Thursday, March 25, 2021
By Zoom Videoconference
M I N U T E S
Members Present: G. Harriman (Governmental Co-chair), D. Walters (Community Co-chair), P. Carr (Finance Officer), A. Abdul-Haqq, S. Altaf, F. Alvelo, D. Beiling, L. Best, A. Betancourt, R. Brown, R. Bruce, M. Caponi, E. Casey, R. Chestnut, B. Cockrell, M. Diaz, M. Domingo, J. Dudley, J. Edwards, B. Fields, R. Fortunato, T. Frasca, M. Gilborn, C. Graham, A. Lugg, D. Martin, G. Plummer, J. Reveil, M. Rifkin, J. Schoepp, C. Simon, M. Singh, M. Thompson, T. Troia, R. Walker
Members Absent: M. Bacon, M. Baney, P. Canady, B. Fenton, MD, B. Gross, J. Natt, D. Powell, A. Roque, L. Ruiz, S. Sanchez, F. Schubert, B. Zingman, MD
Staff Present: DOHMH: D. Klotz, J. Carmona, J. Colón-Berdecía, K. Mack, A. Azor, J. Bell, E. Jimenez-Levi, G. Navoa; Public Health Solutions: A. Feduzi; Parliamentarian: J. Corbisiero
Agenda Item #1: Welcome/Moment of Silence/Introductions/Minutes
Mr. Harriman and Ms. Walters opened the meeting followed by introductions and a moment of silence. Mr. Harriman conveyed condolences to Council staff Melanie Lawrence on the passing of her father. The minutes of the February 28, 2021 meeting were approved with no corrections.
Mr. Harriman and others paid tribute to former Public Health Solutions staff member Gucci Kaloo, who has left the agency after over 20 years. His many years of service and outstanding contributions have greatly enriched the Council’s work and helped improve the lives of Ryan White clients. Mr. Kaloo thanked the Council for the many years of collaboration and expressed his appreciation for the Council’s work.
Agenda Item #2: Recipient (Grantee) Update
Ms. Plummer reported that the Ryan White Services Report (RSR), a client-level data reporting requirement that monitors the characteristics of RWHAP recipients, providers and clients served is due March 29th. Two other conditions of grant award are due to HRSA in the upcoming months: the FY2020 Part A Annual Progress Report (May 29); and the FY2020 Federal Financial Report (July 30).
The Quality Management and Technical Assistance unit in the Care and Treatment Program distributed quarterly programmatic technical assistance memos to all funded programs to provide guidance about assisting clients with COVID-19 vaccination. Programs were instructed that health education about COVID-19, counseling about vaccination, and patient navigation to help clients access COVID-19 vaccinations may be reported under their contracts. December’s Power of Quality Improvement: Redesigning Systems to Address Social Justice and COVID-19 conference materials are now available. These materials can be accessed via the following link: https://drive.google.com/drive/folders/1bhfqSHfF0gjx1ZKA21ZwU9rbDRuBc-CE Finally, in recognition of National Women and Girls HIV/AIDS Awareness Day, the DOHMH Women’s Advisory Board (WAB) invites you to join virtually on March 24-26 for the 2021 Women’s Health and Activism Summit.
Agenda Item #3: Bylaws Amendment: Consumers Committee Duties
Mr. Fields presented a proposed Bylaws amendment to clarify the duties of the Consumers Committee. That Committee met over the winter to review the section of the Bylaws that describes their duties. The Committee felt that the current description was out of date and did not describe the actual roles and responsibilities of the committee. The Committee wrote a revised version, which was approved by the Rules & Membership Committee and is being brought to the EC for approval. The revised language reiterates that the core duty of the Consumers Committee is to ensure the meaningful participation of people with HIV in all aspects of the planning process. It also clarifies their role in recruitment, engagement, support and retention of consumers in Council activities. Mr. Fields read the proposed new language in Article VI, Section 5, IV: Consumers Committee, Section 1. Duties:
- Undertake efforts to ensure meaningful and substantial involvement of people with HIV in all Planning Council activities.
- Participate in outreach, recruitment, training and mentoring of consumers to enhance participation of people with HIV in Planning Council activities.
- Facilitate communication between the Consumers Committee and other Council committees.
- Provide consumer input on the work and products of other Council committees.
- Work with Council support staff to ensure that consumers have the resources they need to participate fully in the planning process.
Mr. Fields made a motion on behalf of the Rules & Membership Committee to the Bylaws amendment as presented. The motion adopted 33Y-0N by a roll call vote.
Agenda Item #4: Understanding the Ryan White Part A Budget and Quality Management
Mr. Harriman explained that it is important for the Council to understand the work of the Grantee and to better integrate the work of the Quality Management Program into the Council’ planning activities.
Mr. Klotz gave an overview of RWPA funding: the components of the award, how funds are funneled from Congressional appropriation through HRSA and the Grantee/Master Contractor to programs. The components of the award were also described: Base (formula and supplemental) and MAI. Ms. Plummer presented on the Administration component of the award and how the Grantee uses their portion of the award. CTP works with cities, states, and local community-based organizations in the EMA to provide comprehensive care and treatment services to PWH who are uninsured or underinsured and is responsible for the overall administration of the Ryan White Part A grant. CTP is part of BHIV, whose mission is to end HIV transmission, promote the health of all New Yorkers with or vulnerable to HIV, reduce HIV-related inequities, and combat stigma. She reviewed the program funding by service category and number of contracts. BHIV is currently led by Dr. Sarah Braunstein. The other key program staff were described.
The Care and Treatment Program oversees the Ryan White Part A and local Ending the Epidemic funding related to care and treatment. The Care and Treatment Program promotes optimal management of HIV infection in NYC through funded care, treatment, and support service programs reducing health disparities in delayed diagnoses focused on retention in primary care and viral suppression. The CTP’s Program Planning and Operations Unit oversees the planning and development of HIV-related health care and supportive service programs, manages the Ryan White Part A grant to ensure compliance with federal, state and local regulations, and works in collaboration with the Planning Council to allocate funding, develop program priorities and produce service directives. CTP is accountable for awarding contracts through a competitive procurement process, ensuring compliance with Conditions of Award, monitoring contracts to ensure fiscal and programmatic compliance, ensuring compliance with the 5% cap on unspent formula funds, and preparing fiscal reports for the DOHMH finance/budget office. CTP also shares reports, data, and aggregated de-identified contract and client-level data proactively in response to Planning Council requests. CTP leads the procurement process through Requests for Proposals (RFPs), and collaborates with the Planning Council to develop service directives which guide the content of the RFP.
Ms. Plummer introduced the Quality Management team led by Jennifer Carmona (see below) and the Research and Evaluation Unit (REU) team, led by Dr. Mary Irvine, which conducts program evaluation and intervention research, grant-writing, data systems design and documentation, and performance measurement for HIV services. REU evaluates RWPA services, prepares reports for the Planning Council, provides data support for annual RWPA progress report, provides oversight of the annual Ryan White HIV/AIDS Services Report (RSR) to HRSA, data systems design, modifications, documentation, and TA for HIV services reporting, and quality indicator measurement. Every REU staff member has been activated for at least portions of the last year for the pandemic response, some for the entire past year; and the vast majority are currently on COVID duty. REU also oversees a number of projects associated with RWPA programs, such as federal EHE grant programs, CHORDS (Care Coordination evaluation), and SUCCEED (HCV elimination). Many of those projects are developed with outside partners, such as CUNY and Columbia Univ.
CTP embeds a health equity lens in order to ensure health disparities for people with HIV are addressed in the delivery of program and collection of data. In addition, the role of health equity includes addressing stigma, institutional and structural racism, inequities, and social justice. This is done in a collaborative effort with the Planning Council to ensure priority population needs are addressed during the development of service directives for RWPA funded programs. is committed to aligning its work with the disease control and the wider Race to Justice goals. In response to that, the CTP is working on projects such as workforce development, trauma-informed organizational change, and improving community engagement in RFP and program development. The Master Contractor, Public Health Solutions (PHS), manages both the NYC and Tri-County contracts. They conduct fiscal and performance-based contract monitoring. The DOHMH and PHS conduct joint site visits for fiscal and program monitoring. Other key BHIV units were described: Business Systems, Finance, and Human Resources.
Electronic System for HIV/AIDS Reporting & Evaluation (eSHARE) is thedata reporting system for all agencies funded to deliver HIV/AIDS services by DOHMHvia PHS. eSHARE provides a unified information system that allows data to be available in real time and accessible by all stakeholders. The HIV Housing Program oversees both RWPA and HOPWA funded housing services. There is also Training and Capacity Building, which provides TA to ensure high quality training and skills-building for RWHAP funded organizations. Finally, the HIV Epidemiology Program uses data from HIV registry to create the Ryan White and NYC HIV Care Continuum.
Ms. Carmona presented on the Quality Management (QM) program and its goals. All RWPA grant areas are required to maintain a QM program and work directly with their sub-recipients (programs) to provide overall direction and to implement, monitor and exchange data for performance measure data and/or quality improvement activities. In response, the NY EMA established its QM program in partnership with the NYSDOH AIDS Institute (AI, which has a long history of providing QM for RW recipients). Over the years, roles and responsibilities have evolved but the QM Plan for 2018-21 (put in place at the beginning of 2018) builds on the program’s earliest foundations. The vision of the QM program is to promote a comprehensive range of high quality care and treatment by ensuring that medical and supportive services address gaps in the HIV Care Continuum for PWH in the NY EMA. The QM Program responds to current challenges in HIV care and promotes the health priorities of PWH throughout the NY EMA.
QM program stakeholders include the Council, units within the DOHMH BHIV (Housing, Technical Assistance), AI, PHS, consumers, etc. There is a committee representing all stakeholders that meets regularly to provide overall guidance. QM can be thought of as having something in common with program evaluation: are programs doing what they are supposed to be doing, and are they doing it well? BHIV Care & Treatment Program (CTP) TA staff work with over 100 programs and are the principal liaison between DOHMH and the funded programs. The main components of the QM program are: 1) Setting expectations for program design and implementation; 2) Technical Assistance in QM (guiding program implementation & coaching for improvement); and 3) Assessment and monitoring. Examples of activities include: 1) Set expectations through contract scopes of work, program protocols; 2) Provide one-on-one TA to help programs meet expectations and provide coaching to recognize and address opportunities for improvement; 3) Work closely with PHS to monitor funded programs (including site visits). PHS monitors compliance with contract terms and DOHMH examines program implementation against expectations.
Another fundamental aspect of QM is peer learning for improvement. The QM program brings together providers in meetings and learning collaboratives to learn from one another. The annual Power of QI conference is another area where innovations have emerged directly. QM program also sets expectations for staff training and helps programs meet those requirements through BHIV’s T-TAP unit or other training providers in the community. Core QM activities also include research, evaluation and quality measurement, and assessing the consumer experience. They do this through systems (eSHARE) for reporting and evaluation, CHAIN, client satisfaction surveys, and the work of colleagues in REU who carry out some essential QM activities like the CSS. They’ve also innovated in the design and distribution of reports that merge eSHARE and surveillance data.
Highlights of upcoming QM program plans include: Updating the QM Plan for the NY EMA; Examining performance against targets during cost-based reimbursement period; Implementing PSS for TIGNCNB persons; Updating site visit protocols; Preparing for value-based payments for care coordination services; and Provider meeting & Power of QI formats.
A summary of the discussion follows:
- The Planning Council determines service category allocations, and in the case of Mental Health, the allocation has decreased over time as the providers meet payer of last resort requirements, meaning that most clients are able to get those services reimbursed by Medicaid.
- CTP provides programmatic assistance (e.g., meeting the terms of the service model), and PHS staff provides fiscal assistance, but both communicate with each other to support effective programs.
- The findings from the QM program (including feedback gathered in provider meetings) should be provided to the Council and its committees in a timely manner in order to help inform planning.
- There is a lot of potential for the Council engaging with the QM program in a more dynamic way.
Agenda Item #5: Public Comment, Part II
Ms. Best reported that the Consumers Committee is continuing its work to create a service directive to address the needs of older people with HIV (OPWH). At this month’s meeting, Moisés Agosto-Rosario from NMAC presented on the health and psychosocial needs of OPWH. The Committee paid heartfelt tribute to former Council staff member Darryl Wong, who accepted an award from the group.
There being no further business the meeting was adjourned.
Minutes approved by the HIV Planning Council on April 22, 2021
Graham Harriman, MA