Meeting of the Priority Setting & Resource Allocation Committee
Monday, January 10, 2022
By Zoom Videoconference
3:05 – 4:05
Members Present: Marya Gilborn (Co-chair), Jeff Natt (Co-chair), Fulvia Alvelo, Matt Baney, Paul Carr, Broni Cockrell, Joan Edwards, Billy Fields, Graham Harriman, Matthew Lesieur, Scott Spiegler (for Guadalupe Dominguez Plummer), Michael Rifkin, Leo Ruiz, Terry Troia, Dorella Walters
Members Absent: Eunice Casey, Henry Nguyen, Claire Simon, Victor Velazquez
Staff Present: David Klotz, Noelisa Montero, Bryan Meisel, Melanie Lawrence, José Colón-Berdecía, Karen Miller, Roland Torres (NYC DOHMH); Arya Shahi (Public Health Solutions)
Agenda Item #1: Welcome/Introductions/Minutes
Mr. Natt and Ms. Gilborn opened the meeting, followed by introductions and a moment of silence. The minutes of the December 13, 2021 meeting were approved with no changes.
Agenda Item #2: Review of the RWPA Portfolio: Mental Health Services (MSV)
Ms. Montero presented data from a study on MSV utilization and MH functioning. Multiple studies have shown that PWH are disproportionately impacted by mental illness and that this is associated with unsuppressed viral load and increased mortality. This study assessed changes in MH functioning among MSV clients and examined the association between levels of participation in MSV and improvement in MH functioning. Data was collected through eSHARE and the NYC HIV Surveillance Registry. Clients studied had to be continuously enrolled for at least 4 months, had at least one clinical visit (e.g., individual or group session or psych consultation), and had a reassessment between 4-8 months after intake. Clinical improvement was measured through a Mental Component Summary (MCS) score. Levels of MSV participation were calculated based on the number of clinical services received between intake and reassessment.
Client characteristics were described (e.g., demographics, employment, education and income levels, drug use, housing status). Most had previous MH treatment. Forty percent had a significant improvement in MH functioning scores from intake to follow-up. The main factor associated with improvement in MH functioning was level of MSV participation. Two-fifths of PWH receiving MSV experienced a clinically significant improvement in mental health functioning. Lower proportions of unemployed mental health services clients experienced an improvement in mental health functioning. There is a significant independent relationship between high and medium levels of mental health service participation and improvement in mental health functioning. Limitations of the study include that clients may have also received other MH services that are not funded by RWPA. Also, we don’t know when the services that clients received occurred in the observation period (e.g., a client who received a total of 20 services could have had 19 in the first month of the observation period, and then 1 in the last month).
A summary of the discussion follows:
- No quantitative data (i.e., client self-assessment of services) was collected, but this can be considered in future analyses.
- There is no data on people who had a need for the service but did not enroll. There is capacity in the programs, and so lack of enrollment would be due to other factors (e.g., personal barriers).
- Other services, particularly Supportive Counseling, use the MCS evaluation tool, which would allow for comparison with NSV clients.
- MSV clients with serious mental illness (SMI) are not broken out in this study, although there is data on them from intake and reassessment forms.
- MSV providers are expected to make referrals to employment and work readiness services.
- Trauma is not assessed, but the Recipient is looking at incorporating it into assessments and data collection in response to the new Framing Directive.
- The study was done pre-COVID, but future data analysis will incorporate the effects of the pandemic.
- It is difficult to separate the effects of MH issues and substance use and the effects of enrolment in Harm Reduction programs.
Agenda Item #3: Review of the RWPA Portfolio: Next Steps
Mr. Klotz presented a document that summarizes the data presented since January 2021 on the NYC services in the RWPA portfolio. The summary captures data from the Fact Sheets, additional studies and reports that were presented, and the highlights of the discussion at each PSRA meeting. Highlights that the Committee should consider as it moves into considering adjustments to the FY 2022 allocations include:
- Medical Case Management/Care Coordination: a further analysis of the overlap with Medicaid Health Homes will be presented at the next PSRA meeting. Also, at next week’s Council meeting, Mr. Shahi will present on how the Recipient monitors payer of last resort compliance.
- Harm Reduction: additional analysis on Medicaid billable services will be presented at the February meeting.
The Recipient will also present information on savings in the carrying costs of programs, as well as their recommendations for consideration by the Committee. Mr. Harriman added that the Committee will consider options for longer-range reductions to guide PSRA’s planning. Also, the Recipient is moving back to performance-based contracting in GY 2022, which will improve the ability to reprogram funds and maximize spending and will also give PSRA better data on actual performance.
Mr. Fields noted that increasing cost of food and the effects of COVID on that category and Housing. Mr. Graham and Mr. Klotz noted that it has always been a challenge to balance the needs for various services with the limited amount of RWPA funding. There is no discussion nationally on another COVID stimulus or HIV-targeted funding. Congress is considering a $10M increase nationally for RWPA, but this will only partially mitigate the cut to the NY EMA’s award. The only other new federal money for HIV is in the Ending the HIV Epidemic Plan.
There being no further business, the meeting was adjourned.