Sustaining Primary Care-Public Health Partnerships for Engagement in Care – The Partnerships for Care Demonstration Project Sue Lin, PhD, MS Director, Quality Division, Office of Quality Improvement Bureau of Primary Health Care (BPHC) Health Resources and Services Administration (HRSA)

HRSA’s Bureau of Primary Health Care Strategic Goals Increase Access to Care Advance Quality and Impact Optimize Operations Health Center Program Mission: Improve the health of the nation’s underserved communities and vulnerable populations

Health Center Program National Impact Source: Uniform Data System, 2017

Partnerships for Care (P4C) Demonstration Project In 2014, HRSA collaborated with OHAIDP/SMAIF and CDC to lead HRSA awarded $30 million to support expanded HIV service delivery over 3 years at 22 Health Centers in Florida, Maryland, Massachusetts and New York Workforce Development Infrastructure Development Quality Improvement/Evaluation 5 P4C Focus Areas Service Delivery across the HIV Care Continuum Sustainable Partnerships with CDC-funded State Health Departments

P4C and the Health Center Program Between 2013 and 2014: Nearly 13% of health centers were also Ryan White HIV/AIDS Program (RWHAP) Part C grantees 1 in 3 health center patients with HIV are served at non-RWHAP health centers P4C was designed to enhance HIV service delivery for non-RWHAP health centers and improve health outcomes for PLWH P4C Source: UDS 2010-2016

Leveraging Partnerships Across Federal Agencies National HIV/AIDS Strategy 2020, Goal 4: Achieving a More Coordinated National Response to the HIV Epidemic Coordination at the Federal level should cascade outward to the health care system Active coordination exchanges ideas and strategies between leaders with common goals Health Centers – Primary Care Safety Net Program CDC’s National Center for HIV, Viral Hepatitis, STD, and TB Prevention State Health Departments HRSA’s Bureau of Primary Health Care Array of services across communities and populations that collectively help people be healthy Medical services to individual patients with immediate health needs Promote health and well-being of all people Primary Care-Public Health Partnership Primary Care Public Health Source: Institute of Medicine, March 2012. http://www.nationalacademies.org/hmd/Reports/2012/Primary-Care-and-Public-Health.aspx

HIV Care Integration P4C Demonstration Project 2014-2017 ↑ HIV testing by 27% to 1.8 million patients 84.5% of HIV patients were Served 165,745 HIV patients linked to care over 616,392 visits P4C Demonstration Project 2014-2017 The 22 P4C health centers built and sustained their expanded HIV service delivery through: Optimized HIV testing, linkage to care, and pre-visit planning policies and procedures Continued partnerships with state health departments through joint case conferencing Past: Partnerships for Care (P4C) Demonstration Project Present: P4C Toolkit & Southeast Practice Transformation Expansion Project (SEPTEP) Future: Public Health Surveillance & Practice Transformation 2017 UDS data shows: 1,808,062 million patients were tested for HIV (increase from 2016 of 27%) (Table 6A, Line 21, Column b); 165,745 HIV Patients were served (increase from 2016 of 5%) at over 616,392 Visits (Table 6A, Line 1-2); 84.5% of HIV patients were linked to care (increase from 83.2% in 2016) (Estimated % of patients seen within 90 days of first diagnosis of HIV) (Table 6B, Line 20) For the HIV care continuum, P4C health centers (79.1%) reported higher than the CDC national average (57.9%) for viral suppression of their HIV-positive patients.   Partnerships for Care (P4C) was a 3-year demonstration project (2014-2017) supported by the Secretary’s Minority AIDS Initiative Fund and HRSA’s Health Center Program Funding to expand the provision of HIV prevention and care services within communities disproportionately impacted by HIV. 22 HRSA-funded health centers partnered with four CDC-funded state health departments in Florida, Maryland, Massachusetts, and New York to improve health outcomes across the HIV care continuum for PLWH, especially among racial and ethnic minorities. HIV Testing: US Preventive Services Task Force recommends screening adolescents and adults aged 15-65 for HIV at least once in their lifetime, regardless of risk. P4C health centers provided routine HIV testing to 77,347 patients aged 15-65 years in the first 2 years (2015-2016) who had never before been tested for HIV. HIV Care Continuum: Linkage to Care within 90 days of HIV diagnosis Retention in Care is defined as HIV medical patients from the previous (vs. current) year who had at least 2 HIV medical visits in the current year Prescribed Antiretroviral Treatment and Achieved Viral Suppression The Southeast Practice Transformation Expansion Project (SEPTEP) is a 9-month HRSA project (September 2017-June 2018) funded by HRSA/BPHC’s Health Center Program in collaboration with the HIV/AIDS Bureau (HAB) AIDS Education and Training Centers (AETC) Program. The goal of SEPTEP is to advance HIV testing, linkage to care, and prevention at HRSA-funded health centers in the Southeast United States (Region 4), which has the nation’s highest rates of HIV diagnoses. SEPTEP leverages lessons learned from BPHC’s P4C demonstration project and HAB’s AETC Program practice transformation projects. Health centers will receive HIV T/TA and practice transformation support from the Southeast AETC at Vanderbilt University to build the capacity of primary healthcare providers and teams caring for patients living with HIV and/or at highest risk for HIV infection in underserved communities. SEPTEP health centers have achieved PCMH recognition and are not dually funded through Part C of the Ryan White HIV/AIDS Program Coaching for practice transformation leadership includes a 2-day in-person workshop to (1) build core leadership skills in communication and strategic planning to overcome implementation barriers and (2) learn best practices for HIV testing, prevention, and motivational interviewing. The workshop is followed by communities of practice to present cases, discuss lessons learned, and share strategies for overcoming barriers to HIV practice transformation. Additional resources can be found on HRSA/BPHC’s HIV Primary Care Integration webpage HIV and Primary Care Training and Technical Assistance Resources URL- https://bphc.hrsa.gov/qualityimprovement/clinicalquality/hivprimarycare-resources.html

Thank You! Sue Lin, PhD, MS Division Director, Quality Division, Office of Quality Improvement Bureau of Primary Health Care (BPHC) Health Resources and Services Administration (HRSA) slin@hrsa.gov 301 443 2923 www.bphc.hrsa.gov @HRSAgov facebook.com/HHS.HRSA