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Ryan White Program
Hennepin County Public Health Department
525 Portland Ave., 3rd Floor
Minneapolis, MN 55415
612.348.5964
Email us
The Ryan White Provider Newsletter is issued semi-annually and provides information about HIV services planning, contract administration, quality management, CAREWare updates and training opportunities. Your feedback and suggestions for future issues are appreciated.
Contact Ryann Freeman
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As we enjoy summer and revel in
the year’s maximum sunlight, let’s take a moment to acknowledge how Minnesota’s
HIV service providers maximize efforts to ensure that all Minnesotan’s living
with HIV have access to high quality core medical and support services.
In 2017, infections in Minnesota declined
for the third year in a row. In Hennepin County alone, new infections in 2017
dropped to 130 cases, 19 fewer than in 2016. Although it may be too early to
conclude this decline in HIV incidence is a trend, the signs are encouraging.
In
2017, 4,386 people living with HIV received services through our Ryan White
system of care, an increase of four percent compared to 2016. Increasing
the number of people living with HIV who are virally suppressed is our mission,
which is key to getting to zero new infections. The work you do is the path to
our collective success. With the eHARS to CAREWare project now fully
operational, 83 percent of Ryan White Program service recipients now have
viral load values in CAREWare and we are better able evaluate our future progress.
In this issue, you will read about
Positively Hennepin’s first-year accomplishments and what we are focusing on in
2018. This summer the Minnesota Council for HIV/AIDS Care and Prevention will
prioritize services, allocate Part A funds, and recommend Part B allocations to
their priorities for fiscal years 2019 and 2020. You’ll also learn about the
cost of the services we fund and some training activities planned for 2018.
Be sure to take some time to enjoy
Minnesota’s glorious warm season.
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 The Minnesota Council for HIV/AIDS
Care and Prevention is busy setting their HIV-related service priorities, preparing to allocate Part A Ryan White HIV/AIDS Program and Part A Minority
AIDS Initiative (MAI) funding, and make allocation recommendations for Part B
federal Ryan White HIV/AIDS Program funding. The Planning
and Allocations Committee, Needs
Assessment and Evaluation Committee, and Disparities
Elimination Committee designed a prioritization and allocation process that is fair and
data driven. The Needs Assessment and Evaluation Committee created Service
Area Review Summaries (SARS) for each service area that the
council currently funds and presented the data to the council in May and June.
Using this data as well as additional
data that was presented at previous council meetings, the council will
use a paired comparison methodology to prioritize service areas. The council
will also prioritize a group of service areas that the Disparities Elimination
Committee believe will have the greatest impact on addressing and reducing
disparities within underserved and disproportionately impacted populations. On
August 7 the council will come together to review the list of core medical and
support service priorities and receive presentations on the Part A and Part B
allocation proposals. On August 14 the council will discuss ideas and evidence,
determine Part A allocations, and recommend Part B allocations for the next two
years. The final step is for the grant recipients
to contract with service providers in accordance with the council’s priorities,
allocations, directives, and recommendations.
Please contact council staff or
co-chairs if you have any questions about the prioritization and allocation
process. All council and committee meetings are open to the public and a
schedule of meetings is located at http://www.mnhivcouncil.org/calendar.html.
We welcome your attendance and participation at our meetings to help us end the
HIV/AIDS epidemic in Minnesota, and we extend an invitation to join the council
as a community
member or to submit an application
for council membership.
Cultural responsiveness update
With the adoption of new cultural
responsiveness standards in the Universal Standards of Care, Ryan White staff
at the Minnesota Department of Human Services and Hennepin County are
developing partnerships with local community-based organizations to offer
relevant trainings. Through a collaboration with the Minneapolis YWCA, we are
excited to offer a half-day training around confronting racism. As soon as we
finalize the logistical details we will send out an invitation to all Ryan
White providers.
As FY2018 Q1 comes to a close, we
will be circulating a survey that providers can use to collect input from
clients around culturally responsive service delivery. While providers are not
required to utilize the survey we are providing, they are required to solicit
feedback from clients around culturally responsive service delivery on an
annual basis.
Please reach out to Ryann Freeman at ryann.freeman@hennepin.us with any questions.
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Hennepin County emphasizes our
core values of employee engagement, workforce development, diversity and
inclusion, customer service, and continuous improvement. To zero in on the
fifth value, Hennepin County Public Health, which includes the Ryan White
HIV/AIDS Program (RWHAP), places a strong emphasis on continuous improvement.
In this spirit, our team sought to improve the efficiency measure targets for
FY2018.
Efficiency measures are the quantity of services provided (i.e.,
clients to be served, units to be provided, HIV tests to be performed). This
contrasts with effectiveness measures that look at quality (i.e., retention in care, referrals for those out of HIV
medical care, viral suppression, care plans documented in CAREWare).
Historically, efficiency measures have been calculated by using providers’
historical performance. Over the years this methodology has led to a high
variance of cost per client in some services across multiple providers. In
FY2018, the RWHAP analyzed cost per client across providers for each service
area and then determined the efficiency measure for the provider using the
methodology summarized below:
- What is
the average cost per client for the past three fiscal years?
- Are there
differences in units per client (for applicable services)?
- If a
provider is above the average cost per client without higher units per client,
the cost per client for FY2018 was adjusted to the average.
As implied in the units per
clients step, variance in cost is not always negative. You would expect there
to be some differences in cost depending on populations being served. A clear
example is medical transportation services; a client in greater Minnesota would
be more expensive than a client in the metro area. However, in most service
areas, particularly for providers’ Part A funded services where all clients
reside in the 13-county metro area, the RWHAP wants to reduce the variance in
cost across providers. The rationale for
this is straightforward: by setting efficiency measure targets for historically
higher cost providers at the average cost per client, more clients can be
reached.
Reaching these targets depends on
the commitment of providers to continuously improve their service delivery. The
RWHAP wants to be clear: you are not on an island. You are our partner in improving
the lives of people living with HIV and ending the HIV epidemic.
Continuous improvement involves the Plan-Do-Check-Act cycle. If
you want technical assistance on this process, please contact our quality coordinator
Anika Kaleewoun at anika.kaleewoun@hennepin.us.
Additionally, the RWHAP wants to increase peer-to-peer technical assistance.
Please do not hesitate to reach out to your fellow providers to ask how they
are approaching service delivery. You can also reach out to your contract
manager, and they would be happy to get you connected with a peer provider.
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 In April
2018, the first progress report on Positively
Hennepin, Hennepin
County’s ambitious, comprehensive strategy to end our HIV epidemic was
released. The report details:
- Baseline
evaluation of Positively Hennepin’s ten milestones, which measure progress
on our journey to ending the HIV epidemic
- Steps
that Positively Hennepin has taken — in partnership with the Ryan White
Program, programs across Hennepin County Government, state and city
governments, HIV-service providers, and community leaders — to coordinate
our response to the HIV epidemic
- Strategies
moving forward that build upon the successes of the last year and draw
increased attention to communities that HIV hits hardest
Through the
county’s HIV strategy, Hennepin County Public Health also became the second
county government in the United States to join the U=U campaign.
This campaign means that undetectable HIV is untransmittable through sex. Built
on a solid foundation of scientific evidence, nearly 700 organizations from 82
countries have signed on to share the U=U message with their communities.
Baseline
evaluation shows that we are in a solid position to achieve many of the
strategy’s ten milestones by 2019. However, the milestones also indicate that
more progress is needed to achieve health equity among the black and Latino
communities.
Over the next
year, Positively Hennepin has five areas of focus:
- Preparing
for an HIV outbreak among people who inject drugs
- Building
an integrated public response to HIV
- Developing
new data methodologies
- Focusing
on black and Latino communities
- Engaging
American Indian and transgender communities
To learn more about Positively
Hennepin’s accomplishments and its focus areas over the next year, visit the
Positively
Hennepin website or contact its coordinator Jake
Maxon at jake.maxon@hennepin.us.
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Emma Boyce, an intern with Hennepin County
Public Health’s Ryan White Program, partnered with African-born communities to
host an HIV forum to increase HIV awareness. This forum was a culturally
competent way to address the disparities that plague African communities. The
forum was well received by community members, with over 200 attendees and over
45 people tested for HIV. Individuals involved in the planning of the forum
were asked to continue this effort and create initiatives to educate the
community, and increase testing, preventative measures, and HIV service utilization. Thus, the West African HIV Taskforce was formed.
Through
partnership with Hennepin County’s Ryan White Program and Positively
Hennepin, the task force will create culturally specific evidence-based
interventions to increase HIV testing, prevention, and care among African-born
communities. We have partnered with the Minnesota Department of Health to provide
HIV testing kits to this disproportionately affected community. We have engaged
over 15 different community organizations, social groups, and religious
institutions to highlight HIV-related disparities and task them to be
companions in our fight against HIV.
One
June 21, 2018, an HIV awareness campaign was held through a Facebook Live
event, where over 35,000 people watched within Minnesota, across the nation,
and globally. Through social media, we have educated over 70,000 people about
HIV. We have partnered with Clinic 555 to develop a culturally specific sexual
and reproductive health/HIV education curriculum in order to train African-born
women to be peer educators and recruit others for testing.
Our next event
focused on protecting your health for African-born women will take place on
July 14, 2018. Testing will also be offered at the event. The task force will
also provide testing at different community events throughout the summer.
Please
contact Emma Boyce at emma.boyce@hennepin.us to register for an
event or learn more about the task force.
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Community
Voices Committee
Members of
the Minnesota Council for HIV/AIDS Care and Prevention have identified the
revitalization of the Community Voices Committee (CVC) as an integral element
in ongoing efforts to improve consumer engagement and outreach. So, after a
hiatus, the CVC reconvened on March 20, 2018. The meeting was well attended and
included a robust contingent of consumers from Greater Minnesota. Many
consumers returned to the CVC’s April meeting, where they prioritized HRSA
allowable service areas.
The CVC met
again on May 23, with 27 consumers from both the TGA and Greater Minnesota in
attendance. At this meeting, members elected two co-chairs, Destiny Holiday and
Joann Vertetis. Consultants Mark Fischer and Steven Vargas, from Jon Snow Inc.,
attended the meeting to discuss the history and value of consumer advocacy.
Mark and Steven also educated members on how the CVC can influence the
council’s work.
Future
meetings will offer an opportunity for consumers to share what their ongoing
needs are, as well as provide a forum to provide feedback on service delivery
and needs. CVC meetings will also include an educational component for
consumers. The next CVC meeting will be scheduled for later this summer;
further information will be provided about this meeting and providers are
encouraged to inform their clients about the council and the CVC.
Technical
Assistance from HRSA
In May 2017,
the council formally requested Technical Assistance (TA) from HRSA’s HIV AIDS
Bureau (HAB) to improve the council’s consumer engagement and outreach efforts.
This request was made at the behest of council members who noted that many Ryan
White consumers are unfamiliar with the council’s work and impact on the
HIV/AIDS community. In February of this year, two consultants from Jon Snow Inc.
began providing this requested TA. Mark Fischer and Steven Vargas conducted
extensive interviews with various stakeholders -- including providers,
consumers, and government representatives -- to better understand how consumers
currently engage with the council. In addition, Mark and Steven held several
onsite meetings with a diverse group of stakeholders from May 23-25, 2018.
Based upon
feedback gathered from these efforts, Mark and Steven developed a report on
their findings, as well as a series of actionable items that the council can
take to improve consumer involvement with the council’s committees and
activities. Some of these items will need coordination with providers to be
successful. For example, one of the actionable items is to implement new ways
of sharing information with and securing input from consumers, eligible consumers, service providers, and others who support
or are served by the council.
The council’s
Executive Committee is currently reviewing the actionable items and will
determine which to prioritize first. Providers will play an integral role in
improving the council’s consumer engagement and are encouraged to attend council and/or
committee meetings (the council’s calendar is available here).
If you are a provider and would like
additional information on TA efforts, or want to learn more about how you
and/or your agency can get involved, please reach out to the council’s
coordinator Carissa Weisdorf at carissa.weisdorf@hennepin.us.
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As
many of you learned at our Hennepin County Ryan White Program contracted
providers meeting in April, we had a number of findings from our 2017 site
visit conducted by HRSA’s HIV/AIDS Bureau. These findings are typical of many
Part A grant recipients across the country. The ones most relevant to our
providers relate to charges for services, program income, and reviewing
standards of care annually. Over the next several months, we will be providing
training on the legislative requirements related to these findings and working
with you to help develop policies and procedures to meet the requirements.
Sliding
fee scale and caps on charges
The
Ryan White HIV/AIDS Program legislation requires all subrecipients (funded
service providers) to have policies and procedures in place to ensure that
charges for services do not exceed caps based on client income. These policies
and procedures include having a sliding fee scale, informing clients of fees
for services and caps on charges, and having a procedure for tracking client
charges so their expenses for HIV services do not exceed the caps. The caps on
charges based on client income are as follows:
- < 100% of FPG – no
charge
- 101 - 200% FPG – not more than 5%
of annual gross income
- 201 - 300% FPG – not more than 7%
of annual gross income
- > 300% FPG – not more than 10%
of annual gross income
The
legislation allows grant recipients (Hennepin County) to approve nominal fees
for services and prohibits providers from denying client services if they are
unable to pay the charges.
Program
income
All
Ryan White HIV/AIDS Program providers must track and report
program income. Program income is most commonly generated by charging for
services and receiving payment from third-party reimbursement such as Medicaid
and private insurance.
The template Hennepin County provides for reporting your
annual revenue and expenses includes lines to specify the source and amount of
program income you receive. Please work with your Hennepin County contract
manager to ensure that you understand this requirement and are reporting any
program income that you receive accurately. All program income that is directly
generated by a supported activity or earned as a result of your Ryan White
grant award must go back into the program to support your Ryan White Program
activities.
Annual
standards of care review
Over
the past several years, many of you have participated in our provider input
meetings. Your on-the-ground expertise is integral to developing standards of
care that ensure the delivery of highly effective HIV care services. We are
working with DHS to develop a process for reviewing standards of care annually
and updating them as needed. We anticipate that there will be two general
tracks of review: one track for services that only require minor updates and one
track for services that warrant more extensive review. We appreciate your
participation in this important process.
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Step one. Identify an area you want to or need to
improve.
Write out your goal as a SMART (specific, measurable, achievable,
relevant, and time-bound).
Priorities should focus on improving health outcomes
for clients, aligning outcomes with the National HIV/AIDS Strategy, and reducing
disparities in services and outcomes.
Step two. Identify how you will measure your
goal and progress towards it.
Ensure you know where you are at now (your
baseline) and where you want to go (your target). Make sure your team is clear
on how to measure your progress, how the progress will be tracked, and how
progress will be communicated and with whom.
Step three. Make an initial plan.
This is
where you make a hypothesis and write out one initial intervention or
experiment. Try to change only one thing at a time; this helps know whether
this change is helping you reach your goal.
Step four. Do.
Test your hypothesis, meaning try out your plan or idea.
Do
it small scale for a short period of time. Maybe test for the next 10 clients
or two weeks, just enough time to make some observations and collect data. Make
sure you are tracking results during your test period.
Step five. Study.
Analyze the results of
your trial. Did it work like you thought it would work? Did things improve or
get worse? What did you observe? What important lessons will you take away from
this experiment?
Step six. Act.
Based on
your analysis, will you adopt what
you tried, make it the standard way you do things, and scale it up for all
clients? Will you adapt it and make
a tweak to your intervention to make it more effective? Or will you abandon
this hypothesis and try a new intervention?
This is the end of your first PDSA
cycle. Then you repeat, starting with step one, until you achieve your desired
goal. Learn more at the Target Center’s Quality Academy.
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