Central Texas hiv/aids planning Area



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BVCOG has had great success in evaluating services outcomes through requiring subcontractors to report HAB measures, which are evaluated quarterly. In addition to being helpful for evaluating provider quality improvement, requiring these measures has been particularly effective for encouraging client receipt and agency tracking of vaccinations and regularly required screenings, such as CD4 and viral load tests. However, tracking health screenings and vaccinations such as influenza and hepatitis series that are available at retail health clinics or other agencies that are not part of the Ryan White system has posed a challenge. Clients appear to be reporting these vaccinations and screenings less often than would be reported in a traditional health setting. This gives the appearance that subcontractors are not providing these services and presents the risk of exposing clients to duplicate vaccinations.


Initial client focus group data seems to indicate that some clients have a misunderstanding of what information is shared in ARIES, as well as who contributes to the ARIES database. If some clients believe that all medical information is shared in ARIES, regardless of the provider, then it is possible that clients are not actively withholding the information; rather the clients may think that information is already available to case management staff. The anticipated output of this goal is an increase in HAB measure vaccinations and screenings in client files and ARIES. The anticipated outcomes are increased client reporting of health services accessed through retail health clinics or other non-Ryan White providers, and increased quality of care. This goal will be completed within less than one year. Though achievement of this goal is vital for improved reporting and quality management purposes, once the underlying issues are identified the problem of vaccinations going unreported/underreported should be relatively easy to address.
Referred to throughout the course of this comprehensive plan is the goal of supporting client self-advocacy. This proposed strategy will equip clients with the tools necessary to independently navigate resource networks in their service areas by reducing informational barriers.


GOAL 3: Support client self-advocacy: improve the information given to clients regarding what services are available from their HIV service provider and through referral.

  • OBJECTIVE 3.A Develop a standardized format of necessary information to be included in client information packets.

  • OBJECTIVE 3.B Provide technical assistance to subcontracted agencies in order to develop standardized client information packet to be given to clients at intake. These packets would include agency, referral and community resource information.

  • OBJECTIVE 3.C Follow up survey of clients for informational barrier reductions.

Clients who are engaged and empowered while seeking services are more likely to adhere to treatment and experience greater satisfaction with the care they receive. Clients receiving these information packets will have the information necessary to request the services they require, and obtain services from their community with greater ease. The anticipated output is a standardized format by which agencies can construct their own information packets to be given to clients at intake and upon request. The anticipated outcome will be an increase in client knowledge of available services, and improved client ability to navigate those services to enhance overall health and quality of life. Though the development of a standardized packet and resource guide should be completed fairly quickly, additional time is necessary to see increases client knowledge of services in any observable way. We predict this project will take between one and two years to accomplish.


One of the more long-term goals is the preparation of subcontracted agencies for the changes that healthcare reform/the Affordable Care Act will bring to the CTHASA service system.


GOAL 4: Preparation of Agencies for Health Care Reform/Affordable Care Act: Prepare providers for the impact of Health Care Reform policy and the Affordable Care Act

  • OBJECTIVE 4.A Research anticipated impact of Affordable Care Act and changes to Medicaid that will be in effect in 2014

  • OBJECTIVE 4.B Develop pertinent TA for case management staff (ex: Enrolling previously ineligible clients in Medicaid, navigating the health insurance exchange voucher program; changes in ADAP benefits, etc.)

  • OBJECTIVE 4.C Facilitate continuing education for case managers on emerging topics related to changes in healthcare policy.

  • OBJECTIVE 4.C Inquire with CTHASA FQHCs about readiness to treat newly Medicaid eligible PLWHA

Though ultimately contingent upon a ruling by the Supreme Court, the Affordable Care Act promises to bring a number of changes for agencies, as more clients than ever before will become eligible for Medicaid or other government health insurance voucher/exchange programs. Currently, enrollment in Medicaid can be a rather difficult process for many clients, and before the changes the Affordable Care Act take effect in 2014, BVCOG would like subcontractors to be prepared to guide clients through the changes. As more clients become eligible for Medicaid, the FQHCs in the area (particularly in Bryan-College Station, Waco, and Austin) may experience an increase in the number of PLWHA seeking medical services. BVCOG will inquire about FQHCs capacity to treat PLWHA and facilitate communication between providers and their local FQHCs. The activities for accomplishing this goal will shift as the Affordable Care Act is rolled out, but the anticipated outcome is increased self-efficacy of BVCOG funded agencies to navigate the new system, and guide clients to making informed decisions about their healthcare in light of these changes.



Section 4: How Will We Monitor Our Progress?
BVCOG will continue to provide the monitoring and evaluation services discussed in the current system of care in Section Two. A matrix will be created for each service system improvement goal to track progress and challenges in the implementation process. The BVCOG Planner will revisit and update these matrices each quarter and report progress during BVCOG’s Quality Management Committee meetings, and in Quarterly Reports to DSHS. The BVCOG Planner will also generate an annual progress report no later than April 30th detailing progress, challenges encountered, and revisions made to the comprehensive plan. This report will be submitted to DSHS as well as the subcontractors and any other interested parties.
For the goal of out of care (OOC) reduction, success will be measured by fewer OOC clients identified at each quarterly data review. Success for the goal of increasing and tracking of preventative vaccinations and screenings will be evaluated by an increase in the percentage of clients meeting the HAB measures related to vaccinations and screenings that are reviewed quarterly. Success in the goal to increase client self-advocacy will be measured by increased client comprehension and navigation of local resource networks. This may be evaluated in a number of different ways, many of which will require subcontractor and client input on the improvements made. Should the next comprehensive needs assessment indicates a reduction in the level of unmet need, this may be one indicator of success, as clients who are better able to navigate the system for themselves will no longer be experiencing the same gaps and barriers to accessing care. Another option would be to conduct a survey or focus group among clients, have them list all the resources they can think of, then pile-sort those resources into services they know how to directly access, services they don’t know how to access but know whom to ask about access, and services they do not know how to access. Measuring success for the final goal, preparing agencies for health care reform/Affordable Care Act implementation, will involve evaluating increased self-efficacy of case management staff to assist clients with services in light of the upcoming changes to national, state and local healthcare environments. Decreased requests for technical assistance is one method of evaluating increased case manager self efficacy, as is the increased number of clients who are successfully enrolling and participating in the new healthcare system. Success will also be measured by increased communication between providers and local FQHCs.


Appendix A – Counties In The Planning Area

Austin HSDA: Bastrop, Blanco, Burnet, Caldwell, Fayette, Hays, Lee, Llano, Travis, Williamson
Austin TGA: Bastrop, Caldwell, Hays, Travis, Williamson
Bryan – College Station HSDA: Brazos, Burleson, Grimes, Leon, Madison, Robertson, Washington
Concho Plateau HSDA: Coke, Concho, Crockett, Irion, Kimble, McCulloch, Mason, Menard, Reagan, Schleicher, Sterling, Sutton, Tom Green
Temple – Killeen HSDA: Bell, Coryell, Hamilton, Lampasas, Milam, Mills, San Saba
Waco HSDA: Bosque, Falls, Freestone, Hill, Limestone, McLennan

Appendix B – Performance Measures
In accordance with guidance issued by the Texas Department of State Health Services (DSHS) on December 8, 2008, the first four measures are included in this plan. The term contractor refers to BVCOG, and sub-contractor or sub-grantee refers to an agency or organization contracted with BVCOG, excluding DSHS.
1. The contractor will have sub-contracted 100% of all Ryan White SD and/or State Services funds as applicable to the contract, no later than thirty (30) days after the start of the contract year.
2. The contractor will submit complete quarterly reports according to the Reporting Due Dates listed in the contract.
3. The contractor will perform at least one monitoring visit on each sub-grantee according to the contracts’ monitoring policy, for a total of nine (9) monitoring visits.
4. No less than ninety-five percent (95%) of Ryan White SD, Ryan White AA, and State Services funds will be expended by the end of the respective contract year.

Appendix C – FY2012 Allocations for RW-B and SS
Following are the allocations and justifications for the 2012-2013 Ryan White Part B and 2011-2012 State Services grant years. Allocations to reflect changes in the Ryan White Part B 2012-2013 contract year and the 2012-2013 State Services allocations will included in the next update of this document.
Austin HSDA Part B Allocations 2012-2013:

Service

Ryan White

State Services

Changes from 2011-2012 Allocations

Outpatient/Ambulatory Medical Care

$719,132

$136,021

Due to the success of one provider in managing multiple funding streams to provide clients with lab and medical visit assistance, OAMC funding has been reduced $20,000 in the Austin HSDA for 2012-2013.

Mental Health Services

$70,000

$20,000




Oral Health Services

$80,000

$0




Health Insurance Premium and Cost Sharing Assistance

$55,768

$69,000

The need for health insurance assistance is particularly high and growing in this HSDA, which necessitated an increase of $5,000.

AIDS Pharmaceutical Assistance-Local

$64,562

$20,000




Case Management- Non-Medical

$0

$258,700





Food Bank/Home Delivered Meals

$0

$7,000




Transportation Services

$0

$10,000




Medical Transportation

$20,000

$0

This service category was added in response to initial client feedback regarding transportation as well as to utilize the Austin HSDA allocation more efficiently.

Bryan/College Station HSDA Allocations 2012-2013:



Service

Ryan White

State Services

Changes from 2011-2012 Allocations

Outpatient/Ambulatory Medical Care

$65,400

$0

OAMC funding in the Bryan HSDA has increased $7,900 for 2012-2013 as frequent reallocations have been necessary to sustain this service category.

Mental Health Services

$6,600

$0




Oral Health Services

$35,215

$13,000




Health Insurance Premium and Cost Sharing Assistance

$8,000

$0

The reduction of $7,900 in HIPCSA funding reflects the decline in the number of clients in the Bryan-College Station HSDA who have health insurance.

AIDS Pharmaceutical Assistance-Local

$11,000

$0

AIDS Pharmaceutical Assistance funding has been reduced by $2,000 due to the provider’s success in assisting clients in applying for the Texas HIV Medication Program (THMP).

Case Management- Non-Medical

$110,553

$40,497




Food Bank/Home Delivered Meals

$0

$2,000




Transportation Services

$0

$19,000




Medical Case Management

$56,006

$0




Psychosocial Support

$0

$1,500



Concho Plateau HSDA Allocations 2012-2013:



Service

Ryan White

State Services

Changes from 2011-2012 Allocations

Outpatient/Ambulatory Medical Care

$89,635

$0

$365 of OAMC funding was moved to Medical Nutrition Therapy as the provider has identified clients who are in need of and willing to receive services from a medical nutrition therapist.

Mental Health Services

$3,000

$0

Funding decreased by $5,500 for this service category as client utilization has declined.

Oral Health Services

$11,369

$0




Health Insurance Premium and Cost Sharing Assistance

$17,600

$0

HIPCSA in the Concho Plateau HSDA received an increase of $11,100 in response to a documented increase in the number of clients requiring assistance to meet COBRA, Medicaid Part D payments in addition to an increase in the number of clients now covered through employers.

AIDS Pharmaceutical Assistance-Local

$3,000

$0

Funding in this service category was decreased by $3,500 in 2012-2013 as the provider has had success helping clients attain medication co-pay cards.

Case Management- Non-Medical

$36,000

$65,450




Food Bank/Home Delivered Meals

$0

$1,800




Transportation Services

$0

$250




Medical Case Management

$18,580

$0

Funding in this service category was decreased $2,100 as the medical case manager is also funded through HUD for providing HOPWA case management.

Medical Nutrition Therapy

$365

$0

This service category was added as the provider has identified clients who are in need of and willing to receive services from a medical nutrition therapist.
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