Ryan White Part A Client-Level Data Report – FY2014 · In 2009, the grantee implemented the first...
Transcript of Ryan White Part A Client-Level Data Report – FY2014 · In 2009, the grantee implemented the first...
Ryan White Part A Program Services Client-Level Data Report – FY2014
Baltimore-Towson EMA
June, 2015
Improve the quality of life for people living with HIV/AIDS and their families in Baltimore city and the surrounding counties through a fiscally responsible subcontracting of Ryan White funds for the provision of HIV primary care and support services.
Monitor fiscal, program, and quality management activities in order
to ensure provision of high-caliber, integrated medical and support services.
Provide comprehensive guidance to Ryan White providers and the
Baltimore Planning Council to ensure compliance with Ryan White legislations and standards of care.
Mission
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Ryan White Part A (RWA) Program Overview
RWA Client-Level Data Report (CLD) Background
Client Demographic and Service Data
Continuum of Care in Baltimore EMA using RWA CLD
Summary
Presentation Overview
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Ryan White Part A Services Overview
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A system of care through primary medical care and essential support services for uninsured/underinsured and low-income people living with HIV (PLWH)
Serves PLWH in Baltimore City and surrounding counties, reaching over 10,ooo people every year
RWA program is funded at $17 million in fiscal year 2015
Ryan White Part A HIV/AIDS Program
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Increase access to care for people living with HIV
Payer of last resort – safety net for uninsured/underinsured and low-income/unemployed individuals living with HIV/AIDS
Provide coverage for needed services that may not be covered by other types of insurance or assistance
Provide an entry way to medical care and assist in enrolling in other more comprehensive coverage
Role and Intent of Baltimore Ryan White Part A Program Post ACA
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Funding a comprehensive care systems for low-income PLWH that:
1. Reduces new HIV infections
2. Improves health outcomes and increases quality of life for PLWH
3. Decreases HIV-related health disparities
Including PLWH in the planning of services
Employing a public health approach to care and treatment
The Ryan White HIV/AIDS Program supports the goals of the National HIV/AIDS Strategy by:
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Client-Level Data Report (CLD) Background
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RWA grantee office collected basic demographic and Ryan White funded service data since 2001
In 2009, the grantee implemented the first RSR report and collected CLD from providers serving RW funded OAHS, MCM, or CM services
2010 - 2014, all providers providing any RW funded service successfully submitted annual RSR/CLD to HRSA/HAB and quarterly CLD to BCHD
In 2015, HRSA/HAB changed funded-scope RSR data reporting to eligible-scope data reporting because HAB believes that Eligible Scope is the best reporting method for the following reasons:
• Continue creating the continuum of care post ACA
• To more fully capture the efforts of the Ryan White Program in a time when more people have access to health insurance
• Continue measuring client health outcomes and progress towards achieving the National HIV/AIDS Strategy that envisions a future America that is free from HIV/AIDS
Ryan White Part A/MAI Client-Level Data Background
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Client Level Data Highlights, 2010 - 2014
2010 2011 2012 2013 2014
CLD Reports 37 38 37 37 37
Clients Served 9,481 9,753 10,356 10,079 9,801
Visits 88,000 112,000 106,000 87,000 83,400
OAHS-PMC Providers 15 15 15 15 14
OAHS Visits 50,000 69,000 44,500 45,800 14,305
OAHS Clients Served 6,520 6,525 6,675 6,683 2,800
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CLD Processes and Data Management Plan
M A M J J A S O N D J F
Data Review and Feedback
Data Cleaning
Data Aggregation
Analytic Files/Data Analysis
Data Reporting
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Client Demography and Service Data
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Clients Served by Gender
Male, 64.1%
Female, 34.4%
Transgender, 1.5%
Gender, N = 8,701
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Clients Served by Ethnicity
Hispanic/Latino, 5.2%
Non-Hispanic/Latino,
94.8%
Ethnicity, N = 8,620
2014 RWA-CLD Report 14
Clients Served by Race
69.7%
29.2%
0.9% 0.0% 0.2%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
Black White Asian NH/PI AI/AN
Race, N = 8,265
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Risk Category Distribution
31.2%
22.6%
43.9%
1.5% 0.7% 0.2% 0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
50.0%
MSM IDU Heterosexual Blood Perinatal Hemophilia
Risk, N = 6,542
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Clients Served by Age
1.1% 0.4%
3.4%
14.6%
16.7%
34.1%
24.2%
5.4%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
< 13 13 - 18 19 - 24 25 - 34 35 - 44 45 - 54 55 - 64 65+
Age, N = 9,801
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Health Care Coverage
13.3%
19.2%
41.8%
22.3%
1.4% 0.3% 1.7%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
Private Medicare Medicaid,CHIP or other
public plan
No Insurance Other Plan VA, Tricareand othermilitary
health care
Multiple
Insurance, N = 8,637
2014 RWA-CLD Report 18
Federal Poverty Level
71.1%
13.0% 9.7%
2.9% 2.5% 0.5% 0.3%
< 100% 100 - 138% 139 - 200% 201 - 250% 251 - 400% 401 - 500% > 500%
FPL, N = 7,233
Note: 84.1 percent of the consumers were eligible for Medicaid expansion through ACA 2014 RWA-CLD Report 19
Clients served by Housing Status
78%
11% 11%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Stable Temporary Unstable
Housing, N = 7,393
2014 RWA-CLD Report 20
Clients Served in FY14 by Year of HIV Diagnosis
3 2 6 3 9
37 31 43
72 88 84
123 130 116
128 145 153
139 161
174
123
172
109
159
333
263 245
276
305
355 349
277 293
398 415
0
50
100
150
200
250
300
350
400
450
1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014
Year of HIV Diagnosis, N = 5,719
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Clients Served by Service Category
37.5%
28.4%
23.1%
20.6%
19.2%
14.6%
13.6%
12.4%
9.5%
8.4%
7.3%
7.1%
6.7%
4.4%
2.4%
1.4%
0.3%
0.3%
0.1%
0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0%
MCM
PMC
Transptn.
HI
EFA
Oral
Outr.
MH
NMCM
MNT
Food
Co-Morb.
Housing
Psych.
SATO
Legal
SATR
Hospice
ChildCare
Percent of all Clients Receiving any RWA Funded Service (N=9,801)
Note: Percent does not add up to 100% since a client may receive service in more than one service categories
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Between 2010 and 2014, most demographic characteristics were stable; however, there were a few changes in the following areas:
• Age
• Race
• Ethnicity
• Housing
• Health Care Coverage
2010 – 2014 Demographic Trends
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Clients Served by Age 2010 - 2014
1.8% 5.0%
32.6%
58.4%
2.2% 1.1% 3.8%
31.3%
58.3%
5.4%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
< 13 13 - 24 25 - 44 45 - 65 65+
2010 (N = 9,479)
2014 (N = 9,801)
2014 RWA-CLD Report 24
Clients Served by Race 2010 - 2014
84.8%
14.6%
69.7%
29.2%
0
10
20
30
40
50
60
70
80
90
Black White
Pe
rce
nt
2010 (N = 8,740)
2014 (N = 8,265)
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Clients Served by Ethnicity 2010 - 2014
1.8%
5.2%
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
2010 (N = 9,261) 2014 (N = 8,620)
Hispanic/Latino
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Clients Served by Housing Status 2010 - 2014
82%
14%
4%
78%
11% 11%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Stable Temporary Unstable
2010 (N = 5,556)
2014 (N = 7,393)
2014 RWA-CLD Report 27
Clients Served by Medical Insurance 2010 - 2014
19.2%
12.2%
35.3%
29.9%
13.3%
19.2%
41.8%
22.3%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
Private Medicare Medicaid No Insurance
2010 (N = 5,944)
2014 (N = 8,638)
2014 RWA-CLD Report 28
2010 – 2014 Service Utilization Trend
Service Category 2010 (N = 9,481) 2014 (N = 9,801) Increase/Decrease
1 Outpatient Ambulatory Health Service 68.5% 29.3%
2 Medical Case Management 31.5% 37.5%
3 Health Insurance Premium 28.9% 20.6%
4 Transportation 23.5% 23.1% =
5 Outreach Services 13.5% 13.6% = 6 Case Management 12.2% 9.5%
7 Oral Health 12.0% 14.6%
8 Mental Health 6.8% 12.4%
9 Medical Nutritional Treatment 8.6% 8.4% =
10 Food Bank 8.5% 7.3% =
11 Psychosocial Services 5.3% 4.4% = 12 Housing Services 3.3% 6.7%
13 Substance Abuse Treatment (Outpatient) 3.1% 2.4% = 14 Legal Services 2.7% 1.4% Note: Percent does not add up to 100% since clients may receive service in more than one service categories
Continuum of Care in Baltimore EMA
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2014 EMA Treatment Cascade Using the First Post ACA Client-level Dataset
11,668
100% 9,801
84% of infected
2,779 24% of infected 28% of enrolled
2,197 19% of infected 79% of linked
1,574 13% of infected 54% of linked
68% of retained
1,848 16% of infected 67% of linked
84% of retained 0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Estimated Infection(estimated based on 16 %
of HIV infected peoplewho are unaware of
their status)
Diagnosed(enrolled in Ryan WhitePart A services in 2014)
Linked to Care(at least one pmc
visit in 2014)
Retained in Care (atleast two pmc visits in
2014)
Prescribed ART(indicated to have been
prescribed HAART in2014)
Virally Suppressed (most recent VL for
Black subpopulation in 2014 that is
undetectable or ≤ 200 copies/ml)
Note: The numbers in red indicate a significant decrease in the number of Ryan White funded OAHS consumers after the implementation of ACA – reason why HAB moved to Eligible Scope data requirement for the 2015 RSR and beyond. 2014 RWA-CLD Report
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Continuum of Care in Baltimore EMA, using 2013 RSR data
14,543
100% 12,216
84% of infected
8,223
57% of
infected 67% of
enrolled
7,465
51% of infected
61% of enrolled
91% of linked
7,014
48% of infected
57% of enrolled
85% 0f linked 94% of
Retained
5,994
41% of infected 49% of
enrolled 80% of
Retained 85% of on ART
Estimated Infection(estimated based on 16 %
of HIV infected peoplewho are unaware of their
status)
Diagnosed(enrolled in Ryan WhitePart A services in 2013)
Linked to Care(at least one pmc
visit in 2013)
Retained in Care (atleast two pmc visits
in 2013)
Prescribed ART(indicated to have been
prescribed HAART in2013)
Virally Suppressed (most recent VL for Black
subpopulation in 2013 that is undetectable or ≤
200 copies/ml)
Baltimore Ryan White Part A HIV Treatment Cascade, 2013
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Continuum of HIV Care in Baltimore EMA and areas of future efforts towards Zero New Infection
100%
67%
61%
57%
49%
0%
20%
40%
60%
80%
100%
Diagnosed Linked to care Retained in care Prescribed ART Virally Suppressed
Continuum of HIV Care In Baltimore EMA, 2013
Goal Not Met
Goal Met
100% Zero New Infections
100% 100% 100%
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Retention, ART, Viral Suppression by Race and MSM Risk Factor, RSR 2012 - 2013
86% 83%
74% 75% 72%
75%
82%
55%
79%
70%
78% 78%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Retention - All(at least two pmc visits
that are at least 90days apart for all
people)
ART - All(indicated to havebeen prescribed
HAART for all people )
VS - All (most recent VL for all
people that is undetectable or ≤ 200
copies/ml)
VS - MSM (most recent VL for
MSM that is undetectable or ≤ 200
copies/ml)
VS - Black (most recent VL for
Black that is undetectable or ≤ 200
copies/ml)
VS - Hispanic (most recent VL for
Hispanic that is undetectable or ≤ 200
copies/ml)
2012
2013
2014 RWA-CLD Report 34
Retention in Primary Care and Viral Suppression by Age – CLD 2014
44.8%
68.4% 67.2%
77.9% 82.6% 84.0% 83.6%
90.0%
92.6%
71.0%
82.9% 81.8% 83.3% 79.2%
85.4%
96.5%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
< 13 13 - 18 19 - 24 25 - 34 35 - 44 45 - 54 55 - 64 65+
Retention VS
Note: Retention = percent of clients with at least any two primary care visits in 2014; Viral Suppression = percent of clients who had at least one primary care visit and one viral load result with last viral result of 200 cells/ml or less.
2014 RWA-CLD Report 35
Retention and Viral Suppression for Black-MSMs by Age, CLD 2014
86.70%
78.40%
83.80%
79.30%
62.10%
59.60%
0% 20% 40% 60% 80% 100%
Black MSM - All
Black MSM - 18 - 24
Black MSM - 25 - 34
VSRetention
2014 RWA-CLD Report 36
Overall EMA’s Retention and Viral Suppression Rates, 2010 – 2014
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
2010 2012 2014
Retention
VS
2014 RWA-CLD Report 37
Retention and Viral Suppression by Gender and Race, 2014
Retention and VS by Gender, 2014 Retention and VS by Race, 2014
80.6% 78.4%
92.5% 75.9%
81.1% 76.3%
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
Retention
VS
94.5% 87.6%
100.0%
83.4%
72.7%
92.3%
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
White Black Asian
Retention
VS
2014 RWA-CLD Report 38
Summary of Client-Level Data Results
Notable changes in Ryan White service utilization pattern, especially in OAHS, MCM, HI, and Housing
Decline in the volume of Ryan White funded OAHS (OAMC) consumers
Steady increase in viral suppression rates across all groups and sub-groups between 2010 and 2014
Young black MSMs (18 – 34) trail behind the most in viral suppression among all sub-groups
Retention in care remains steady above 80 percent for most groups except the youth (13 – 18)
Disparity in retention and viral suppression exists across several groups and sub-groups but needs further investigation for better understanding
2014 RWA-CLD Report 39
Thank You ! Yohannes Abaineh, Epidemiologist
410-396-1408