1. Maintaining and Improving a System of Care 1
Slides for Module 7

2. Maintaining and Improving a System of Care 2
Concept of a System of Care
Maintaining and Improving a System of Care through Service Standard, CQM and Coordination of Services
Assessment of the Efficiency of the Administrative Mechanism
How the PC/PB Helps Improve the System of Care

3. Concept of a System of Care
Defining and Understanding the System of Care
Shared Responsibility for the System of Care

4. Training Objectives: Concept of a System of Care
Following this portion of the training, participants will be able to:
Define and describe a “comprehensive system of HIV care”
Describe the shared responsibility of the PC/PB and recipients in establishing, maintaining, and improving the local system of care

5. Centrality of the System of Care
RWHAP exists to support a system of comprehensive, appropriate core medical and support services for people living with HIV that have limited financial resources
In its early years, RWHAP helped to establish a continuum or system of HIV care
Current focus is on maintaining, assessing, and improving the system of care to reflect changes in the epidemic, prevention, treatment, and the broader health care system―and integrating prevention and care
PC/PB and recipient share responsibility for improving the system of care

6. Legislative Language Part A funds must support:
“core medical services that are needed in the eligible area for individuals with HIV/AIDS” including services related to “co-occurring conditions” ― [§2604(c)(1)]
Support services “that are needed for individuals with HIV/AIDS to achieve their medical outcomes” ― [§2604(d)(1)]

7. HRSA/HAB Expectations for a Comprehensive System of Care
System of care is not limited to services paid for through RWHAP funds
The annual Part A application asks for a “description of the comprehensive system of care in the entire EMA/TGA, including the available core medical and support services funded by RWHAP Part A and by other sources, where services are located, and how clients access those services, including services for disproportionately impacted subpopulation(s) supported by MAI funds” [FY 2019 Notice of Funding Opportunity, p 11]

8. HRSA/HAB Expectations (cont.)
RWHAP “requires services to be provided in a coordinated, cost-effective manner” and be “coordinated with all other public funding for HIV/AIDS” in order to:
Ensure that RWHAP is the “payor of last resort”
“Maximize the number and accessibility of services available”
“Reduce any duplication” − Part A Manual, pp 15-16

9. HRSA/HAB Expectations (cont.)
The system of care should:
“address the service needs of newly affected and underserved populations – including disproportionately impacted communities of color and emerging populations”
“be consistent with HSRA’s goals of increasing access to services and decreasing HIV/AIDS health disparities…”
“be designed to address the needs of PLWH across all life stages” from being unaware of their “HIV status, through HIV counseling and testing, early intervention and linkage to care, to retention in care and treatment adherence” − Part A Manual, pp 15-16

10. Desired Characteristics of a Comprehensive System of Care
Availability of both core medical and support services
Accessible services – in terms of location, public transportation, and service hours
Appropriate services for diverse PLWH populations based on such characteristics as race/ethnicity, sexual orientation, gender/gender identity, age, and risk factor – provider staff speak needed languages and are culturally competent, with appropriate training and skills
Effective services that meet performance standards and contribute to viral suppression and other positive medical outcomes

11. Shared Responsibility for the System of Care
The PC/PB:
Assesses service needs and gaps, which requires reviewing the existing system of care – including RWHAP- funded and other core medical and support services
Establishes service priorities and allocates Part A and Part A Minority AIDS Initiative (MAI) funds to specific service categories
Provides guidance and models for meeting service needs overall and for particular PLWH subpopulations, through use of tools like directives and service standards

12. Shared Responsibility for the System of Care (cont.)
The Recipient:
Contracts with providers to deliver services
Specifies service requirements in RFPs and subrecipient agreements
Monitors subrecipients to ensure service quality
Manages a CQM program with subrecipients that:
Measures performance and medical outcomes
Implements quality improvement efforts
Coordinates with other RWHAP Parts and other public and private funders and services

13. Quick Scenario A: Describing the Local System of Care
Suppose you meet a person with HIV who receives HIV care through RWHAP in another city but is thinking of moving to your EMA/TGA. That person asks you to “tell me about the system of HIV care, and how I can get access to both medical and support services.”
What would you say if the question came from:
A young MSM of color?
A transgender woman?
A long-time HIV survivor aged 60+?
How prepared are you to answer this question?

14. Service Standards, CQM and Coordination of Services
Development and Use of Service Standards
Role of Clinical Quality Management
Coordination of Services/Relationships with Other Programs

15. Training Objectives: Maintaining and Improving a System of Care
Following this portion of the training, participants will be able to:
Service Standards
Define “service standards”
Identify ways service standards are used by consumers, subrecipients, PC/PBs, recipients and Quality Managers
Describe a process for developing service standards

16. Training Objectives: Maintaining, and Improving a System of Care (cont
Clinical Quality Management
Explain the concept of Clinical Quality Management (CQM) and the legislative requirement of the RWHAP to implement a CQM program
Identify and describe the three main components of a CQM Program
Describe at least 3 ways PC/PBs use CQM data
Coordination of Services:
Explain HRSA/HAB expectations for PC/PB involvement in the coordination of services and relationships with other programs

17. Development and Use of Service Standards
Understanding Service Standards
Use of Service Standards
Development and Updating of Service Standards

18. What are Service Standards?
Written guidelines that outline for subrecipients the elements and expectations for implementing a service category in the EMA or TGA
Designed to:
Ensure that all subrecipients provide the same basic service components
Establish a minimal level of service or care
A jurisdiction’s service standards include:
Universal service standards that apply to all service categories
Separate standards for each funded service category

19. HRSA/HAB Expectations for Service Standards
Responsibility not addressed directly in the legislation
HRSA/HAB Guidance says that:
Recipient is “responsible for the development, distribution, and use of service standards”
For Part A programs, “developing service standards is a shared responsibility, typically led by the Planning Council”
Service Standards: Guidance for Ryan White HIV/AIDS Program Grantees/Planning Bodies

20. Service Standards: A Tool for Many Users
Consumers: Any consumer should be able to read service standards and know what to expect “when accessing or receiving RWHAP funded services”
Subrecipients/Service Providers: “Service standards define the core components of a service category to be included in the model of service delivery”
PC/PBs: Service standards help PC/PBs understand what activities are being provided by subrecipients – and can help them identify possible changes/improvements
Service Standards: Guidance for Ryan White HIV/AIDS Program Grantees/Planning Bodies

21. Service Standards: A Tool for Many Users (cont.)
Recipient: Service standards are used in Requests for Proposals, subrecipient contracts, and monitoring (including site visits and chart reviews) “to ensure that services are provided to clients in a consistent manner across service providers”
Quality Managers: “Service standards are the foundation for the clinical quality management program, and provide the framework and service provision from which processes and outcomes are measured”
Service Standards: Guidance for Ryan White HIV/AIDS Program Grantees/Planning Bodies

22. Understanding Service Standards (cont.) 1
Medical care standards must be consistent with HHS/Public Health Service (PHS) “care and treatment guidelines and other clinical and professional standards”
Non-clinical/support services may use “evidence-based best practices, National Monitoring Standards, and/or guidelines developed by state or local government”
Service Standards: Guidance for Ryan White HIV/AIDS Program Grantees/Planning Bodies

23. Understanding Service Standards (cont.) 2
Term used was previously “standards of care,” but that language has been used outside RWHAP to mean medical care and treatment – and RWHAP service standards cover both medical and support services
National service standards are not feasible due to:
Differences in state and local requirements
The need to tailor services to meet the needs of the jurisdictions

24. Understanding Service Standards (cont.) 3
Service standards should be readily available to providers, consumers, and the public – on the recipient and/or PC/PB website
Service standards should describe the services so that anyone who reads them can understand:
What the service is
What a client can expect when receiving the service

25. HRSA-Recommended Topics to Address in Service Standards
Service Category Definition
Intake and Eligibility
Key Service Components and Activities
Personnel Qualifications (including licensure)
Assessment and Service Plan*
Transition and Discharge
Case Closure Protocol
Client Rights and Responsibilities
Grievance Process
Cultural and Linguistic Competency
Privacy and Confidentiality (including securing records)
Recertification Requirements*
*Where Applicable

26. HRSA/HAB Guidance: Performance and Health Outcome Measures
Jurisdictions should NOT include performance measures or health outcomes in their service standards
Use of these measures is a recipient responsibility:
Recipients include performance standards in their RFPs
Potential subrecipients indicate in the application their ability to meet the performance standards
Selected subrecipients have performance measures in their contracts
Recipient monitoring addresses whether these measures, which are based on the service standards, are being met
Recipient monitoring for compliance is an administrative function

27. Developing Service Standards
Assign responsibility – usually to a PC/PB committee such as Care Strategy or System of Care
Determine priorities for development of service standards
Include all service categories that are currently funded or have been allocated funds for the next program year
Agree on the order of development based on clear criteria such as a service category’s allocation level or local priority
Set a timeline that fits into your annual calendar
Review and agree on an outline to be used for all service category-specific service standards

28. Developing Service Standards (cont.) 1
Develop Universal Standards that apply to all service categories:
Include programmatic and fiscal requirements in the RWHAP Part A National Monitoring Standards
Address such topics as:
Access to Services
Personnel, Training, Licensing & Supervision
Agency Policies & Procedures
Client Rights & Responsibilities
Intake and Eligibility
Cultural & Linguistic Competence
Transition and Discharge
Privacy & Confidentiality
Grievance Process
Program Safety

29. Developing Service Standards (cont.) 2
Establish a process for drafting service standards that:
Includes a review of federal guidelines, standards from other jurisdictions, and relevant state and local requirements
Includes ongoing recipient representation/participation
Provides for systematic technical input from providers, consumers, and other experts, including RWHAP-funded and other service providers
Manages potential conflict of interest by ensuring that subrecipients do not dominate in numbers or influence
Uses a combination of meetings and written input and reviews

30. Developing Service Standards (cont.)
Develop service standards using the agreed-upon process
Reference Universal Standards but do not repeat their content in service category-specific standards
Present draft standards for review by the PC/PB and recipient
Make needed revisions, then allow for external review by providers, consumers, and other experts
Consider and integrate external input to draft standards
Finalize service standards by vote of the PC/PB

31. Reviewing and Updating Service Standards: Use of Outcome Data
Review of outcomes is essential to measure the impact of RWHAP services
The PC/PB should consider the following
Are some outcome measures, as shared with the PC/PB, unacceptably low – for example, failure to reach adherence goals or low levels of viral suppression?
Does aggregate monitoring data from the recipient indicate that subrecipients are fully compliant with service standards?
If the answer to both questions is yes, then perhaps service standards may be outdated and need to be reviewed and refined

32. Reviewing and Updating Service Standards
Review and update standards as needed to incorporate:
The need for changes to improve outcomes
Legislative or HRSA/HAB administrative changes in service category definitions and descriptions
Changes in guidelines for HIV care and treatment
New or revised state or local requirements (e.g., licensing or certification changes)
Review all standards at least every 3 years, on a pre- determined cycle
Obtain technical input and public review from the same types of sources as in original development

33. Quick Scenario B: Updating Service Standards
You are the PC/PB Care Strategy Committee. It has been 4 years since your service standards were updated. A comprehensive site visit from HRSA/HAB is scheduled in about 5 months and you want to move quickly on standards review and updates. The committee Co-Chair, who runs a large subrecipient, suggests the committee focus on the 4 service categories with the most funding, work with PC/PB and recipient staff to make essential updates based on HRSA/HAB guidance, and then ask the subrecipients providing those services to provide input for committee review and action.
Is this a good idea? Why or why not?
What might the committee do instead?

34. Clinical Quality Management: A Recipient Responsibility
Understanding CQM
Recipient Role
PC/PB Use of CQM Data

35. Legislative Language: CQM
“REQUIREMENT- The chief elected official of an eligible area that receives a grant under [Part A] shall provide for the establishment of a clinical quality management program to assess the extent to which HIV health services provided to patients under the grant are consistent with the most recent Public Health Service guidelines for the treatment of HIV/AIDS and related opportunistic infection, and as applicable, to develop strategies for ensuring that such services are consistent with the guidelines for improvement in the access to and quality of HIV health services”
―§2604(h)(5)(A)

36. Funding for CQM
Legislation allows for activities associated with CQM to be supported with up to the lesser of:
5 percent of the grant amount
$3 million
CQM activities are not considered administrative expenses
CQM funds must not be used to cover administrative costs

37. Clinical Quality Management
Involves the coordination of activities aimed at improving:
Patient care
Health outcomes
Patient satisfaction

38. HRSA/HAB Expectations
CQM is a recipient responsibility
Part A PC/PB usually has primary responsibility for development of service standards, which are used in CQM but are a separate administrative activity
PC/PB should review CQM data for use in decision making such as:
Development or refinement of service standards
Priority setting and resource allocation
Development of directives

39. HRSA/HAB Expectations (cont.) 1
Requirements described in Policy Clarification Notice (PCN) 15-02
Recipient works directly with subrecipients to implement, monitor, and provide needed data on the CQM program
Recipients under RWHAP Parts A, B, C, and D all establish CQM programs
Coordination across all RWHAP-funded recipients and subrecipients is encouraged, to:
Reduce data burden
Align performance measurement
Maximize the impact of improved health outcomes

40. CQM Components
Infrastructure – provides capacity to plan, implement, and evaluate CQM program activities
Performance Measurement – the process of collecting, analyzing, and reporting data regarding patient care, health outcomes, and patient satisfaction
Quality Improvement – the development and implementation of quality improvement activities to make changes to the program in response to the data from performance measurement

41. CQM Component: Infrastructure
Includes leadership, dedicated staffing and resources, stakeholder involvement, a CQM Plan, and evaluation of the CQM program
Requires a CQM committee established by the recipient that develops the program and related activities
CQM Committee is not a PC/PB committee
Recipient may choose to include some PC/PB representatives as members
Includes involvement of consumers
Consumers often serve on the CQM Committee, but need not be PC/PB members
Can be trained to serve as quality advocates in their communities and participate in quality improvement activities

42. CQM Component: Performance Measurement
Selection of a portfolio of measures that best assess the services the recipient is funding – and reflect local HIV epidemiology and identified needs of PLWH – to include:
At least 2 performance measures for every funded service category where ≥50% of the recipient’s eligible clients receive at least 1 unit of service
At least 1 performance measure for every service category where greater than15% and less than 50% of the recipient’s eligible clients receive at least 1 unit of service
No measure need be identified for a service category where ≤15% of eligible clients receive at least 1 unit of service
An identified process to regularly collect, analyze, and report performance measure data at least quarterly

43. CQM Component: Quality Improvement
Quality Improvement activities are:
Aimed at improving patient care, health outcomes, and patient satisfaction
Implemented using a defined approach or methodology
Carried out in an organized, systematic fashion – so the recipient can understand whether the changes or improvements had a positive impact or further changes are needed
Documented in writing

44. PC/PB Use of CQM Data PC/PB should receive CQM data such as:
Performance and outcomes data overall and by service category
Aggregated data on service access, patient care, health outcomes, and consumer satisfaction
Information on the extent to which support services contribute to positive medical outcomes
Results of quality improvement projects
PC/PB uses CQM data for decision making about:
Allocation
Service models
Directives to improve services in particular geographic areas or for particular PLWH subpopulations

45. Quick Scenario C: Using CQM Data
Your PC/PB is very concerned about low rates of retention and viral suppression among male Latino RWHAP clients, as reported in HIV care continuum data. You recently held 2 focus groups and a key informant session, which identified language issues, insufficient evening or weekend service hours, and limited awareness of the importance of early and continued antiretroviral therapy. The recipient’s Quality Manager tells the committee that this is also a priority concern of the CQM program.
How might the PC/PB benefit from the work of the CQM program in addressing this problem?

46. Coordination of Services/ Relationships with Other Programs
HRSA/HAB Expectations
PC/PB Strategies for Service Coordination

47. HRSA/HAB Expectations for Service Coordination
HRSA/HAB “expects to see collaboration, partnering and coordination between multiple sources of treatment, care and HIV testing, and HIV prevention service providers”
“In a mature continuum of care, collaboration between HIV testing sites, non-Ryan White Program providers, all Ryan White Program Parts (A, B, C, D, and F), Medicaid, and Veterans Administration should be established and maintained in the planning and implementation of services”
―Part A Manual, p 16

48. HRSA/HAB Expectations (cont.) B
Recipients “are required to participate in an established HIV community-based continuum of care if such continuum exists within the area and maintain appropriate referral relationships with entities considered key points of access to the healthcare system” ―Part A Manual, p 15

49. PC/PB Role in Coordination of Services
PC/PB is a logical place for coordination of services/discussion of relationships among programs because of its composition--including representatives of:
Other RWHAP Parts
Other federal HIV programs – e.g., prevention, Housing Opportunities for Persons with AIDS (HOPWA)
Providers of a wide range of core medical and support services
Diverse consumers
Integrated/comprehensive plan includes an inventory of services and funding

50. PC/PB Role in Coordination of Services (cont.) 1
PC/PB should keep informed about full range of HIV-related services, regardless of funding source
Committee responsible for system of care might discuss services funded through other Parts and provide a summary to the full PC/PB
PC/PB reviews data on other funding streams annually before doing resource allocation
PC/PB may hold roundtables with service providers to discuss issues, challenges, and opportunities to improve collaboration
Discussions must include management of Conflict of Interest for subrecipients

51. PC/PB Role in Coordination of Services (cont.) 2
Integrated prevention-care or RWHAP Part A/Part B planning bodies may have a role in determining use of Part A and other HIV resources. For example:
A joint planning body may allocate Part A funds and recommend allocation of Part B funds (Part B recipient is the decision maker)
Agreement might be made for Part B to pay for certain service categories, while Part A pays for others
Planning body may have a role in deciding how HOPWA or other federal or local HIV funds are used

52. Quick Scenario D: Coordination of Services
Your PC/PB has members representing other RWHAP Parts, but limited information about other programs and resources used for services to PLWH as part of the system of care. You are especially interested in better understanding support services and core medical and services other than outpatient/ambulatory health services and medical case management. As the Executive Committee, you are discussing how the PC/PB can learn more about these programs and services.
How might you address this need for information?

53. Sum Up: System of Care
Service standards play an important role in ensuring service quality and consistency across funded providers – and the PC/PB usually takes the lead on developing them
CQM is a recipient responsibility, but uses service standards, may involve PC/PB members as CQM Committee members, and provides valuable data for PC/PB decision making
Many programs and funders help support the local system of HIV care and treatment, with RWHAP as payor of last resort – coordination with other programs and services increases service options for PLWH

54. Assessment of the Efficiency of the Administrative Mechanism (AAM)
Understanding the AAM Requirement
Scope and Challenges
Typical Steps

55. Training Objectives: Assessment of the Efficiency of the Administrative Mechanism
Following this portion of the training, participants will be able to:
Explain the legislative requirement for the assessment of the efficiency of the administrative mechanism (AAM)
Identify at least 4 components and 2 common challenges of conducting an AAM
Describe typical steps in the AAM process

56. Legislative Requirement
Planning Council must “assess the efficiency of the administrative mechanism in rapidly allocating funds to the areas of greatest need within the eligible area”
―§2602(b)(4)(E)

57. Assessment of the Efficiency of the Administrative Mechanism (AAM) 2
A review of how quickly and well the Part A recipient carries out the processes to contract with and pay providers (subrecipients) for delivering HIV-related services
Helps ensure that the needs of PLWH throughout the Part A service area are met – with emphasis on those with the greatest need for RWHAP services
The only PC/PB task that involves looking at procurement and contracting, which are recipient responsibilities

58. AAM and the System of Care
AAM can help strengthen the system of care by calling attention to issues such as the following:
Need for outreach to new potential providers, which may improve service access and ability to serve emerging target populations
Importance of ensuring that subrecipients are paid promptly – necessary for participation of smaller community-based providers that may have special skills in serving disproportionately affected subpopulations

59. HRSA/HAB Expectations for AAM
PC/PB expected to:
Conduct an AAM annually
Provide a written report to the recipient with conclusions and recommendations
Recipient expected to:
Provide needed data to the PC/PB for the AAM
Provide a written response to recommendations in the AAM report
Include a summary of the AAM in the annual RWHAP Part A application as requested by HRSA/HAB

60. AAM Language from FY 2019 RWHAP Part A Notice of Funding Opportunity
“Include in your application a narrative that describes the results of the PC/PB’s assessment of the administrative mechanism in terms of the following:
Assessment of grant recipient activities to ensure timely allocation/contracting of funds and payments to contractors; and
The RWHAP Part A jurisdiction’s response to any deficiencies identified by the PC/PB and the status of your corrective actions in response to administrative assessment findings”

61. Typical Scope of the AAM
The procurement process – including outreach to potential new service providers, applications received and funded, the review process, and subrecipient selection criteria
Contracting – including the length of time between Notice of Grant Award (NGA) to the recipient and completion of fully executed subcontracts with subrecipients
Reimbursement of subrecipients – including time required for payments following receipt of monthly reports and invoices
Use of funds – whether contracting and expenditure of Part A funds are consistent with the allocations made by the PC/PB, and the proportion of formula and supplemental Part A funds that are expended by the end of the program year

62. Optional Component of the AAM
Engagement with the PC/PB in the planning process:
How and how well the recipient and PC/PB work together to carry out shared and coordinated planning tasks and meet legislative requirements
PC/PB access to data needed for sound decision making
If there is an MOU between the PC/PB and recipient, the extent to which both parties met their commitments

63. Challenges Limiting the Scope of the AAM:
The AAM should NOT address subrecipient monitoring or other aspects of recipient management: “The planning council should not be involved in how the administrative agency monitors providers” [Part A Manual, p 102]
The AAM should include necessary data but is not meant to be an evaluation of the recipient or of individual subrecipients
Subrecipient data: The PC/PB will need data from or about individual subrecipients, but members should not receive or review data with agency names attached

64. Typical Steps in the AAM Process
Assign responsibility for the AAM to a PC/PB committee
Agree on the process, tools, and data needs early in the program year
Work with the recipient to agree what questions will be answered and what data will be provided, in what format, on what schedule
Specify data needs for the AAM in your MOU, if you have one
Early agreement allows the recipient to collect data throughout the year and provide it promptly

65. Typical Steps in AAM (cont.) 1
Obtain summary data from the recipient about agreed-upon topics―for example:
Procurement: Number of providers receiving the Request for Proposals for Part A services, number responding, number of new applicants, independent review process
Contracting: Percent of contracts fully executed within 30, 60, and 90 days after Notice of Grant Award
Payments: Average time required for the recipient to issue checks to subrecipients based on accurate invoices
Allocations and Expenditures: Amount and percent of Part A funds allocated by the PC/PB to each service category versus the amount and percent contracted and spent

66. Typical Steps in AAM (cont.) 2
Survey subrecipients to learn about their experiences related to procurement, contracting, and reimbursement (optional):
Usually an online survey
Response rate highest if survey is short and most questions require only check-offs or ratings
PC/PB support staff or a consultant typically receive, aggregate, and summarize results for PC/PB review – so members do not see individual subrecipient responses
Many EMAs/TGAs do such surveys every 2-3 years rather than each year

67. Typical Steps in AAM (cont.) 3
Review data to answer key questions and prepare a concise written report including recommendations for any needed changes to address areas of concern around procurement, contracting, reimbursement, and/or use of funds consistent with PC/PB allocations
Meet with the recipient to present and discuss findings
Obtain a written response and plan from the recipient on how any problem areas will be addressed
Debrief and refine the AAM process for next year
Follow up on recipient implementation of action plan

68. Quick Scenario E: Implementing the AAM
The AAM process in your EMA/TGA has been challenging in recent years. A special task force appointed by the Executive Committee is established each year to plan the process, specify data needs, obtain data from the recipient and from subrecipients, and prepare the report. Membership varies, and the recipient says the constant changes in process and data requests creates a burden.
What might the PC/PB do to address these issues?

69. How the PC/PB Helps Improve the System of Care
Review of ways a PC/PB can help improve the system of care – as a body and as individuals

70. Training Objectives: How the PC/PB Helps Improve the System of Care
Following this portion of the training, participants will be able to:
Describe at least 3 actions a PC/PB and its members can take to ensure an in-depth understanding of the local system of HIV care
Identify 5 ways a PC/PB and its members can use their legislative responsibilities to help improve the local system of HIV care

71. How the PC/PB Helps Improve the System of Care 1
PC/PB members must understand the system of care, including its strengths and weaknesses and how it serves particular PLWH subpopulations:
Be sure your needs assessment includes a resource inventory and a profile of provider capacity and capability – the components focusing on the current system of care

72. How the PC/PB Helps Improve the System of Care (cont.) 2
Work with your recipient to ensure regular access to program data about the system of care and about service utilization and client outcomes – overall and by subpopulation
Continually learn about the system of care, asking for needed data and analyses, reviewing new information carefully, and asking questions – become thoroughly familiar with the current system of care, including service needs and gaps by location and subpopulation

73. How the PC/PB Helps Improve the System of Care (cont.) 3
Use available tools to improve the system of care:
Make sure conversations about the system of care always include consideration of service access and utilization by specific subpopulations
Assign a specific committee or other entity within the PC/PB ongoing responsibility for addressing system of care issues
Explore promising service models that can strengthen services, overall or for particular PLWH populations

74. How the PC/PB Helps Improve the System of Care (cont.)
Use directives to test new service models or strategies
Use service standards to ensure service quality and consistency
Ensure that Minority AIDS Initiative (MAI) funds provide population-appropriate service models
Play an active role in coordination of services
Use evaluation of service quality and outcomes in decision making about the system of care