Transcript Continuing HIV Care Services in the Absence of Ryan White Funding Interfaith Community Health Center Bellingham, Washington.

Continuing HIV Care
Services in the Absence
of Ryan White Funding
Interfaith Community Health Center
Bellingham, Washington
What We Decided
• In February 2014, the ICHC Board of Directors voted
unanimously to relinquish the clinic’s Part C grant
effective March 31, 2014.
• Grant amount was approximately $400,000.
• ICHC was an April 1 start date with one year left in
grant cycle before re-competition.
• ICHC had been a Ryan White grantee for 11 years.
• ICHC’s Ryan White Program offered a comprehensive
program of primary care, dental, case management,
behavioral health, and nutrition services.
• One Ryan White patient is a ICHC Board Member.
However…
Board also voted unanimously to continue
the same array of services offered through
our Ryan White Program using other
funding sources (e.g., 340b and Medicaid
expansion revenue)
Why We Did It
• Unique nature of ICHC clinic
• FQHC with approximately 14,000 patients
• Only about 170 HIV patients
• No stand-alone HIV program, so…
• Different eligibility process for HIV patients vs. other clinic
patients (e.g., income verification every 6 months, even if
insured, and residency documentation – not required of any
other clinic patients)
• Different Ryan White sliding fee scale rules vs. 330 rules (e.g.,
no charge for patients below 100% FPL, slide beyond 200%
FPL)
• Clinic EMR with CAREWare double entry
• Considerable drain on Finance, Front Desk, and Medical
Records
Why We Did It (continued)
• ACA implementation
• Fewer uninsured patients
• Likely grant underspend into the future
• Strong safety net in Washington State through
state’s Early Intervention Program (although
Medicaid patients are categorically ineligible)
• Coverage for undocumented patients
• Comprehensive dental coverage
• Assistance with copays/premiums/deductibles
Why We Did It (continued)
• Increasing administrative burden
• Eligibility verification twice annually
• Very likely to have required a core services waiver
• Had increase administrative staffing .2 FTE to
handle eligibility documentation
• Administrative requirements were becoming an
impediment to quality care
• Paper chasing by medical staff
• Frustrated patients
• Frequently changing requirements meant frequent
“system change,” which was disruptive to program
efforts
Why We Did It (continued)
• Cost shifting – We were covering more of the
costs of care with non-grant funds anyway
• Guidance that more costs (e.g., medical
records, referrals, front desk) categorized as
administrative costs
• Patients with lapsed eligibility documentation
couldn’t be billed to grant
• Compliance concerns
• Retroactive policy clarifications
What Has Happened
• Continue to provide same services we have
historically provided – same staff, same services
• Continue to contract with our case management
partners
• If anything, the relationship has become stronger
• They have been understanding of our decision
• Continue to have a Consumer Advisory Group
• Continue to track HAB measures, with a few
slightly modified, for QI program
• No change in number of HIV patients served
What Has Happened (continued)
• Time to “drill down” into quality measures and
refine systems that should have been addressed
long ago
• Moving towards implementation of a Hepatitis C
program
• Focusing more on engagement/retention
• Expanding some RW benefits to other clinic
patients (e.g., HIV nutritionist will start offering
classes to patients with HIV and other chronic
conditions)
What Has Happened (continued)
• Plans to work more with community
partners on prevention and moving to optout HIV testing
• Patients have rolled with the change
• Those with incomes above 200% FPL are
no longer eligible for the sliding fee scale,
in compliance with 330 rules
What Has Happened (continued)
• If there’s a gap, it’s dental
• Medicare and privately-ensured patients have
strong dental coverage through Early
Intervention Program
• Medicaid adult dental program is not as
generous
• Working through gaps in care for Medicaid
patients in partnership with our case
management contractor