Baltimore EMA ClientLevel Data in FY 2016 among

Baltimore EMA Client-Level Data in FY 2016 among all Ryan White Part A/MAI Eligible clients Planning Council Meeting June 20 th, 2017 FY 2016 Client Level Data Stephon Effinger, CAREWare Database Administrator

Mission BCHD Ryan White HIV/AIDS Bureau Part A/MAI • Improve the quality of life for people living with HIV/AIDS and their families in Baltimore City and surrounding counties • Provide comprehensive guidance to Ryan White providers and the Baltimore Planning Council to ensure compliance with Ryan White legislations and standards of care Objective • Demonstrate 2016 fiscal year’s client level data for resource allocation decision making

BCHD Ryan White Part A/MAI Client Level Data FY 16 • CAREWare is a free, electronic health and social support services information system for Ryan White HIV/AIDS Program grant recipients and their providers. CAREWare was developed by HRSA’s HIV/AIDS Bureau and first released in 2000. CAREWare installations manage HIV clinical and support service data from more than 360, 000 client records in 48 states, Washington, DC, Puerto Rico, and the U. S. Virgin Islands. The application is currently used by more than half of all funded grant recipients to report year-end, Ryan White HIV/AIDS Services Report (RSR) client-level data and to monitor quality of care on a regular basis. • All Ryan White Clients with at least one service funded by Ryan White Part A/MAI – Capture clients with a Federal Poverty Level <=300% living with HIV in the era of the Affordable Care Act, where more people have access to health insurance – # of unduplicated clients N = 8279

Who are the Ryan White Part A/MAI clients in the Baltimore EMA? v 8% newly diagnosed with HIV (n=649) v 18% CDC-defined AIDS diagnosis (n=1482) v 83% residents of Baltimore City (n= 6871) v 14% New to Ryan White Providers (first visit or encounter in FY 16) (n=1151) v 15% report to have unstable or temporary housing (n=1241)

Monitoring Clinical Outcomes Retention in HIV Medical Care Definition: Percentage of clients with HIV infection who had two or more medical visits in an HIV care setting in the measurement year Numerator: Number of HIV-infected clients who had a medical visit with a provider with prescribing privileges 1 , i. e. MD, PA, NP, in an HIV care setting 2 two or more times at least 3 months apart during the measurement year Denominator: Number of HIV-infected clients who had a medical visit with a provider with prescribing privileges at least once in the measurement year Numerator Denominator Percentage 3487 4914 71%

Monitoring Clinical Outcomes Viral Load Suppression Definition: Percentage of patients, regardless of age, with a diagnosis of HIV with a HIV viral load less than 200 copies/m. L at last HIV viral load test during the measurement year Numerator: Number of patients in the denominator with a HIV viral load less than 200 copies/m. L at last HIV viral load test during the measurement year Denominator: Number of patients, regardless of age, with a diagnosis of HIV with at least one medical visit in the measurement year Numerator Denominator Percentage 3829 4914 78%

Viral Load Suppression by Gender, FY 2016

Viral Load Suppression by Age Group, FY 2016

Care Continuum All Clients known to Ryan White regardless of payer i. e. BCHD Part A, DHMH Part B, HRSA Part C, HRSA Part D, Medicare, Medicaid, Private, etc. (All Eligibles/Consumers) 100% in care 70% of those in care -45% of those in care -64% of those retained in care At least one documented HIV medical visit In care and had two or more HIV medical visits at least 90 days a part In care, retained in care, and were prescribed ART -39% of those in care -56% of those retained in care -89% of those prescribed ART In care, retained in care, prescribed ART, and have a documented viral load of <200 copies/ml at last viral load test

Monitoring Clinical Outcomes among Ryan White Part A Clients who are Uninsured & at least one documented OAHS visit Ø 10% of the Ryan White population remain uninsured (n=471) Ø 88% FPL <= 300% (n=414) Ø 11% were new to Ryan White services (n=50) Ø 7% were newly HIV Diagnosis (n=32) Ø 62% are men (n=295) Ø Mean age = 44 years

Retention by Insurance Type among Ryan White Part A consumers, FY 2016 63. 9% Unknown 74. 7% Private 86. 1% Other 64. 3% No Insurance 77. 0% Medicare 72. 2% Medicaid 50. 0% IHS 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Viral Load Suppression by Insurance Type among Ryan White Part A Consumers, FY 2016

Ryan Part A/MAI FY 16 Service Utilization Service Category # Units of Clients Service Avg Units Per Client Outpatient Ambulatory Medical Care Case Management (non-medical) Health Insurance Premiums Housing (including bed nights) Emergency Financial Assistance Legal Services Substance Abuse Residential Medical Case Management MAI Medical Transportation MAI Outreach MAI Mental Health MAI Oral Health MAI Food Bank-Home Delivered Meals (individuals meals not counted) MAI Medical Nutrition Therapy MAI Psychosocial Support MAI Substance Abuse Outpatient MAI 4914 1714 1284 588 1641 281 5 5249 1194 2990 989 1435 289 706 546 1476 388 696 250 237 116 716 317 171 68 5 5 4 31 3 5 1 10 11 8 6 3 4 6 5 3 3 1 1 5 2 7 20 25240 8957 5322 18119 5010 1478 5 51220 13656 22681 6342 4927 1140 4315 2747 3853 970 1869 803 309 149 3382 734 1265 1342

THANK YOU! QUESTIONS? ?

Limitations • A Ryan White documented HIV care visit in CAREWare those who have had a funded RW OAHS visit and we may be missing Ryan White consumers receiving care elsewhere