FY20 Department For HIV
Elimination (Ryan White Part A)
Annual Providers Meeting
Welcome!
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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
(404) 635-8200
W. ADOLPHUS LIBURD
Fiscal Designee
(678) 921-2706
PHYLLIS JONES-CHURN, LMSWProgrammatic
Designee
(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
e2Polls
e2Polls
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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