Minutes of the Meeting of the
Integration of Care Committee
Veronica Fortunato & Steve Hemraj, IOC Co-Chairs
Wednesday, November 22, 2024
10:05am-11:25pm
Minutes
Members Present: Steve Hemraj (Co-chair), Billy Fields, Charmaine Graham, Deborah Greene, Christopher Joseph, David Klotz, Cesar Nuñez, Guadalupe Dominguez Plummer (ex-officio), Leah Richberg, John Schoepp, Gretchen Ty
Staff Present: NYC DOHMH: Michael Navejas, Doienne Saab, Meghan Peterson, Faisal Abdelqader, Mary Irvine, Gina Gambone, Grace Herndon, Scott Spiegler, Adrianna Eppinger-Meiering, Johanna Acosta, Kimbirly Mack, Nicki Harris, Marilyn Baculima, Connor Emmert
Agenda Item #1: Welcome/Introductions/Minutes/Public Comment
Mr. Hemraj opened the meeting followed by a roll call and a moment of silence. The draft minutes from the October 16th meeting were approved with no changes.
Agenda Item #2: Medical Case Management/Care Coordination (CCR) Service Category
The Committee continued the process of reviewing the CCR service category for revision of the directive in advance of a rebid of the program.
CCR Fact Sheet
Ms. Peterson presented three years of data (2021-23) on the CCR program, including client demographics, enrollment (including by priority populations identified as those with significant health disparities, service units provided by type and expenditures. It was noted that the enrollment, service units and expenditures were remarkably stable over the three years. Programs were also able to maintain their enrollments and services in the face of COVID-related challenges around staffing and retention that all social services faced.
Mr. Joseph noted that clients who find mDOT intrusive can use virtual services (which are now reimbursed). He described a pilot program using an app called “Wellth”, and he will provide the Committee with data on its effectiveness. Using technology is a low-cost, high impact way of providing many CCR services, although some clients will also require in-person services, such as accompaniment. There is also the consideration that technology may be unavailable or difficult to use for some clients. The app can also help close the gap between self-reports of treatment adherence and data from bloodwork.
Ms. Gambone and Ms. Herndon added that video conferencing in CCR started before COVID, but providing technology to clients who need it has been challenging, as HRSA has not allowed the use of RWPA funds for that. The programs are encouraged to refer clients to the Emergency Financial Assistance program, which can pay for that.
PROMISE Study
Mr. Abdelqader presented the results of the PROMISE Study, an outcome evaluation of the CCR program and its impact of viral load (VL) compared to PWH not enrolled in CCR. The study used program data from eSHARE for all CCR clients enrolled between August 2018 and March 2021, and VL results reported in the HIV surveillance registry. The base line groups were those with no VL results >200, newly diagnosed, inconsistently suppressed, and consistently suppressed. Outcomes evaluated were: short-term viral suppression (VS), durable VS, and re-engagement in care.
Data on the above outcomes were presented by overall CCR clients and broken down by priority population. CCR showed a significant 12-month VS advantage over usual care among those lacking evidence of VS in the prior year, within every priority population. Results related to durable VS pointed in the right direction but were not statistically significant. PWH enrolled in CCR had a shorter time to first VS after enrollment/pseudo-enrollment compared to usual care in all baseline treatment status groups.
Limitations to the data were described (e.g., small sample size for some populations), but overall, CCR was effective in improving short-term VS at 12 months among PWH who lacked evidence of VS, were inconsistently suppressed, or newly diagnosed with HIV relative to usual care. CCR improved DVS among clients lacking evidence of VS at enrollment, but no other baseline treatment group. These findings were consistent within nearly all priority population groups. CCR has a potential positive impact on re-engagement in care and time to VS.
There was discussion about why people who are eligible for CCR do not enroll, the overlap with Medicaid Health Homes, and the higher level of support needed for those who are eligible for Health Homes but can benefit from the additional attention that CCR can provide.
At the next meeting, the Committee will review the results of a literature review and will hear testimony from providers and clients of current programs.
There being no further comment, the meeting was adjourned.
