June Gipson, PhD, President and CEO, My Brothers Keeper, Inc

Rozetta Roberts, RN, Director of Clinical Services, Medical AIDS Outreach of Alabama

Reginald Vicks, RN, BSN, MBA, COO, Crescent Care

June Gipson, PhD

President/CEO

My Brother’s Keeper, Inc

November 29, 2016

Mission

To enhance the health and well-being of minorities through leadership in public and community health practice, collaboration, and partnerships.

Center for Research, Evaluation, and Environmental Policy Change

Center for Community Based Programs

Open Arms Healthcare Center

Today’s changing U.S. healthcare landscape places an urgent emphasis on improving the quality of patient care and reducing overall costs, and creating more patient centered outcomes.

ACA• Affordability • Limited Coverage exclusion • Choice • Extended coverage for young adults

Medical-Home Model• Quality

Decentralizing’ Healthcare to the Community Level • Promoting Public Health-Prevention

Community based organizations (CBOs) play a frontline role in HIV/AIDS prevention activities. However, CBOs face formidable challenges to effective delivery of HIV prevention services.

• Bio Medical Intervention• PrEP/PEP

• Treatment as Prevention

• Third Party Billing

• Lack of diversity in services and staff

• Weak partnerships (Academia, Clinics, and Hospitals)

Open Arms Healthcare Center

Open Arms Healthcare Center (OAHCC) is an innovative, holistic primary healthcare clinic that offers preventive, clinical, and mental health services to underserved, underinsured, and underrepresented populations in Mississippi, with emphasis on the Lesbian, Gay, Bi-sexual, Transgender, and Intersex (LGBTI) communities.

Open: 2013

Preventive Health-Monday-Friday

Clinical care-Saturdays only

Becoming a Healthier U

Men Health

1 part-time internal medicine physician

1 part-time nurse practitioner

The Clinical-Community Based Model for Healthcare Services is a Community Health Team led initiative that emphasizes coordinated service delivery to prevention and clinical services. The model emphasizes that the clinical and community-based professionals are bi-directionally educated about their roles and that they collaborate with one another about their patient’s health to achieve optimal patient well-being.

The CCB Model includes components: Harmonization

• Speaking the same language

Service delivery• Service Profile

Communication• Health record

Evaluation• Meaningful use• Data Collection • Billing

Community Based Organization

My Brother’s Keeper

Clinic

Open Arms Healthcare Center

Primary Healthcare

PrEP/PEP

HIV Care

Family Planning

Men’s Health

Sister to Sister

Clear

ARTAS

Becoming a Healthier U

Transportation

Patient Navigators

Case Management

Food Pantry

Housing

Monday-Friday Women’s Health Family Planning PrEP Transgender Health Mental Health Transportation Emergency Food Assistance 3 part-time internal medicine physicians 1 full-time nurse practitioner 1 part-time nurse practitioner

Successes• Blended Approach to Providing HIV Prevention, Care and

Treatment Services• Broader Reach• Improved Retention

Challenges• Communication• Service Profile

Lessons Learned• Invest in your staff• Partnerships create limitless opportunities• Layer Program Services

“If you do what you’ve always done, you’ll get what you’ve always gotten.”

-Tony Robbins

Thanks

Rozetta Roberts, RNClinic Director

MAO of Alabamawww.maoi.org

November 29, 2016

Mission Statement: MAO educates the public about HIV/AIDS and related illnesses and how to prevent transmission of infection. MAO provides culturally competent education, medical and social services to those living with and affected by HIV/AIDS and related illnesses.

Vision: HIV/AIDS will be eradicated; until that is accomplished, MAO will ensure that all people in its service area living with HIV/AIDS and related illnesses can live a healthy life filled with dignity and respect.

1987 volunteer organization established to provide respite and transportation

1992 Health Monitoring Clinic nurse and physician volunteers 1993 Ryan White Part C funds, transitioned from a volunteer

education and service organization to a full-time, health care facility $200,000 budget

Hired an Executive Director staff total 10 Started traveling to rural counties, opened small free standing clinic

Dothan, AL Today, HIV, Hep C, PrEP and largest HIV-specific health care facility

by geographic area served, within the state of Alabama with 68 employees

Ryan White Part B, C, D total budget over $13 million Future expansion into Wellness Facility to serve families of all

“The stigma surrounding AIDS is a key reason that the South is the epicenterof new HIV infections in the United States. Half of all new infections in the United States are in the South…”-The Washington Post

Map: AIDSVu.org

Source: AIDSVu.org/state/Alabama

Source: ADPH.org/AIDS

Source: AIDSVu.org/state/Alabama

Source: ADPH.org/AIDS

71% of newly diagnosed HIV cases and 70% of all persons living with HIV were Black during 2014.

Poverty

Transportation

Stigma

Health Professional Shortages

Source: AlabamaPossible.org

Source: ADPH.org/ruralhealth

62 of Alabama’s 67 counties are HPSAs

Specialty care is even more limited.

Serving 29 counties & more than 1600 patients MAO complete primary health care that includes

physician visits, laboratory tests, clinical pharmacist counseling, etc.

MAO-Dothan, a second permanent clinic site, provides primary HIV specific health care five days per week.

10 rural medical clinic sites Social services provide case management, assistance

in housing, securing medications, financial and support counseling and community referrals..

Pharmacy consultations Housing services Food Pantry on-site Mental health counseling Case management Education Prevention education HIV and Hepatitis C testing PrEP (Pre –Exposure Prophylaxes) Interpretation services Family Wellness clinic

Prevention education and outreach is available to make the community aware of exposure risk factors. Prevention education programs are held in public housing communities, community centers, public and private schools and local churches/synagogues. AIDS in the workplace programs are provided to businesses and city/county/state agencies.

Collaborations with 3 area substance abuse treatment centers to provide prevention education and HIV testing to this high-risk population.

MAO also houses the Alabama AIDS Education and Training Center, a continuing education program serving healthcare providers and professionals statewide.

In 2011, faced with the confluence of rurality and poverty driven barriers and an ever increasing diagnosis rate, MAO sought a new means of providing care for rural clients. Realizing that the barriers to care were preventing rural Alabamians from accessing the care they needed, MAO looked for ways to break down barriers in order to bring quality care to underserved rural populations.

Thanks to a matching grant from AIDS United in 2011, MAO was able to establish Alabama’s first telemedicine network serving PLWH/A in rural Alabama. Using high-speed internet connections, Bluetooth peripherals, high definition audio-video equipment, and partnerships with rural social services organizations, MAO created a network to bring primary HIV care to rural Alabama without the need for travel.

Medical Care (initial visit done in person)

Individual psychotherapy

Pharmacologic management

Social Work Services

Individual medical nutrition therapy

Follow-up inpatient telehealthconsultations

Alabama AETC is a joint project of MAO and the Southeast AIDS Education & Training Center (SE AETC). As the only SE AETC site managed by a non-academic CBO, Alabama AETC is uniquely qualified to develop and support professional and practice-based training programs focused on HIV care and prevention in our region, particularly in the areas of rural health and telemedicine.

Alabama AETC can provide or connect you with in-person and online trainings, conferences, learning series, skill-building workshops, preceptorships and internships, clinical consultation, and technical assistance. Alabama AETC welcomes both practicing and student healthcare professionals with all levels of HIV experience.

Buy in from Collaborating Partners Buy in from State and Local Leaders Finding Matching Funds in a Poor State Third Party Payments Web-based Electronic Medical Records Work Space Issues for the Equipment Stigma in Rural Communities Technological Issues for ASO/CBO

Entities

1/4 of our clinic patients are telemedicine patients

Every patient has the right to see the provider in person

Most patients found the technology nondisruptive and not significantly different than traditional care

Patients did not view telemedicine as negatively impacting patient-provider relationship

Concerns about telemedicine care were minimal

>90% reported being extremely satisfied

>95% virologic suppression rate

>94% retention rate

“I like seeing my doctor through the TV” “It’s not really different because it’s the same

person” “Seeing Dr. Bhat in person & then on TV: I see it

the same” “That’s my buddy” 83% of patients (15/18) reported being extremely

satisfied (10 out of 10) with telemedicine services Patients expressed extreme gratitude for having

access to compassionate, HIV care

Alabama eHealth Funders: AIDS United Alabama Department of Public Health CDC Alabama eHealth Collaborating Agencies: UAB Family Practice Residency Program, Selma, AL Southeast Alabama Rural Health Associates (SARHA)

and their Doctor's Center in Troy, AL and Clayton Family Health Center, Clayton, AL

Health Services Inc., Hayneville Family Health Center, Hayneville, AL

Expansion of telemedicine services to the Wiregrass & Black Belt areas to bring care to some of the poorest areas in the US

Diabetes management Substance abuse treatment and counseling Wellness Center STI Clinic Direct Practice Telemedicine Resource Center Alabama AETC

• LGBTQ Cultural Competence Training• HIV testing & linkage• Telemedicine University• Hep C testing & linkage

2005 – events following Hurricane Katrina 2006 – regroup (recognize need contingency fund) 2007 – full time Primary Medical Care 2009 – Ryan White Part C grant 2011 – Strategic Management 1 – growth / expand scope 2012 – HRSA Planning Grant

• Merger with AIDSLaw of Louisiana

2013 – Strategic Management 2 – move toward CHC model• Ryan White Part D grant• HRSA Section 330 grant (became FQHC)

2014 – Family Care Service Center – first site under scope• Re-Branding – CrescentCare• Opened new clinic – CrescentCare Health & Wellness Center

2015 – CrescentCare Specialty Center under scope• Strategic Management 3 – internal systems/structure• LSU Sexual Health Center Partnership (STD screening/treatment)• Opened CrescentCare Oral Health Center

YearAnnual Budget

Staff Size

Community Volunteers RSR

RWPMC

UDS

2006 $3.5m 36 100+

2008 $6.6m 68 350+

2010 $11.9m 107 400+

2012 $19m 170 400+ 2600

2013 $20m 184 400+ 2884 1552

2014 $27m 220 400+ 3300 2774 4348

2015 $28m 240 400+ 3376 1188 4903

2016 $32m 250+ 400+ 6500

2017 $34m 400+ 9000

Target population• People living with HIV

• Partners and family of current (HIV) constituents

• LGBTQ population

• Service industry personnel

• Those living in geographic vicinity

3 CHC sites under Scope of Service

- CrescentCare Health and Wellness Center

- Family Care Services Center

- Crescent Care Specialty Center

Move from primarily grant driven reimbursements to billing/payment methodology

Billing / sliding-fee / collections “How do we pay for it?” Expanded mission (not strictly

HIV focused) Communication to community /

clients / staff Structural changes

(administrative / cultural) Board composition &

responsibilities Compliance / reporting

• EHR/practice mgmt. system• Billing and sliding-fee-scales• New community partnerships• Increased CQI activities

• Transition from ASO to CHC• Expanded Mission• Maintain organization legacy• Expanded Information

Technology

• PCMH (NCQA Level III)

• CARF Accreditation

• Leader in LGBT Healthcare Equality

• Personnel (skills/expertise)

• Newly insured

• Revenue increase by 20%

• 49% increase in overall clients

• 82% increase in PMC clients

• Improved health outcomes

• Patient satisfaction feedback

• Incentive payments

New services Pediatrics Obstetrics/Gynecology Family Medicine Internal Medicine Integrated Behavioral Health Outreach/Enrollment Employment Services Medical/Legal Partnership Case Mgmt./Care Completion Patient/Community Education PrEP Clinic HCV screening/treatment On-site labs

2015• STD program partnership• Dental Services (suite)• Psychiatry• HCV testing/treatment• Nutrition

2016• Contract pharmacy (new

site)• PrEP campaign• Transgender clinical care• New CMO• New EHR

2017/18

• Plans for new site (combining 2 clinics, 2 prevention projects and administration

• LGBTQ Center of Excellence

• Radiology

• Optometry

• Dermatology

• Centering Pregnancy

• Expand Dental

• Expand access points

• Explore partnerships

Noel Twilbeck, CEO, NO/AIDS Task Force A Division of CrescentCare2601 Tulane Avenue, Suite 500, New Orleans, LA 70119 Phone: (504) 821-2601, ext. 228; Fax: (504) 212-2777; Cell: (504) 439-3071 E-mail: Noel.Twilbeck@CrescentCareHealth.orgWeb: www.noaidstaskforce.org

www.CrescentCareHealth.orgfollow us on twitter @noaidsfind us on facebook: www.facebook.com/noaidstaskforce

Reginald VicksChief Operations Officer

NO/AIDS Task Force A Division of CrescentCare2601 Tulane Avenue, Suite 500, New Orleans, LA 70119 Phone: (504) 821-2601; Ext. 577E-mail: Reginald.Vicks@CrescentCareHealth.orgWeb: www.noaidstaskforce.org

www.CrescentCareHealth.orgfollow us on twitter @noaidsfind us on facebook: www.facebook.com/noaidstaskforce