Department of Public Health Ryan White Program Ryan

Department of Public Health Ryan White Program Ryan White Resource Gap Estimate (2017/2018) Shannon Swims Administrative Supervisor Ryan White Program June 24, 2020 www. SBCounty. gov

Gap Analysis 2 I’m on it! Department of Public Health Ryan White Part A Program www. SBCounty. gov

3 Gap Analysis HRSA FORMULA: DISEASE “BURDEN” Department of Public Health Ryan White Part A Program COST OF CARE = RESOURCE NEEDS www. SBCounty. gov

Gap Analysis – Medical Care EXAMPLE Part B/C Medi-Cal Medicare Private 4 Market place Estimated Diagnosed (Aware) PLWHA Living in Riverside and San Bernardino Counties CCS Job-based VA Department of Public Health Ryan White Part A Program Unmet www. SBCounty. gov

5 Gap Analysis – In Care EXAMPLE Funding Need Estimate for Medical Care = ~ 315 IN CARE Gap ~$1, 266 cost/client $398, 199* funds needed to meet the medical service gap of those in care N = 315 *Total calculation is slightly different due to rounding of input numbers. Department of Public Health Ryan White Part A Program www. SBCounty. gov

Gap Analysis – Unmet Need/Unaware 6 Unmet Unaware • EIS and Outpatient Medical: • Need = All those Unaware and out of care (Unmet Need) need these services • Contact Rate/Expectation = Estimate of the # we can reasonably expect to serve Add these amounts to “Care” amounts for total funding need to MEET the resource gap Department of Public Health Ryan White Part A Program www. SBCounty. gov

Gap Scenarios Department of Public Health Ryan White Part A Program 7 www. SBCounty. gov

Service Sources Department of Public Health Ryan White Part A Program 8 www. SBCounty. gov

9 Service Sources Other Points to Keep in Mind: • Medical (Outpatient/Amb): • Most of need is now met by other sources • A few gaps still remain: undocumented individuals, those with very high Share of Cost, those transitioning in/out/between insurance sources, some procedures, emergency medication • Dental (Oral Health): • Most of need is now met by Denti-Cal (Adult benefits fully restored Jan 2018) • But a few gaps still remain: SAME AS MEDICAL (above) Department of Public Health Ryan White Part A Program Not exhaustive! www. SBCounty. gov

10 Department of Public Health Ryan White Part A Program www. SBCounty. gov

Department of Public Health Ryan White Program Ryan White Service Category Dashboards Shannon Swims Admin Supervisor Ryan White Program June 24, 2020 www. SBCounty. gov

12 Service Dashboards MEDICAL CASE MANAGEMENT 2013 -2020 Service Trends and Data - HOME AND COMMUNITY-BASED HEALTH SERVICES 2013 -2014 Final Expenditures Category Surplus Cost Per Client 2 0 0 2 29 $141, 419 $127, 782 $143, 492 $147, 001 $200, 000 $247, 361 $170, 613 $200, 000 $184, 571 $116, 992 $163, 743 $123, 743 $127, 782 $0 $6, 725 $146, 979 $22 $7, 349 $141, 322 $106, 039 $9, 421 $110, 677 $59, 936 $7, 905 $108, 443 $76, 128 $5, 707 $96, 971 $20, 021 $5, 104 $112, 555 $11, 188 $3, 881 0 All Clients 2 1 0 15 19 14 29 19 . . 1. . . 20 1. 20 20 1. 20 20 . . 1. . . 20 20 20 1. . . 20 $100, 000 1. . . 20 1. . . 1. 20 20 . . $0 20 Cost Per Client Category Surplus $10, 000 $150, 000 $100, 000 $50, 000 $0 $5, 000. . 1. . . 20 20 1. . . 1. 20 . . 20 1. . . 1. 20 1. . . $0 20 . . 1. 20 Final Expenditures $200, 000 20 2014 Needs Assessment Core Services Ranking - #5 20 19 20 0 $300, 000 $200, 000 $100, 000 $0 . . This study supports the continuing need for RW-funded Medical Case Management (MCM) as the primary source of support and assistance for those that need intense care coordination. Coordination is increasingly challenging and timeconsuming as RW-funded MCM staff are required to connect with outside/non-RW systems of care on behalf of their clients that are in care with facilities such as Kaiser and other local health organizations. 40 0 20 2019 -2020 0 19 0 1. A National Alliance of State & Territorial AIDS Directors (NASTAD) study (June 2014) concluded the following: 1) While new health coverage options have been made available through the ACA, the Ryan White Program continues to offer the most robust case management services for PLWH; 2) Credentialing requirements for case management providers within benchmark QHPs, traditional fee-for-service Medicaid and the Ryan White Program varies widely in each state [10 states analyzed, CA not included]; 3) Eligibility for case management in state Medicaid programs is often reserved for specific populations based on level of need; and 4) The majority of benchmark QHPs analyzed offer very limited case management services. 2018 -2019 1 19 4 20 2017 -2018 0 14 Final Allocation Analysis and Updates 2016 -2017 0 15 New Clients 20 In addition to providing the medically oriented services above, Medical Case Management may also provide benefits counseling by assisting eligible clients in obtaining access to other public and private programs for which they may be eligible (e. g. , Medi-Cal, Medicare Part D, State Pharmacy Assistance Programs, Pharmaceutical Manufacturer’s Patient Assistance Programs, other state or local health care and supportive services, and insurance plans through the health insurance Marketplaces/Exchanges). Final Allocation 1. Original Allocation 20 Medical Case Management is the provision of a range of client-centered activities focused on improving health outcomes in support of the HIV care continuum. Activities may be prescribed by an interdisciplinary team that includes other specialty care providers. Medical Case Management includes all types of case management encounters (e. g. , face -to-face, phone contact, and any other forms of communication). Key activities include: • Initial assessment of service needs • Development of a comprehensive, individualized care plan • Timely and coordinated access to medically appropriate levels of health and support services and continuity of care • Continuous client monitoring to assess the efficacy of the care plan • Re-evaluation of the care plan at least every 6 months with adaptations as necessary • Ongoing assessment of the client’s and other key family members’ needs and personal support systems • Treatment adherence counseling to ensure readiness for and adherence to complex HIV treatments • Client-specific advocacy and/or review of utilization of services 2015 -2016 0 20 20 2014 -2015 0 19 New Clients All Clients 1. Service Category Definition www. SBCounty. gov

Outpatient/Ambulatory Medical Care 13 • Outpatient/Ambulatory Medical Care program has seen an approximately 66% decrease in overall clients during the past several years due to implementation of the ACA. No additional reductions in overall client numbers are anticipated to occur as the vast majority of clients have transitioned to other funding sources. • The remaining clients include certain population groups that are unable to obtain health care coverage (i. e. undocumented), those that have a lapse in insurance coverage, and those that require procedures/service not reimbursable by other funding sources. All of these groups will continue to need RW funded medical care. Department of Public Health Ryan White Part A Program Core Services Ranking #1 www. SBCounty. gov

Oral Health 14 • Senate Bill 97 (2018) fully restored adult optional dental benefits, which resulted in a decrease in dental clients as many basic services previously funded by RW funds became billable to Denti. Cal. However, access to Denti-Cal providers remains a barrier to receiving care. • According to the Medi-Cal Dental Review (July, 2015) from the California Department of Health Care Services, Denti-Cal providers have decreased over 14% since 2008. Therefore, it is expected that RW funded services will remain necessary to cover services during transition as well as for those that are ineligible for services, and, once enrolled, to cover necessary services that remain uncovered by Denti-Cal or unreachable due to high Share of Cost. Department of Public Health Ryan White Part A Program Core Services Ranking #2 www. SBCounty. gov

Early Intervention Services 15 • Early Intervention Services (EIS) maintains a steady number of clients averaging about 8, 500 HIV+ and HIVclients per year. • It is anticipated that client numbers will increase as target populations are identified and more individuals are being linked to care within the Riverside/San Bernardino, CA TGA. Department of Public Health Ryan White Part A Program Core Services Ranking #4 www. SBCounty. gov

Medical Transportation Services 16 • Emerging methods/modes such as Uber and Lyft can also be explored by the council and by service providers as additional tools to address transportation barriers to care. Great care should be taken to ensure services are cost effective and utilized appropriately. • A new transportation van service was recently implemented in the high-desert area of San Bernardino County (Victorville/Hesperia/etc. ) and San Bernardino. Still, client need remains. Any significant usage increases or decreases will be impacted solely by increases or decreases in allocations to the service category. Department of Public Health Ryan White Part A Program Support Services Ranking #5 www. SBCounty. gov

Housing Services 17 • Housing services were provided to 559 Part A clients in 19/20. • Approximately the same amount of money was spent in 19/20 as 18/19. • 87. 7% of our Part A/MAI client base is considered “Stably Housed”. • HOPWA contracts continue to experience considerable delays, causing uncertainty and instability in the housing assistance system. Department of Public Health Ryan White Part A Program Support Services Ranking #4 www. SBCounty. gov

Mental Health & Substance Abuse 18 • The need for RW-funded Mental Health support groups will remain as no other source provides HIV-specific support groups. • With the need for services outweighing the current availability, RW funds are still necessary to cover service gaps in Substance Abuse services. • Availability of services will continue to be monitored in order to determine the level of need throughout the TGA. Department of Public Health Ryan White Part A Program www. SBCounty. gov

19 How these data can help… • Service Dashboards • Provides comprehensive information on each service category • Can help in allocating funds to services clients indicated as most important Department of Public Health Ryan White Part A Program www. SBCounty. gov

20 Department of Public Health Ryan White Part A Program www. SBCounty. gov

21 Department of Public Health Ryan White Part A Program www. SBCounty. gov