Integration of Care Minutes – February 21, 2024

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Minutes of the Meeting of the

Integration of Care Committee

Veronica Fortunato & Steve Hemraj, IOC Co-Chairs

Wednesday, February 21, 2024

10:00am-11:30pm

Watch the Zoom Meeting Here

Minutes

Committee Members: Ronnie Fortunato (Co-chair), Steve Hemraj (Co-chair), Raffi Babakhanian; Mitchell Caponi, Billy Fields, Deborah Greene, Christopher Joseph, David Klotz, Marcelo Maia, Karen McKinnon, Jeff Natt, John Schoepp, Gretchen Ty

Staff: Adrianna Eppinger-Meiering; Doienne Saab; Scott Spiegler, Johanna Acosta, Monika Pathak, Maria Ma, Tye Seabrook, Kimbirly Mack, Alyssa Prince

Agenda Item 1: Welcome, Roll Call & Moment of Silence

Ronnie and Steve opened the meeting followed by a moment of silence and a roll call.  The minutes from the January 24th meeting were approved with no changes.  

Agenda Item 2: Non-Medical Case Management for Incarcerated/Recently Released (NMI)

David reminded the Committee that at the last meeting, IOC began discussion of revising the EIS service directive, with an explanation of HRSA allowable EIS services and a review of the current directive to flag potential areas for review and revision.  For several years, RWPA EIS funds have been rolled into the PlaySure Network 2.0 (PSN) program along with City tax levy funds.  Maria and Tye presented on the PSN 2.0 program.

As background, HIV Surveillance data shows that inequities persist among new HIV diagnoses.  To address these inequities, over the years, DOHMH HIV Prevention has held community engagement activities, public forums and listening sessions and have found the same themes emerging over the years: invest in the health care workforce, focus on addressing stigma, address social determinants of health.  In designing PSN 2.0, the program took the foundation of the PlaySure Network 1.0 program which supported CBOs and clinical sites to work together in a network to provide HIV prevention and care services, and wove frameworks such as Human-Centered Design and Race to Justice.  PSN2.0 shifts away from the idea of quantity so that the goals are not just about numbers of HIV tests conducted or people on PrEP, but about increasing access to services in a one-stop shop model and the provision of non-stigmatizing and quality services.  The program has three core principles: client choice, pleasure-based approach to sexual health, reimagined one-stop shop model.  There are three indicators for quality-based reimbursement: process, experience and outcomes.  There are sixteen priority populations and programs should be tailored to them.  agencies must provide in-house and on-site services.  For those in non-clinical settings, that includes outreach (non-social media-based), navigation and HIV testing.  There are five agencies that provide services in non-clinical settings that receive both RWPA and NYC City Council funds.  

Services delivered through RWPA funds from Sept. 2022-August 2023 are HIV testing, referral to PrEP for those who test negative, and for those who test positive, referrals to iART, primary care and additional health and social services.  996 tests were performed, 20 of which were positive, of which 14 were successfully linked to HIV care.  A breakdown of those who were tested by priority population was given.  285 people were referred to PrEP, 15 to primary care and 5 to iART.  Of the $2.5M allocated to the program, $2.2M was spent.  A structural challenge to PSN 2.0 involves the hiring and retention of staff, given the various programmatic requirements with both City Tax Levy and RWPA funding being utilized across the portfolio.  The intensity and variety of services provided, and populations targeted in the program requires sophisticated Electronic Medical Records for tracking service delivery and utilization, and data entry systems that vary across funding sources.  This has proven to be an issue, especially in non-clinical settings, and has led to delays in service delivery.  Delays in hiring staff for necessary staffing positions have resulted in longer wait times for clients to receive or be referred to more supportive services and the timely and accurate submission of data to the Recipient.  Another data challenge involves PSN 2.0 agencies’ EMR capabilities.  There is great variation among PSN 2.0 agencies, including several agencies that do not have an EMR or who only recently obtained an EMR through PSN 2.0 funding (CTL). Without an EMR that contains PSN 2.0 data points, monthly and quarterly data extractions for submission can become a time-consuming process.  While CTL funds can be used to pay for the establishment of an EMR, Ryan White funds cannot.  Additionally, each payor allows for funds to be used to provide services that both differ and overlap, causing reporting challenges that have impacted PSN 2.0 programs.  Payor of Last Resort (POLR) requirements have emerged as an issue in current EIS programs in terms of reporting, administrative burden/staffing, and service delivery.  While CTL funds can be utilized to provide navigation and support services for participants regardless of HIV status, RWPA EIS funds have very specific requirements for the types of services that can be provided based on HIV status.  POLR requirements for RWPA programming require that EIS funds supplement, and not supplant, current testing efforts/programs. As such, agencies that are smaller and do not have the ability to capture data in an EMR find it exceedingly challenging to report services as required by HRSA.  They are also finding a demanding administrative burden with regards to ensuring POLR requirements are upheld while delivering a varied and intensive set of services that need to be tracked by payor.

Scott stressed that PSN2.0 is a navigation service with split RWPA and CTL funding that has had challenges with program monitoring, overall spend down and performance.  The two funding streams have very different reporting requirements, plus the POLR restrictions for RWPA can make having a contract burdensome and a lot of technical assistance is required, particularly for small agencies.  Some have returned contracts due to the high burden.  He also reiterated the HRSA standards and allowable services for EIS programs.  

A summary of the discussion follows:

  • The indicators are measured based on baseline data collected in the first year on progress towards delivering client-centered, affirming, non-stigmatizing care.
  • Some of those connected to care were previously tested and not newly diagnosed.
  • Reporting is very hard to track across funding streams.
  • Testing is done in areas where there are people with higher risk, but not necessarily at sex venues.  Other testing programs might be in those locations.  The IOC can include that programs provide testing in those venues as part of a revised directive.
  • Priority populations include people who with multiple identities, as they can chose “all that apply”.
  • There are goals for PrEP initiation, and it should be noted that people have the right to choose not to start PrEP, although the program will follow up with those clients for possible future uptake.
  • Spending is very high for the number of tests and the number of newly identified positives (although it should be noted that expenditures include staff, overhead, etc.).
  • The allocation amount will be determined by the PSRA Committee based on the need to fill gaps in the testing landscape.  The allocation was reduced about 10 years ago based on the low positivity rate and availability of other funders.
  • New EIS services would begin March 1, 2025 through a competitive bid process (RFP).  The RFP is based on the Council’s directive.  The Recipient and Public Health Solutions make widely known the availability of funding and give opportunities for proposers to get clarification through bidder’s conferences, forums, etc.  

David noted that the Committee will continue its process of fact finding and review for development of a revised directive, which can include direct feedback from current providers.

There being no further business, the meeting was adjourned.