Session Goals Present an integrated care and interdisciplinary - PDF document

6/24/2014 Session Goals • Present an integrated care and interdisciplinary Integrated Care at a Community approach to the delivery of HIV/AIDS care Health Clinic Setting Specializing • Discuss specific aspects of care team in the Treatment of HIV/AIDS • Provide an overview of the Patient Centered Home criteria Tracy Murphy, MHA – Compare integration vs co-location Natalie Perkins, PharmD, AAHIVP • Discuss peer support and its use Session 38 July 17, 2014 Overview of El Rio Community Health El Rio Community Health Center is Center A Federally Qualified Health Center • Established 1970 – Organization that receives a grant under section 330 of the Public Health Service. • Provides accessible and affordable healthcare A non-for-profit primarily to underserved populations • Serving the greater Tucson area and southern – Managed by a Community Board of Directors, CEO/Executive Director and Senior Staff. Arizona – Multicultural organization imbedded in the community • Special population groups, including: women – 16 languages spoken other than English at risk, children, the homeless, individuals The 14 th largest community health center in with HIV/AIDS, teen parents the nation. 1

6/24/2014 El Rio Community Health Center is Overview cont., A nationally recognized organization. • Medical Services (Primary Care) National Committee for Quality Assurance Family Practice • NCQA is a private, non-profit organization dedicated to Internal Medicine improving health care quality. Pediatrics HIV / AIDS Treatment, Education and Intervention The Joint Commission Health Care for the Homeless Immunizations • An independent, not-for-profit organization, accredits and certifies more than 19,000 health care organizations and Nurse Midwifery Services Obstetrics and Gynecology (OB/GYN) programs in the United States . Optometry Overview cont., Overview cont., • Dental services • El Rio serves primarily low-income and medically underserved people. • Pharmacy services • Radiology services • In 2013, El Rio Community Health Center • Lab services served 80,987 patients and provided over 330,000 medical and dental visits. 2

6/24/2014 El Rio Locations EL Rio Demographics Of the 80,987 patients served in FY 2013 17 locations throughout – 54% were at or below the federal poverty line Tucson. – 46% were on Medicaid – 26.5% were uninsured SIA is immediately West of St. Mary’s Hospital Demographics by Age Stage of Engagement in HIV Care Age Under 5 5-19 years 20-44 years 45-64 years Over 65 years 8% 14% 22% 27% 29% Clin Infect Dis. 2011 March 15; 52(6): 793 – 800 3

6/24/2014 El Rio SIA Health Center • Special Immunology Associates – Provides quality comprehensive health care to people living with HIV/AIDS & affected family members – Integrated care – Interdisciplinary approach – Aftercare support to affected family members El Rio Special Immunology Associates The SIA Treatment Team Treatment Team • Medical providers • Behavioral health providers • Care coordinators • Substance abuse counseling/groups • Specialty pharmacy • Nationally recognized adherence program • Nutritionist & Diabetes Educator • Lab services • Coming soon, peer support! 4

6/24/2014 Logistics SIA Demographics • Total patients in care: 1101 • Immediate communication and collaboration • Males served: 84% • Wraparound supports to patients • Females: 15% • Transgender: 1% • Shared EHR – Treatment plan • By diagnosis: – Medication list *Living with HIV: 48% – Progress notes – Real time follow up *Living with AIDS : 51% SIA Demographics by Age SIA Demographics by Ethnicity • 13 -24 years of age: 1% • White: 56% • 25-44 years of age: 28% • Hispanic: 30% • 45-64 years of age: 64% • African American: 9% • 65+ years of age: 7% • Native American/Pac. Islander: 3% • SIA provides care to those ages 18+, however • Asian: 1% we occasionally treat transition age youth* 5

6/24/2014 Funding SIA Demographics by Insurance • Grants • Medicaid: 31% • Health Resources & Services Administration • Medicare Part A/B: 29% (HRSA) • Private: 25% – Ryan White HIV/AIDS Program • Part B • No insurance: 10% • Part C Supplemental • Part C EIS • Other: 5% • Lutheran Medical Center community Based Dental Partnership Program Funding Viral Suppression Outcomes • Viral suppression treatment goal of  200 • Contracts • In December 2013, 91.09% of patients met this goal • Community Partnership of Southern AZ (CPSA) Lowest Viral Load - 2013 • Non-CPSA BH Third Party Revenue 100.00% 91.09% 90.00% • Clinic-based Medical Third Party Revenue 80.00% 70.00% (including patient fees) 60.00% 50.00% • Mona Private Foundation 40.00% 30.00% 20.00% 8.91% 10.00% 0.00% <200 Over 200 6

6/24/2014 Retention in Care Outcomes Outcomes • Retention & adherence is key • Patient satisfaction • Retention rate as of December 2013: 89.81% – 127 El Rio Providers – SIA Providers Rank in the top 10 Retention Rate Percentage • SIA consistently ranks highest in patient 92% 90% 88% satisfaction among all El Rio health centers 86% 84% 82% 80% 7

6/24/2014 Importance of Adherence Treatment Adherence • Suboptimal adherence has been associated Program with: Special Immunology – Incomplete viral suppression Associates – Emergence of resistant strains – Decrease in CD4 count – Increase in mortality and progression to AIDS – Public health concern Pharmacist’s Role Pharmacist’s Role • Importance of adherence – pharmacy refills – medication routine – identify barriers to adherence • ARV combination complete – Guidelines – Drug-interactions • Assist with ADEs • Decrease stigma 8

6/24/2014 Pharmacist’s Role Treatment Adherence Program • OI prophylactics Individual Consults – Disease state counseling • Interpreting lab values – Medication counseling • Interpret resistance tests • “Show and tell” • Collaborative practice – Side effect management • Drug information resource – Readiness to start ART • Chart reviews Appetite for Adherence: Treatment Adherence Program Club Medbox • Support between patients through: • Goal: – Club Medbox Assist patients in developing skills to increase – Club 95 medication adherence through identifying and – Patients who are non-adherent with treatment are overcoming barriers to adherence. identified and referred to adherence program for engagement 9

6/24/2014 Club 95 Treatment Adherence Program Results • 20 out of 26 patients enrolled in Club Med Box have • Goal Viral Loads of  50 (77%) • 17 out of 19 patients enrolled in Club 95 have Viral To provide patients who have achieved at Loads of  50 (89%) least 95% adherence to their antiretrovirals • 901 of 1102 total SIA patients have Viral Loads of and medical appointments for a period of  50 (82%) three months with an incentive to foster • Patients brought into adherence program are continued adherence . brought in line with rest of patients re: Viral suppression rates. Patient Centered Medical Home Patient Centered Medical Home • Integration versus Co- location: what’s the difference? What is it? • Integration is:  Team based comprehensive integrated care * Shared electronic health record (EHR)  Focus on needs of patients * One common treatment plan  Treats whole person, physical and behavioral health * Verbal communication between providers needs * Behavioral health as embedded member of  Coordinated, accessible care focused on quality primary care team * Warm hand offs to providers  Patients as partners in their care * Shared physical space & patient population 10

6/24/2014 Patient Centered Medical Home Patient Centered Medical Home • Co-located care is: “Whole Person” Model: • Improved patient care experience * Ancillary service provider on site • Reduced hospitalization rates/ER visits * Maintains separate treatment plan • Healthcare cost savings * Access services via referral • Higher quality of care * Written communication between providers • Reduce stigma/increase likelihood of patient predominant accessing behavioral health services Peer Support Patient Centered Medical Home Eligibility Why? • Practice must demonstrate “whole person” • Many benefits to implementing peer support including: care model:  Impact of the shared personal experience  Comprehensive care  Shared experience fosters trust, credibility  Self management support of health conditions  Promotes & role models wellness and healthy coping  Emphasizes spectrum of care skills  Preventive care focus  Bridges the gap that can exist between provider &  Must meet other elements for majority of patients patient (75%)  Benefit to both peer provider and recipient of support 11