Greg Moody gmoody@ healthmanagement 614-560-3212

Local Needs, Local Decisions:Improving HIV Care Services System Performance

Ohio AIDS Coalition/ODH

Leadership 2008April 15, 2008

Greg [email protected]

614-560-3212

mailto:[email protected]

mailto:[email protected]

Health Management Associates

Purpose of Today’s Session

• Present preliminary findings from a statewide systems assessment of Ohio’s Ryan White Part B Program

• Review epidemiologic, funding, and provider access trends that could impact local service capacity

• Discuss strategies to improve organizational effectiveness (participant input will assist HMA in developing final recommendations for ODH)


Part B Assessment Activities

Refine Methodology July-September

Collect Data August-November

Design an Interview Guide September-May

Consortium 2 Pilot October-November

Provider Survey October-December

Consortia Site Visits January-March

Reports May 2008



• HMA is a research and consulting firm specializing in public programs and underserved populations

• Our staff includes 80 former senior-level government officials and public program administrators

• Expertise in Medicaid, Medicare, and public health

• Nine offices nationwide including Columbus− On this project: Lisa Duchon, PhD, Donna Strugar-Fritsch,

Lori Weiselberg

− In Columbus: Barbara Edwards, Anne Harnish, Greg Moody, Alicia Smith, Aimee Lashbrook, Suzie Garcia


Consumer Profile

• HMA prepared a basic epidemiologic profile for each region

• ODH Surveillance trend data as of June 2007

• Translate ODH data tables into graphical information to assist thinking about current & future resource needs


Number of Residents Living with HIV/AIDS, by Part B Region, 2007

3,456

2,874

1,203894

489321 240 250 366

1,210

672

2,160

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

1 2 3 4 5 6 7 8 9A 9B 9C Unknown

Source: ODH HIV/AIDS Surveillance Program Trend Data, as of June 2007

14,135 Ohio residents are living with HIV/AIDS


Prevalence Rate of HIV/AIDS per 100,000 population, by Part D region

128.2

169.7

131.9120.1

82.7 75.2

50.1 49.3 43.9 45.8

112.7

184.7

0

40

80

120

160

200

Ohio 1 2 3 4 5 6 7 8 9A 9B 9C

Source: ODH HIV/AIDS Surveillance Program; percentage of Ohio population and PLWHA as of December 2005; percentage of new cases 2003-2005.


Ohio Prevalence Rates of Reported PLWHA,

by Gender and Race/Ethnicity, 2005

51.2 39.1

313.2

209.9

128.2

475.2

77.0

0

100

200

300

400

500

Total Male Female White, Non-Hispanic

Black, Non-Hispanic

Hispanic Asian/PI

Source: Ohio Dept. of Health HIV/AIDS Surveillance Program. Data reported through December 31, 2005. U.S. Bureau of the Census, 2000, for population data.

Rate/100,000 pop.


Distribution of Total Ohio Population and HIV and AIDS Prevalence, by Age Groups, 2005

18

17

5 2

13

20

16

40

41

2333

43

1 2

111

13

0

20

40

60

80

100

General pop. PLWHIV PLWAIDS

65+

45-64

35-44

25-34

13-24

<13

Source: Ohio Dept. of Health HIV/AIDS Surveillance Program. Data reported through December 31, 2005. U.S. Bureau of the Census, 2000, for population data.

percent


Ohio Incidence Rates of HIV Infectionby Age Groups, 2000-2004

1.8 2.5

15.4 16.113.7 14.5 14.3

33.536.4 36.1

38.635.4

2.02.11.7

0

10

20

30

40

2000 2001 2002 2003 2004

Source: Census 2000, U.S. Bureau of the Census, Ohio Dept. of Health HIV/AIDS Surveillance Program. Data reported through Dec. 31, 2005.

Rate/100,000 pop.

Age 35+

Age 13-24

Age 25-34


Funding Profile

• HMA analyzed state and federal funding streams for HIV/AIDS services in each region

• Based on ODH 2006 actual and 2007 grant data

• Part B spending per client ranges from $1600-$3400 (the per-client range is $2200-$5200 from all sources)


Ohio Part B Service Spending by Part Bregion, 2006 Actual (Yr 16)

$0

$500,000

$1,000,000

$1,500,000

$2,000,000

$2,500,000

$3,000,000

$3,500,000

1 2 3 4 5 6 7 8 9A 9B 9C

Source: Ohio Department of Health HIV Care Services, April 1, 2006 to March 31, 2007

Ohio Part B Service Spending = $13.1 million in 2006


Part B Spending per PLWHA and per client,

by region, 2006 (Yr 16)

$1,528

$2,619

$1,605

$2,674

$2,124 $2,166

$3,223

$2,237

$3,374

$2,179

$1,829

$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000

$3,500

1 2 3 4 5 6 7 8 9A 9B 9C

Per PLWHA Per Part B Client

Source: HMA Calculation based on ODH HIV/AIDS Surveillance Program Trend Data and ODH HIV Care Services data on Part B funding and number of clients


Part B Spending per client by major service category and region, 2006 (Yr 16)

$1,145

$1,893

$1,121

$1,673

$1,388

$1,721

$2,347

$1,625

$2,815

$1,760

$1,399

$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000

1 2 3 4 5 6 7 8 9A 9B 9C

Support Services Pot 15 OHDAP

Source: HMA Calculation based on ODH HIV/AIDS Surveillance Program Trend Data and ODH HIV Care Services data on Part B funding and number of clients


Part B and Other Federal HIV/AIDS spending in Ohio Part B region, 2007 (Yr

17)

$0

$1,000,000

$2,000,000

$3,000,000

$4,000,000

$5,000,000

$6,000,000

$7,000,000

$8,000,000

$9,000,000

1 2 3 4 5 6 7 8 9A 9B 9C

Other Federal Funds

Part B Services Spending

Source: Ohio Department of Health; “other” includes Ryan White Parts A, C, D and E, CDC prevention funds, and HOPWA funds

Ohio Part B Services = $13.1 million; Other = $15.1 million


Federal HIV/AIDS spending per PLWHA and per client, by region, 2006 (Yr 16)

$4,080

$4,747$4,242

$4,755$5,012

$3,946

$4,826

$4,089

$3,374

$2,179

$5,197

$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

1 2 3 4 5 6 7 8 9A 9B 9C

Per PLWHA Per Part B Client

Source: HMA Calculation based on ODH HIV/AIDS Surveillance Program information; and ODH HIV Care Services data on Part B funding and number of clients for 2006.


Delivery System Profile

• HMA prepared a regional service capacity profile for core services, with a focus on mental health and substance abuse services

• Called all Part B-contracted MH/SA providers to see if they are taking new patients and the wait, if any

• Called all Part B-contracted primary care providers to ask if they collect & report HRSA quality measures

• Reviewed access barriers to care (2007 needs assessment of PLWHA)


Percent of PLWHA in Case Management, by Part B region

62%

39% 39%46%

34%

76%

35%

55%

64%

55%

45%

0%

20%

40%

60%

80%

1 2 3 4 5 6 7 8 9A 9B 9C

Source: Ohio Department of Health


Case Management Outcome Survey Results

0%

20%

40%

60%

80%

100%

2 3 4 5 6 7 8 9A 9B 9C

% Received Needed Service % Did not receive needed service

Source: Case Management Outcomes Survey (April-September 2007) provided by ODH.


Number of Part B Clients Per Case Manager

0 0 0 0 0 0

150

52

75

6074

65

32

0

20

40

60

80

100

120

140

160

2a 2b 2c 3 4 5 6 7 8 9A 9B 9Ca 9Cb

Source:


Organizational Profile

• HMA visited every region (not Cleveland) to analyze how each community determines service needs, coordinates linkages and referrals, and coordinates planning, funding and service delivery

• Reviewed documents provided by ODH

• In-person interviews with case management staff and/or consortium coordinator and co-chair

• General themes emerged—HMA recommendations to ODH will be in response to the general themes…


General Themes

1. Streamline Program Oversight and Reporting

2. Share Data to Improve System Performance

3. Provide Consistent Policy Direction Statewide

4. Engage Regional Leadership to Define System

Objectives

Greg Moody gmoody@ healthmanagement 614-560-3212

Documents

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