MEDICAL CASE MANAGEMENT QI NETWORK January 7, 2014 at 9:30 a.m. Ryan White Part A Program Office 115 S. Andrews Ave., Ft. Lauderdale, FL 33301

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1 Broward Regional Health Planning Council, Inc. Inc Oakwood Lane, Suite Hollywood, Florida T: T: (954) F: F: (954) MEDICAL CASE MANAGEMENT QI NETWORK January 7, 2014 at 9:30 a.m. Ryan White Part A Program Office 115 S. Andrews Ave., Ft. Lauderdale, FL AGENDA I. Call to Order II. III. IV. Welcome/Introductions Review January 7, 2014 Meeting Agenda and November 5, 2013 Meeting Minutes Janssen Innovative Digital Assets Presentation ACTION ITEM: Participate in a live demonstration of the Care 4 Today Mobile Health Manager App. V. NQC In + Care Campaign Measures Report ACTION ITEM: Review summary of retention rates and continue discussion on role of MCM in retention. VI. Case Study Review ACTION ITEM: Review client case to facilitate sharing of ideas and problem solving strategies. VII. Old/New Business VIII. Resource Sharing IX. Review Agenda Items for Next Meeting X. Adjournment Next Meeting Date: February 4, 2014

2 COMMUNITY PARTNERSHIPS DIVISION Health Care Services Section 115 S Andrews Avenue, Room A300 Fort Lauderdale, Florida FAX MEDICAL CASE MANAGEMENT QI NETWORK November 5, 2013 at 9:30 A.M. Ryan White Part A Program Office 115 S. Andrews Ave., Ft. Lauderdale MINUTES MEMBERS PRESENT Pont, A., SBHD Whyte, K. Broward House Desire, J. NBHD Earp, A., Care Resource Alexis, G. BCFHC CLINICAL QUALITY MANAGEMENT (CQM) SUPPORT STAFF Eshel, A. Solomon, R. MEMBERS ABSENT Spicer, D., AHF GUESTS Colon, B. BCFHC Doe, J. AHF PART A GRANTEE Strong, K. I. Call to Order The meeting was called to order at 9:43 A.M. II. III. IV. Welcome/Introductions CQM Staff welcomed everyone and individual introductions were made. Review November 5, 2013 Meeting Agenda and October 1, 2013 Meeting Minutes The Network reviewed the November 5, 2013 Meeting Agenda and October 1, 2013 Meeting Minutes. The agenda and minutes were approved via Network consensus. Ryan White Part A Outreach Discussion The Network heard a presentation on Ryan White Part A Outreach services from Jeff Doe at AIDS Healthcare Foundation (AHF). AHF links anyone testing positive at one of their centers to a linkage specialist to discuss treatment options within 72 hours; uninsured clients are linked to Ryan White. AHF noted that they are now doing jail linkage to link clients to care once released; the program collaborates with other community agencies to assist clients with a variety of services following their release (i.e. housing and substance abuse). The Network inquired about the contact person for clients lost to care; Jeff Doe provided his contact information to the Network. There was a discussion about clients lost to care and ways to bring clients back to care. It was noted that Provide Enterprise (PE) is used to identify clients linked at other agencies and to provide information to contact family members. Members discussed the decrease in community outreach initiatives. The Network suggested using direct community involvement interventions to increase retention in care. It was noted that education seems to correlate with adherence and developing an undetectable viral load. Members also discussed the attitudes of newly diagnosed clients who have been positive for years. Broward County Board of County Commissioners Sue Gunzburger Dale V.C. Holness Kristin Jacobs Chip LaMarca Ilene Lieberman Stacy Ritter John E. Rodstrom, Jr. Barbara Sharief Lois Wexler

3 It was noted that the AHF Broward Wellness Center contracted with Prevention to do STD testing; STD screening is no longer done at the Florida Department of Health-Broward County (FLDOH-BC). The Broward Wellness Center is located at 700 SE 3 rd Avenue, Suite 200, Ft. Lauderdale, FL; testing and treatment are available free of charge. The Network was informed that they can refer clients to the Broward Wellness Center for care; FLDOH Disease Intervention Specialist (DIS) staff follow up with clients following their visit. The Network inquired about which bus system goes to the Broward Wellness Center-Members to look up information and relay to clients. The Network shared scenarios for clients receiving services at more than one agency and inquired about when to close client records in PE. It was noted that clients can only have one medical case manager (MCM) at a time with the exception of Minority AIDS Initiate (MAI) MCM who work in collaboration with Part A MCM. The Network was asked to refer clients to MAI MCM-the only requirement is that the client is a minority and missed one medical appointment. V. Agency Specific Presentation on QIP Implementation The Network tabled review of the Agency specific presentations summarizing Quality Improvement Project (QIP) findings based on the PE report No Activity in 120 Days. VI. NQC In+Care Measures and Viral Load Reports The Network reviewed the NQC In+Care Measures and Medical Case Management (MCM) and system wide viral load analysis reports (copy on file). Members noted the MCM viral load analysis categories: Undetectable VL: Viral Load is < / = 50 (60%); Suppressed Detectable VL: Viral Load > 50 and </ = 200 (14%); Not Suppressed VL: Viral Load > 200 and < 100,000 (22%); High VL: Viral Load is > / = 100,000 (4%). The Network noted that approximately 26% of clients have either high or not suppressed viral loads. There was a discussion about reviewing client level data to identify trends in viral load analysis (i.e. newly diagnosed, lost to care, not adherent, etc ). Members also discussed ways to collect lab reports for the approximately 2,000 clients who do not have a current viral result in PE (i.e. reminding clients to submit lab reports at their recertification appointments). Members discussed running the viral load analysis report at their agency and inquired about the following: Is there a report that can show all clients who did not have a VL/CD4 in the last 6 months of a measurement period? (Would it be associated with the alert for no viral load or CD4?; Is there a way to get that kind of detail with the Required Action Report?); The MCM supervisors mentioned that in some cases, when a client file is opened, the alert for no VL/CD4 comes up even though labs have been entered/uploaded; Can MCM supervisors run a client level VL analysis report for their agency? Staff to contact PE and disseminate information to the Network. The Network inquired about eliminating client paper records by scanning documents into PE. The Grantee explained that documents used for monitoring need to be available- the mechanism for housing the documents is up to the agency. One agency noted that the client plan of care and consent forms are the only documents in their paper file. The Grantee agreed to follow up to ensure that PE is capable of housing client scanned documents for all agencies. VII. Case Study Review The Network tabled review of the Case Study. BCFHC to discuss outcomes report at the January Network meeting. VIII. Discuss Next Steps for Data Review The Network discussed the next steps for data review. Members were asked to run the PE report No Activity in 120 Days every other month and report findings to the Network. Staff to resend template to the Network. Members to report reasons clients are on the No Activity in 120 Days report and next steps done by the Agency (i.e. Outreach, Linkage, follow-up call, etc ). There was a discussion about clients closed to MCM but open at the Agency; Members noted that the PE report includes all clients open to the agency regardless of whether they are in MCM or not. Staff to inquire with PE about running the No Activity in 120 Days report by service category (i.e. only clients in MCM). 2

4 IX. Old/New Business There was a discussion about the importance of conducting Desktop and Supervisory Note reviews. Members noted the importance of reviewing case manager notes to identify issues and check the quality of the notes. Members also noted the importance of ensuring that case managers feel comfortable coming to their supervisors with questions/concerns. The Network agreed that an upcoming MCM training should review Plan of Care and ways to assess client goals. The Network reviewed the revised bus pass eligibility (copy on file). Members noted the change in bus pass eligibility (400% FPL), with at least 2 appointments scheduled per month (i.e. core/support services). X. Resource Sharing One member inquired about changes to the Request for Proposal (RFP) regarding reclassification of medical case management and non-medical case management services. The Grantee to provide information as it becomes available. Legal Aid to come to the next Network meeting to have a discussion about assisting clients with disability paperwork; Legal Aid is spending more time than anticipated with this task. World AIDS Day event taking place on December 3, 2013 at Hagen Park from 4pm-7pm Wilton Manors Drive, Wilton Manors, FL Flyers to be distributed when they are ready. There will be 3 Education and Community Engagement sessions about Ryan White Reauthorization with a speaker from Washington D.C. The first session will be held on Wednesday December 18, 2013 from 6pm- 8pm at the Family Success Center 4733 S.W. 18 th Ave., Hollywood, FL The second session will be held on Thursday December 19, 2013 from 2:30pm-4:30pm at MODCO 401 NW 9 th Ave., Ft. Lauderdale, FL The third session will be held on December 19, 2013 at Hagen Park from 6pm-8pm Wilton Manors Drive, Wilton Manors, FL Medical Case Managers are encouraged to invite clients to attend these community engagement sessions. Flyers to be distributed when they are ready. XI. Review Agenda Items for Next Meeting Standing Agenda Items Legal Aid Presentation NQC In+Care Campaign Measures XII. Adjournment The meeting was adjourned at 10:53 A.M. Next Meeting Date: January 7,

5 IN+CARE CAMPAIGN RETENTION MEASURES Gap Measure Percentage of patients, regardless of age, with a diagnosis of HIV/AIDS who did not have a medical visit with a provider with prescribing privileges in the last 6 months of the measurement year. Medical Visit Frequency Percentage of patients, regardless of age, with a diagnosis of HIV/AIDS who had at least one medical visit with a provider with prescribing privileges in each 6-month period of the 24-month measurement period with a minimum of 60 days between medical visits. Patients Newly Enrolled in Medical Care Percentage of patients, regardless of age, with a diagnosis of HIV/AIDS who were newly enrolled with a medical provider with prescribing privileges who had a medical visit in each of the 4-month periods in the measurement year. Viral Load Suppression Percentage of patients, regardless of age, with a diagnosis of HIV/AIDS with a viral load less than 200 copies/ml at last viral load test during the measurement year. DATA SUBMISSION DATES Submission Due Date Measurement Year* 24 Month Measurement Period** 12/01/ /01/ /30/ /01/ /30/ /01/ /01/ /30/ /01/ /30/ /02/ /01/ /31/ /01/ /31/ /01/ /01/ /31/ /01/ /31/ /01/ /01/ /31/ /01/ /31/ /01/ /01/ /31/ /01/ /31/ /03/ /01/ /30/ /01/ /30/ /01/ /01/ /30/ /01/ /30/ /01/ /01/ /31/ /01/ /31/ /03/ /01/ /31/ /01/ /31/ /01/ /01/ /31/ /01/ /31/ /01/ /01/ /31/ /01/ /31/ /02/ /01/ /30/ /01/ /30/2013 *applies to the following measures: Gap Measure, Patients Newly Enrolled in Medical Care, and Viral Load Suppression ** applies to the Medical Visit Frequency measure 1 NQC In+Care Retention Rates

6 BROWARD COUNTY RATES Gap Measure 30% 28% 22% 23% 23% 23% 22% 20% 19% 17% 18% 21% 22% Medical Visit Frequency 49% 47% 48% 49% 49% 51% 51% 52% 54% 56% 55% 55% 58% Patients Newly Enrolled in 35% 44% 46% 41% 40% 47% 50% 53% 51% 54% 52% 46% 39% Medical Care Viral Load Suppression 66% 67% 61% 61% 61% 62% 70% 70% 69% 68% 66% 71% 63% 2 NQC In+Care Retention Rates

7 PART A BENCHMARK REPORT GAP MEASURE Broward 30% 28% 22% 23% 23% 23% 22% 20% 19% 17% 18% 21% 22% Average 16% 16% 15% 15% 14% 15% 15% 14% 14% 14% 17% 13% 12% Top 10% 3% 4% 3% 3% 3% 4% 3% 3% 3% 2% 2% 2% 2% Top 25% 6% 6% 6% 6% 6% 6% 6% 5% 5% 5% 4% 4% 4% 3 NQC In+Care Retention Rates

8 PART A BENCHMARK REPORT MEDICAL VISIT FREQUENCY Broward 49% 47% 48% 49% 49% 51% 51% 52% 54% 56% 55% 55% 58% Average 63% 64% 63% 64% 65% 65% 65% 68% 69% 69% 66% 68% 70% Top 10% 93% 96% 93% 94% 94% 94% 94% 93% 95% 96% 94% 96% 93% Top 25% 85% 86% 86% 86% 86% 87% 88% 88% 89% 90% 91% 91% 89% 4 NQC In+Care Retention Rates

9 PART A BENCHMARK REPORT PATIENTS NEWLY ENROLLED IN MEDICAL CARE Broward 35% 44% 46% 41% 40% 47% 50% 53% 51% 54% 52% 46% 39% Average 56% 58% 59% 60% 59% 55% 56% 58% 57% 52% 61% 62% 60% Top 10% 97% 98% 97% 94% 96% 100% 100% 96% 100% 100% 100% 100% 100% Top 25% 84% 84% 84% 85% 83% 89% 88% 80% 86% 88% 92% 88% 88% 5 NQC In+Care Retention Rates

10 PART A BENCHMARK REPORT VIRAL LOAD SUPPRESSION Broward 66% 67% 61% 61% 61% 62% 70% 70% 69% 68% 66% 71% 63% Average 70% 70% 71% 72% 72% 72% 72% 72% 72% 72% 71% 73% 73% Top 10% 86% 87% 87% 87% 88% 88% 88% 87% 88% 88% 88% 89% 87% Top 25% 82% 83% 83% 83% 84% 84% 84% 84% 85% 85% 85% 86% 85% 6 NQC In+Care Retention Rates

11 PE Follow-Up to MCM Network Questions - Is there a report that can show all clients who did not have a VL/CD4 in the last 6 months of a measurement period? (Would it be associated with the alert for no VL or CD4?; Is there a way to get that kind of detail with the Required Action Report?) Yes, I would run the Required Actions by Action - Selective Report. - The MCM supervisors mentioned that in some cases, when a client file is opened, the alert for no VL/CD4 comes up even though labs have been entered/uploaded Example clients, please? - Can MCM supervisors run a client level VL analysis report for their agency? Yes, Viral Load Analysis - Detail - We have been encouraging the supervisors to run the No Activity in 120 Days Report. The report has helped them clean up their caseloads. The supervisors say that the report includes all clients open to the agency regardless of whether they are in MCM or not. Is there a way to run the report only for clients who are in MCM? Active Clients With No Activity in Selective # of Days - Selective Category MCM Network, January 7, 2014

12 FY Medical Case Management Network Work Plan March April May Review Annual WP In+Care Data Review Meeting Cancelled Review baseline HHS Data Discuss Analysis of Gap Measure CLD Discuss findings from agency CLD review Review Findings from Client Survey June July August Review Client Level Retention Rates Develop Retention QIP Review Training Evaluations and Pre/Post Test Results Review Summary Findings from Client Survey Meeting Cancelled In+Care Data Review Review Do stage of PDSA/Agency Presentations on QIP findings Review Summary Findings from Client Survey Case Conference September October November Meeting Cancelled Mental Health Presentation on Assessing Depression Agency Specific Presentation on QIP Implementation Case Conference Ryan White Part A Outreach Discussion Agency Specific Presentation on QIP In+Care Data Review Review Supervisory Action Plan Review Summary of Desktop Review Case Conference December January February Meeting Cancelled Annual Breakfast Janssen Innovative Digital Assets Presentation In+Care Data Review Case Conference Legal Aid Presentation In+Care Data Review Data Review on PE Report: No Activity in 120 Days Annual Evaluation of Accomplishments and Challenges Case Conference Update WP