Women-Focused CBOs and ASOs Thriving Post Healthcare Reform

1. We are Here to Stay: Women-Focused CBOs and ASOs Continuing to Thrive Post Healthcare Reform Liz Johnson Executive Director, Christie's Place Ingrid Floyd Executive Director, Iris House Patricia Nalls Founder/Executive Director, The Women's Collective Dázon Dixon Diallo Founder/President, SisterLove, Inc.

2. Perspectives from Christie’s Place Elizabeth Brosnan Johnson Executive Director Christie's Place (San Diego, CA)

3. Christie’sPlace Liz Johnson Executive Director johnson@christiesplace.org www.christiesplace.org

4. Integrated Continuum of Services* *All services are bilingual English/Spanish.

5. CBOs and the ACA

6. Community Based Organizations -A Matter of Relevance & Sustainability • Understand the Strategic Options • Status quo • Subcontract • Strategic alliances or restructuring • Transition to a CHC, FQHC or FQHC look alike model • Must know the “speak” – learn the language • Coordinated Care methodology • Medicaid Health Home • NCQA Standards and Guidelines for Patient-Centered Medical Homes (PCMH 2011/2013) • accreditation includes services CBOs provide, we help to make this work • Organizational Readiness Planning • Assessment: • How do your services promote linkage and engagement in testing, risk-reduction, and primary care for persons who are HIV positive or at high risk for HIV? • Are there services for which you can bill Medi-Cal/ Medicaid or other payers, such as mental health and/or substance abuse services, or insurance enrollment specific services such as Assistors or Navigators? • How do you/will you document the outcomes of your services? • Have you explored options for diversification of services? • What are your relationships with medical clinics? • Develop plan with tactics to position your organization

7. Christie’s Place Critical Path • Business/strategic planning • Expansion of billable services (behavioral health) • Strategic alliances with clinical partners • Strengthening medical home models (PCMH, MHH) through care coordination • Covered California Certified Enrollment Entity (education & enrollment) • Public and commercial third party insurance reimbursement for behavioral health services • Providers on the Health Exchange/Marketplace plans • Creation and expansion of a research portfolio • Social enterprise - capacity building assistance provider informing the sector

8. Strategic Alliances • Staying true to our mission and expertise • Understanding and articulating what we bring to the table – the “value added”/ROI for clinical partners • Developed/developing strategic alliances with clinical partners • Co-location with primary care • Peer navigation/community health workers • Behavioral health • Medical case management • Part of clinic health teams • Whole person care • Patient and family support • Social support services • Strengthening medical home models

9. Steps to the Goal Identify & Screen Against Fit • Identify internal stakeholders • Identify and convene the project team biweekly • Conduct client (customer) benchmarking • Determine which clinical partners • Stakeholders have initial meeting with identified partners • Agree on partnership benefits • Assess joint programming opportunities • Identify funding sources for joint programming • Determine joint programming scope • Develop MOA or contract to formalize partnership • Agreement execution • Implementation plan • Secure funding sources for joint programming • Formative phase • Cultural integration of program staff • Implementation • Monitoring • Evaluation Select Fit Shared Future State Operating Arrangement Finalize Agreement Set Shared Performance Targets, Goals Monitor Progress

10. Billing and Revenue Generation Must know the cost-per-service-unit to ensure reimbursement will cover full cost of providing service Translate public health service into language of payers/insurance (e.g., CPT codes) Assess provider requirements (licensed provider; provider supervision; provider recommendation; setting) Compare reimbursement rate (within capitation or FFS) with cost of providing service

11. Impact - Measuring Outcomes • The “partnership” - tactics are strengthening medical home model and improving care coordination • Peer Navigation model has brought close to 250 out-of-care and sub-optimally engaged in care women living with HIV back into care • Reducing “no show” rates • Reducing lost to follow-up • Medical visit preparation/agenda setting • Improved health outcomes of clients enrolled in CHANGE for Women • UCSD Women’s Center of Excellence 2011-12: Viral suppression: 82.1% • RiC clients 2013-2015: 87% retained in care • SIF clients 2011-2015: 77% viral load suppression

12. Outcomes (continued) • Diversified agency services by 40% • Increased staffing by 42% • Increased revenue by $700,000 -- a 72% increase • CHANGE for Women programming cost-saving and cost-effective • A2C: • Only 0.82 HIV transmissions need be averted to be cost-saving • Only 2.90 QALYs need be saved to assert cost-effectiveness • RiC (preliminary): • Only .45 HIV transmissions need to be averted to be cost saving • Only 1.59 QALYS need to be saved • Since program implementation, local unmet need has steadily decreased (access to care increased by 14%)

13. Christie’s Place Critical Path 2.0 • EMR/EHR roll out • Public and commercial third party insurance reimbursement for behavioral health services • Reimbursement through sub-recipient agreements • Working with CA State partners on MHH linkage and retention in care as reimbursable activities • Relationship building with managed care organizations • 340B Pharmacy model • Leadership transitions

14. Lessons Learned • Relevance, positioning, sustainability • Never underestimate the value of relationship capital • Planning is a must • Take time for strategic thinking . . . be proactive, forecast and don’t do it in a bubble • Know the data, the drivers and the deliverables required • Be willing to take smart, calculated risks • Must constantly evolve the way you do business – “evolve or become extinct” • Power of advocacy and policy

15. Contact Info: Liz BrosnanJohsnon Executive Director Christie’s Place Email: johnson@christiesplace.org Website: www.christiesplace.org

16. Perspectives from Iris House Ingrid Floyd, MBA Executive Director Iris House (New York, NY)

17. Iris House

18. Iris House: Who we were five years ago • Founded in 1993 as an organization for women living with HIV & AIDS • Services include case management, housing, food & nutrition, behavioral health, HIV prevention education and testing, harm reduction and support groups • Services focused on women but included family members and men who were referred by other providers • Linkage agreements with a variety of healthcare and social service organizations • Main office in Central Harlem with a satellite site in East Harlem

19. Iris House: Our Experience

20. Iris House: Our Experience • Mission Expansion • Looking beyond HIV…what other health disparities impact our communities? • Are there other target populations we can serve? • Service Expansion • Medicaid billable services • 340B Contract Pharmacy Services • Home and Community Based Service offerings • HepC education and testing services • STI education and testing services

21. Iris House: Our Experience • Geographic expansion to other target areas in high need • New site in Central New Jersey • Strategic partnerships instead of 100 linkage agreements • Determined how to best meet our client needs • Identified key healthcare partners • Identified key social support agencies to form stronger relationships • Maintaining our identity • Balancing our identity as an organization for women • Maintaining a family feel to our offices and services

22. Contact Info: Ingrid Floyd Executive Director Iris House Email: ifloyd@irishouse.org Website: www.irishouse.org

23. Perspectives from The Women’s Collective Patricia Nalls Founder/Executive Director The Women's Collective (Washington, DC)

24. About • Founded in 1990 by Patricia Nalls, as a private phone line in her home • In 1992, it transformed into a support group called the Coffee House • In 1995, the women incorporated as a non-profit organization as The Women’s Collective; Secured it’s first two grants in 1996 • TWC opened its first office in 1998 and was the trail blazer in Health Services, Policy & Advocacy for Women and Girls living HIV/AIDS in the District of Columbia • TWC is the ONLY girl and woman focused community health and human service agency in D.C. • Policy and Advocacy Priorities include Sexual and Reproductive Health and Rights, Housing, Gender-based Violence, Employment and Income Disparities, Health Care Access

25. Prevention to Care Continuum Prevention Care Medical Case Management Community Health Worker Program (Peer Navigation) Mental Health Services Food Bank & Hot Meals on Site Clothing & Hygiene Products Emergency Financial & other Support Services Psychosocial and Trauma Informed Services & Support groups • Outreach & Navigation • CDC funded Targeted HIV Counseling & Testing (mobile van & on-site • Social Networking Strategy • PrEP Education • Prevention Case Management • Prevention Education & Support Groups • Referral & Support Services • Willow

26. Snapshot of HIV in the District HIV/AIDS, Hepatitis, STD, and TB Administration District of Columbia, Department of Health , 2014 • Living cases were: • Female: 27% (Male: 73%) • Among females only • The majority of living cases were Black, 93% • White: 3% • Hispanic: 3% • Other: 1% • By current age • Nearly two thirds were 40-59 years (60%)

27. New Healthcare Landscape • Medicaid Expansion • Federal & State Marketplaces • Expanded Coverage • Essential Health Benefits • Preventive Services • Mental health services

28. The Options: Merge Grow Go

29. Step 1: Strategic Planning

30. Areas of Opportunity

31. Outreach and Enrollment • Education and Outreach • Enrollment assistance • Navigators/In-person Assisters • Certified Application Counselors (CACs) • Insurance Navigation • Co-pays, co-insurance, networks, deductibles • Filing appeals • TWC • Providing educational materials during intakes and testing? • Screening for insurance and linking to navigators? • Getting certified to be CACs?

32. New Coverage Options • Provider networks, credentialing and billing for services • Services currently being provided • Adding new covered services • Partnerships • TWC • Joining networks and getting credentialed for testing, counseling, and case management? • Providing other preventive services that are billable? • Partnering with medical providers or Medicaid Managed Care Organizations?

33. Changing Business Model • Service Expansion • Providing new medical or support services • Expanding service area • Mission Expansion • Serving new populations • Filling gaps in services • What about TWC? • Adding medical professionals to the staff? • Serving women from Maryland or Virginia? • Serving men? Women with other chronic conditions? • Providing child care or transportation?

34. How do we show impact of CBO’s ? • Documentation! Data! • Population being reached • Effectiveness of services • Need being met • Gap in services being filled • Articulate WHY support services are important!

35. Contact Info: Patricia Nalls Founder/Executive Director The Women's Collective Email: pat@womenscollective.org Website: www.womenscollective.org

36. Perspectives from SisterLove Dázon Dixon Diallo, DHL, MPH Founder/President SisterLove, Inc. (Atlanta, GA)

37. SisterLove, Inc. • Founded July 1989 • Metropolitan Atlanta, GA – 20 county area • 10 Full time, 3 Part time, 3 Interns, 1 Law/Policy Fellow • Serve over 3,500 women, men and youth per year • 2+1 Office locations “We are a small organization doing really big things!”

38. Mission • SisterLove is on a mission to eradicate the impact of HIV and sexual and reproductive oppressions upon all women and their communities in the US and around the world.

39. Principles of Practice • Women-centered, feminist-based • Human Rights & Reproductive Justice • Lived Experiences/Power of Own Story • Respect & Acknowledge Women’s Sexuality and Sexual Rights • Non-judgmental, Inclusive and Trusted • The “I” Principles

40. The “I” Principles of Practice • Imagination • Inclusion • Innovation • Intersectional • Interrelated & Interdependent • Integration

41. SisterLove Programs • Health, Education And Prevention (HEAP) • Advocacy & Policy Mobilization • Positive Women’s Leadership • Community-Based Prevention Research • SisterLove International/South Africa (SLISA)

42. Logos

43. Sustaining SisterLove – The What • Strategic & Succession Planning & Implementation • Innovating Interventions – TLC4ALL, Healthy Love, STARSHIPP, etc. • Partnering with Infectious Disease and Primary Care clinical providers • Strategic Partnerships for Sexual & Reproductive Justice Advocacy • In Our Own Voice: National Black Women’s RJ Agenda • Trust Black Women Partnership • Community-based Participatory Research • Intervention Evaluation Studies • Women’s Interagency HIV Study (Emory University) • Contracting as Subject Matter Experts • Property Ownership and Development • International Programs & Partnerships

44. Sustaining SisterLove – The How • Frequent/Periodic Review of Plans Implementation • Build and maintain Organizational Resume’ for capability and quality contractual relationships • Branding Beyond HIV • Diversity of Staff Development Practices • Market CBPR capacity, experience and success • Leverage fixed assets for growing real estate holdings • Unique positioning as domestic and international agency • Securing contracts with primary care and clinical providers (access to third party billing, EMR platforms, etc.) • Social entrepreneurial enterprises – still exploring/planning

45. The Resilience to Revolution Factor

46. Contact Info: Dázon Dixon Diallo, MPH Founder/President SisterLove Inc. 3709 Bakers Ferry Rd, SW Atlanta, Georgia 30331 Office: 404-505-7777 Email: ddiallo@sisterlove.org Handle: @dazondiallo OR @SisterLove_Inc Website: www.sisterlove.org or www.sisterwisdom.org

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