June Gipson, PhD, President and CEO, My Brothers Keeper, Inc Rozetta Roberts, RN, Director of Clinical Services, Medical AIDS Outreach of Alabama

Transcription

1 June Gipson, PhD, President and CEO, My Brothers Keeper, Inc Rozetta Roberts, RN, Director of Clinical Services, Medical AIDS Outreach of Alabama Reginald Vicks, RN, BSN, MBA, COO, Crescent Care

2 June Gipson, PhD President/CEO My Brother s Keeper, Inc November 29, 2016

3 Mission To enhance the health and well-being of minorities through leadership in public and community health practice, collaboration, and partnerships.

4 Center for Research, Evaluation, and Environmental Policy Change Center for Community Based Programs Open Arms Healthcare Center

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6 Today s changing U.S. healthcare landscape places an urgent emphasis on improving the quality of patient care and reducing overall costs, and creating more patient centered outcomes. ACA Affordability Limited Coverage exclusion Choice Extended coverage for young adults Medical-Home Model Quality Decentralizing Healthcare to the Community Level Promoting Public Health-Prevention

7 Community based organizations (CBOs) play a frontline role in HIV/AIDS prevention activities. However, CBOs face formidable challenges to effective delivery of HIV prevention services. Bio Medical Intervention PrEP/PEP Treatment as Prevention Third Party Billing Lack of diversity in services and staff Weak partnerships (Academia, Clinics, and Hospitals)

8 Open Arms Healthcare Center

9 Open Arms Healthcare Center (OAHCC) is an innovative, holistic primary healthcare clinic that offers preventive, clinical, and mental health services to underserved, underinsured, and underrepresented populations in Mississippi, with emphasis on the Lesbian, Gay, Bi-sexual, Transgender, and Intersex (LGBTI) communities.

10 Open: 2013 Preventive Health-Monday-Friday Clinical care-saturdays only Becoming a Healthier U Men Health 1 part-time internal medicine physician 1 part-time nurse practitioner

11 The Clinical-Community Based Model for Healthcare Services is a Community Health Team led initiative that emphasizes coordinated service delivery to prevention and clinical services. The model emphasizes that the clinical and community-based professionals are bi-directionally educated about their roles and that they collaborate with one another about their patient s health to achieve optimal patient well-being.

12 The CCB Model includes components: Harmonization Speaking the same language Service delivery Service Profile Communication Health record Evaluation Meaningful use Data Collection Billing

13 Community Based Organization My Brother s Keeper Clinic Open Arms Healthcare Center

14 Primary Healthcare PrEP/PEP HIV Care Family Planning Men s Health Sister to Sister Clear ARTAS Becoming a Healthier U Transportation Patient Navigators Case Management Food Pantry Housing

15 Monday-Friday Women s Health Family Planning PrEP Transgender Health Mental Health Transportation Emergency Food Assistance 3 part-time internal medicine physicians 1 full-time nurse practitioner 1 part-time nurse practitioner

16 Successes Blended Approach to Providing HIV Prevention, Care and Treatment Services Broader Reach Improved Retention Challenges Communication Service Profile Lessons Learned Invest in your staff Partnerships create limitless opportunities Layer Program Services

17 Thanks If you do what you ve always done, you ll get what you ve always gotten. -Tony Robbins

18 Rozetta Roberts, RN Clinic Director MAO of Alabama November 29, 2016

19 Mission Statement: MAO educates the public about HIV/AIDS and related illnesses and how to prevent transmission of infection. MAO provides culturally competent education, medical and social services to those living with and affected by HIV/AIDS and related illnesses. Vision: HIV/AIDS will be eradicated; until that is accomplished, MAO will ensure that all people in its service area living with HIV/AIDS and related illnesses can live a healthy life filled with dignity and respect.

20 1987 volunteer organization established to provide respite and transportation 1992 Health Monitoring Clinic nurse and physician volunteers 1993 Ryan White Part C funds, transitioned from a volunteer education and service organization to a full-time, health care facility $200,000 budget Hired an Executive Director staff total 10 Started traveling to rural counties, opened small free standing clinic Dothan, AL Today, HIV, Hep C, PrEP and largest HIV-specific health care facility by geographic area served, within the state of Alabama with 68 employees Ryan White Part B, C, D total budget over $13 million Future expansion into Wellness Facility to serve families of all

21 The stigma surrounding AIDS is a key reason that the South is the epicenter of new HIV infections in the United States. Half of all new infections in the United States are in the South -The Washington Post Map: AIDSVu.org

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23 Source: AIDSVu.org/state/Alabama

24 Source: ADPH.org/AIDS

25 Source: AIDSVu.org/state/Alabama

26 Source: ADPH.org/AIDS 71% of newly diagnosed HIV cases and 70% of all persons living with HIV were Black during 2014.

27 Poverty Transportation Stigma Health Professional Shortages

28 Source: AlabamaPossible.org

29 62 of Alabama s 67 counties are HPSAs Specialty care is even more limited. Source: ADPH.org/ruralhealth

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34 Serving 29 counties & more than 1600 patients MAO complete primary health care that includes physician visits, laboratory tests, clinical pharmacist counseling, etc. MAO-Dothan, a second permanent clinic site, provides primary HIV specific health care five days per week. 10 rural medical clinic sites Social services provide case management, assistance in housing, securing medications, financial and support counseling and community referrals..

35 Pharmacy consultations Housing services Food Pantry on-site Mental health counseling Case management Education Prevention education HIV and Hepatitis C testing PrEP (Pre Exposure Prophylaxes) Interpretation services Family Wellness clinic

36 Prevention education and outreach is available to make the community aware of exposure risk factors. Prevention education programs are held in public housing communities, community centers, public and private schools and local churches/synagogues. AIDS in the workplace programs are provided to businesses and city/county/state agencies. Collaborations with 3 area substance abuse treatment centers to provide prevention education and HIV testing to this high-risk population. MAO also houses the Alabama AIDS Education and Training Center, a continuing education program serving healthcare providers and professionals statewide.

37 In 2011, faced with the confluence of rurality and poverty driven barriers and an ever increasing diagnosis rate, MAO sought a new means of providing care for rural clients. Realizing that the barriers to care were preventing rural Alabamians from accessing the care they needed, MAO looked for ways to break down barriers in order to bring quality care to underserved rural populations. Thanks to a matching grant from AIDS United in 2011, MAO was able to establish Alabama s first telemedicine network serving PLWH/A in rural Alabama. Using high-speed internet connections, Bluetooth peripherals, high definition audio-video equipment, and partnerships with rural social services organizations, MAO created a network to bring primary HIV care to rural Alabama without the need for travel.

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39 Medical Care (initial visit done in person) Individual psychotherapy Pharmacologic management Social Work Services Individual medical nutrition therapy Follow-up inpatient telehealth consultations

40 Alabama AETC is a joint project of MAO and the Southeast AIDS Education & Training Center (SE AETC). As the only SE AETC site managed by a non-academic CBO, Alabama AETC is uniquely qualified to develop and support professional and practice-based training programs focused on HIV care and prevention in our region, particularly in the areas of rural health and telemedicine. Alabama AETC can provide or connect you with in-person and online trainings, conferences, learning series, skill-building workshops, preceptorships and internships, clinical consultation, and technical assistance. Alabama AETC welcomes both practicing and student healthcare professionals with all levels of HIV experience.

41 Buy in from Collaborating Partners Buy in from State and Local Leaders Finding Matching Funds in a Poor State Third Party Payments Web-based Electronic Medical Records Work Space Issues for the Equipment Stigma in Rural Communities Technological Issues for ASO/CBO Entities

42 1/4 of our clinic patients are telemedicine patients Every patient has the right to see the provider in person Most patients found the technology nondisruptive and not significantly different than traditional care Patients did not view telemedicine as negatively impacting patient-provider relationship Concerns about telemedicine care were minimal >90% reported being extremely satisfied >95% virologic suppression rate >94% retention rate

43 I like seeing my doctor through the TV It s not really different because it s the same person Seeing Dr. Bhat in person & then on TV: I see it the same That s my buddy 83% of patients (15/18) reported being extremely satisfied (10 out of 10) with telemedicine services Patients expressed extreme gratitude for having access to compassionate, HIV care

44 Alabama ehealth Funders: AIDS United Alabama Department of Public Health CDC Alabama ehealth Collaborating Agencies: UAB Family Practice Residency Program, Selma, AL Southeast Alabama Rural Health Associates (SARHA) and their Doctor's Center in Troy, AL and Clayton Family Health Center, Clayton, AL Health Services Inc., Hayneville Family Health Center, Hayneville, AL

45 Expansion of telemedicine services to the Wiregrass & Black Belt areas to bring care to some of the poorest areas in the US Diabetes management Substance abuse treatment and counseling Wellness Center STI Clinic Direct Practice Telemedicine Resource Center Alabama AETC LGBTQ Cultural Competence Training HIV testing & linkage Telemedicine University Hep C testing & linkage

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47 2005 events following Hurricane Katrina 2006 regroup (recognize need contingency fund) 2007 full time Primary Medical Care 2009 Ryan White Part C grant 2011 Strategic Management 1 growth / expand scope 2012 HRSA Planning Grant Merger with AIDSLaw of Louisiana 2013 Strategic Management 2 move toward CHC model Ryan White Part D grant HRSA Section 330 grant (became FQHC) 2014 Family Care Service Center first site under scope Re-Branding CrescentCare Opened new clinic CrescentCare Health & Wellness Center 2015 CrescentCare Specialty Center under scope Strategic Management 3 internal systems/structure LSU Sexual Health Center Partnership (STD screening/treatment) Opened CrescentCare Oral Health Center

48 Year Annual Budget Staff Size Community Volunteers 2006 $3.5m $6.6m $11.9m RSR 2012 $19m RW PMC 2013 $20m UDS 2014 $27m $28m $32m $34m

49 Target population People living with HIV Partners and family of current (HIV) constituents LGBTQ population Service industry personnel Those living in geographic vicinity

50 3 CHC sites under Scope of Service - CrescentCare Health and Wellness Center - Family Care Services Center - Crescent Care Specialty Center

51 Move from primarily grant driven reimbursements to billing/payment methodology Billing / sliding-fee / collections How do we pay for it? Expanded mission (not strictly HIV focused) Communication to community / clients / staff Structural changes (administrative / cultural) Board composition & responsibilities Compliance / reporting

52 EHR/practice mgmt. system Billing and sliding-fee-scales New community partnerships Increased CQI activities Transition from ASO to CHC Expanded Mission Maintain organization legacy Expanded Information Technology

53 PCMH (NCQA Level III) CARF Accreditation Leader in LGBT Healthcare Equality Personnel (skills/expertise) Newly insured Revenue increase by 20% 49% increase in overall clients 82% increase in PMC clients Improved health outcomes Patient satisfaction feedback Incentive payments

54 New services Pediatrics Obstetrics/Gynecology Family Medicine Internal Medicine Integrated Behavioral Health Outreach/Enrollment Employment Services Medical/Legal Partnership Case Mgmt./Care Completion Patient/Community Education PrEP Clinic HCV screening/treatment On-site labs

55 2015 STD program partnership Dental Services (suite) Psychiatry HCV testing/treatment Nutrition 2016 Contract pharmacy (new site) PrEP campaign Transgender clinical care New CMO New EHR

56 2017/18 Plans for new site (combining 2 clinics, 2 prevention projects and administration LGBTQ Center of Excellence Radiology Optometry Dermatology Centering Pregnancy Expand Dental Expand access points Explore partnerships

57 Noel Twilbeck, CEO, NO/AIDS Task Force A Division of CrescentCare 2601 Tulane Avenue, Suite 500, New Orleans, LA Phone: (504) , ext. 228; Fax: (504) ; Cell: (504) Noel.Twilbeck@CrescentCareHealth.org Web: follow us on find us on facebook:

58 Reginald Vicks Chief Operations Officer NO/AIDS Task Force A Division of CrescentCare 2601 Tulane Avenue, Suite 500, New Orleans, LA Phone: (504) ; Ext Reginald.Vicks@CrescentCareHealth.org Web: follow us on find us on facebook: