Meeting Minutes. Meeting Date: December 5, Approved by Planning Council: January 5, Grantee: Multnomah County Health Department

Transcription

1 Meeting Minutes Meeting Date: December 5, 2017 Approved by Planning Council: January 5, 2018 Grantee: Multnomah County Health Department Draft to (Co)Chair(s) (12/8/2017) APPROVED (12/12/2017) Page 1 of 4

2 MEETING MINUTES Planning Council Portland Area HIV Services Planning Council December 5, :00 pm 7:30 pm McCoy Building 426 SW Stark St Conference Room 10A Members Present: Leave of Absence: Members Absent: Staff Present: Others Present: Recorder: Sara Adkins, Emily Borke, Katy Byrtus, Tom Cherry (Council Co-Chair/Operations), Carlos Dory (Evaluation Chair/Operations), Maurice Evans, Greg Fowler (Operations), Alison Frye (Council Co-Chair/Operations), Lorne James, Toni Kempner, Julia Lager-Mesulam (Operations), Heather Leffler, Jonathan Livingston (Operations), Jeremiah Megowan, Scott Moore, Robert Noche, Joseph Pyle, Michael Stewart, Michael Thurman (Membership Co- Chair/ Operations), Rosemary Toedtemeier John Conway Erin Butler, Monica Dunn, Shaun Irelan, Toni Masters, Laura Paz-Whitmore, Jace Richard (Membership Co-Chair/ Operations), Nathan Roberts Jenny Hampton, Amanda Hurley, Marisa McLaughlin Steve Headington, Dennis Grace-Montenro, Michael Taylor Jenny Hampton Tom Cherry, Planning Council Co-Chair, called the meeting to order at 4:00 p.m. Item: Presenter(s): Summary: Item: Presenter(s): Summary: Candle Lighting Ceremony Lorne James Lorne led the lighting of the ceremonial candle in remembrance of those lost to HIV/AIDS. Welcome & Introductions Tom Cherry Tom welcomed everyone to the meeting and introductions were made with Council members declaring any conflicts of interest. Item: Agenda Review and Minutes Approval Presenter(s): Tom Cherry Summary: The agenda was accepted by unanimous consent The meeting minutes from the October 10 th meeting were approved by unanimous consent o A member who was not at the last meeting expressed distress at reading that another member felt that the t-shirts given out at the retreat were somehow exclusionary. The history of the pink triangle symbol and the fight against HIV/AIDS was then discussed. Item: Presenter(s): Summary: Finalize Contingency Planning for FY18-19 Amanda Hurley & Alison Frye Amanda presented history and options (yellow handout) This is what was approved for previous fiscal year There will be no changes 3% decrease funding scenarios (pink handout) Scenario #1 take funding from substance abuse treatment (new programs) o Reductions would be taken from financial assistance programs, not from Addictions Benefits Coordinators (in which funding is for staffing) Draft to (Co)Chair(s) (12/8/2017) APPROVED (12/12/2017) Page 2 of 4

3 o Substance abuse funding is very helpful to those on Medicare Scenario #2 decrease spread across all categories Scenario #3 maintain new programs, take cuts in health insurance (Clark County only), oral health (Clark County only), and early intervention (new funding coming) o For Early Intervention, this reduction would impact more intense interventions. DIS programs will be funded by other funding streams. Linkage to care will increase. Services will not go away, but will be funded differently. Taking EIS to the next level o Oral health is now covered in WA with no financial benefits limit General agreements no cuts from substance abuse, maybe from the other categories Q: What if the political situation impacts ACA? A: State project officer has confirmed that if ACA is changed, CAREAssist will remain, PLWA/H insurance situation should not change Q: What would be the impact of Health Insurance reduction in Clark County? A: Primary purpose of funds was to ensure parity, but Washington has essentially copied Oregon s program Group consensus: Scenario #3 Flat funding scenarios (blue handout) Scenario #1: flat funding maintain exactly as it is in FY17-18 Scenario #2: flat funding holding MCM (medical case management) harmless at grant request level using funding levels o Q: What was the reasoning behind holding MCM harmless? A: To help maintain (or possibly increase) MCM staffing, keep caseloads lower and help reduce turnover o Unemployment is low, and keeping good people is very important right now o This would be $93K increase in MCM, with 4.3% decrease across all other categories Preference would be to hold both medical care and medical case management harmless o This would mean cutting another 89K out of rest of budget, i.e. 8% less for all except medical care and medical case management Q: Can we come back at some point and adjust these numbers? A: We need to make a decision now due to how contracting works. Group consensus: Scenario #1 flat funding 3% increase funding scenarios (green handout) We did not discuss these scenarios at the last meeting, but came out of conversations between Alison and Amanda These scenarios cover what would happen if we did not get our full 5% increase, but still got an increase. Based on the previously agreed increase philosophy, these scenarios review what would happen for different increase percentages. o 1st: 1% or less (~34K or less): Additional money into medical care and MCM only o 2nd: 1.1%-1.9%: Apply COLA except for Health Insurance, EIS and Substance Abuse o 3rd: 2.0%-4.9%: Apply COLA and add remaining to medical care and MCM Group consensus: agree to proposed scenarios for different percentages Item: Presenter(s): Summary: Bylaws Review Process Update Michael Thurman Update Bylaws Committee met the last time, cleaned up wording Bylaws draft has been sent out to Council please review prior to January meeting We will have about 30 minutes at January meeting for discussion and vote Draft to (Co)Chair(s) (12/8/2017) APPROVED (12/12/2017) Page 3 of 4

4 Thanks to the Bylaws Committee Item: Preliminary Carryover Request Presenter(s): Amanda Hurley Summary: We have to submit a preliminary carryover request to HRSA this is what we think won t be spent this current FY We don t have to say where we will put that money Projection as of now: $75K (this is under the required 5% threshold) o HCS is overestimating what will be unspent due to new programs that just started and have not submitted invoices yet Previous years: $48K, $64K and $128K This is a unique year due to all the new programs and all of the Part B money coming in Item: Presenter(s): Summary: Health Insurance Enrollment Update Jonathan Livingston & Sara Adkins Update on ACA (Affordable Care Act see handout) We re looking good What s working against us o Open enrollment time cut in half (7 weeks instead of 14) o 41% cut in federal navigator funding (did not impact OHA assistance) o 90% less funds put towards advertising o System maintenance: website down 12A-12P on Sundays Despite these barriers, we re doing very well o 99% of CAREAssist clients have insurance o We have uninsured clients at any given time Categorically Ineligible = undocumented immigrants Most recent tax bill (not yet passed) eliminates health insurance mandate, which is a concern Item: Presenter(s): Summary: Introduction to the Viral Suppression Support Project Marisa McLaughlin Overview of Viral Suppression Support Project (see PowerPoint slides) Systems-level quality improvement project Q: What is Orpheus? A: Antiquated state system for tracking disease. Orpheus is not just for HIV; every case of communicable disease is reported. Q: Will this reduce manual data entry? A: If it works as planned, yes. Q: When a client gets a viral load test from a provider, how does that information get into Orpheus? A: Mostly from laboratories doing tests. All providers, with exception of VA, required to submit this information to the state. Once submitted, the state does a lot of validation. The meeting was adjourned at 6:30 p.m. Draft to (Co)Chair(s) (12/8/2017) APPROVED (12/12/2017) Page 4 of 4

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10 Viral Suppression Support Project Planning Council Meeting December 5, 2017

11 Overview of Viral Suppression Support Project Objectives: Provide overview of why we are implementing this project Provide overview of how it will be implemented: Data Client support plan Provide details of implementation and next steps Opportunity for input and feedback

12 Overview of Viral Suppression Support Project What are we planning on doing? Importing Orpheus data into CareWare More regular follow-up and outreach with RW clients What data are we importing? Date of Viral Load Result Viral Load Results Date of HIV Diagnosis Date of CD4 Count Results CD4 Count Results

13 Timeline of HIV Data Integration HIV data reported in aggregate from all HCS contractors in Excel spreadsheets CAREWare implemented CAREAssist data pilot for individual providers Shared eligibility system in CAREWare implemented CAREAssist data imported from State for eligibility determination Contractor client-level client and service data in TOURS Unduplicated client counts and analysis at HCS OHCA in place & some data shared between contractors Data matching btwn Orpheus & CAREWare in aggregate ORPHEUS data imported into CAREWare Updated CAREWare version to be web-based

14 Viral Load Data Matching Disparities exist in viral suppression rates by: Race Gender Youth HIV Risk Factor Housing Status FPL

15 Overview of Viral Suppression Support Project cont. Reasons to import Orpheus data into CareWare Some contractors required by contract Manual process Missing data Coordination of care Reporting

16 Viral Suppression Support Plan

17 Viral Suppression Support Planning Meetings 3 Planning Meetings to develop plan with Part A providers and consumers Planning Meeting 1: Sept. 7 th : Start developing plan for client viral suppression and care re-engagement support Planning Meeting 2: Oct 18 th : Finalizing plan and discuss unintended consequences and mitigation using Health Equity and Empowerment Lens Planning Meeting 3: Oct 31 st :Communications plan to internal and external stakeholders and Implementation Plan

18 Overview of What Data will be in CW Not getting labs Un suppressed CAREWare Getting labs, virally suppressed No Match Made

19 Suppression Support Strategy CAREWare Un suppressed Not getting labs Getting labs, virally suppressed

20 Suppression Support Strategy WHO/WHAT Medical providers/mcm s: Primary Response follow-up with client or client s medical provider CareLink, Housing CM, MAI MCM providers will follow-up with client s MCM as appropriate for shared clients. DIS provider if a client can t be reached or engaged CareLink, Housing CM, MAI MCM: Secondary Response if clients not shared with MCM/Medical, as situationally appropriate WHEN Depends on provider, monthly (RW Medical) or quarterly review (RW MCM, other CM) or as needed/situationally appropriate (DIS) WHY Utilizing what s already done at contractors Low impact on clients because current process Un suppressed 94% received Medical, MCM or EIS

21 Suppression Support Strategy WHO/WHAT HCS: Primary Reviewer of list generated DIS: Primary Reviewer/Response to determine medical provider and appropriate point of contact, including their program Other RW Contractors: Primary Response, follow-up with prior MCM service providers or client, as appropriate Un suppressed WHEN Monthly review (HCS and DIS) for follow-up as appropriate quarterly (RW contractors) with clients WHY HCS sees all clients in CW and DIS has access to medical provider sometimes Contractors maintains client relationship 6% did not receive Medical, MCM or EIS services

22 Re-engagement Support Strategy CAREWare Not getting labs Getting labs, virally suppressed Un suppressed

23 Re-engagement Support Strategy cont. WHO/WHAT Medical providers/mcm s: Primary Response follow-up with client or client s medical provider CareLink, Housing CM, MAI MCM providers will follow-up with client s MCM as appropriate for shared clients. DIS provider if a client can t be reached or engaged DIS: Secondary Response, with clients not shared need to be able to de-duplicate client re-engagement lists from State w/rw. WHEN Depends on provider, monthly (Medical and DIS) or quarterly review (MCM) panel review monthly WHY Utilizing what s already done at contractors Low impact on clients because current process New resources if local health departments receive EIO $. Not getting labs 73% received Medical, MCM or EIS

24 Start Developing Re-Engage Strategy cont. WHO/WHAT DIS: Primary Response for follow-up with client or client s medical provider WHEN WHY Within 30 days of HCS/OHA notification New State grant with PH EIO as follow-up agency Not getting labs Not getting labs 27% did not receive Medical, MCM, or EIS services

25 Communications Plan Internal and External Stakeholder Communication Plan developed Based in part on Health Equity and Empowerment Lens discussion Main Client Communication Points Providers should: Use universal messaging explaining OHCA/data sharing Be honest with clients around information access Acknowledge hesitancy of clients Use language that focuses on care coordination with healthcare team Use language that nurtures trust Use culturally competent, trauma informed language that accounts for cultural significance of being virally suppressed.

26 Communications Plan Cont. HCS communications occurring at: Contractors Meetings, Planning Council Meetings, HIV Network Meeting, HHSC CAB, and other groups as necessary Additional HCS communications to: Inform State/coordinate with EIO Work with contractors to develop provider specific reports Coordinate evaluation plan and Standards of Care revisions Ongoing legal permissions with Washington and Clackamas counties, etc. Communications at RW provider level to: Inform staff of any altered workflows/standard work based on plan, Provide any standard client language for providers to use

27 Implementation Plan Communications and Feedback: December January Initial Build and User Testing December Evaluation Plan development - January Agency specific workflows, any procedure changes January-February Custom report programming and training January March Standards of Care Revisions: March Data import into CareWare: March 1 st year implementation & baseline evaluation: March 2018 Feb 2019

28 Any Questions? Any Suggestions or Feed back?

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