Philadelphia Department of Public Health

AIDS Activities Coordinating Office Planning Council Meeting May 9, 2013

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 case management services

Information and referral services for all other AACO funded programs

Process individuals’ requests for subsidized housing

Feedback about funded providersLocal Case Management

Coordination Project

CSU Information Health Information Helpline is open 8 a.m. to 6

p.m. Monday through Friday 1-800/215-985-2437

Staffing: ◦ 1 Manager ◦ 1SW Supervisor◦ 1Housing Supervisor◦ 4 City Social Workers ◦ 2 Housing Staff ◦ 1 Data Specialist◦ 1 Training Coordinator

Staff speak Spanish◦ Other languages available through PDPH

CSU Waiting List186 people as of 5/7/13Followed 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 three months

Intake Data

MCM Intakes

Calendar year Intakes

2007 1873

2008 2092

2009 2356

2010 2310

2011 2087

2012 2038

2012 Intake Demographics

11.5%

18.4%

69.4%

0.6%0.1%

0.5%

3.1% 0.2%

Client Race

Hisp/LatinoWhiteBlackAsianHawaiianNative AmerOtherUnknown

66.5%

32.2%

1.3%

Client Gender

malefemaletrans. M->F

2012 Intake Demographics

30.0%

13.3%46.6%

1.1%

3.3%

1.6%

13.7%

Risk factor/Mode of trans-mission

MSMIDUHeteroBloodPerinatalOtherUnknown

6.3%15.8%

40.2%7.2%

27.0%

2.3% 0.7%

Insurance type

PrivateMedicareMedicaidOther publicNo insuranceOtherUnknown

Calendar Year 2012: Client needs at intake (N=2038)

All Clients

Latino MSM

Afr. Amer. MSM

Youth 13-24

Newly Diagnosed

(w/in 1 year of intake)

Number of intakes 2038 182 280 150 239

Percent of total intakes 100.0% 8.9% 13.7% 7.4% 11.7%

Service Category          

Benefit Assistance 59.0% 71.4% 50.0% 54.7% 55.6%

Housing Assistance 51.7% 41.2% 56.1% 41.3% 34.3%

Transportation Assistance

31.2% 20.3% 32.5% 24.7% 34.3%

Mental Health Treatment 29.1% 22.5% 30.0% 28.0% 32.2%

Medical Insurance 27.6% 37.9% 26.1% 40.7% 38.1%

Medical Care 23.1% 37.9% 14.6% 48.7% 40.6%

Calendar Year 2012: Client needs at intake (N=2038)

All Clients

Latino MSM

Afr. Amer. MSM

Youth 13-24

Newly Diagnosed(w/in 1 year of intake)

Number of intakes 2038 182 280 150 239

Percent of total intakes

100.0% 8.9% 13.7% 7.4% 11.7%

Service Category          

Medications 20.3% 37.9% 12.5% 30.0% 28.9%

Rental Assistance 17.6% 29.7% 11.8% 11.3% 9.6%

Food Bank/Home Delivered Meals

17.2% 8.8% 21.4% 8.7% 13.0%

Support Groups 14.4% 13.2% 13.9% 17.3% 16.3%

Dental Care 11.0% 17.0% 11.4% 28.0% 23.4%

HIV Education/Risk Reduction

10.4% 22.0% 7.5% 33.3% 41.0%

Substance Abuse 8.5% 6.0% 5.7% 2.0% 6.3%

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 and State funding for

housing continues to decline

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

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 Scope

8 housing sponsors663 housing slots out of 1015

slots ◦522 HOPWA◦131 S+C

89% tenant based11% project based

Waiting List

290 applicants on the waiting list as of 5/7/13 ◦Priority 1- 9 months wait time (includes homeless individuals)

◦Priority 2- 4 year wait time◦Priority 3- 5 year wait time

Quality Management in the EMA

What is Quality ManagementThe 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

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

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 EMAPerformance MeasuresSystem Measures

◦Appointment Availability Disparities in Care

Medical Measures

27 measures for medical (O/AMC) services

9 MCM measures5 oral health measuresMeasures for all other

servicesMental Health Substance Abuse

O/AMC Performance in the EMA

Medical Case Management (MCM) Measures Retention in MCM services Linkage to HIV medical care Mental Health History and Treatment

Status Substance Abuse History and

Treatment Secondary Risk Assessment Medication Assessment and

Counseling Care Plan Medical Visits Unmet need

Performance measures

2008 2009 2010 2011 2012 (1/1-9/30)

Retention in MCM (< or = 10 weeks after intake) 76% 81% 80% 78% 82%

Retention in HIV medical care for clients getting MCM

87% 92% 95% 97% 96%

MCM Performance Measures

EMA’s Baseline Performance for MCM

Oral Health Care Performance Measures

CY 2011

Dental and medical history 95%

Dental treatment plan 91% Oral health education 66%

Monitoring and FeedbackStrong emphasis on feedbackQuickly highlights trends, strengths

and needsData visualization is critical in getting

attention of program leadershipBenchmarking contextualizes data

and can capitalize on competitiveness of providers

Assists in prioritizing QIPs

Performance Feedback Reports

Performance Feedback Reports

Quality Improvement Projects• Expanded to all core services in 2012• Grantee provides feedback to

providers on all plans and requires revisions as needed

• In 2012, 168 QIPs were collected and reviewed

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

Criteria For Evaluating Quality Improvement Projects

Focus on systems and processesAre data-drivenUtilize a sound QI process (e.g. FOCUS

PDSA)Investment by program leadershipIncorporation of consumers in the QI

processProduces desired improvements

◦ ISU analysis demonstrates that QIPs work

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

Questions or Comments