Meeting of the Priority Setting & Resource Allocation Committee
Monday, March 8, 2021
By Zoom Videoconference
3:05 – 4:30
Members Present: Marya Gilborn (Co-chair), Jeff Natt (Co-chair), Fulvia Alvelo, Matt Baney, Randall Bruce, Paul Carr, Broni Cockrell, Joan Edwards, Billy Fields, Graham Harriman, Guadalupe Dominguez Plummer, Michael Rifkin, John Schoepp, Claire Simon, Terry Troia, Dorella Walters
Members Absent: Leo Ruiz
Staff Present: David Klotz, Scott Spiegler, Eleonora Jimenez-Levi, Mary Irvine, Jacinthe Thomas, Matthew Feldman, Kimbirly Mack, Karen Miller, José Colón-Berdecía, Dave Ferdinand (NYC DOHMH); Andrea Feduzi, Rosemarie Santos, Gemma Ashby-Barclay (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 February 11, 2021 meeting were approved with no changes.
Agenda Item #2: Data Needs and Sources for Planning
Mr. Klotz reviewed that the PSRA Committee, upon completing the FY 2021 spending scenario plan, agreed that PSRA would undertake in-depth planning to examine the service portfolio. The ADAP allocation will not be available indefinitely to cover reductions in the award and new initiatives. In addition to the data collected annually in the Service Category Fact Sheets (enrollment, spending, client demographics, service units), PSRA needs to look at service effectiveness and impact.
The BHIV Research and Evaluation Unit (REU) is almost entirely activated for COVID, and so there will need to be time allowances for compiling and presenting data. The process of evaluating every service category will take at least a full year, which will allow PSRA to complete the process for the final FY 2022 spending plan in spring 2022. For the application spending request, there will likely have to be a placeholder plan requesting a proportionate increase up to the maximum allowed by HRSA (5%).
Fact Sheets will be created for three categories for which they do not currently exist (Care Coordination, Food & Nutrition, Early Intervention), as they were newly rebid with new service models. For other categories, the Fact Sheets will be not revised, since the data for FY 2020 is skewed by the disruptions of the pandemic. Enrollment and spending are atypical as service provision moved to telehealth and reimbursement was shifted to a cost-based methodology.
In response to a questions, Ms. Irvine explained that information on clients’ employment and housing status is collected, which could be used as a proxy for overall changes due to COVID, but even that does not necessarily give an accurate picture, as only about 15% of RWPA clients report being employed in a non-pandemic year.
The Committee reviewed possible data and data sources by service category:
Care Coordination: The CHORDS study has data on linkage/engagement in care, and viral load suppression (VLS) for the old model, and the PROMISE study only has one finding so far for the new model. The new Fact Sheet and CHORDS may be the most useful sources of data.
Food & Nutrition (FNS): Published research by Dr. Feldman as well as the CHAIN study details the correlation between food insufficiency and lower health outcomes/VLS, underscoring the need for FNS generally. It will be unlikely to find data linking the impact of specific FNS programs (and models, such as home delivered meals, pantry bags) to VLS. It was noted that the federal government has increased the amount of SNAP benefits (food stamps), which may have an impact of payer of last resort (POLR) issues.
EIS: PSRA reviewed positivity and linkage to care rates when they voted to reduce the allocation to this category several years ago. Also, some metrics (linkage to PrEP/PEP) are specific to prevention-funded EIS services.
Housing: Information on the impact of Housing on engagement and durable VLS is available both from BHIV Housing Unit reports and from CHAIN. Information on the number of people placed in housing who then drop out of housing would be helpful. Also, information on demand through provider self-reports is available.
Non-Medical Case Management/Rikers: There is data on engagement and VLS from the H+H program that works on Rikers Island.
Legal Services: There is limited outcome data on this category due to issues of attorney-client privilege. Aggregate data may be available, for example, on evictions prevented or successful applications for SSI benefits. This will require new data collection from providers, possibly by a Quality Management Specialist, which will take time. Programs are not required to do reassessments of clients for primary care status measures (e.g., VLS).
Mental Health: Data on dose-dependent outcomes (VLS depending on level of use of MH services) is available through research published by Dr. Feldman based on PHQ (Patient Health Questionnaire) and GAD (General Anxiety Disorder) quality of life and mental health assessments. It is difficult to control for level of MH need.
Harm Reduction: Dr. Feldman and CHAIN have also published data on the link between use of hard drugs and lower engagement/VLS.
Supportive Counseling: VLS data can’t control for baseline (the state people were in when they first sought services). A better metric would be resolution of the immediate issue presented.
Health Education & Risk Reduction: There is good pre- and post-intervention data on engagement and VLS using HIV surveillance matches.
Emergency Financial Assistance: Housing stability and income data would help assess this program.
In general, it was noted that there is a lot of dual enrolment (both with other RWPA programs, as well as non-RWPA), which makes it difficult to isolate the effects of one specific service.
Mr. Klotz will revise the service category data chart based on the above feedback and draft a timeline of presentations, beginning with the most readily available data. The timeframe for presentations could be as much as two service categories per meeting, including presentation of data and Q&A/discussion.
There being no further business, the meeting was adjourned.