Ryan White Part A Program Services Client-Level Data Report FY2015 Planning Council Meeting May 17, 2016 Yohannes Abaineh, MPH Yohannes.abaineh@baltimorecity.gov
Mission Improve the quality of life for people living with HIV/AIDS and their families in Baltimore city and the surrounding counties through a fiscally responsible subcontracting of Ryan White funds for the provision of HIV primary care and support services. Monitor fiscal, program, and quality management activities in order to ensure provision of high-caliber, integrated medical and support services. Provide comprehensive guidance to Ryan White providers and the Baltimore Planning Council to ensure compliance with Ryan White legislations and standards of care. 2015 RWA-CLD Report/BCHD 2
Ryan White Part A/MAI Client-Level Data Background Ryan White Part A grantee office collected basic demographic, eligibility and Ryan White funded service data since 2001 In 2009, the grantee implemented the first RSR report and collected CLD from providers serving RW funded OAHS, MCM, or CM services. 2010-2015, all providers providing any RW funded service successfully submitted annual RSR to HRSA/HAB and quarterly CLD to BCHD. 2015 RWA-CLD Report/BCHD 3
Ryan White Part A/MAI Client-Level Data Background, con t In 2015, HRSA/HAB changed funded-scope RSR data reporting to eligible-scope data reporting because HAB believes that Eligible Scope is the best reporting method for the following reasons: Continue creating the continuum of care post ACA To more fully capture the efforts of the Ryan White Program in a time when more people have access to health insurance Continue measuring client health outcomes and progress towards achieving the National HIV/AIDS Strategy that envisions a future America that is free from HIV/AIDS. Ryan White Part A grantee collected quarterly client-level data from 38 funded sub-recipients in fiscal year 2015 that produced 9,379 unduplicated clients. This number is the basis for data analysis and the results presented in this report. 2015 RWA-CLD Report/BCHD 4
Client Level Data Highlights, 2010-2015 2010 2011 2012 2013 2014 2015 CLD Reports 37 38 37 37 37 38 Clients Served 9,481 9,753 10,356 10,079 9,801 9,379 Visits 88,000 112,000 106,000 87,000 83,400 91,000 OAHS-PMC Providers 15 15 15 15 14 15 OAHS Visits 50,000 69,000 44,500 45,800 14,305* 45,700 OAHS Clients Served 6,520 6,525 6,675 6,683 2,800* 8,200 *In 2014, many clients were transitioned to other primary care coverages due to ACA and as a result the amount of data the grantee received on funded clients decreased. In 2015 the requirement was changed to eligible clients in addition to funded clients. 2015 RWA-CLD Report/BCHD 5
Clients Served by Gender Clients Served by Ethnicity 1.8% 3.7% 32.8% 65.5% Male Female Transgender Hispanic/Latino Non-Hispanic/Latino 96.3% 2015 RWA-CLD Report/BCHD 6
Clients Served by Race HIV Risk Category Distribution (All Time) 80.00% 70.00% 71.67% 50.0% 45.0% 44.6% 60.00% 50.00% 40.00% 30.00% 27.06% 40.0% 35.0% 30.0% 25.0% 20.0% 28.1% 20.1% 20.00% 10.00% 0.00% 1.08% 0.04% 0.15% White Black Asian NH/PI AI/AN 15.0% 10.0% 5.0% 0.0% 1.4% 0.1% 2.0% 2.9% 1.0% 2015 RWA-CLD Report/BCHD 7
Clients Served by Age Health Care Coverage 35.0% 30.0% 25.0% 33.0% 25.8% 45.0% 40.0% 35.0% 30.0% 40.0% 20.0% 15.0% 15.5% 16.2% 25.0% 20.0% 15.0% 16.5% 19.6% 20.8% 10.0% 5.0% 0.0% 0.3% 0.2% < 13 13-18 3.0% 19-24 25-34 35-44 45-54 55-64 6.0% 65+ 10.0% 5.0% 0.0% 0.9% 2.2% Mean Age = 47.5 Median Age = 50 Mode = 52 2015 RWA-CLD Report/BCHD 8
Federal Poverty Level Clients served by Housing Status 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% 78.3% 10.5% < 100% 100-138% 6.1% 139-200% 2015 RWA-CLD Report/BCHD 2.5% 2.1% 0.3% 0.2% 201-250% 251-400% 401-500% > 500% 9% 5% 86% Stable Temporary Unstable 1=Stable/Permanent: includes HOPWA, Section 8, and institutional settings where continued residence is expected 2=Temporary: includes transitional/temporary residence with family, friends, or institution, and hotel/motel not paid for with emergency shelter voucher 3=Unstable: includes homeless, living outside or in a place not ordinarily used as a sleeping accommodation for people (i.e. car), emergency shelter, jail, prison or juvenile detention, and hotel/motel paid for with emergency shelter voucher 9
Client Distribution by Residence in the EMA 80.0% 74.9% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 16.8% 10.0% 3.4% 2.9% 1.3% 0.4% 0.2% 0.0% Baltimore City Baltimore Anne Arundel Howard Harford Carroll Queen Annes Note: A very small fraction of clients (31 or 0.4%) from neighboring counties, majority being from PG and Montgomery counties, crossed over to the EMA to receive various Part A/MAI funded services. 2015 RWA-CLD Report/BCHD 10
Clients Served by Zip Code Areas Percent distribution of clients served by zip code areas with >100 clients 21222 21133 21230 21234 21231 21225 21239 21212 21207 21224 21216 21223 21229 21205 21202 21206 21201 21213 21218 21217 21215 0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0% 2015 RWA-CLD Report/BCHD 11
<2 2-12 13-18 19-24 25-34 35-44 45-54 55-64 65+ Male Female Transgender New Diagnoses by Age, Gender, and Risk Factor (2015) 30% 70% 60% 25% 60% 50% 20% 15% 50% 40% 30% 40% 30% 10% 20% 20% 5% 0% 10% 0% 10% 0% 2015 RWA-CLD Report/BCHD 12
Percent Distribution of Clients Served, by Service Category 40.0% 35.0% 30.0% 36.1% 33.9% 28.6% 25.0% 20.0% 16.9% 15.2% 15.0% 12.4% 12.2% 10.0% 9.9% 9.8% 8.6% 7.7% 5.0% 0.0% 5.3% 5.2% 4.9% 3.8% 2.0% 0.4% 0.2% Note: Percent does not add up to 100% since a client may receive service in more than one service categories 2015 RWA-CLD Report/BCHD 13
1.8% 1.1% 0.3% 5.0% 3.8% 3.2% 2.2% 5.4% 6.0% 32.6% 31.3% 31.7% 58.4% 58.3% 58.8% Clients Served by Age 2010-2015 70.0% 60.0% 50.0% 40.0% 2010 30.0% 2014 2015 20.0% 10.0% 0.0% < 13 13-24 25-44 45-64 65+ Note: Steady decrease in the percentage of clients in the < 13 and 13 24 age groups versus steady increase in the over 65 age group after ACA implementation. 2015 RWA-CLD Report/BCHD 14
Clients Served by Race 2010-2015 90.00% 84.80% 80.00% 70.00% 69.70% 71.67% 60.00% 50.00% 40.00% 30.00% 29.20% 27.10% Black White 20.00% 14.60% 10.00% 0.00% 2010 2014 2015 Note: Post ACA implementation, the proportion of black consumers has decreased by about 15% while the proportion of white consumers has increased by about the same percentage. 2015 RWA-CLD Report/BCHD 15
Clients Served by Housing Status 100.0% 2010-2015 90.0% 80.0% 82.0% 78.0% 85.8% 70.0% 60.0% 50.0% 40.0% Stable Temporary Unstable 30.0% 20.0% 10.0% 14.0% 4.0% 11.0% 11.0% 9.3% 5.0% 0.0% 2010 2014 2015 2015 RWA-CLD Report/BCHD 16
Clients Served by Medical Insurance 2010-2015 45.0% 40.0% 35.0% 35.3% 41.8% 40.0% 30.0% 29.9% 25.0% 20.0% 19.2% 16.5% 19.2% 19.6% 22.3% 20.8% 2010 2014 2015 15.0% 10.0% 13.3% 12.2% 5.0% 0.0% Private Medicare Medicaid No Insurance 2015 RWA-CLD Report/BCHD 17
Service Utilization Trend 2010 2015 Service Category 2010 2014 2015 Increase/Decrease 1 Outpatient Ambulatory Health Service 68.5% 29.3% 33.9% 2 Medical Case Management 31.5% 37.5% 36.1% 3 Health Insurance Premium 28.9% 20.6% 20.6% 4 Transportation 23.5% 23.1% 28.6% 5 Outreach Services 13.5% 13.6% 16.9% 6 Non-Medical Case Management 12.2% 9.5% 9.9% 7 Oral Health 12.0% 14.6% 12.2% = 8 Mental Health 6.8% 12.4% 9.8% 9 Medical Nutritional Treatment 8.6% 8.4% 4.9% 10 Food Bank 8.5% 7.3% 8.6% = 11 Psychosocial Services 5.3% 4.4% 5.3% = 12 Housing Services 3.3% 6.7% 7.7% 13 Substance Abuse Treatment (Outpatient) 3.1% 2.4% 3.8% = 14 Legal Services 2.7% 1.4% 2.0% = Note: Percent does not add up to 100% since clients may receive service in more than one service categories 2015 RWA-CLD Report/BCHD 18
Baltimore EMA Treatment Cascade, 2015 (Diagnosed and Undiagnosed) based on a CDC estimate of the percentage of undiagnosed persons in Maryland (18.7%) 100% 100% 90% 80% 70% 60% 50% 40% 11,536 81% 9,379 71% 8,200 60% 47% 43% 30% 6,922 20% 5,458 4,955 10% 0% Estimated Infection (estimated based on CDC's 18.7 % of HIV infected people who are unaware of their status) Diagnosed (received any Ryan White Part A funded service in 2015) Linked to Care (at least one pmc visit in 2015) Retained in Care (at least two pmc visits in 2015) Prescribed ART (indicated to have been prescribed HAART in 2015) Virally Suppressed (most recent VL in 2015 that is undetectable or 200 copies/ml) Note: CDC s MMWR weekly report published on June 26,2015 reported that Maryland has an estimated 8,100 people (18.7%) who were unaware of their infections by the end of 2012. This cascade could have been much different if generated using the most current estimate since then, which does not exist for now. 2015 RWA-CLD Report/BCHD 19
Baltimore EMA Treatment Cascade, 2015 (Diagnosed) 100% 90% 100% 87% 80% 9,379 74% 70% 60% 50% 8,200 6,922 58% 53% 40% 30% 5,458 4,955 20% 10% 0% Diagnosed (received any Ryan White Part A funded service in 2015) Linked to Care (at least one pmc visit in 2015) Retained in Care (at least two pmc visits in 2015) Prescribed ART (indicated to have been prescribed HAART in 2015) Virally Suppressed (most recent VL in 2015 that is undetectable or 200 copies/ml) 2015 RWA-CLD Report/BCHD 20
Retention in Primary Care and Viral Suppression by Age CLD 2015 100% 90% 80% 89% 76% 81% 73% 83% 83% 85% 86% 86% 89% 83% 91% 70% 60% 56% 62% 50% 40% 40% 44% 30% 20% 10% 0% <13 13-18 19-24 25-34 35-44 45-54 55-64 65+ Retention Viral Suppression Note: Definition: Retention = percent of clients with at least two primary care visits in 2015; Viral Suppression = percent of clients who had at least one primary care visit and one viral load result with last viral result of 200 cells/ml or less. 2015 RWA-CLD Report/BCHD 21
100% 90% 80% Retention and Viral Suppression for Black-MSMs by Age, CLD 2015 90% 90% 92% 92% 89% 89% 89% 85% 87% 88% 82% 83% 75% 75% 70% 60% 50% 40% 30% 20% 10% 0% 19-24 25-34 35-44 45-54 55-64 65+ Black MSM - All Retention Viral Suppression 2015 RWA-CLD Report/BCHD 22
Retention and Viral Suppression by Gender 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 96% 90% 89% 88% 87% 87% Male Female Transgender Retention Viral Suppression 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Retention and Viral Suppression by Race 86% 88% 91% 93% 89% 88% 85% 83% Black White Hispanic Asian Retention Viral Suppression 2015 RWA-CLD Report/BCHD 23
Retention and Viral Suppression by Health Care Coverage Retention and VS by Housing Status 100% 90% 80% 70% 94% 90% 90% 92% 93% 87% 83% 85% 100% 90% 80% 90% 92% 95% 89% 81% 85% 60% 70% 50% 40% 60% 50% 40% 30% 30% 20% 20% 10% 0% Private Medicare Medicaid No Insurance Retention Viral Suppression 10% 0% Stable Temporary Unstable Retention Viral Suppression 2015 RWA-CLD Report/BCHD 24
Overall EMA s Retention and Viral Suppression Rates, 2010 2015 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 2010 2011 2012 2013 2014 2015 Retention 76% 85% 81% 86% 79% 84% Viral Suppression 58% 73% 77% 54% 78% 85% 2015 RWA-CLD Report/BCHD 25
Summary of Client-Level Data Results A third of the consumers are between 45 54. About 60% are b/n 45 64. Nearly 75% of the EMA consumers lived in Baltimore City MCM,OAHS, and Transportation are the top three most utilized services Proportion of black consumers decreased by about 15 % while white consumers increased by the same proportion 85 percent of are virally suppressed Viral suppression in the continuum of care cascade continued to increase by an average 3 5 percent annually while linkage to care and retention increased by 5 7 percent since 2010 Youth, specifically black MSM youth 13 24 years of age, continued to have the lowest viral suppression and retention rate among all groups and subgroups even though youth accounts only for less than 5% of the number of PLWHA in the EMA Slight disparity in retention and viral suppression continued to exist across several groups and sub-groups 2015 RWA-CLD Report/BCHD 26
Thank You! Yohannes Abaineh, Epidemiologist Yohannes.abaineh@baltimorecity.gov 410-396-1408