Greg Moody gmoody@ healthmanagement 614-560-3212

1. Local Needs, Local Decisions:Improving HIV Care Services System PerformanceOhio AIDS Coalition/ODHLeadership 2008April 15, 2008 Greg Moody gmoody@healthmanagement.com 614-560-3212

2. Purpose of Today’s Session • Present preliminary findings from a statewide systems assessment of Ohio’s Ryan White Part B Program • Review epidemiologic, funding, and provider access trends that could impact local service capacity • Discuss strategies to improve organizational effectiveness (participant input will assist HMA in developing final recommendations for ODH) Health Management Associates

3. Part B Assessment Activities Health Management Associates

4. Health Management Associates • HMA is a research and consulting firm specializing in public programs and underserved populations • Our staff includes 80 former senior-level government officials and public program administrators • Expertise in Medicaid, Medicare, and public health • Nine offices nationwide including Columbus • On this project: Lisa Duchon, PhD, Donna Strugar-Fritsch, Lori Weiselberg • In Columbus: Barbara Edwards, Anne Harnish, Greg Moody, Alicia Smith, Aimee Lashbrook, Suzie Garcia Health Management Associates

5. Consumer Profile • HMA prepared a basic epidemiologic profile for each region • ODH Surveillance trend data as of June 2007 • Translate ODH data tables into graphical information to assist thinking about current & future resource needs Health Management Associates

6. Number of Residents Living with HIV/AIDS, by Part B Region, 2007 14,135 Ohio residents are living with HIV/AIDS Source: ODH HIV/AIDS Surveillance Program Trend Data, as of June 2007 Health Management Associates

7. Prevalence Rate of HIV/AIDS per 100,000 population, by Part D region Source: ODH HIV/AIDS Surveillance Program; percentage of Ohio population and PLWHA as of December 2005; percentage of new cases 2003-2005. Health Management Associates

8. Ohio Prevalence Rates of Reported PLWHA, by Gender and Race/Ethnicity, 2005 Rate/100,000 pop. Source: Ohio Dept. of Health HIV/AIDS Surveillance Program. Data reported through December 31, 2005. U.S. Bureau of the Census, 2000, for population data. Health Management Associates

9. Distribution of Total Ohio Population and HIV and AIDS Prevalence, by Age Groups, 2005 percent Source: Ohio Dept. of Health HIV/AIDS Surveillance Program. Data reported through December 31, 2005. U.S. Bureau of the Census, 2000, for population data. Health Management Associates

10. Ohio Incidence Rates of HIV Infectionby Age Groups, 2000-2004 Rate/100,000 pop. Age 35+ Age 25-34 Age 13-24 Source: Census 2000, U.S. Bureau of the Census, Ohio Dept. of Health HIV/AIDS Surveillance Program. Data reported through Dec. 31, 2005. Health Management Associates

11. Funding Profile • HMA analyzed state and federal funding streams for HIV/AIDS services in each region • Based on ODH 2006 actual and 2007 grant data • Part B spending per client ranges from $1600-$3400 (the per-client range is $2200-$5200 from all sources) Health Management Associates

12. Ohio Part B Service Spending by Part Bregion, 2006 Actual (Yr 16) Ohio Part B Service Spending = $13.1 million in 2006 Source: Ohio Department of Health HIV Care Services, April 1, 2006 to March 31, 2007 Health Management Associates

13. Part B Spending per PLWHA and per client,by region, 2006 (Yr 16) Source: HMA Calculation based on ODH HIV/AIDS Surveillance Program Trend Data and ODH HIV Care Services data on Part B funding and number of clients Health Management Associates

14. Part B Spending per client by major service category and region, 2006 (Yr 16) Source: HMA Calculation based on ODH HIV/AIDS Surveillance Program Trend Data and ODH HIV Care Services data on Part B funding and number of clients Health Management Associates

15. Part B and Other Federal HIV/AIDS spending in Ohio Part B region, 2007 (Yr 17) Ohio Part B Services = $13.1 million; Other = $15.1 million Source: Ohio Department of Health; “other” includes Ryan White Parts A, C, D and E, CDC prevention funds, and HOPWA funds Health Management Associates

16. Federal HIV/AIDS spending per PLWHA and per client, by region, 2006 (Yr 16) Source: HMA Calculation based on ODH HIV/AIDS Surveillance Program information; and ODH HIV Care Services data on Part B funding and number of clients for 2006. Health Management Associates

17. Delivery System Profile • HMA prepared a regional service capacity profile for core services, with a focus on mental health and substance abuse services • Called all Part B-contracted MH/SA providers to see if they are taking new patients and the wait, if any • Called all Part B-contracted primary care providers to ask if they collect & report HRSA quality measures • Reviewed access barriers to care (2007 needs assessment of PLWHA) Health Management Associates

18. Percent of PLWHA in Case Management, by Part B region Source: Ohio Department of Health Health Management Associates

19. Case Management Outcome Survey Results Source: Case Management Outcomes Survey (April-September 2007) provided by ODH. Health Management Associates

20. Number of Part B Clients Per Case Manager Source: Health Management Associates

21. Organizational Profile • HMA visited every region (not Cleveland) to analyze how each community determines service needs, coordinates linkages and referrals, and coordinates planning, funding and service delivery • Reviewed documents provided by ODH • In-person interviews with case management staff and/or consortium coordinator and co-chair • General themes emerged—HMA recommendations to ODH will be in response to the general themes… Health Management Associates

22. General Themes • Streamline Program Oversight and Reporting • Share Data to Improve System Performance • Provide Consistent Policy Direction Statewide • Engage Regional Leadership to Define System Objectives Health Management Associates