Catholic Charities of Boston $ 30,030.00 Montachusett Opportunity Council $ 96,537.00 Victory Programs $ 710,950.00

FY 19 PC Allocation FY 19 RFP Request Variation

$ 762,630.00 $ 964,972.00 $ (202,342.00)

Health Education and Risk Reduction

Agency FY 19 Request AIDS Project Worcester $ 47,128.00 Boston Children’s Hospital $ 58,689.00 Casa Esperanza $ 67,009.00 Fenway Health $ 17,774.00 Multicultural AIDS Coalition $ 39,616.00 Massachusetts Alliance of Portuguese Speakers $ 21,761.00 MGH Chelsea $ 25,279.00 Montachusett Opportunity Council $ 70,951.00 Victory Programs $ 186,975.00

FY 19 PC Allocation FY 19 RFP Request Variation

$ 278,474.00 $ 513,421.00 $ (234,947.00)

Housing

Agency FY 19 Request

AIDS Project Worcester $ 74,628.00 Codman Square Health Center $ 48,488.00 Father Bill’s and Mainspring $ 253,691.00 Fenway Health $ 384,939.00 Harbor Health Services $ 190,062.00 Justice Resource Institute $ 270,373.00 Victory Programs $ 284,129.00

FY 19 PC Allocation FY 19 RFP Request Variation

$ 970,620.00 $ 1,506,311.00 $ (535,691.00)

Medical Transportation

Agency FY 19 Request

AIDS Project Worcester $ 72,508.00 Beth Israel Deaconess - Plymouth $ 4,125.00 Boston Medical Center $ 3,080.00 Boston Health Care for the Homeless $ 6,996.00 Casa Esperanza $ 14,377.00 Codman Square Health Center $ 3,303.00 Dimock Community Health Center $ 5,500.00 Edward M. Kennedy CHC $ 3,950.00 Fenway Health $ 5,777.00 Greater Lawrence Family Health Center $ 35,420.00 Justice Resource Institute $ 5,500.00 Lynn CHC $ 30,800.00 Multicultural AIDS Coalition $ 3,000.00 MGH - Boston $ 4,323.00 MGH - Chelsea $ 2,750.00 Montachusetts Opportunity Council $ 20,570.00 Victory Programs $ 46,834.00 Whittier Street Health Center $ 11,000.00

FY 19 PC Allocation FY 19 RFP Request Variation

$ 242,655.00 $ 277,062.00 $ (34,407.00)

Non-Medical Case Management

Agency FY 19 Request

AIDS Project Worcester $ 120,765.00 Beth Israel Deaconess - Plymouth $ 60,537.00 Casa Esperanza $ 196,884.00 Catholic Charities of Boston $ 144,052.00 Codman Square Health Center $ 50,594.00 Fenway Health $ 355,649.00 Multicultural AIDS Coalition $ 98,911.00 MAPS $ 157,794.00 MGH - Boston $ 60,258.00 MGH - Chelsea $ 133,662.00 Montachusetts Opportunity Council $ 339,620.00 Upham's Corner Health Center $ 64,168.00 Victory Programs $ 201,875.00 Whittier Street Health Center $ 71,233.00

FY 19 PC Allocation FY 19 RFP Request Variation

$ 1,063,059.00 $ 1,972,052.00 $ (908,993.00)

Psychosocial Support

Agency FY 19 Request

AIDS Project Worcester $ 205,505.00 Boston Children’s Hospital $ 45,857.00 Catholic Charities of Boston $ 50,480.00 Codman Square Health Center $ 49,259.00 Dimock Community health Center $ 103,980.00 East Boston CHC $ 29,653.00 Edward M. Kennedy CHC $ 12,339.00 Fenway Health $ 71,651.00 Justice Resource Institute $ 300,489.00 Lynn CHC $ 12,339.00 Multicultural AIDS Coalition $ 169,199.00 MGH - Boston $ 9,541.00 Montachusetts Opportunity Council $ 85,875.00 Southern NH Task Force $ 82,253.00 Victory Programs $ 136,246.00 Whittier Street Health Center $ 92,958.00

FY 19 PC Allocation FY 19 RFP Request Variation

$ 1,050,350.00 $ 1,192,946.00 $ (142,596.00)

Substance Abuse Residential

Agency FY 19 Request Victory Programs $ 231,103.00

FY 19 PC Allocation FY 19 RFP Request Variation

$ 231,100.00 $ 231,103.00 $ (3.00)

Presenter: Katherine D’Onfro, Senior Program Coordiantor, BPHC

Quality Management Update/Overview

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Clinical Quality Management Program Update Boston EMA Planning Council

January 10th, 2018 KC D’Onfro, MPH CQM Coordinator

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Presentation Road Map



Terms and Definitions



QA/QI/ CQM



PNC 15-02



Building CQM Infrastructure



CQM Plan



CQM Committee



Collaboration with BPHC AQI



Collaborating with Stakeholders



Involving Consumers in QI



Building CQM Performance Measures



Quarterly Data Displays



Client Satisfaction Surveys



Building a CQM Quality Improvement Program



Annual QI Culture Assessment



QI Training



QI Projects



Vision for the Upcoming Fiscal Year

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Definitions

Quality Assurance

• A broad spectrum of activities aimed at ensuring

compliance with minimum quality standards Quality Improvement

• A deliberate process to continuously improve efficiency,

effectiveness, equity, and satisfaction in the current system Clinical Quality Management Program

• The coordination of activities aimed at improving patient

care, health outcomes, and patient satisfaction among PLWH/A

Clinical Quality Management

(From PCN-15-02)

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Components of a CQM Program

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Quality Improvement

Infrastructure Performance Measurement

Infrastructure: CQM Plan

What’s in the EMA CQM Plan?

Quality Improvement Goals

To Create a Culture of Continuous Quality Improvement within the RWSD and among subrecipients of the Ryan White Part A Boston EMA To increase viral suppression among PLWH/A in the Boston EMA from 87% to 90% by 2020.

To Create a Culture of Improvement

Engage

Subrecipients on a quality improvement project

Develop Develop a robust portfolio of

performance measures

Support A CQM Committee

Increase the percentage of patients regularly measuring client satisfaction from 50-100% by 2020

Increase

Increase the percentage of clients who are retained in HIV-related medical care from 62-65% by 2020

Increase

Increase the percentage of clients who report ‘Excellent Adherence’ to their HIV- related medication from 77-80% by 2020

Increase

To Increase Viral Suppression to 90% by 2020

Infrastructure: BPHC CQM Committee

 12 Members  Representatives from NHDHHS and MDPH  Includes Providers, Consumers, and Stakeholders  Meets 6Xs Per Year  Provided input and feedback on:

 CQM Charter  CQM Plan  Performance Measures and Data Displays  QI Culture Assessment  THIS PRESENTATION ☺

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Partnership with the BPHC Accreditation and Quality Improvement Team

Infrastructure: Collaborating with Stakeholders

 Close Relationship with MDPH and NHDHHS  Massachusetts State Wide Quality Network  Echo N+ Disparities Collaborative  Coordinating Performance Measures and Quality Projects

Infrastructure: Consumer Involvement

CQM Committee Consumer

Satisfaction Surveys

CQII 2-Day Training:

Training of Consumers on Quality

Performance Measurement HRSA Requirements for Performance Measures

 Service Category Specific  Tracked Quarterly (on e2Boston)  Improvable  Related to Patient Care, Health

Outcomes, or Satisfaction

 Ideally a HAB Measure

Service Category Performance Measure Medical Case Management Gap in Medical Visit Frequency Non-Medical Case Management Care Adherence Oral Health Retention in Dental Care Foodbank/ Home Delivered Meals Client Satisfaction Psychosocial Support Access to Support Network Medical Transportation Gap in Medical Visit Frequency Residential Substance Abuse HIV Medication Adherence Housing Client Satisfaction Medical Nutrition Therapy Client Satisfaction

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FY18 Performance Measures

Undetectable viral load was gathered through e2Boston ‘Outcomes Summary Report’ and is defined as number of clients with a viral load <75 copies (numerator) over number of clients with a recorded viral load outcome (denominator). ‘Access to Support Network’ was gathered through e2Boston ‘Outcomes Summary Report’ and is defined as the number of clients with access to support network as either ‘Good/ Fair’ or ‘Excellent’ (numerator) over all clients with a recorded access to support network outcome (denominator).

PLEASE CONTACT BPHC’S CQM TEAM WITH QUESTIONS:

KC D’Onfro: kdonfro@bphc.org 617-5432604

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FY18 QUALITY IMPROVEMENT

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NACCHO’s Roadmap to a Culture of Quality Improvement

Phase 1 Phase 2 Phase 3 Phase 4 Phase 5 Phase 6

No Knowledge

• f QI

Not Involved with QI Activities Informal

• r Ad Hoc

QI Activities Formal QI Activities Implemented in Specific Areas Formal Agency- Wide QI QI Culture

Leadership and staff do not understand QI Leaders understand and staff are beginning to understand QI Staff may view QI as an added responsibility Multiple QI champions are well known among staff as QI experts and mentors Several QI champions exist throughout the agency QI knowledge and skills are strong across majority of staff Agency performance is not monitored; decisions are not data- driven Simple, informal elements of QI exist (evaluation activities, some data collection) Discrete QI projects may

• ccur but not

fully aligned with steps in a QI model Use of formal QI is well used in certain areas of the agency Progress and

• utcomes

related to QI and strategic goals are reported widely and routinely Every staff member is held accountable with QI competencies in evaluations

7 8 16 14 18 18 10 12 12 7 14 17 12 12 16 19 12 14 8 7 15 14 10 15 16 17 2 4 6 8 10 12 14 16 18 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28

OVERALL SCORE Agency ID

BOSTON EMA 2018 OVERALL CULTURE ASSESSMENT SCORE

Overall Culture Score Overall median

Quality Improvement Pilot Two Day Training

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FY19 Vision

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Goal: Improve Viral Suppression

What are we trying to accomplish? Increase Viral Suppression Rates from 85% to 90% in 3 months (December 2017) How will we know a change is an improvement 1. Increase in Viral Suppression Rates 2. Reduction in the percentage of patients with no lab work What change can we make that will result in improvement? PLAN: 1. Present Drill Down Data in HIV PCC meeting and carefully evaluate those patients who are not virally suppressed. 2. Develop an Individual plan for each patient who is not virally suppressed or who is missing lab data and implement this plan. 3. Add any patients who are not virally suppressed to the Highest Risk Registry. DO: Between September and December 2017: Providers, Case Manager, ID Clinical Care Specialist, and Nurse tested the above ideas with different patients STUDY: After 3 months, the team observed the following changes 1. Viral suppression rates increase from 85% to 92% 2. Patients without lab work reduce from 4% to 1% ACT: The changes were adopted because the team liked results.

An Example: Harbor Health Services

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Presenter: Ori Odugbesan, Senior Program Coordinator, BPHC

Progress Report Update (H-3)

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FY18 Demographic ics, Util iliz ization, and Healt lth outcome Progress Report RWSD

Or Ori i Odu Odugbesan, , MD D MPH Sen Senio ior Prog rogram Coo Coordinator, RWSD

Outline

• Overview
• Medical case Management
• Utilization
• Demographics
• Outcome
• Spending
• Housing
• Oral health

Overview

• 32 agencies
• 9 services

categories

• 5,150 clients so

far!

Medical Case Management Psychosocial Support Medical Nutrition Therapy

Medical Transportation

Substance Abuse Housing Food Bank/Home- Delivered Meals AIDS Drug Assistance Program

Oral Health Care

Ryan White Part A: : Demographic Breakdown

3457 (67.1%) 1636 (31.8%) 57 (1.1%)

Gender

Male Female Transgender 28, (.5%) 31 (.6%) 1527 (29.7%) 3564 (69.2%) <13 13-19 20-44 45+

Age

31% 33% 32% 1% 0% 3%

Race/ Ethnicity

White, Non-Hispanic Hispanic Black, Non-Hispanic Asain Native Hawaiian/ Native American Other/ Unknown

Medical Case Management

• 22 Funded Agencies
• Provides client-centered services that

link clients with primary medical care and all health-related support services

• MAI Medical Case Management

Medical Case Management

FY 2015 FY 2016 FY 2017 FY 2018 Units of service 30,831 51,640 76,428 62,578

Units of service MCM

2,940 2,870 2,995 2,995 FY 2015 FY 2016 FY 2017 FY 2018

Number of clients MCM

Total allocation Total spent YTD MCM $3,632,614 $2,221,828 MAI $688,779 $460,279

FY18 Demographics- MCM

Age Gender

Male 66% Female 33% Transgender 1% 22-44 years 36% >45 years 62% <13 years 2%

FY18 Race & Ethnicity- MCM

26.50% 37.70% 31.30% 2.10% 0.30% 2.10% White, Non- Hispanic Hispanic Black, Non-Hispanic Asain Native Hawaiian/ Native American Unknown

Outcome Measure - MCM

81.3% 86.3% 86.7% 86.10% FY15 FY16 FY17 FY18

Undetectable Viral Suppression Rates MCM

Main Highlights - MCM

• Demographics is similar to the last four years
• Number of clients and unit of service are within the same range as

FY17

• Viral suppression rate is about the same with last year but we hope

there could be an increase before the end of FY18

Housing

• 3 Agencies Funded
• Short term , emergency or transitional

housing assistance

• Housing search support
• Advocacy support
• Goal is to improve access, medical adherence

and health outcome

Housing

499 510 135 150 FY 2015 FY 2016 FY 2017 FY2018

Number of clients Housing

FY 2015 FY 2016 FY 2017 FY2018 Units of service 3513.5 3655 4018.25 2746.5

Units of service

Total Allocated Total Spent YTD Housing $646,449 $356,309

FY18 Demographics- Housing

Age Gender

Male 61% Female 38% Transgender 1% 22-44 years 21% >45 years 76% <13 years 3%

FY18 Race & Ethnicity - Housing

31.20% 22.10% 42.90% 1.30% 0.00% 2.60% White, Non-Hispanic Hispanic Black, Non-Hispanic Asain Native Hawaiian/ Native American Unknown

Outcome measure - Housing

84.9% 89.6% 92.2% 92.44% 2015 2016 2017 2018

Viral Suppression Rates

Main Highlights - Housing

• Increase number of client
• In the past Rental and utility assistance had been combined with

search and advocacy but that has changed and that could explain the reduction in units of service

• Viral suppression rates have progressively increased in the last 4 years

Oral health Care

• Recruitment of dentists
• Preventive services
• Diagnostic services
• Therapeutic services

Oral Health Care

1496 1476 1781 1986 FY 2015 FY 2016 FY 2017 FY2018

Number of clients

FY 2015 FY 2016 FY 2017 FY2018 Units of service 6558 6587 6776 6102

Units of service

Total Allocation Total spent YTD Oral Health care $1,518,327 $1,158,155

FY18 Race & Ethnicity - Oral Health

33.50% 34.70% 28.10% 1.20% 0.10% 2.20% White, Non-Hispanic Hispanic Black, Non-Hispanic Asain Native Hawaiian/ Native American Other/ Unknown

Outcome measure - Oral Health Care

91.62% 91.48% 89.95% 90.52% 2015 2016 2017 2018

Viral Suppression Rates

Main Highlights - Oral Health

• Number of clients has increased
• Unit of service is reduced but this could change before the end of

the fiscal year

• Undetectable viral suppression rates increased from last FY

Conclusion

• Demographics have been stable over the last 4 years, with more

clients being males and older adults over the age of 45

• No of clients per service categories varied but similar to previous years
• Outcome varied; Oral health and housing achieved a viral suppression

rate of over 90% while MCM had 86%

• MCM has not achieve the target viral suppression rate but there is a

steady increase

PCS, Richard Swanson, and Michael Swaney

Ryan White Conference Update

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AGENCY REPRESENTATIVE REPORTS (H-4)

Each month, each representative will offer policy, legislative, and programmatic updates from their government agency. The agency reps are:

 MA Office of Medicaid – Alison Kirchgasser  NH Department of Health and Human Services, NH Care Program – Sarah

McPhee

 MA Department of Public Health, Office of HIV/AIDS - Barry Callis  Mayor's Office of Health and Human Services - André Lima  Boston Public Health Commission – Marcos Palmarin

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OTHER ANNOUNCEMENTS

This is your chance to spread the word about community events, research studies, or other resources that are related to the Planning Council's work.

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EVALUATION AND ADJOURN (H-5)

Please fill out your evaluation forms! Please respond to quick smart phone survey! Don’t forget to clean up & recycle!

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