Thursday, March 30, 2023
By Zoom Videoconference
Members Present: G. Harriman (Governmental Co-chair), D. Walters (Community Co-chair), B. Fields (Finance Officer), R. Babakhanian, K. Banks, A. Betancourt, R. Brown, M. Caponi, R. Chestnut, J. Dudley, J. Edwards, R. Fortunato, M. Gilborn, J. Gomez, C. Graham, S. Hemraj, R. Henderson, B. Hribar, E. Kaywin, M. Lesieur, M. Maia, D. Martin, H. Martinez, J. Natt, J. Palmer, G. D. Plummer, J. Schoepp, M. Sedlacek, C. Simon, T. Troia, S. Wilcox
Members Absent: S. Altaf, F. Alvelo, M. Bacon, M. Baney, L. Beal, G. Bruckno, B. Gross, F. Laraque, N. Martin, W. LaRock, L. F. Molano, MD, L. Sabashvili, M. Rifkin, M. Thompson
Staff Present: DOHMH: M. Lawrence, D. Saab, S. Spiegler J. Acosta, G. Gambone, J. Nettles, K. Mack, D. Bickram, I. Newman, A. Eppinger-Meiering, C. Rodriguez-Hart, S. Torho, D. Noble, R. Torres, B. Meisel, C. Reynolds, J. Jaramillo; Public Health Solutions: G. Ashby-Barclay, A. Shahi, R. Santos
Agenda Item #1: Welcome/Introductions/Minutes/Public Comment
Mr. Harriman and Ms. Walters opened the meeting followed by a roll call and a moment of silence in honor of Women’s History Month and the many women who contributed to the fight against HIV. The Council also remembered former Council member Ruben Rios, who passed away recently. The minutes from the March 2, 2023 meeting were approved with no changes.
Agenda Item #2: Public Comment, Part I
Mr. Fields urged everyone to take action against gun violence.
Mr. Palmer and Mr. Lesieur urged people to continue advocacy around legislation to save the 340B program. The Medicaid pharmacy carveout is scheduled to be moved from managed care to fee-for-service this weekend, which may affect client ability to get their prescriptions. The switch may be delayed until a State budget is passed.
Agenda Item #3: Data Collection Workgroup Recommendations
Mr. Harriman presented the recommendations of the Council’s Data Collection Workgroup, which was formed to address long-standing challenges around Ryan White Part A (RWPA) program data collection (barriers to provider-level data, Inefficient data entry, inability to import or export data, and data collection burden on consumers and providers). The Workgroup was charged with developing recommendations to share with the Recipient, colleagues in NYC DOHMH, NYSDOH AIDS Institute, and HRSA to improve RWPA data collection through improved database technology. Current data flow was compared to an equitable data flow that benefits all stakeholders. A timeline of Workgroup meetings from February 2022 was given, including presentations from HRSA, DOHMH, eSHARE, and RWPA providers and consumers. The recommendations are summarized below:
- Remove collection for eSHARE of data on: AIDS diagnosis date, hospitalizations and ED visits, sexual history, other assessments.
- Eliminate collection of lab test data (except for Ambulatory Outpatient Care programs).
- Increased coordination between Recipient and Planning Council to ensure agreement on data collection needs.
- Recipient work with eSHARE or a future information system administration to develop routine service category data reports to inform the community planning process.
- Recipient inform Council of any additional data collection requirements communicated to Ryan White Part A funded programs
- Database changes (accommodate multiple funders, share with NYS AI).
- Sharing intake, eligibility, and demographic data between providers to reduce barriers to services for consumers and reduction of data collection burden for providers and consumers.
- Ensure organizations have access to their own data for performance measuring, quality assurance, and quality management.
- data collection efforts should be aligned with Medicaid data collection to increase interoperability, reduce redundancy, and burden.
After the Council ratifies the recommendations, they will be shared with NYC DOHMH, NYS AI, HRSA/HAB, the HIV Planning Group and other planning bodies. Ms. Simon and Ms. Plummer affirmed the desire of NYS AI and DOHMH to partner on a uniform data collection system.
A summary of the ensuing discussion follows:
- eSHARE is only for RWPA services (which do not include medical care) and is not an electronic medical record system like MyChart that clients would have access to for health care information.
- The chief benefit to consumers is that much of the data currently collected at intake in RWPA programs would already be available to providers, meaning less burden at intake and quicker access to RWPA services for consumers.
- Most eSHARE data is currently collected from consumers, and the information is being asked from consumers again and again, so these recommendations would reduce the burden on consumers.
- There is no patient portal or app for consumers to access their eSHARE data, which would require extracting the data, and the client making an appointment to come to the office and meet with staff in a secure space, which would create an undue burden for the programs.
Mr. Harriman recommended adding a recommendation for long-term consideration that there be a way for clients to access their eSHARE data in a reasonable time frame (for example by downloading data into a PDF that can be conveyed to the client), including information on which staff has access to the data.
A motion was made and seconded to accept the Data Collection Workgroup recommendations as presented with the addition as described above concerning consumer access to their personal data. The motion was adopted 26Y-0N.
Agenda Item #4: Quality Management Plan
Ms. Gambone presented the NY EMA Quality Management (QM) Plan for 2023-26, which was developed. QM is a systematic approach that supports assessment, assurance and improvement activities. HRSA requires the EMA to have a QM program that includes priorities and performance measures. The 2023-26 plan development started in January 2022 with strategic planning, obtained input from other sources, including the Council and Consumers Committee, and the QM Committee (which includes Council and Consumer Committee members) incorporated that feedback into the final document, which will be submitted to HRSA tomorrow. The Recipient partners with the NYSDOH AIDS Institute to drive the QM program in collaboration with other stakeholders, including the Council and consumers. The plan’s guiding principles include a trauma-informed approach, the Council’s Framing Directive, the Institute for Healthcare’s model for improvement. The QM activities (previously presented) were reviewed, e.g., capacity building, peer learning, training, resource development, and dissemination of resources (e.g., referral directory), lessons learned and consumer experience (e.g., client satisfaction surveys).
The QM program priorities and goals were described (health equity, consumer engagement, collaboration, capacity building, service engagement and quality). Overarching and measurable objectives for each goal were described (e.g., for Consumer Engagement, objectives include increasing the number of peer learning sessions). Consumer Committee feedback from a meeting on March 7, 2023 was incorporated, including multiple strategies for assessing services (e.g., secret shopper), trainings, feedback and other considerations (e.g., addressing stigma). Other ways of addressing Consumer Committee feedback were outlined, some already in progress (e.g., process mapping, QI training for consumers). Concerning consumer advisory boards, RWPA providers are already required to have a meaningful way for clients to provide input (e.g., CABs, surveys, participation in QM committees). RWPA providers expressed concerns about secret shoppers (staff burden, ineffectiveness for long-term service delivery, too many variables).
Mr. Fields and Mr. Babakhanian stressed the importance of CABs in providing high quality feedback through collective consumer input, but they need support, including training for CAB members and funding and TA to support them. In response to a question, Ms. Gambone stressed that training consumers on QM will help equip them with knowledge to optimize their feedback.
Agenda Item #5: NYC Mental Health Agenda
Dr. Neckles, DOHMH Assistant Commissioner of Mental Health, presented the NYC Mental Health Agenda to improve mental health treatment and outcomes, announced a month ago Mayor Adams. The agenda hopes to strengthen services for NYC residents in three areas: 1) Child, Youth and Family Plan, 2) Overdose Plan, 3) Seriously Mentally Ill (SMI) Plan. The plan is based on four pillars: 1) Health (improve access to specialty care), 2) Home (expand stable housing options), 3) Community (expand infrastructure), and 4) Response. Actions to implement these were described, such as a digital hub for referrals and expansion of clubhouses (social spaces for place-based interventions).
In response to a question, Dr. Nettles explained that the goal for people in crisis is to offer a health-first response. DOHMH trains first responders on de-escalation and other approaches to assess if someone needs a higher level of care (e.g., hospitalization). Cases can be challenging, particularly when someone does not want to go to the hospital voluntarily, and there are many variables. The Agenda focuses on alternatives to law enforcement involvement when possible through peer and clinical intervention.
Agenda Item #6: Public Comment, Part II
Mr. Martin reported that the Consumers Committee is sending a letter to the Recipient outlining additional concerns on the QM plan, particularly around consumer involvement in QM and CABs. The Consumers Committee is seeking that CABs be made mandatory and be provided with the training, funding and support to make them truly effective.
Mr. Harriman encouraged Council members to complete a survey concerning preferences for in-person and virtual meetings.
There being no further business, the meeting was adjourned.