FY20 Department For HIV Elimination (Ryan White Part A

FY20 Department For HIV

Elimination (Ryan White Part A)

Annual Providers Meeting

Welcome!

Housekeeping• If you can’t hear the speakers, make sure your computer audio is turned on.

• If you are joining by phone, email questions to: Stephanie.Pepper@fultoncountyga.gov

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• Hold questions (as much as possible) until appropriate time.

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Department For HIV Elimination

*Meet the Staff*

Jeff CheekDirector

Bridget HarrisDeputy Director

Andrea S. DavisOffice Manager

Stephanie PepperProject Officer

Uliecia BoltonProject Officer

Jocelyn McKenziePROGRAM MANAGER

R YA N W H I T E PA R T A Q U A L I T Y M A N A G E M E N T P R O G R A M

8FY19 QI BOOTCAMP: QUALITY MANAGEMENT AND YOU!

Pamela PhillipsQUALITY MANAGEMENT SPECIALIST

R YA N W H I T E PA R T A Q U A L I T Y M A N A G E M E N T P R O G R A M

9FY19 QI BOOTCAMP: QUALITY MANAGEMENT AND YOU!

Tiffany LawrenceQUALITY MANAGEMENT SPECIALIST

R YA N W H I T E PA R T A Q U A L I T Y M A N A G E M E N T P R O G R A M

10FY19 QI BOOTCAMP: QUALITY MANAGEMENT AND YOU!

Warren HendricksDATA MANAGERR YA N W H I T E PA R T A Q UA L I T Y M A N AG E M E N T P R O G R A M

11FY19 QI BOOTCAMP: QUALITY MANAGEMENT AND YOU!

MariAnna O’ReeQUALITY MANAGEMENT SPECIALIST

R YA N W H I T E PA R T A Q U A L I T Y M A N A G E M E N T P R O G R A M

12

Ray JacksonDepartmental Accountant

Troy ScottFiscal Program Manager

Ying HeEpidemiologist

Planning Council

Sandra VincentProject OfficerPlanning Council

Atlanta Eligible Metropolitan Area (EMA)

*Meet the Providers*

AHF Ryan White Part A Grant Team

Katherine Barbera, Practice Manager AHF Piedmont Courtney Brooks, Senior Contracts Manager

Justin Chow, Contracts Accountant ManagerSandra Najuna, Senior Project Manager – Quality Contracts

Jenetter Richburg Director of Client

Services (Program Designee)

Latonya MorrissetteDirector of Quality

and Compliance(Data Designee)

Michelle Lynch Senior Accountant

(Fiscal Designee)

Meet the Wonder Women of AID Atlanta!!

• Pius Akande– Data Designee• Nahomie Julien– Programmatic Designee

atlantalegalaid.org

Atlanta Legal Aid/AIDS Legal Project

Elaine Landry Stefanie Ramirez Sparks Toni Bonds

Fiscal Programmatic Data

Ph: 404-614-3969

Programmatic Designee(retiring Dec. 2020)

Programmatic Designee Fiscal Designee Data Designee

Deborah Swinford Don Eisman Emily Eisenman Ada Figueroa-Monell

ATHENS

Hawa Kone –Programmatic designee Deborah Powell –Fiscal designee KortneeGriffin –Data designee

DeKalb County Board of Health- RW Early Care Clinic

Ashley S. Bennett-Programmatic Designee

Phuong Le-Fiscal Designee

Filson KelemewarkData Designee

Emory University Ryan White Designees

Alan Bailey - Programmatic Designee

Bill Lambert - Fiscal Designee

Nordia Edwards – Data Designee

Stacey Coachman, MPARyan White

Health Program AdministratorProgrammatic Designee

Programmatic, Lisa Roland

Data, LaShonda Johnson • Fiscal, David Noble

Grady –Infectious Disease

Program (IDP) Designees

Patricia E. ParsonsProgram Designee

MERCY CARE

Marilyn BrownFiscal Designee

Malika StokesData Designee

ALEX ZOHORE

FISCAL DESIGNEE

BRODDERICK ROARY

PROGRAMMATIC/DATA

DESIGNEE

Open Hand Atlanta

Aleta McLeanRDR Designee

Bob CuellarFiscal Designee

Jennifer GilbertProgrammatic Designee

Positive Impact Health CentersRW Part A Designees

Porter Draughon Steven Bales

Finance Designee Data Designee

Sheila Trapp

Programmatic Designee

SOUTHSIDE MEDICAL CENTER

FISCAL DESIGNEE

CLAUDIO AZZARITI

PROGRAMMATIC AND INTERIM

DATA DESIGNEE

ANDREA STEWARD

Someone Cares, Inc. of Atlanta’s RW

Designees

MARK T. SANDERSData Designee

LeMarkoSanders@s1catl.org

(404) 635-8200

W. ADOLPHUS LIBURD

Fiscal Designee

WinstonLiburd@s1catl.org

(678) 921-2706

PHYLLIS JONES-CHURN, LMSWProgrammatic

Designee

PhyllisJonesChurn@s1cat.org

(678) 921 - 2706

Department UpdatesJeff Cheek & Bridget Harris

Overview

HRSA Updates

DHE Awards

• Part A

• Part A COVID Response (CARES)

• Building Capacity

• Ending the Epidemic

New Initiatives

Q & A

DHE Awards

Part A HRSA Updates

Part A RFP for Subrecipients

HRSA Site Visit

HRSA Part A 3-yr Cycle

Part A COVID Response Award

9 Subrecipients

Interventions

• Telehealth

• Centralized Eligibility Portal

• Client level database

• PPE

Building Capacity Award

Partnership with Thrive SS

2 year Cooperative Agreement (FY19 & FY20)

Overview Later Today

Ending the Epidemic (EHE) Award Four subrecipients

• Extended Hours

• Telehealth

• Transgender HRT

RFP

• Extended Hours and Tablets

• Housing

Ending the Epidemic (EHE) Award

EHE Recruitment

• Health Program Manager

• Community Engagement Specialist

• Fiscal Support Specialist

DHE New Initiatives

KFF Greater than AIDS Campaign – Video

Greater Than Aids Campaign

The UCSF Learning Collaborative – 10/28 & 10/29

Patient Tablet Access Platform –www.continuud.com

DHE New Initiatives: Systems Improvements

Client-Level Database• Client Level Data Management and Analysis• Data Quality Monitoring and Improvement• System-wide Automated Eligibility & Document

Management

e2 Hotspot Tracker

eCOMPAS

DHE New Initiatives: Systems Improvements

Contract Management

• Manage Multi-contract Systems

• Unit Cost Service utilization and fiscal reports

• See what’s over under budget, in real time

Quality & Outcomes Management

• Perform dynamic charting of indicators

• Identify trends in real-time

• Generate graphical demographics reports with real-time data

• Better understand populations and sub-populations

eCOMPAS

DHE New Initiatives: Systems Improvements

Federal Reporting

• Visual and Interactive RSR

• Automated Data Validation Engine Built-in QM features help ensure data quality and completeness

Client Satisfaction Module

• Collect client satisfaction surveys online (multi-lingual audio component)

• Deliver real-time feedback in graphical format

• Drilldown for gap analysis

• Multi-level security and encryption to protect sensitive client data

eCOMPAS

DHE New Initiatives: Systems Improvements

Enrollment • Submit Documentation

Medication Reminders and Appointment Reminders

Affirming messages and virtual prizes for successful adherence

Self-reported data will be entered into eCOMPAS and used to track adherence

Links to Resources

Collect client satisfaction surveys online

e2My Health

DHE New Initiatives: RDE Red

Real-time Polling

Rent Calculator• Automated

calculation of tenant rent and subsidies for HOPWA and RW Housing programs

Grant Writing• Secure funding for

Technology Improvement and Capacity Development

• Part C Capacity Building Grant

o E.g., HL7 Interface

RDE AT-A-GLANCE

Re-name e2Fulton

• Must start with “e2”

• Reflect the 20-county Atlanta EMA region

• Can not be associated with any existing companies, organizations, or affiliates

• Consider room for growth as we hopeto partner with other HIV-related programs in the years to comeData System Survey

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Quality Management Updates

Overview

• Mandates and Requirements

• Program Scope and Expectations

• Program Updates

• CY2018 Chart Review Results

Requirements

Legislative Requirements

Title XXVI of the Public Health Service Act RWHAP Parts A – D1

HRSA HAB Requirements

Policy Clarification Notice, 15-02-Clinical Quality Management

Contractual Requirements

The Ryan White HIV/AIDS Treatment Extension Act Part A Grant Atlanta EMA Agreement Paragraph 4.5

How we deliver our services

How well we deliver our services

How we improve our

services

Quality Management

Program

Standards of Care

Performance

Measures

QI Projects

Expectations for Agencies• Leadership supports quality management efforts

• Dedicated staff to monitor performance and implement improvement projects

• Assess and train staff regular for quality service delivery

• Solicit feedback and input from clients and make changes to program delivery to improve satisfaction

• Attend PC QM Committee Meeting

• Conduct 1-2 QI projects a year

• Write and monitor QM Plan and Work Plan

• Document projects and share best practices with the community

Quality Management Designee

• Acts as liaison between QM Committee, Recipient, and Subrecipient

• Attends and participates in all Planning Council QM Committee Meetings

• Participates, leads, or coordinates quality activities at subrecipient level

• Ensures subrecipient adheres to standards of care

QM Program Team

QM Program Manager

QM Specialists (3)

Data Manager

• Update/revise standards of care for each service category

• Develop and monitor performance measures

• Support CQI Projects and service evaluations

• Data Quality Checks and Chart Reviews

• Provide technical assistance and training related to improving service delivery

QM Program Updates

• Current QI Project Topic: Improving Viral Load Suppression Rates among BMSM and Transgender clients

• QM Program funding will be available to agencies in FY2021

• QM Specialists will meet with agencies to review and update Corrective Action Plans and QI Project Plans during 4th Quarter

• Re-formatting standards of care to include staff roles by service category

Upcoming Trainings

Partnered with Georgia AETC to provide the following trainings…• Cultural Humility Training – November 16th

• Morning and Afternoon Sessions (2)

• Scenarios and Panel Questions due by Nov 6th

• Customer Service Training – December 9 - 10th

• Morning and Afternoon Sessions (4)

• LIVE and recorded sessions open to all staff that interact with Ryan White Clients

• Certificates available upon completion of training

HRSA PCN 15-02 Changes

Infrastructure

Updated on 09/1/2020

HRSA PCN 15-02 Changes

• Identify at least two performance measures for the RWHAP service categories where greater than or equal to 50% of the recipients’ eligible clients receive at least one unit of service.

• Identify at least one performance measure for RWHAP service categories where greater than 15% and less than 50% of the recipients’ eligible clients receive at least one unit of service.

• Do not need to identify a performance measure for RWHAP service categories where less than or equal to 15% of the recipients’ eligible clients receive at least one unit of service.

Eligible Clients (n) Served by category

# of Measures Needed

n ≥ 50% of all RW 2

15% < n < 50% of all RW 1

n ≤ 15% of all RW 0

Updated on 11/30/2018

Performance Measurement

Service Utilization – CY2019

PRIORITY CATEGORY% OF ALL CLIENTS

(14,061)

REQUIRED MINIMUM NUMBER OF PERFORMANCE

MEASURES

Outpatient Ambulatory Health Services 78% 2

Oral Health 22% 1

Medical Case Management 21% 1

Medical Transportation 18% 1

Referral for Health Care and Support Services 58% 2

Psychosocial Support Services 27% 1

FY2020 Performance MeasuresPerformance Measure Target Goal

HIV Viral Load Suppression 83%

Syphilis Screening 77%

Archived HAB: Mental Health Screening 70%

Oral Health: HAB Annual Retention in Care (12 months) 94%

Medical Case Management: Viral Load Suppression 84%

Psychosocial Support: HAB Annual Retention in Care (12 months) 75%

Medical Transportation: HAB Annual Retention in Care (12 months) 81%

Referral for Health Care & Support Services: HAB Annual Retention in Care (12 months) 87%

Referral for Health Care & Support Services: HAB Viral Load Suppression 83%

OAHS Agencies have additional measures for review based on their CY2017 clinical chart review findings. QI Project measures may differ depending upon agency intervention.

2018 Chart Review Results

Tiffany Lawrence, MPH

2018 Chart Review

Clinical Quality Management

Quality Assurance

Chart Reviews

Quality Checks

Quality Improvement

Performance Measurement

Quality Improvement

Projects

Quality Assurance activity

Reviewed client charts from January 1, 2018-December 31, 2018

Categories Reviewed: Eligibility

Oral Health

Medical Transportation

Linguistics

Other Professional Services

Charts Reviewed

Category Charts Reviewed (#) Agencies Reviewed (#)

Eligibility 766 18

Oral Health 289 9

Medical Transportation 352 12

Linguistics 77 4

Other Professional Services 21 1

ELIGIBILITY

Ryan White Eligibility

• PPPN-001 Client Eligibility

• Initial Certification• Proof of HIV Status• Proof of Residency• Proof of Income• Proof of Payer of Last

Resort

• Recertification • Self-Attestation of No

Changes• Proof of Changes

• Proof of Income• Proof of Residency

• Client Protections

• Signed Acknowledgement of

• Rights and Responsibilities

• Grievance Procedures

• HIPAA

Eligibility

0%

20%

40%

60%

80%

100%

Initial- POS, POI,POR

Recert- POI, POR POLR Client Protections

87%

63%73%

78%83%71%

60%

83%

Comparison of Mean EMA Eligibility Scores

2017 2018

EXEMPLAR AGENCIES- Eligibility

Initial/ Recertification

AHF

Cobb BOH

Grady IDP

Mercy Care

Open Hand

Southside

Payer of Last Resort

AHF

Cobb BOH

Grady IDP

Southside

Client Protections

AHF

AID Atlanta

ANIZ

Atlanta Legal

Clarke BOH

DeKalb BOH

Here’s to Life

PIHC

Southside

Someone Cares

ORAL HEALTH

Oral Health Services

Documentation that the dental record for each client is signed by the licensed provider and includes a treatment plan, services provided, and any referrals made.

HAB Performance Measures for Oral Health include documentation of Dental and Medical History, Oral Health Education provided, and Periodontal Screening or Exam.

Oral Health Services

70%

75%

80%

85%

90%

95%

Performance Measures Documentation Requirements

80%

95%

Mean EMA Oral Health Services Results

EXEMPLAR AGENCIES- Oral Health

Performance Measures

AHF

Grady IDP

Documentation Requirements

AIDAtlanta

DeKalb BOH

MEDICAL TRANSPORTATION

Medical Transportation Services

Maintain program files that document:

The level of services/number of trips provided

The reason for each trip and its relation to accessing health and support services

Trip origin and destination

The cost per trip

The method used to meet the transportation need

Medical Transportation Services

0%

20%

40%

60%

80%

100%

Performance Measures Documentation Requirements

67%80%

Mean EMA Medical Transportation Services Results

EXEMPLAR AGENCIES- Medical Transportation

Performance Measures

DeKalb BOH

Documentation Requirements

Clarke BOH

Emory

PIHC

LINGUISTICS

Linguistic Services

Maintain program files that document:

Number and types of providers requesting services

Languages involved

Types of services provided

Linguistic Services

0%

20%

40%

60%

80%

100%

Performance Measures Documentation Requirements

61%

93%

Mean EMA Linguistic Services Results

EXEMPLAR AGENCIES- Linguistics

Performance Measures

DeKalb BOH

Documentation Requirements

AID Atlanta

DeKalb BOH

OTHER PROFESSIONAL SERVICES

Other Professional Services

Maintain program files that document:

A description of how the legal service is necessitated by the individual’s HIV status

Types of services provided

Hours spent in the provision of such services

Other Professional Services

0%

50%

100%

Documentation Requirements

100%

Mean EMA Other Professional Services Results

EXEMPLAR AGENCY- Other Professional Services

Atlanta Legal Aid

NEXT STEPS

CHART REVIEW NEXT STEPS

• Review Individual Reports• Opportunities for Improvement

• Recommendations

• Technical Assistance • Agency and Group Trainings

• Toolkit Development

• CY2019 Chart Review• Postponed due to COVID-19

TOGETHER WE WIN

Adapting to the Pandemic

Presenting Agencies:-AHF

-ATLANTA LEGAL AID SOCIETY

-GRADY IDP

-PIHC

Continuing Care Through COVID-19

AHF Piedmont & Lithonia Healthcare Center’s

Presented by:

Katherine Barbera, Practice Manager and Courtney Brooks, Senior Contracts Manager

Telehealth Implementation

Zoom for Healthcare –

Clients did not get automatic appointment information

and access

Labor intensive for Healthcare Center staff

Smart Clinix –

Providers were not happy with the lack of integration with

existing EMR system

EZ-Tel/EZ-Access –

Integrated well with existing EMR system

Automated appointment links and reminders

EZ-Tel/EZ-Access

Easy for Patient to Access –

Receive link at time appointment is made and a reminder

15 minutes prior to appointment

Patients sign into visit with a secure and unique link

DOB authentication is needed to access

Able to preform a pre-visit check to ensure access

Easy for Provider to Access –

Able to send the patient reminder emails, texts or new

link on demand

Option to take a photo of the patient to be added into EMR

system

Ability to send staff a message in EMR directly from EZ-

Access portal

Ability to change call to audio only visit in the event of

video failure

Safety Policies

Mandatory Masking –

All persons in the Healthcare Center are required to wear

AHF provided surgical masks

Social Distancing –

Reduced waiting room seating to allow for 6 feet distance

between seats

Guests are not permitted in the building (unless necessary

for appointment)

Utilization of unused spaces in Healthcare Center to provide

additional waiting areas for patients who need labs drawn or

an injection/procedure

One Way Foot Traffic –

Foot traffic is directed in a one way pattern through the

Healthcare Center in order to adequately distance from one

another

Wellness Screenings & Temperature Checks –

All staff and clients undergo a wellness screening and

temperature check upon arrival at the Healthcare Center

Outcome of Implemented

Measures

Since March 1, 2020 –

Telephone Visits

Piedmont HCC – 1,529

Lithonia HCC – 262

TeleHealth (Audio/Video) Visits

Piedmont HCC – 759

Lithonia HCC – 106

In Person Visits

Piedmont HCC – 1,091

Lithonia HCC - 236

atlantalegalaid.org

Atlanta Legal Aid Society

atlantalegalaid.org

Legal Services & Housing

COVID-19 response: ALAS offices closed to public

beginning March 16th/staff working remotely, online

applications for assistance, 24/7 intake hotline, Zoom meetings

with clients, virtual/”tele-legal” sessions with partner agencies,

follow up with past clients regarding COVID-19 needs

From March 1st through August 31st, we assisted

approximately 275 Ryan White-eligible clients with their legal

issues.

COVID-19 and Housing: CARES Act protections, CDC

Eviction Moratorium, amicus brief for CDC lawsuit, referrals

for housing assistance/rental assistance programs, media

coverage

atlantalegalaid.org

GRADY IDP

atlantalegalaid.org

Grady Health System – Response to COVID

Key Implementation Steps

• Development of technical capacity to support video visits

• Purchase of equipment for successful implementation

• Engaging staff for buy-in and identification of “super users” to support local capacity

• Extensive staff training

• Regular technical assistance to users and multidisciplinary team group meetings

• Implementation of procedures for preparing patient for the visit

• Expansion of enrollment in MyChart (patient portal required for video visit)

• Availability of cell phones and data support for patients

Successes

• Use of telehealth in Center for Well Being and Primary Care clinics at IDP

• Expansion of telehealth to include consultation with Crestview Nursing Home

• Initiation of home visits to IDP patients via Mobile Integrated Health (MIH) program

Challenges

• Scheduling appropriate visit type

• Technical issues

POSITIVE IMPACT HEALTH CENTERS

PIHC Tele-health/Tele-mental health

Piloting • Telehealth

• revising consent forms & SOPs

• choosing equipment

• phone/video platforms

“Certifying” staff readiness• Encrypted laptop and headphones

• Access to the VPN

• Specific training completed for telemental health

• Access to phone platforms for use at home

• Telehealth platform account

• E-signature account

PIHC open for on-site/telehealth services

Clinic and Client Services departments:• Telehealth from home or from office• Staggered on-site schedules to reduce Covid-19 transmission risk• Use of telehealth coordinators• In-person appointments 15 minutes and under

Behavioral Health and Addiction departments:• Almost exclusively telehealth• On-call to come on-site to manage BH emergencies• Clients with poor access provided with phones or come on-site for telehealth

sessions

HIPAA-compliant Telehealth platforms

• Phones• Forwarding office phones to cell through Mitel or other phone system• Doximity for calling from cell phone using office number • GoogleVoice if paying for GSuite

• Video• Zoom Health, Cerner (or other EMR-based)• Others: Teams (with BAA), Doxy.me, Doximity, FaceTime

• Texting• Clicksend, Googlevoice if paid for with Gsuite

• Esignature• AdobePro, Docusign, Jotform

Using Social Media to Engage Clients

Re-Engage Retain Reduce

Link to care, Link to community, Link to Love

The Team @ THRIVE Support Services

Our mission is to achieve health equity for Black gay men through direct support, advocacy and building collective community power.

Lorenzo Lewis Michael Morris

Purpose: To strengthen efforts to end the HIV epidemic in the Atlanta Metropolitan Area through improvements in reaching and engaging BSGL men into care.

Service Types:• Linkage to Care• Housing Opportunities• Support Network for BSGLs• Support Network for People of Trans

Experience• Support Network for Cis Gendered

Women• Food Assistance• PrEP• PEP• Mental Health Resources• Clothing• Medical Appt Transportation

1)Reduce new HIV infections

2)Increase access to care and improve

health outcomes for

PLWH

3) Reduce HIV-related health disparities and

health inequities

4) Achieve a collaboratively

coordinated response to client needs

4 Areas of Focus

Outcome

Media PlatformsTotal

Views/Impressions

Average Clicks

per DayCTR

Number of

Advertisments

Adam4Adam 179,525 91.27 3% 5

Facebook/Instagram 1,759,722 284.23 1% 5

GrindR 780,366 80.13 1% 5

JackD 135,922 12.37 1% 4

Total 2855535

Clicks

Media Platforms May-20 20-Jun

Adam4Adam 1,926 2,738

Facebook/Instagram 3,479 8,527

GrindR 5485 2404

JackD 1394 371

63 Days

116 services

106 clients

THRIVE SS Fact Sheet

Impressions

Media Platforms May-20 20-Jun

Adam4Adam 59,351 110,803

Facebook/Instagram 611,862 1,147,860

GrindR 103571 676678

JackD 119457 16465

Looking forward w/Fiscal Team

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Questions