1. Public Health Solutions HIV Care Services (HIVCS) Subcontractor Site Visits 2011 February 8, 2011 Bettina Carroll Director for Programs and Contract Management

2. HIVCS’ “Charge” Ensures services maintain fidelity to associated RFP guidance by monitoring contracts Public Health Solutions is the Master Contractor for the New York City Department of Health and Mental Hygiene (DOHMH) Serves to ensure Ryan White and Prevention funded services are provided in a manner that is compliant with the terms and conditions of their contracts; Ensures contract activities are consistent with federal, state and local funding requirements

3. HIVCS Contract Monitoring Programs’ compliance with the terms of their contracts; delivery of projected units of service and other requirements detailed in the contract scope of services Verification Contract Monitoring focuses on: Qualitative analysis of reported services or billed services (performance-based contracts) and supporting documentation for deliverables contracts Verification Monitoring also involves:

4. Service Verification - Site Visits Documentation reviews Automated application of payment rules Site visits conducted by a HIVCS Contract Manager (CM) and/or Program Assistant Service verification methodology determined by how the contract is reimbursed Reimbursement: cost, performance, deliverables-based payments or any combination of these

5. Types of Site Visits Visit TypeContract Reimbursement Methodology CostPerformanceDeliverables InitialXXX RoutineXXX FiscalX X* (Performance-based) Reimbursement Documentation X (Expenditure) Support Documentation X Single Payer Verification (SPV) X RW Payer of Last Resort (POLR) XX RW PCSMsXXX Technical AssistanceXXX Event/OccurrenceXXX

6. Arranging a Site Visit 3 months HIVCS plans and contacts contractors to schedule required site visits within three months of the start of the contract year 2 weeks Pre-site visit letter is sent two weeks prior to visit; includes month of review, details about required documentation, HIVCS staff to attend and suggested program attendees 3-5 days 3-5 days before visit specific client charts are identified for review

7. What should you expect at a site visit? Entrance Conference- introductions, overview of the purpose and process for the visit, brief discussion from program regarding challenges and successes, review of documents previously requested, opportunity for questions Provide access to review area, charts, logs, EMRs and any documentation to substantiate services and/or expenses reported to HIVCS Provide documentation of staff trainings, credentials, required QA, CAG and other meetings, grievances and access for activity observation if requested (primarily for Routine Site Visits) Provide contact person for reviewer to direct any concerns Exit conference- feedback regarding the site visit including any preliminary findings which will be sent in a formal report within 60 days post visit

8. Who needs to attend the site visit? Visit TypeProgram Staff Program DirectorFiscal Director InitialXX RoutineXX Fiscal X* X (Performance-based) Reimbursement Documentation XX (Expenditure) Support Documentation X*X Single Payer Verification (SPV) XX RW Payer of Last Resort (POLR) XX RW PCSMsX Technical AssistanceX* Senior Administrator is usually only present for the Entrance and Exit Conferences Billing Department staff may be needed for POLR and SPV visits *Shared responsibility specific to PB contracts and/or dependent on nature of TA After the entrance conference, staff are not required to be present while HIVCS reviews are conducted

9. Improved Coordination of Site Visits We recently implemented a process to share site visit scheduling among HIVCS, DOHMH and AI using a Google calendar HIVCS, DOHMH and AI host an Interagency meeting-monthly-and share planning for Learning Network related activities including site visits HIVCS and DOHMH hold senior level bi- weekly coordination meetings to ensure coordination of targeted field activities CMs, POs and TACs have service-category specific contract assignments. This expedites the ability to consistently confer throughout meeting interims CM/PO/TAC conduct quarterly service category review of concerns and coordinate related visits HIVCS provides site visit schedule to DOHMH each month Contract Managers and DOHMH Technical Assistance Coordinators and Project Officers conduct joint initial site visits POs and TACs may accompany CMs on routine visits Some Technical Assistance visits are conducted together

10. DOHMH

11. AIDS Institute Quality Program Site Visits/Performance Reviews Dan Belanger, Director, New York State Quality Program Tracy Hatton, Director, Part A Quality Management Program February 8, 2011

12. Quality Management Program NYSDOH AIDS Institute Quality Program experience: – Clearly defined HIV quality of care clinical indicators for adults and adolescents – Clinical Advisory Committee of New York State experts refine clinical indicator definitions to reflect current standards – Annual quality indicator reviews (ehivqual) at 200 HIV ambulatory care facilities throughout New York State, including New York City – Organizational Assessments conducted at HIV clinics throughout NYS

13. ORGANIZATIONAL ASSESSMENTS Assess the program’s capacity to effectively manage and improve the quality of care and evaluate the element necessary for an effective quality improvement program:  Organizational leadership  Program infrastructure  Staff participation and buy-in  Resources allotted to QI

14. Organizational Assessment Tool

15. Organizational Assessment (OA) AIDS Institute staff and quality consultants conduct an assessment of these elements and then work with programs /organizations to develop a capacity- building plan to address any elements that need strengthening. – Offer recommendations to inform: Areas for Improvement Annual Goals Capacity building

16. Elements of the OA  Quality Structure  Quality Planning  Quality Performance Measurement  Quality Improvement Activities  Staff Involvement  Consumer Involvement  Evaluation of Quality Program  Clinical information Systems

17. Organizational Assessment Process  Contact in advance of scheduling to outline the purpose and goals of assessment;  On site interview conducted by AI quality staff with key representatives from programs (medical director, program director, QI staff person, administrator, program staff, consumer)  Assessment should include brief listing of recommendations for program  Collect any examples of best practices, QI projects, quality plans  Written feedback sent to participants after completion of OA

18. Part A Performance Measurement Program Currently reviewed programs :  Mental Health  Care Coordination  Supportive Counseling  Tri-County Medical Case Management  Harm Reduction  Food and Nutrition  Early Intervention Services Chart reviews conducted by IPRO/NYCHSRO

19. Performance Review Process  Indicators Developed  Review planned with providers  Data collection strategy developed  Case List requested from each program  Sampling plan derived from facility case size

20. Performance Reviews-On Site Activity  Review date scheduled (generally 2-4 days)  List of records to be reviewed requested (review sample)  Entrance interview conducted at program site  Charts/records reviewed by professional analysts on site  Exit interview conducted when reviews complete  Data scored according to indicators  Performance measurement reports prepared—both aggregate and facility specific results

21. Using Performance Measurement  Prioritizing areas for improvement  Identification of common issues through performance data  Measuring progress  Benchmarking and goal setting to improve the care for PLWHA in NY EMA-not about measurement, about improvement!

22. Comments  What suggestions do you have?

23. Contact Us Daniel R. Belanger, LMSW New York State HIV Quality Program Director drb08@health.state.ny.us Tracy Hatton Part A Quality Management Program teh04@health.state.ny.us