2019 Priority Setting and Resource Allocations · 2018. 7. 18. · prevention of domestic and...
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2019 Priority Setting and Resource Allocations
Transcript of 2019 Priority Setting and Resource Allocations · 2018. 7. 18. · prevention of domestic and...
2019 Priority Setting and Resource Allocations
Norfolk TGA At-A-Glance
TheNorfolkTransitionalGrantArea(TGA)hasapopulationof1,705,057.TheTGAisuniqueinthatitservestwoStates,VirginiaandNorthCarolina.ThepopulationoftheTGAiscomprisedof14Cities/CountiesinVirginiaandonecountyinNorthCarolina.Fortypercent,6of15Cities/CountiesoftheTGAhaveapopulationlivingat/orbelowFederalPovertylevelandahigherratethantheNationalaverageof14.8%.TheTGA’sgeneralpopulationracial/ethnicrepresentationisabout70%White/Caucasian,19%Black/AfricanAmerican,3%Multiracial,6%Asian,andlessthan1%combinedforAmericanIndians,AlaskanNatives,NativeHawaiiansand/orPacificIslanders.Approximately9%ofaboveracesidentifyasbeingHispanicorLatininorigin.
Whoweserve:• Chesapeake• Norfolk• VirginiaBeach• Portsmouth• Suffolk• IsleofWight• Hampton• Poquoson• NewportNews• Williamsburg• JamesCityCounty• GloucesterCounty• MathewsCounty• YorkCounty• CurrituckCo.,NC
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Norfolk TGA ROLES AND RESPONSIBILITIES
Basedonneedsassessment,utilization,andepidemiologicdata—thePlanningCouncildecideswhatservicesaremostneededbypeoplelivingwithHIVintheTGA(prioritysetting)anddecideshowmuchRWHAPPartAmoneyshouldbeusedforeachoftheseservicecategories(resourceallocations).
Theplanningcouncilmayalsoprovideguidancetothe
recipientonservicemodels,targetingof
populationsorserviceareas,andotherways
tobestmeettheidentifiedpriorities
(directives)
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Norfolk TGA LEGISLATIVE REQUIREMENTS
Theplanningcouncilusesneedsassessmentdataaswellasdatafromanumberofothersourcestosetprioritiesandallocateresources.ThismeansthemembersdecidewhichservicesaremostimportanttopeoplelivingwithHIVintheEMAorTGA(prioritysetting)andthenagreeonwhichservicecategoriestofundandhowmuchfundingtoprovide(resourceallocations).Insettingpriorities,theplanningcouncilshouldconsiderwhatservicecategoriesareneededtoprovideacomprehensivesystemofcareforpeoplelivingwithHIVintheEMAorTGA,withoutregardtowhofundsthoseservices.
TheplanningcouncilmustprioritizeonlyservicecategoriesthatareincludedintheRWHAPlegislationascoremedicalservicesorsupportservices.ThesearethesameservicecategoriesthatcanbefundedbyRWHAPPartBandRWHAPPartCprograms.
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Norfolk TGA LEGISLATIVE REQUIREMENTS
Theplanningcouncilmakesdecisionsaboutprioritiesandresourceallocationsbasedonmanyfactors,including:• Needsassessmentfindings;• Informationaboutthemostsuccessfulandeconomicalwaysofprovidingservices;• Actualservicecostandutilizationdata(providedbytherecipient);• PrioritiesofpeoplelivingwithHIVwhowilluseservices;• UseofRWHAPPartAfundstoworkwellwithotherserviceslikeHIVpreventionandsubstanceabusetreatmentservices,
andwithinthechanginghealthcarelandscape;and• TheamountoffundsprovidedbyothersourceslikeMedicaid,Medicare,stateandlocalgovernment,andprivatefunders—
sinceRWHAPisthe“payoroflastresort”andshouldnotpayforservicesthatcanbeprovidedwithotherfunding.
Afteritsetspriorities,theplanningcouncilmustallocateresources,whichmeansitdecideshowmuchRWHAPPartAfundingwillbeusedforeachoftheseservicepriorities.Forexample,theplanningcouncildecideshowmuchfundingshouldgoforoutpatient/ambulatoryhealthservices,mentalhealthservices,etc.Inallocatingresources,planningcouncilsneedtofocusonthelegislativerequirementthatatleast75percentoffundsmustgotocovermedicalservicesandnotmorethan25percenttosupportservices,unlesstheEMAorTGAhasobtainedawaiverofthisrequirement.Supportservicesmustcontributetopositivemedicaloutcomesforclients.Typically,theplanningcouncilmakesresourceallocationsusingthreescenariosthatassumeunchanged,increased,anddecreasedfundinginthecomingprogramyear.
75%
25%Core
SUPPORT
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Norfolk TGA Notice of funding opportunityFunding Opportunity Number: HRSA-19-033 Funding Opportunity Type(s): Competing Continuation Catalog of Federal Domestic Assistance (CFDA) Number: 93.914 Application Due Date: September 21, 2018
B.PlanningResponsibilitiesSection2602(b)(4)(C)ofthePHSActrequiresPC/PBstodeterminethepriorityforRWHAPallowableservicesandserviceallocationsofRWHAPPartAfundseveryyear.Tofulfillthisresponsibility,EMA/TGAPC/PBssetserviceprioritiesandallocateRWHAPPartAfundsbasedonthesize,demographics,andneedsofpeoplelivingwithoraffectedbyHIV,withparticularfocusonindividualswhoknowtheirHIVstatusbutarenotincare.TheRWHAPPartAPC/PBsalsoareresponsibleforevaluatingtheefficiencyoftherecipientindistributingfundstoserviceproviders.
PC/PBsanalyzeinformationtodevelopanin-depthunderstandingofthecurrentHIVepidemicanditsimpactontheservicearea.PC/PBsreviewneedsassessmentdata,HIVepidemiologicdata,andco-occurringconditionsdata.Thereviewincludesserviceutilizationdatarelatedtocomplexityofprovidingcare,includingserviceavailabilityandunitcostperservice,aswellasserviceneedsofemergingpopulations.ThepurposeofthesedatareviewsistoguidedecisionsaboutHIV-relatedservicesandresourcesintheEMA/TGA.Furthermore,planningandimplementationoftheRWHAPPartAisdrivenbyoverallcomprehensiveplanningandtherecentlydevelopedIntegratedHIVPreventionandCarePlan,includingtheStatewideCoordinatedStatementofNeed,CY2017- 2021asaroadmapforrelevantgoals,objectives,andstrategiesfordeliveringRWHAPPartAservicesalongtheHIVcontinuumofcare 6
Norfolk TGA Notice of funding opportunityPlanningandResourceAllocationThepurposeofthissectionistodocumenttheexistenceofafunctioningplanningprocessintheEMA/TGAthatisconsistentwithRWHAPandHRSAprogramrequirements.SuchaplanningprocessisimperativeforeffectivelocalandstatedecisionmakingtodevelopsystemsofpreventionandcarethatareresponsivetotheneedsofpersonsatriskforHIVinfectionandPLWH.BothHRSAandCDCsupportactivitiesthatfacilitatecollaborationand/ordevelopajointplanningbodytoaddresspreventionandcare.Communityengagementisanessentialcomponentforplanningcomprehensive,effectiveHIVpreventionandcareprogramsintheUnitedStates.
ThecompositionofthePC/PBmustreflectthedemographicsoftheHIVepidemicintheEMA/TGAandberepresentativeofvariousrequiredcategoriesofmembershipascitedinSec.2602(b)(1)-(2)ofthePHSAct.PC/PBmembersmustbetrainedregardingtheirlegislativelymandatedresponsibilitiesandothercompetenciesnecessaryforfullparticipationincollaborativedecision-making.PC/PBsareencouragedtoeducatemembersaboutserviceissuesrelatedtothepreventionofdomesticandsexualviolence,opioidandotherdruguse,andtraumainformedcareaspartoftheirongoingtraining.PC/PBsshouldalsoconsiderrecruitingmemberswhoareknowledgeableabouttheseissues.
1STAGE 1
PlanningandResourceAllocation
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Norfolk TGA Notice of funding opportunity
1STAGE 1
PlanningandResourceAllocation
2019PrioritySettingProcess–NorfolkTGA
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Norfolk TGA Notice of funding opportunity
1STAGE 1
PlanningandResourceAllocation
2019ResourceAllocationProcess–NorfolkTGA
ResourceAllocationPercentagesbyHRSAdefinedServiceCategoryResourceallocationpercentagesaredevelopedandapprovedbythePlanningCouncilbasedonthetotalgrantaward.TheapprovedpercentagesarereportedtotheRecipientwiththedirectivetoapplyservicedollarsinaccordancewiththeapprovedresourceallocations.TheTGA’sserviceprioritiesandallocationsalignwiththeupdatedNationalHIV/AIDSStrategy,theIntegratedHIVPreventionandCarePlanandtheTGA’sContinuumofCaregoalofviralsuppression.
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Norfolk TGA Notice of funding opportunityDescriptionoftheCommunityInputProcessDescribetheoverallcommunityinputprocessandhowitinformsthePC/PBprioritysettingandresourceallocationprocessforthejurisdictionandincludeasummaryofhowtheprocesswasconducted.Also,includeadiscussionofhowtheIntegratedHIVPreventionandCarePlan(IP)hashelpedinformtheRWHAPPartAserviceprioritiesandresourceallocations,aswellasadescriptionofhowtheIPisinterwovenintoyourPartAactivities.
Specifically,address:i.HowPLWHwereinvolvedintheplanningandallocationprocessesandhowtheirprioritieswereconsideredintheprocess;ii.HowtheinputofthecommunitywasconsideredandwhetherthecommunityinputprocessadequatelyaddressedanyfundingincreasesordecreasesintheRWHAPPartAaward;iii.HowMAIfundingwasconsideredduringtheplanningprocesstoenhanceservicestominoritypopulations;iv.Howdatawereusedintheprioritysettingandallocationprocessestoincreaseaccesstocoremedicalservices,ensureaccesstoservicesforwomen,infants,children,andyouth(WICY)andtoreducedisparitiesinaccesstoHIVcareintheEMA/TGA;andv.Anysignificantchangesintheprioritizationandallocationprocessfrom2018to2019projectperiodsandtherationaleformakingthosechanges.
2STAGE 2
DescriptionoftheCommunityInputProcess
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Norfolk TGA Notice of funding opportunity
2STAGE 2
DescriptionoftheCommunityInputProcess
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REVIEW OF DATA
Norfolk TGA EPIDEMOLOGICAL DATA
HIVIncidence
2011 2012 2013 2014 2015 2016 2017
305 297311
298 304326
289
AIDSIncidence
129 135 132110
121143
104
-5%Since 2011
-19%Since 2011
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Norfolk TGA EPIDEMOLOGICAL DATA
HIVPREVALANCE
2011 2012 2013 2014 2015 2016 2017
3,256 3,362
3,6353,765
3,918
3,508
4,075
AIDSPREVALANCE 2,617 2,673
2,7992,844
2,886
2,722
2,968
25%Since 2011
13%Since 2011
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Norfolk TGA EPIDEMOLOGICAL DATA
TOTALCASES
2011 2012 2013 2014 2015 2016 2017
6,307 6,467
6,8777,017
7,229
6,699
7,436
22%Since 2011
3%Since 2016
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Norfolk TGA EPIDEMOLOGICAL DATA
TOTALCASES - age
2011 2012 2013 2014 2015 2016 2017
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<13 YEARS
13 – 19 years
20 – 44 YEARS
45+ YEARS
2011 2012 2013 2014 2015 2016 2017<13years 9 13 14 9 8 9 713-19years 68 53 68 61 62 50 6620-44years 2,874 2,889 2,935 2,980 3,033 3,122 3,21645+years 3,356 3,512 3,682 3,827 3,914 4,048 4,147Unknown 0 0 0 0 0 0 0Total 6,307 6,467 6,699 6,877 7,017 7,229 7,436
Norfolk TGA EPIDEMOLOGICAL DATA
TOTALCASES –Race/Ethnicity
2011 2012 2013 2014 2015 2016 2017
17
AFRICAN AMERICAN
NATIVE AMERICAN
Asian/Hawaiian
Hispanic/Latino
Multiracial/other
White, non-Hispanic
9
56
228
362
1676
5105
Norfolk TGA EPIDEMOLOGICAL DATA
TOTALCASES –Race/Ethnicity
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African-American,notHispanic 4363 4476 4632 4771 4882 4989 5105White,notHispanic 1409 1451 1508 1529 1551 1623 1676Hispanic/Latino(allraces) 291 294 304 307 330 352 362Multi-race/Other/Unknown 203 196 203 219 200 207 228Asian/Hawaiian/PacificIslander 31 40 42 42 43 49 56AmericanIndian/AlaskaNative 10 10 10 9 11 9 9
AFRICAN AMERICANS 69%WHITE, Non-Hispanic 23%
Hispanic/Latino 5%
2011 2012 2013 2014 2015 2016 2017
Norfolk TGA EPIDEMOLOGICAL DATA
TOTALCASES –GenderMethod of EXPOSURE
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Male 4,493 4,605 4,834 4,960 5,080 5,257 5,433Female 1,814 1,862 1,865 1,917 1,937 1,972 2,003
Menwhohavesexwithmen 2,764 2,842 3,009 3,098 3,199 3,357 3,425Injectiondrugusers 601 596 578 561 550 532 527Menwhohavesexwithmenandinjectdrugs 230 226 226 226 226 216 221Heterosexuals 1,196 1,242 1,240 1,290 1,265 1,293 1,302Bloodrecipient(Receiptofbloodtransfusion/transplant,Adultreceivedclottingfactor) 15 15 15 15 14 14 14Risknotreportedoridentified 1,429 1,470 1,554 1,610 1,691 1,742 1,872Pediatric(perinatalexposure,childreceivedtransfusion/transplant,childreceivedclottingfactor,childwithnoreportedoridentifiedrisk 72 76 77 77 72 75 75
GENDER 2011 2012 2013 2014 2015 2016 2017
2011 2012 2013 2014 2015 2016 2017METHOD OF EXPOSURE
Norfolk TGA EARLY INTERVENTION SERVICES
EISTOTAL CLIENTS
298
NEWLY DIAGNOSED 41
78%Newly DX LINKED
20
NEWLY Dx LINKED TO CARE 32
NEW TO CARE 59NEWLY Dx LINKED TO CARE 42
OUT OF CARE 188OUT OF CARE LINKED TO CARE 111
71%New TO CARE LINKED
59%OUT OF CARE LINKED
Norfolk TGA SERVICE UTILIZATION DATA
EISEarly Intervention Services
Minority AIDS Initiative
-9.3%Total expended
21
Total Clients Served 175
13%TOTAL CLIENTS SERVED
-19%Cost per client
2014 2015 2016 2017
227 245 197
UNITS OF SERVICE 4,310 7,227 6,141 2,550
COST PER CLIENT $2,816.69 $2,144.45 $1,875.84 $2,270.06
TOTAL EXPENDED $492,921 $486,789 $459,582 $447,201
2014
20172014
20172014
2017
Norfolk TGA SERVICE UTILIZATION DATA
EISEarly Intervention Services
REGULAR
55%Total expended
22
Total Clients Served
106%TOTAL CLIENTS SERVED
-25%Cost per client
2014 2015 2016 2017
49 101
UNITS OF SERVICE 397 913
COST PER CLIENT $2,127.82 $1,600.83
TOTAL EXPENDED Not funded $104,263 $161,683
2016
20172014
2017
Not funded
Not funded
Not funded
Not funded
Not funded
Not funded
Not funded
2016
2017
Norfolk TGA SERVICE UTILIZATION DATA
OAHSOutpatient Ambulatory
Health Services
-31%Total expended
23
Total Clients Served 813
-9.3%TOTAL CLIENTS SERVED
-24%Cost per client
2014 2015 2016 2017
659 677 737
UNITS OF SERVICE 1,836 1,560 1,459 1,639
COST PER CLIENT $2,193.48 $2,716.21 $2,204.51 $1,667.80
TOTAL EXPENDED $1,783,296 $1,789,977 $1,492,252 $1,229,170
2014
2017
2014
2017
2014
2017
Norfolk TGA SERVICE UTILIZATION DATA
MCMMedical Case
Management Services
36%Total expended
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Total Clients Served 1,385
-5.5%TOTAL CLIENTS SERVED
44%Cost per client
2014 2015 2016 2017
1,299 1,283 1,309
UNITS OF SERVICE 69,923 68,961 68,689 68,942
COST PER CLIENT $769.42 $1,003.11 $1,113.36 $1,110.05
TOTAL EXPENDED $1,065,652 $1,303,037 $1,428,447 $1,453,050
2014
20172014
20172014
2017
Norfolk TGA SERVICE UTILIZATION DATA
HIPCSAHealth insurance premium
And cost sharing assistance
37%Total expended
25
Total Clients Served 835
66%TOTAL CLIENTS SERVED
-60%Cost per client
2014 2015 2016 2017
1,038 1,091 1,388
UNITS OF SERVICE 3,481 3,879 4,134 4,191
COST PER CLIENT $491.69 $222.32 $273.99 $196.15
TOTAL EXPENDED $199,189 $230,769 $298,928 $272,251
2014
2017
2014
20172014
2017
Norfolk TGA SERVICE UTILIZATION DATA
lpapLocal Pharmaceutical
Assistance Program
-22%Total expended
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Total Clients Served 302
-43%TOTAL CLIENTS SERVED
37%Cost per client
2014 2015 2016 2017
162 167 171
UNITS OF SERVICE 854 417 436 503
COST PER CLIENT $299.25 $339.78 $316.58 $411.20
TOTAL EXPENDED $90,375 $55,044 $52,869 $70,315
2014
20172014
20172014
2017
Norfolk TGA SERVICE UTILIZATION DATA
MHMENTAL HEALTH
SERVICES
-7%Total expended
27
Total Clients Served 130
-22%TOTAL CLIENTS SERVED
18%Cost per client
2014 2015 2016 2017
115 83 102
UNITS OF SERVICE 786 599 501 664
COST PER CLIENT $511.16 $449.01 $514.57 $605.54
TOTAL EXPENDED $66,451 $51,636 $42,709 $61,765
2014
20172014
20172014
2017
Norfolk TGA SERVICE UTILIZATION DATA
SASubstance abuse Services
outpatient
7.8%Total expended
28
Total Clients Served 4
25%TOTAL CLIENTS SERVED
14%Cost per client
2014 2015 2016 2017
5 4 5
UNITS OF SERVICE 1,230 1,864 1,317 1,801
COST PER CLIENT $3,183.99 $3,148.80 $2,668.50 $2,754.40
TOTAL EXPENDED $12,736 $15,744 $10,674 $13,722
2014
2017
2014
20172014
2017
Norfolk TGA SERVICE UTILIZATION DATA
OHORAL HEALTH
SERVICES
16%Total expended
29
Total Clients Served 553
10%TOTAL CLIENTS SERVED
5.3%Cost per client
2014 2015 2016 2017
642 591 609
UNITS OF SERVICE 2,013 2,519 2,019 2,085
COST PER CLIENT $670.63 $671.66 $699.81 $706.77
TOTAL EXPENDED $370,858 $431,202 $413,587 $430,423
2014
2017
2014
2017
2014
2017
Norfolk TGA SERVICE UTILIZATION DATA
NMCmCase management
Non-medical services
21%Total expended
30
Total Clients Served 295
-6.2%TOTAL CLIENTS SERVED
4.8%Cost per client
2014 2015 2016 2017
1,909 2,040 2,307
UNITS OF SERVICE 1,863 20,058 20,366 18,820
COST PER CLIENT $263.85 $128.35 $122.91 $134.61
TOTAL EXPENDED $77,836 $245,007 $250,737 $310,535
2015
2017
2015
20172015
2017
Norfolk TGA SERVICE UTILIZATION DATA
EFAEMERGENCY FINANCIAL
ASSISTANCE
229%Total expended
31
Total Clients Served 52
146%TOTAL CLIENTS SERVED
33%Cost per client
2014 2015 2016 2017
108 109 128
UNITS OF SERVICE 55 140 172 218
COST PER CLIENT $847.03 $398.76 $1,084.23 $1,126.44
TOTAL EXPENDED $43,775 $43,066 $118,181 $144,184
2014
2017
2014
2017
2014
2017
Norfolk TGA SERVICE UTILIZATION DATA
MTMEDICAL TRANSPORTATION
SERVICES
18%Total expended
32
Total Clients Served 493
-2.6%TOTAL CLIENTS SERVED
21%Cost per client
2014 2015 2016 2017
512 484 480
UNITS OF SERVICE 6,403 8,916 9,126 8,809
COST PER CLIENT $456.13 $520.30 $529.45 $553.16
TOTAL EXPENDED $224,874 $266,391 $256,256 $265,517
2014
2017
2014
20172014
2017
Norfolk TGA SERVICE UTILIZATION DATA
FBFOOD BANK /
HOME DELIVERED MEALS
33
Total Clients Served
2017
226
UNITS OF SERVICE 784
COST PER CLIENT $115.08
TOTAL EXPENDED $26,008
Norfolk TGA Virginia Medicaid Expansion
Thousands of Virginians aged 19 to 64 will soon be able to sign up for new health coverage that will give them access to services at low cost. Starting January 1, 2019, eligible adults will be able to visit their doctor for help with preventing illness and improving their health.
FamilySize Yearly* Monthly*
1 $16,754 $1,397
2 $22,715 $1,894
3 $28,677 $2,391
4 $34,638 $2,887
5 $40,600 $3,384
6 $46,562 $3,881
7 $52,523 $4,378
8 $58,485 $4,875
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Norfolk TGA VIRGINIA MEDICAID EXPANSION
VDH ADAP DATA (TGA)
NORFOLK TGA DATA
≤ 138% FPL 139% – 400% FPL
1,367
35
709
2,258 856
Total Clients RECEIVING OAHS 737
OAHS ≤ 138% FPL 581
Approximately 581 clients will become eligible for Medicaid on January 1, 2019. This is approximately $968,991.80 in services for Outpatient Ambulatory Health Services.
OAHS 139% - 400% FPL 156Approximately 156 clients will be eligible for an ACA/Market Place insurance plan during open enrollment. This is approximately $260,176.80 in services for Outpatient Ambulatory Health Services.
Norfolk TGA INSURANCE DATA FOR CLIENTS
NORFOLK TGA DATA
≤ 138% FPL 139% – 400% FPL
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2,258 856
Total Clients RECEIVING Services 3,114
Clients with no Insurance 672
Clients w/o Insurance ≤ 138% 555 Approximately 117 clients will not qualify for a Virginia Medicaid Plan. This is approximately $136,632.60 in services for Outpatient Ambulatory Health Services.
During the 2018 – 2019 grant year, initiatives to identify clients who are eligible for Medicaid (≤138%FPL)andACA/MarketPlacePlans(139-400%FPL)shouldbeinitiatedandtrackedtoensureRyanWhiteremainsthepayeroflastresort.
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QUESTIONS?
