Evelyn Torres and Sebastian Branca's update on AACO's Client Services Unit (CSU), Housing Services Program (HSP), and Quality Improvement (QI) programs

1. Philadelphia Department
of Public Health
AIDS Activities Coordinating Office
Planning Council Meeting
May 9, 2013

2. Client Services Unit
(CSU)

3. 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

4. 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 providers
 Local Case Management Coordination
Project

5. 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

6. CSU Waiting List
 186 people as of 5/7/13
 Followed 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

7. Intake Data

8. MCM Intakes
Calendar year Intakes
2007 1873
2008 2092
2009 2356
2010 2310
2011 2087
2012 2038

9. 2012 Intake Demographics
11.5%
18.4%
69.4%
0.6%
0.1% 0.5%
3.1% 0.2%
Client Race
Hisp/Latino
White
Black
Asian
Hawaiian
Native Amer
Other
Unknown
66.5%
32.2%
1.3%
Client Gender
male
female
trans. M->F

10. 2012 Intake Demographics
30.0%
13.3%
46.6%
1.1%
3.3%
1.6%
13.7%
Risk factor/Mode of transmission
MSM
IDU
Hetero
Blood
Perinatal
Other
Unknown
6.3%
15.8%
40.2%
7.2%
27.0%
2.3% 0.7%
Insurance type
Private
Medicare
Medicaid
Other public
No insurance
Other
Unknown

11. 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%

12. 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%

13. Housing Services
Program
(HSP)

14. HSP Funding
 The 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

15. 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

16. What HSP Does
 Process and evaluate individual
applications for housing
 Maintain the waiting list
 Provide training to southeastern PA
service providers
 Provide ongoing TA to providers
 All services at no cost
 Do not provide emergency housing

17. HSP Scope
 8 housing sponsors
 663 housing slots out of 1015 slots
◦ 522 HOPWA
◦ 131 S+C
 89% tenant based
 11% project based

18. 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

19. Quality Management in the
EMA

20. What is Quality Management
 The 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

21. 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

22. Outcome Monitoring in the
EMA
Performance Measures
System Measures
◦ Appointment Availability
Disparities in Care

23. Medical Measures
 27 measures for medical (O/AMC)
services
 9 MCM measures
 5 oral health measures
 Measures for all other services
 Mental Health
 Substance Abuse

24. O/AMC Performance in the EMA

25. 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

26. 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

27. EMA’s Baseline Performance for
MCM

28. Oral Health Care Performance
Measures
CY 2011
 Dental and medical history 95%
 Dental treatment plan 91%
 Oral health education 66%

29. Monitoring and Feedback
 Strong emphasis on feedback
 Quickly highlights trends, strengths and
needs
 Data visualization is critical in getting
attention of program leadership
 Benchmarking contextualizes data and can
capitalize on competitiveness of providers
 Assists in prioritizing QIPs

30. Performance Feedback Reports

31. Performance Feedback Reports

32. 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

33. Criteria For Evaluating Quality
Improvement Projects
 Focus on systems and processes
 Are data-driven
 Utilize a sound QI process (e.g. FOCUS
PDSA)
 Investment by program leadership
 Incorporation of consumers in the QI
process
 Produces desired improvements
◦ ISU analysis demonstrates that QIPs work

34. 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

35. Questions or Comments