Ryan White 2012 Grantee Meeting

Those attending this session will have the opportunity to hear Ryan White's story as told by his mom, Jeanne White Ginder. Hear about Ryan's personal struggles, his ability to rise above multiple barriers, and how he became a national spokesman and forever changed the public's perception of AIDS. Mrs. White Ginder will provide insight into how the original Ryan White legislation passed, and will talk about the 2009 Reauthorization. There will be time for questions and answers during this session.

Learning Objectives:

• By the end of the session, participations will understand the role of Ryan White in raising awareness of HIV/AIDS in the United States.
• Participants will be able to identify how the initial Ryan White legislation came into being.
• By the end of the session, participants will be able to describe the history of the Ryan White legislation.

HRSA’s AIDS Education and Training Centers (AETC) programs have developed multiple interventions to support national HIV/AIDS strategies (NHAS), both in the US and Internationally.  This panel presentation will highlight three aspects of those interventions as they focus on developing a competent HIV healthcare workforce:  1) the coordinated response of the domestic AETC program linked to the three goals of the US NHAS, 2) relevant best practice examples of the International Training and Education Center for Health (the International AETC) across 14 countries, and 3) a training evaluation framework and tools developed to assist training program planners with developing programs with the best chance of demonstrating their desired outcomes.  The combined 35 year experience of the AETC programs, with lessons informing domestic and international efforts, underpins this work.

Learning Objectives:    

• Participants will be able to describe the training framework used both domestically and internationally to build a competent HIV health workforce.
• Participants will be able to identify tools for planning trainings that will likely produce the outcomes they desire.
• Participants will recognize key strategies used by the domestic AETC program which support the goals of the US National HIV/AIDS Strategy.

This workshop will provide participants with an overview of the important role routine HIV testing in clinical settings plays in the national HIV/AIDS prevention and care plan. The ACTS (Advise, Consent, Test, Support) system of streamlined counseling and practice change utilizing buy-in, implementation planning, training, and monitoring/evaluation using existing resources will be described. Illustrations of ACTS successes in clinical practice (i.e., clinics, hospitals, and CBOs) in the US and South Africa will be described as models for implementation planning in participants' own settings. The workshop will also feature practical sessions that skill participants in streamlined counseling and routine testing implementation.

Learning Objectives:

• Participants will be able to describe four practice change elements that can facilitate implementation of routine HIV testing in clinical settings.
• Participants will practice delivery of a streamlined HIV counseling protocol that they can use in clinical care.

Participants will be guided through a routine testing implementation process that can be tailored to their own institutions.

Ryan staff members will make use of interactive tools and screen demonstrations to instruct the audience on effective and efficient ways to use medical records to collect data points necessary for quality improvement activities, program analysis, and reporting. The audience will be able to actualize the transition between data capture and reporting back to funders. The Data Manager, Assistant Coordinator of HIV Testing and Linkage to Care, and the Supervising Case Manager have helped with the successful implementation of a network-wide EHR system. Ryan’s experience comes from its chosen EHR system, eClinicalWorks, which will be used as a model during the workshop. On a daily basis, these staff members are responsible for data entry, reporting, quality assurance, and oversight of the Ryan Network’s expansive HIV Programming.

Learning Objectives:

• Using paper exercises, staff will guide the audience in creating a crosswalk based on data elements required for both reporting and evaluation, to be collected in existing fields or structured data fields, which close the data capture gaps in EMR. Staff will provide best practices on the most appropriate area for collecting and documenting data required for external reporting.
• Staff will demonstrate how to extract data using data extraction solutions, such as Cognos and BridgeIT. Staff will then illustrate how to import the data into other data analysis tools to support quality management activities to furnish data for reporting. Data analysis tools could include Access, Excel, EpiInfo, ERA, or EMR packaged reporting tools.
• Using handouts and flowcharts, staff will provide an overview of the process of pushing data to external reporting tools, such as CAREWare or AIRS, to satisfy various funders, including HRSA. This could include an electronic push or manual data entry, with the ultimate goal of submitting an RSR.

The SPNS Oral Health Initiative was implemented by 15 sites in urban and rural locations to expand access to oral health care and improve oral health outcomes of PLWHA. Outcomes included the patient experience of care, health of teeth and gums, completions of Phase 1 treatment plan (the elimination of active disease and restoration of function), and retention in dental care. Other objectives included integrating medical and dental care and sustaining services beyond the grant period. This first Institute session addresses program models, implementation decisions, and factors that contributed to success in patient recruitment and retention in oral health care, including the role of dental case management, transportation, satellite clinics, patient education, and integrated medical and dental care.

Learning Objectives:

• Identify several different program models that address gaps in care in both urban and rural areas.
• Compare strategies for addressing geographic obstacles to care, including different transportation and care coordination options.
• Describe outreach and retention strategies for patient engagement in care and self-care management.

With increasing frequency and urgency, grantees and providers are looking for ways to automate the movement of data from electronic health records (EHRs) and labs into CAREWare, thus eliminating double data entry, improving data quality, and ensuring that the RSR can be readily generated with complete information. This session will highlight three Grantees that have tackled a number of issues to coordinate data collection and overcome a number of logistical, administrative, and IT-related barriers.

Learning Objectives:

• Understand major logistical and programmatic barriers that specific grantees had to overcome to successfully import data from EHRs and labs into CAREWare
• Gain an understanding of major technical issues that need to be addressed to successfully map data from other sources into CAREWare.
• Examine the major benefits to importing data electronically into CAREWare, and also what is required to maintain such a system.

Since 2001, NYC Department of Health and Mental Hygiene (DOHMH), in collaboration with New York State Department of Health (NYSDOH) AIDS Institute, have developed a quality management (QM) program using a peer-to-peer learning model. The Part A QM program groups providers by service category and conducts Quality Learning Network (QLN) meetings quarterly. Providers also participate in webinars between these meetings. Performance measurement systems, essential to any professional application of quality management, are developed within these service category-based groups. Over the last decade, the QM Program has accumulated experience in developing indicators and conducting reviews fulfilling the EMA’s commitment to ensure that measurement guides quality improvement. Performance measures selected by each QLN reflect key programmatic endeavors within the contract service category, linking services to health outcomes.

Learning Objectives:

• Understand at least three methods for actively engaging Part A-funded providers in quality management efforts.
• Describe at least two benefits of the peer-to-peer learning model.
• Apply aspects of the NY EMA QM program within their own EMA.

Medical case managers play a critical role in engaging and retaining HIV+ individuals in care. Their roles have evolved significantly in recent years. In this workshop, we review HAB MCM monitoring standards, MCM functions and processes, MCM roles in the HIV care continuum, and training curriculum needed to ensure managers’ readiness for their new roles. We also describe methods to assess MCM quality, ways to obtain feedback from the MCM workforce, and findings of MCM quality assessments conducted in Part A EMAs in Texas and Florida. MCM monitoring tools and other useful resources are presented. The Houston Part A grantee will discuss steps taken to address MCM quality assessment findings through quality improvement and training.

Learning Objectives:

• Increase trainees’ knowledge of HAB’s MCM standards.
• Trainees will learn about key MCM roles, responsibilities, and processes.
• Trainees will gain sufficient knowledge to apply methods for monitoring subgrantee MCM performance.

The Patient-Centered Medical Home (PCMH) has been advocated as a model for improving the delivery and outcomes of primary, particularly care of chronic illness. Increasing numbers agencies are transforming their care and becoming certified PCMHs through NCQA, the Joint Commission, and other organizations. The HIV Medical Homes Resource Center (HIV-MHRC) is a cooperative agreement, funded by the HRSA/HAB, to support Ryan White HIV/AIDS program clinics/practices to develop PCMHs for persons living with HIV (PLWH) and achieve PCMH certification. This workshop will provide an introduction to the PCMH model of care and the role of PCMHs in the care of PLWH. It will also discuss PCMH development in Ryan White HIV/AIDS program clinics/practices and the activities and resources of the HIV-MHRC.

Learning Objectives:

• To describe the patient-centered medical home model of care and the role of PCMHs in the care of persons living with HIV.
• To discuss what is happening throughout the Ryan White HIV/AIDS program related to PCMH development and certification, including key needs assessment findings.
• To describe the HIV-MHRC and available resources that can assist them in with PCMH development and certification.

The National Committee for Quality Assurance (NCQA) developed the patient centered medical home (PCMH) model for improving standards in primary care. Objectives of NCQA's vision for a medical home mirror those envisioned for HIV quality care (HIVQC): a patient centered, comprehensive, coordinated system of care with quality, safety and enhanced access. UFCARES recently received level 3 NCQA recognition. This process required an extensive evaluation of current practice policies/procedures. The corner stones of a robust medical home are communication, health education, care plan development/coordination requiring active patient participation. Our center had the capability to perform all these functions but required concerted effort and pooling all resources to put into practice.This process will result in a) emphasis on improving HIVQC and improved health outcomes, b) potential for greater reimbursements and cost savings by health plans. During this session we plan to work with other Ryan White Grantees to achieve the same.

Learning Objectives:

• Learn the process for achieving NCQA recognition as a PCMH and understand the conceptual framework for the PCMH model adapted within a Ryan White out-patient clinic as well as expected transformation necessary for becoming a PCMH. Understand the different NCQA standards and the elements associated with each standard some of which are must pass. Each standard will be discussed in detail and participants will be asked to join in the discussion and interpret these standards as they see them. Further discussion on how UFCARES interpreted and presented the practice standards to meet those defined by NCQA.
• Assess readiness to achieve PCMH within a particular practice. Focus on establishing a team dedicated to development of an action plan and identification of resources needed to create a realistic project timeline. We will encourage participant discussion on how to identify and define their current practice in light of the NCQA requirements. Specific screen shots of different items will be shared to help participants understand and apply the same standards in their own practice which will help develop more efficient patient centered care.
• Review UFCARES experience in applying for PCMH recognition, challenges encountered, and helpful suggestions for a successful application utilizing SOPs, electronic medical record screen shots, and other guidelines developed during this process. Include recommendations to evaluate data and system capabilities necessary to achieve performance standards. For those working within the context of a large organization, legal and contractual issues (as in our case) may also present a significant challenge and will also be discussed.

In April 2012, NASTAD convened a consultation to advise the creation of two ADAP financial forecasting models for implementation in ADAPs. Consultation participants included NASTAD and HRSA/HAB staff, ADAP coordinators, fiscal monitoring staff from Ryan White Programs and national experts, including actuarial experts. The consultation addressed topics such as the data elements needed to create a financial forecasting model, examination and analysis of trends among data inputted into a financial forecasting model, how to project fiscal needs in ADAPs, and how to bring all of these components together into a sophisticated yet user-friendly model. This session will provide a summary of this consultation and NASTAD’s continued work to create a financial forecasting model for ADAP.

Learning Objectives:

• Participants will understand the process NASTAD has taken to gain input into the creation of an ADAP financial forecasting model, including outcomes from an ADAP Financial Forecasting Consultation and focus groups with ADAP coordinators.
• Participants will learn about the components ADAP coordinators have identified as necessary to create an accurate financial forecasting model to project costs and fiscal need for ADAP.
  Participants will gain pratical knowledge of the importance of financial forecasting, including budget projections and identifying future need for a program.

More than 1.1 million individuals are estimated to be living with HIV in the United States, with an estimated 50,000 new infections occurring annually. The Patient Protection and Affordable Care Act (PPACA) will rapidly change health care delivery in the United States. Primary care settings will likely see the majority of the potentially 30 million people newly insured and seeking care, including the estimated 600k – 850k PLWH who are currently not in care and could be newly insured. Moreover, the HIV workforce is shrinking, while the demand for treatment is increasing. These factors drive the need to advance HIV care in primary care settings and achieve the goals of the National HIV/AIDS Strategy to ensure access, quality, and equity.

Learning Objectives:

• The session will review findings from a national survey of the state of HIV in primary care based on the impact of the PPACA on access to HIV care, including increasing caseloads of HIV-positive patients for all providers; barriers to HIV-positive patients accessing care; and training and education needs of HIV care providers.
• Describe HIV and primary care workforce challenges considering PPACA amidst increasing numbers of HIV patients
• The need to integrate HIV into primary care and next steps will be explained.

As a participant in DC Cross-Part Collaborative Project, two ADAP Performance measures will be discussed: the percent of ADAP applications approved/denied for new ADAP enrollment within 14 days, and the percent of ADAP enrollees reviewed for continued ADAP eligibility two/more times, and who were to be reported in seven rounds every 2 months (May 2011 to May 2012). Preparing the data for these performance measures revealed the scale of incorrect/missing (up to 50%) data that could not be used. This finding triggered immediate corrective actions in DC ADAP’s client enrollment process and initiation of routine enrollment data monitoring. As a result of the reduced data error rate (only 10%) within a year, the accuracy/completeness of ADAP performance measures improved significantly. The collaborative encouraged more time and resources to continuous QI throughout the Bureau including in ADAP. Results/successes are shared routinely among stakeholders for their active/continuous engagement.

Learning Objectives:

• This workshop will explain how performance measures can reveal inadequacies in a RW Care program’s key processes – ADAP client enrollment?
• Participants will learn how to adapt mini-projects that can be implemented to improve data quality and positively impact overall processes and outcomes.
• Participants will learn how to engage stakeholders to implement PDSA model for quality improvement within AIDS Drugs Assistance Program.

340B For Ryan White Grantees The compliance risks associated with building and operating a contract pharmacy program are not insignificant. To protect against diversion and improperly billing Medicaid, covered entities and their contract pharmacies need to develop numerous systems that require expertise and resources from both parties, especially in the areas of patient verification, inventory management, recordkeeping and third party billing. The panel of our contract pharmacy workshop will provide an in-depth overview of the steps involved in starting up and managing a contract pharmacy arrangement, focusing on the dos and don’ts of operationalizing these complex programs. Representatives from the 340B provider community, legal consultants, and contract pharmacies will expand on the topics above and share their own experiences with contract pharmacy arrangements.

Learning Objectives:

• This session will review the following topics: • Negotiating contract terms • 340B compliance obligations • “Ship to/bill to” arrangements • Inventory management challenges • Billing and collection functions • Role of pharmacy benefit managers and contrac

A navigator is a peer, uniquely qualified to provide a voice of experience and to serve as a model of healthy behavior and as a liaison between the client, his or her care providers, and the other support services. Through a shared background with the client, common culture and language, peers can most effectively relate to clients in ways that health care providers may not. Because of this shared background, the navigator can provide the client access to HIV and AIDS services that is critical to the medical, mental, and spiritual health and the quality of life for people living with HIV and AIDS. The navigator can also provide the client with emotional and social support in order to prevent the challenges and realities of care from overwhelming them and allows them to be linked and retained in care.

Learning Objectives:

• Participants will learn how to integrate Peer Navigators as conduits for linking PLWHA to primary care, prevention, and support services.
• Participants will learn how to utilize Peer Navigators to resolve core problems rather than merely treat crises situations.
• Participants will learn how to enlist Peer Navigators to empower consumers to tackle their own issues, thereby helping them develop personal skills and a sense of efficacy.

One in four HIV-positive individuals admitted to a hospital in southwestern Pennsylvania is readmitted within 30 days. Literature provides evidence that comprehensive primary care, including patient education and care management, can significantly reduce hospital readmissions. However, many HIV/AIDS providers find it challenging to find the time and resources to implement these best practices. This presentation will showcase how a Part C clinic reduced the rate of 30-day hospital readmissions through the adoption of Lean quality improvement strategies. It will also describe the FOCUS-PDSA model, low-tech intervention methods, process evaluation elements, and outcome measures associated with reducing hospital readmissions. Early results indicate the 30-day hospital readmission rate fell by more than 50 percent since implementation.

Learning Objectives:

• Participants will learn how to adopt a robust system to follow-up with their patients while in the hospital to make up for common challenges related to the discharge of complex patients. They will learn the steps that the clinic implemented to effectively reach out to their hospitalized clients during and after hospitalization.
• Participants will be introduced to the Lean process improvement methodology that has been successfully applied to wide variety of healthcare and social service settings around the country. Specifically, the HIV clinic at the heart of the program used concepts from this method to improve operations at the clinic that led to the reduction of 30-day hospital readmissions. Participants will participate in a Lean methodology training activity similar to one provided to the HIV clinic to introduce key concepts including unambiguous communication, workflow analysis and balancing, and process mapping.
• The third objective of this Participants will learn how to investigate whether hospital readmissions among HIV- positive individuals are an issue in their region. In SWPA the research indicated that this was an important HIV/AIDS related health disparity, as the rate of 30-day hospital readmissions was more than 50 percent higher than that of the general population. This issue is at the confluence of the National HIV/AIDS strategy (as an HIV/AIDS health disparity) and the Affordable Care Act (as a cost containment and care coordination issue).

The Cultural Interactions workshop 101 is a training developed to address the needs of various healthcare organizations to improve the interactions between patients/clients and providers. The training consists of 3 Power Point presentations and a manual with notes for the trainer. We will present the 3 units in a condensed format for the basic and intermediate levels. Workshop 101 addresses culture and how it affects our interactions, and also provides a broader definition of culture in order to disabuse participants of the notion that culture only exists as ethnicity. Finally, participants will learn to actively define the culture of their organization and create a plan to reinforce that defined culture.

Learning Objectives:

• Define "culture."
• Contrast cultural awareness vs. cultural competence.
• To gain an understanding of culture and the impact it has on quality of care for the patient and the organization environment.

Early Intervention Services (EIS) has demonstrated its effectiveness within the Indianapolis area. This workshop will highlight two uniquely successful programs that utilize this resource to identify new patients with HIV and link them to care. In a side-by-side presentation, Step-Up, a local CBO, will discuss a multi-venue HIV testing program targeting a high-risk population which has led to over a 2% HIV positive testing rate. Information will be presented on new ways to approach old venues as well as strategies for marketing to even more people. While Wishard Hospital will discuss the development of EIS programming in an Emergency Department setting, its protocol and explore contributing factors to their 87% consent rate. Through their universal screening program, they reach over 4,000 emergency department patients per year. The presentation will demonstrate how entirely different approaches to EIS can be successful.

Learning Objectives:

• Participants will learn two unique programming styles for implementing EIS.
• Participant will explore resources that contribute to successful programming and barriers to anticipate.
• Participants will learn how GPS technology is used to find individuals at high risk for HIV and other STDs. Participants will learn about practical, in the field experience from using this method as well as stumbling blocks and successes.

Eleven HRSA SPNS demonstration sites were funded to develop interventions/programs increasing access to and retention in care for HIV-positive Women of Color in various settings. Three sites have adapted various CDC intervention models to aid linkage to care, secondary risk reduction, and/or skill-building. Project WE CARE (Chicago, IL) has adapted the Healthy Relationships model and modified components such as film clips, facilitators, series schedule, incentives, and resource packets. The LIFT Program’s (Bridgeton, NJ) intervention, “Yo Me Cuido” (I Take Care of Myself), is an adaptation of the SISTA model. They created two versions of the curriculum, one for Latinas and one for African Americans. And Health Services Center (Hobson City, AL) has adapted the Antiretroviral Treatment and Access to Services (ARTAS) model’s manual and select sessions to suit their population.

Learning Objectives:

• This workshop will discuss implementation of various CDC intervention models in various care settings.
• Modifications made to various CDC intervention models to suit varying populations will be described.
• Outcomes and lessons learned from the modified models will be shared.

While more than 95 percent of Ryan White agencies have Web sites, social media use lags (55% are on Facebook, 38% use Twitter, and 28% have YouTube channels). Very few planning councils use any social media. This introductory workshop is designed for non-technical staff who want to kick start or refresh their program’s online presence. We will highlight online and social media best practices and explain the principles behind them (using the “Pecha Kucha” presentation methodology of 20 slides in 20 seconds). The remainder of workshop time will be devoted to group exercises where participants will have the opportunity to apply the principles of user-centered design to project scenarios common to the Ryan White Community. Planning and implementation worksheets will be available online to guide participants post-meeting.

Learning Objectives:

• Improve Web presence by featuring high-value content to the target audience.
• Participants will learn how to work with technical staff or contractors to establish 1-3 new online training/communications tools for their agencies, planning bodies, or consumer groups.
• Colleagues will be oriented to the basic operations of 3-5 online tools that will connect clients and providers to services and resources.

ActionAIDS, one of Pennsylvania’s largest AIDS Service Organizations, has been billing Managed Care Organizations and insurance companies for Medical Case Management services since 1992. This presentation will discuss how our model was established and grown. Through this program we have significantly increased revenue to support programs and services. In addition, our model helps us to meet the HRSA requirement of insuring that Ryan White Funds are the “funds of last resort”. This training will provide a general overview of the Pennsylvania Department of Public Welfare’s Targeted Case Management Program and the process by which to seek reimbursement for medical case management services provided by HIV/AIDS service organizations. We will discuss and brainstorm with participants to share marketing and branding strategies to work with Managed Care Organizations to contract with community based AIDS Service organizations for Medical Case Management.

Learning Objectives:

• Increase awareness of fee for service models for Medical Case Management at a community based ASO.
• Provide a framework to understand how to brand and market fee for service models for Medical Case Management at a community based ASO.
• Develop strategies to initiate and grow a fee for service model for Medical Case Management services.

The Affordable Care Act authorizes a variety of initiatives to promote the formation of innovative models of integrated and coordinated community-based provider partnerships. Such partnerships can be beneficial to grantees looking to offer a comprehensive range of services while achieving efficiencies in care delivery while simultaneously reducing costs. Federally Qualified Health Centers (FQHCs) are potential partners for grantees interested in this approach. This session will offer guidance on the development, negotiation and implementation of collaborations with FQHCs.

Learning Objectives:

• Describe options for developing collaborative arrangements with community partners.
• Understand relevant policies and rules regarding collaborative arrangements.
• Identify strategies to develop community collaborations.

In September 2009, the Special Projects of National Significance of HRSA’s HIV-AIDS Bureau funded 11 programs to engage and retain women of color living with HIV in care. The majority of the interventions involve peers who bolster agency access and retention efforts through activities including: outreach, barrier assessment and linkages, education, and support. Challenges and successes in developing and implementing peers' roles will be shared, including those relating to position development, nature of compensation, recruitment, training, role acquisition, retention, and ongoing support. Data informing the lessons shared come from an ongoing qualitative process evaluation involving local and multisite collaboration. Lessons can help inform the ongoing and future development of a variety of peer roles. In addition, strategies for evaluating peer components will be presented.

Learning Objectives:

• Lessons learned will be shared, from an ongoing qualitative process analysis.
• Challenges and successes of utilizing peers in access and retention programs will be shared.
• Strategies for peer component evaluation will be shared.

This workshop will be conducted via interactive powerpoint presentation and includes hands on work with computers, tablets, and/or smartphones to illustrate how technology can increase feedback and thereby increase program quality and efficiency. We will show how our project has used mobile web on smartphones and a low cost audience response system (ARS) to collect evaluation information on our learners and inform our trainers on how they can improve programs. ARS utilizes clickers and mobile web uses smartphones and tablets to collect information immediately from learners and to allow the learner to offer feedback in a way that is nonthreatening and fun. We will show participants how to develop protocols for ARS and for mobile web. We will also break learners into groups so they can create their own ARS and mobile web evaluations.

Learning Objectives:

• Participants will understand the benefits of using mobile web and ARS technology to collect evaluation data and understand how to create protocols specifically for these technologies.
• Participants will create an evaluation on a smart phone using low cost or free technology.
• Participants will create an evaluation using an Audience Response System (ARS).

Ryan White Part A providers in culturally diverse communities often pride themselves on their ability to bring culturally competent care to their HIV clients. Yet, when it comes to measuring and improving proficiency levels and meeting cultural competency standards, they often find the task complex and challenging. A Cultural Competency Task Force initiated by the Planning Council of the Bergen-Passaic TGA led to a comprehensive improvement plan for operationalizing cultural competency at multiple organizational levels, from management to direct provider to the client. This workshop will help participants identify policy, operational, and collaborative steps to create a true “culture of competency” in the provision of care and services for persons with HIV/AIDS.

Learning Objectives:

• This workshop will allow participants to gain a deeper understanding of cultural competency standards and challenges in achieving them through  an overview of various cultural competency model(s) and standards
• Identification of common challenges and experiences of policy makers, managers, direct-line staff, and clients
• Participants will learn how to assess cultural competencies and proficiencies of non-profit agencies, including key characteristics or factors to be evaluated at each level of the organization, and will gain an understanding of cultural competence as a continuous process, not an event. Our message: Wherever you are, that is where you start. The problem is not where you are starting but whether or not you start
• Participants will learn how to initiate and complete a collaborative strategic planning process to raise cultural competencies beyond the basics, including • Transforming your assessment into measurable goals, objectives, and actions; • Using the organizational chart as a reference for determining who will address the policies, procedures, community, client, and continuous quality improvement; and • Integrating client, community, and key stakeholder input throughout the process

Quality Measures are a key ingredient in the Continuous Quality Improvement process and must be compiled for Ryan White, governmental and institutional reporting requirements including Meaningful Use and HIVQual. Although Electronic Medical Records collect huge volumes of data, the process of extracting that data to meet specific reporting requirements poses its own challenges. This workshop will introduce a method to identify overlap among the various reporting demands, and consolidate the creation and reporting of quality metrics. Further, it will discuss how to navigate organizational and interpersonal relationships to use the metric data for meaningful behavioral change in the context of patient centered medical homes.

Learning Objectives:

• List three sources of pre-defined quality metrics.
• Discuss human factors that influence how metric data is perceived and acted upon through the use of provider report cards.
• Identify novel techniques for reporting/reviewing metric data.

Bone disease is an important metabolic complication of HIV infection. Studies have demonstrated that osteopenia and osteoporosis occur earlier and more frequently in those infected with HIV than in the uninfected. However, bone health remains a relatively neglected area of preventive care in this population due to limited evidence for recommended screening and treatment practices in this group and concerns about drug toxicity. A didactic presentation and handouts will provide available evidence based background information on current issues and newer recommendation and algorithms. Small “break out” groups will evaluate clinical cases relating to specific topics in bone health and devise a screening and intervention plan for each case. Discussion from these groups will be presented to the large group at the conclusion of the workshop with the goal of consensus building for this very important issue in primary care for the HIV infected.

Learning Objectives:

• At the end of this workshop, the attendees will be able to describe key issues related to bone health in HIV-infected patients.
• Participants will learn how to develop an evidence-based plan to screen HIV- infected patients for bone disease.
• Participants will be able to formulate a treatment plan for HIV infected patients with osteopenia and osteoporosis.

The HIV/AIDS Bureau (HAB) continues its commitment to provide the highest level of customer service to our grantees. As a part of this commitment, HAB conducted the first ever survey of grantees’ experiences with our program operations and processes. In particular, the survey assessed grantees’ level of satisfaction with the processes in place for HRSA and HAB to communicate with grantees on a range of topics from the application process to policy notifications to technical assistance opportunities. This presentation will provide the results of the survey and the action plan by HAB to address areas for improvement.

New York City (NYC) jails are at the epicenter of an epidemic that overwhelmingly affects black and Hispanic men and offers a significant opportunity for public health intervention. The NYC Department of Health and Mental Hygiene, the Health Authority in the NYC jail system, instituted a program to identify the HIV-infected, initiate transitional care coordination services within 48 hours of jail admission, and facilitate linkages to primary care in the community. Trained health professionals provide transitional care coordination services using a caring and supportive, 'warm transitions' approach. Post-release, access to care is facilitated with an aftercare letter, discharge kit including condoms and medication, and accompaniment and transportation as needed. Linkages to primary care may be the right first step to facilitate continuity of care for people with HIV returning home from jail and the public health of the community to which they return. Program outcomes will be highlighted

Learning Objectives:

• Participants will be able to identify five strategies to facilitating access to care for hard-to-serve populations.
• Participants will be able to implement a 'warm transitions' approach to working with hard-to-serve populations including criminal justice involved, and housing insecure persons with substance use disorders.
• The process of integrating care coordination with primary care services to improve medication adherence and continuity of care will be discussed.

All across America, states are submitting various applications to the Centers for Medicare and Medicaid Services (CMS) to gain approval to begin the enrollment of the Medicaid population into various Medicaid Managed Care Programs (MCOs). Enrollment into MCOs can potentially increase access to health care services, enhance the quality of services provided, and reduce health care fragmentation, thereby leading to stronger care coordination. For years, States have developed this model of health care delivery for their healthy populations, but what about the population of individuals living with a chronic disease, such as HIV/AIDS? States are beginning to submit various applications to CMS to enroll PLWA into developed MCO. In this presentation, grantees will discuss the challenges to and accomplishments of Ryan White-funded organizations to prepare people living with HIV for Managed Care enrollment.

Learning Objectives:

• This session will describe the procedures to become a network provider of HIV-related services under a managed care network.
• Development of procedures to educate current organizations medical, non-medical providers, and clients on managed care enrollement will be reviwed.
• The session will review the process of working with local, county, and State officials and the organization to ensure smooth transitions for HIV/AIDS clients.

Viral load suppression helps keep HIV-positive individuals healthy and decreases HIV transmission; achieving this goal requires public health and clinical health care systems to work together to coordinate efforts to diagnose, link, and retain HIV-positive individuals in care. This session will begin with a review of the work that HRSA and CDC have done, centered around the framework of the HIV treatment cascade. Following the introduction of the HIV treatment cascade, Ryan White grantees will present their success stories about how they have successfully diagnosed, linked, and/or retained HIV-positive patients in care. This session will end with a panel discussion with questions from the audience.

Learning Objectives:

• This session will help participants understand the HIV treatment cascade.
• Larn about HRSA’s activities related to the HIV treatment cascade.
• Learn specific tools that Ryan White grantees have used to promote linkage and retention in HIV care.

Building upon 2010's well-received demonstration on how a New Jersey TGA utilized a Web-Based Needs Assessments for in-care and out-of-care populations while saving money and producing better data, the presentation will demonstrate how such strategies have been implemented by four different grant types in three different regional geographies: The State of Minnesota’s Part B grantee, the Minneapolis-St. Paul Part A grantee, California’s Riverside and San Bernardino County’s part A grantee and North Carolina’s Access Network of Care Collaborative (which includes 5 Part C and 2 Part D grantees). Each program will detail how it used an Online Evidenced Based approach to improve its response to the epidemic via analyzing needs and barriers relating to reducing HIV incidence, increasing access to care, optimizing health outcomes, reducing HIV-related health disparities and strengthening competitiveness for scarce financial resources.

Learning Objectives:

• Workshop participants will be able to see how a paradigm of improved data collection strengthens grant applications, provides answers to community planning bodies, illuminates counterintuitive insights important for the description of barriers and helps positively to influence health planning and policy recommendations.
• By end of workshop, participants will be able to describe how to adopt and adapt strategies and tools to deliver web-based technology to the community and planning bodies while overcoming digital divides and perceptions of digital divides.
• Participants will be able to understand the challenges and benefits of an innovative program for web-based data collection and build upon lessons learned by modifying tools used by other programs.

New HIV testing technology facilitates the earlier detection of HIV primary and early infection. Early access and entry into care is critical. Early initiation of ARV therapy is recommended relative to treatment as prevention. Contact and source identification can lead to difficult legal and social situations for patients. The optimal timing of initiation of therapy remains uncertain for the individual patient with regards to long term survival, adherence and prevention of transmission. This workshop will review new 4th generation testing technology, its interpretation and effect on earlier recognition of HIV. Through the use of facilitated small group case discussions; the dilemmas, issues and potential solutions that early diagnosis raises for the clinician in terms of counseling and decision making for initiation of ARV therapy will be explored. A final summary of dilemmas and potential solutions will be facilitated by the presenters.

Learning Objectives:

• Interpret the results and significance of new HIV testing technology and its effect on diagnosing HIV earlier.
• Analyze the various dilemmas (contact and source identification, optimal timing of initiation of ARV therapy, issues of adherence and prevention related to therapy, etc.) brought about by earlier HIV diagnosis.
• Develop an appropriate and personalized counseling and medical care plan for patients with primary or early HIV infection.

The New York State Department of Health AIDS Institute has been collecting client-level data from all subcontractors since 1995. Strategies utilized in the AIDS Institute Reporting System (AIRS) to ensure complete, accurate data collection include comprehensive data validations; development of suites of reports to allow providers to manage data quality on an ongoing basis; the creation of a client-level “RSR Completeness Assessment” within the data collection system; collecting an interim RSR and providing a 6- month aggregate completeness report to catch issues earlier in the process; continuous training and technical assistance; and designing the data collection system with a level of granularity that allows mapping to multiple funding sources, improved utility to providers for local client management, and flexibility as requirements change.

Learning Objectives:

• Participants will learn techniques for ensuring data accuracy and completeness in a data collection system.
• Participants will learn feedback strategies for data quality.
• Participants will be understand the design of tools for data QA and submission at the grantee level.
  
  

This session will discuss the main outcomes of the SPNS oral health initiative. Questions we will answer incude: How did we measure performance and what did we find? How many people completed their treatment plans and how long did it take? Which program models were most successful in expanding access? What strategies were effective in recruiting and training clinical providers? What patient edcuation strategies were employed? What factors were associated with retention in oral health care and improvements in oral health-related quality of life?

Learning Objectives:

• Participants will be able to describe successful and sustainable oral health delivery models and the factors that contributed to this success.
• Participants will be able to find and use interactive patient and provider education materials.
• Participants will be able to identify the challenges associated with timely treatment plan completion and factors that impact performance.

Client-level data reported in the Ryan White Services Report (RSR) permit HRSA/HAB to monitor the outcomes of HIV/AIDS clients receiving care and treatment through RWHAP grantees and/or providers; report to Congress and the Department of Health and Human Services concerning the HIV/AIDS epidemic and the RWHAP; and assess progress towards achieving the goals of the National HIV/AIDS strategy. All of these goals require unduplicated data, combining client-level data across providers. This session will describe HAB’s approach to cleaning, deduplicating and merging the client-level RSR data to develop an estimate of the unduplicated number of clients served by RWHAP grantees and providers. The workshop will then present the first results on characteristics of the RWHAP clients, the services they receive, and the program’s success in meeting HAB’s performance measures.

Learning Objectives:

• Understand how their RSR data are cleaned, deduplicated and merged to create unduplicated counts and client level service data;
• Learn the characteristics of the RWHAP clients, the services they receive, the degree to which clients receive services from multiple providers, and how the RWHAP has performed on measures established for reporting to Congress and other stakeholders;
• Understand the importance of accurate demographic data, eUCIs and other RSR data in creating an accurate profile of the Ryan White Program.
  
  

More HIV-positive offenders are released into Harris County than any other area in Texas, and more than 1,000 local jail inmates are HIV-positive. While incarcerated, PLWHA receive HIV care, but there is a lack of continuity of care post-release. The Serving the Incarcerated and Recently Released (SIRR) Partnership was formed in 2009 to fortify the Houston system of HIV care at reentry. Its work includes the region’s first conference on engagement strategies, the allocation of EIS funds for reentry linkage to care, and training for parole and probation. SIRR is now evaluating its impact on the continuum of care overall. This workshop will describe the process and outcomes of a community-based IRR coalition as well as “lessons learned” for an effective reentry system of HIV care.

Learning Objectives:

• Identify specific barriers and attitudes that make serving this population challenging.
• Learn creative ways of collaborating with community partners and correctional institutions to improve health outcomes and linkage to care upon release.
• Learn how to analyze and evaluate your collaboration to improve its outcomes.

The goal of this workshop is to share lessons learned, strategies, tools and resources used by Ryan White HIV/AIDS clinics/practices who have successfully become certified as PCMHs. A “lessons from the field” panel will share details of how they began the process of becoming a PCMH, who in their organizations were key in leading this process, and their barriers and facilitators to changing their practice to become a PCMH. Details will be shared on which “change concepts” or “building blocks” were used as a starting place, models of improvement used to facilitate the implementation of change in practice, internal and external motivators, and patient/staff responses to the changes.

Learning Objectives:

• Share lessons learned and strategies used by Ryan White HIV/AIDS clinics/practices who have successfully become certified as PCMHs.
• Discuss barriers and facilitators to changing practice to become a PCMH.
• Discuss resources and tools available to support this change process.

Session will provide an overview of the AETC Telehealth Training Centers Program grant. Grant focuses on providing clinical consultation and education to low-volume providers. The intent is to build the capacity of the HIV workforce, especially in the era of Affordable Care Act.

Learning Objectives:

• Define telehealth in terms of this grant program.
• Provide lessons learned from Year 1 grantees.
• Discuss the different technology options for providing distance based clinical consultation.

One grant is typically not enough to make a program work. It often requires multiple Ryan White Parts/Grants and funding streams working together to serve the needs of the HIV-positive patient population. This session will focus on managing one program with multiple funding streams. This presentation will discuss integrating eligibility, allocation of resources, and fiscal management to ensure that funding sources are not duplicative, but are working in tandem to meet the needs of the entire HIV patient population.

Learning Objectives:

• Participants will learn about the variety of Ryan White grants that exist and how they uniquely work together to serve the HIV patient population.
• Participants will be able to integrate program eligibility, budgets, and expenditures for a variety of funding sources to obtain a realistic picture of the entire HIV program at work.
• Using case studies, participants will look at different types of HIV programs and discuss how funds could be better utilized or more creatively structured to meet program requirements and to serve the growing patient population.

The Patient Protection and Affordable Care Act and National HIV/AIDS Strategy highlight the need to increase HIV workforce capacity and expand access through primary care. The HIV Community Care Continuum (CCC) Model for integration of HIV into primary care responds to limitations of existing models for building and measuring capacity for HIV care in primary care settings. This dynamic model guides the assessment and delivery of training to progressively build capacity to deliver a range of services while ensuring quality HIV care and treatment either internally or through collaborations. Tiered performance measures demonstrate clear baselines and allow tracking of HIV care improvements aligned with current Institute of Medicine recommendations to identify baseline and progress in HIV care delivery.

Learning Objectives:

• The session will address the need for HIV care models to incorporate assessment, training plan development, and performance measurement in a comprehensive approach for successful integration into primary care settings.
• Barriers and facilitators to successful integration of HIV into primary care and the role of Ryan White providers in assuring quality care will be discussed.
• This session will describe the process of aligning evaluation and performance indicators to the recent IOM repor,t Monitoring HIV Care in the United States, to ensure and measure quality HIV services.

The Philadelphia EMA's quality management program uses CAREWare for data collection on medical and MCM performance indicators. The approach incorporates quality assurance, continuous quality improvement, and client outcomes evaluation through the jurisdiction’s de-identified data set of more than 12,000 clients receiving HIV medical care and 8,000 clients receiving medical case management at funded sites. The EMA has implemented a quality management program that closely integrates performance, available tools in the EMA's custom Report Generator module in CAREWare, individualized feedback, and QI plans to improve outcomes in the EMA. The workshop will focus on issues such as the exporting and analyzing of data, quality indicators measured, continuous feedback to funded providers and adaptation of CAREWare to facilitate data collection. Special emphasis will be placed on using data, including the RSR, to improve client and system level outcomes in outpatient/ambulatory medical care and medical case management.

Learning Objectives:

• By the end of the workshop participants will be have an understanding of how the various components of a quality management program can be integrated to demonstrate consistent improvements over time to care delivery systems.
• By the end of the workshop, participants will understand how to utilize data to improve system outcomes, including the use of data, benchmarking and feedback to guide quality improvement activities.
• By the end of the workshop participants will be able to utilize CAREWare to strengthen their quality management program and guide improvement activities in their EMA.

Ryan White Program providers have increasing opportunities for participation in health insurance programs and managed care networks.

Learning Objectives:

• Increase trainees’ knowledge of HAB’s payer of last resort and health insurance standards.
• Trainees will learn strategies for assisting clients to enroll in public and commercial health insurance.
• Subgrantees will acquire skills needed to assess and undertake readiness for health insurance participation.
  
  

Increasingly, the model of Patient Centered Medical Home is creating opportunities for patient interaction outside the traditional office visit. The introduction of secure patient web portals creates an opportunity for patients to send messages, enter and view medical information online. This workshop will cover the planning, conversion, and pilot phase of a patient Spanish EHR portal in an urban academic medical center with a Hispanic population around twenty-five (25) percent. Practical advice and lessons learned will be shared in three key areas: technical conversion; implementation planning; and introduction to patients.

Learning Objectives:

• Explain the challenges of translating the contents of the Medical record, financial and legal considerations for third party message translation.
• Describe the different level of translation accuracy demanded by clinical, scheduling, and customer messages.
• Describe successes and challenges in Spanish patient chart work experienced by patients and clinicians.

In 2012, the STD/HIV Program (SHP) of the Louisiana Office of Public Health established a Health Care Work Group (HCWG) consisting of staff from SHP, medical centers, Ryan White Part A and B providers, planning bodies, and clients as well as pharmacy representatives. The overall objective of this workgroup was to prepare for the implementation of the Patient Protection and Affordable Care Act (PPACA) with its first goal being to develop PCIP training for case mangers and services providers. The purpose of this 90-minute workshop is to describe the process of developing this training and to present the key elements of the training.

Learning Objectives:

• Explain the role of the Health Care Workgroup (HCWG) in light of current and upcoming changes as a result of the Patient Protection and Affordable Care Act (PPACA).
• Ensure that Ryan White service providers have an adequate baseline understanding of key learning points related to health insurance coverage options in Louisiana, with special emphasis on the Pre-existing Condition Insurance Plan (PCIP) and the Ryan White-funded services available to assist with insurance maintenance.
• Workshop participants will learn effective methods to train RW service providers regarding the PCIP application processes, action required for insurance maintenance, and knowledge of resources for troubleshooting with respect to PCIP and corresponding Ryan White-funded services.

The Cultural Interactions workshop 201 focuses on how stigma develops, who we stigmatize and how it affects those populations we serve. Participants will explore their personal biases and will be given concrete methods to reduce bias and stigma through self-awareness, empathy, asking questions, generalizing and not stereotyping, and using the teach-back method. Participants will learn to identify health disparities as they exist in their community and how their organization can effectively address those health disparities. Finally, we will teach participants how to focus their efforts on specific populations served by their organizations.

Learning Objectives:

• To explore how empathy, generalizing and not stereotyping cultures, and improved communication can help providers effectively interact with their patients.
• Identify personal root causes of stigma.
• Learn ways to reduce the effect of stigma for those living with HIV.

The 12 Cities Project strives to further cross-agency coordination to combat the HIV/AIDS epidemic. Divisions between HIV prevention and care programs in the U.S. are diminishing.

Learning Objectives:

• To enhance grantees’ understanding of how the 12 Cities project relates to and differs from ECHPP and the NHAS.
• To disseminate successful efforts at coordination and integration that have been implemented in several of the 12 cities.
• To discuss and brainstorm how to address challenges that arise from increased coordination.

Quality HIV care is often complicated by substance use, mental health issues, and other co-morbidities among people living with HIV/AIDS (PLWH). Interdisciplinary, team-based approaches can be successful in providing coordinated, comprehensive HIV care and services that address the range of needs of PLWH. Such approaches can be challenging given pressures to minimize healthcare costs and increase efficiency, regulatory changes related to the Affordable Care Act, and the expanded role of community health centers in providing HIV care. HRSA/HAB contracted with John Snow, Inc. to identify effective models of interdisciplinary care and understand specific components and factors critical to the success of such programs. This workshop will review the study findings including the implications for Ryan White Program grantees in the current health care environment. Several grantees that participated in the study will also share key factors in the success of their interdisciplinary care programs.

Learning Objectives:

• Based on findings from the study and presentations from the participating clinics, participants will: Be able to identify factors which make interdisciplinary HIV care programs most effective, including how success is defined, optimal service configurations, and key elements of success;
• Understand how interdisciplinary HIV care models have been implemented in a range of care settings, including common elements and challenges to their implementation, and adaptations that grantees have made to respond to local context and populations served;
• And, be able to understand the potential implications of health care reform and other national trends on adopting or strengthening interdisciplinary HIV care models as Ryan White Program grantees.

With basic knowledge about online tools in hand and creative inspiration, this 201 workshop will explain how to use and integrate social media and Web sites to maximum effect. Lessons include making the most of social media (e.g., Facebook and Twitter techniques and best practices to expand your reach); using multimedia tools (e.g., YouTube, Vimeo, Flickr); online writing tips (Web pages, Tweets, and blogs). Panelists will demonstrate effective integrations and then break down how they were achieved. Additional free and/or low-cost training resources will be outlined and shared post-meeting.

Learning Objectives:

• Participants will be instructed in the use of social media add-on resources (e.g., HootSuite, Blogger) to expand their social media audiences.
• Participants will learn to write more effective content for online platforms.
• An individual technology training approach and plan for keeping informed will be developed.

Young people living with HIV face a number of challenges in transitioning from pediatric to adult health care. These challenges are shared among the youth, their health providers and primary caregivers, and can pose a significant threat to young people’s overall health as they manage HIV in adulthood. This workshop will present a project of the Massachusetts Department of Public Health’s Ryan White Part D program, MassCARE, to engage youth living with HIV, their primary caregivers and their health providers in dynamic discussions about health care transition. The resulting recently published guidebook “Moving On Positively”, provides these three populations with practical steps that each can take to prepare for successful transition. In addition to the guidebook, transition tools, standards and quality indicators will be distributed

Learning Objectives:

• Articulate the key challenges to youth health care transition across the populations (youth, provider, caregiver).
• Identify actionable strategies for helping youth make a successful transition (all populations).
• Gain information and tools to implement transition standards in Ryan White programs.

Mental illness and substance use disorders are common co-morbidities among people with HIV infection. These conditions are under-diagnosed and under-treated despite extensive evidence that they are associated with HIV transmission risk, failure to initiate and adhere to treatment, slower viral suppression, faster virilogic failure, and increased morbidity and mortality. HIV-related neurocognitive disorders are also common (even among people on effective antiretroviral treatment) and can interfere with treatment through forgetfulness, the most common reason for nonadherence to medication. This workshop seeks to encourage the use of screening tools to identify important and neglected co-morbidities that undermine HIV care and treatment. All three goals of the National HIV/AIDS Strategy are addressed by promoting treatment as prevention, optimizing health outcomes and addressing well-known health disparities in the detection and treatment of mental, substance use and neuropsychiatric disorders.

Learning Objectives:

• Participants will be better able to identify useful mental health/substance use/neurocognitive screening tools, know how to access them on line in multiple languages, and obtain companion scoring sheets.
• Participants will be better able to identify mental health/substance use/neurocognitive co-morbidities in their patients and/or programs through increased comfort with and knowledge of how to administer and score these screening instruments.
• Participants will be better able to decide which of these co-morbidities they/their programs can treat and which require referral to other providers.

Two Texas Special Projects of National Significance (Special Health Resources for Texas and UT Health Science Center) have collaborated to provide insight into the differences and similarities of women living in rural and urban settings across the State of Texas, utilizing HIV/AIDS survival stories to identify ‘themes of survival.' This interactive workshop will report on how these survival stories provide information to enhance the effectiveness of ongoing programs that are designed to engage and retain women of color in quality care. The survival stories and their themes are utilized by staff to empower women. The presentation will further explain methods for collecting these survival stories and explain how they empower individuals, thus bringing about behavior change. In addition, benefits of tools used to provide valuable data towards program enhancement and development of best practices will also be included.

Learning Objectives:

• This workshop will help participants develop knowledge about the use of survival stories as tools to bring about individual patient behavior change.
• Learn how survival stories can be used as a tool to enhance case management program effectiveness.
• Learn how differences and similarities in rural and urban survival stories can affect best practices and program development.

In response to the NHAS HIV+ Peer Educators are vital in the treatment, care and prevention of client service.

Learning Objectives:

• Provide an overview of the peer program at Kansas City Free Health Clinic response to the NAS.
• Outline strategies to work collaboratively with the healthcare team to improve client outcomes.
• Identify and share methods to improve retention in medical care within the multi-disciplinary team.
  
  

This is an open session for meeting participants to meet representative members of the CDC/HRSA Advisory Committee on HIV, Viral Hepatitis and STD Prevention and Treatment (CHAC). Participants will have an opportunity to learn about the Advisory Committee's work, recommendations and resolutions over the past two years, including current work preparing for the reauthorization of the Ryan White HIV/AIDS Program. Participants will be invited to share their thoughts and experiences working in CDC and HRSA funded programs to help inform the Committee's advice for and recommendations to CDC and HRSA.

Learning Objectives:

• Understand the current prevention, care, and treatment initiatives, as well as recommendations and resolutions from the CHAC and its workgroups.
• Learn about key Federal programs and policies including the Ryan White Reauthorization efforts.
• Learn more about community issues for HIV, viral hepatitis, and STD care and treatment as articulated by members of the programs and public attendance, particularly with the passage of the health care reform legislation.
  
  

The Continuum of Engagement in Care is now a standard focus for testing and care programs. With multiple funding streams, it is easy to get bogged down in similar initiatives by different programs. The RUSH-Link (Routine Universal Screening for HIV and LINKage to Care) program is a successful marriage of three major initiatives in HIV/AIDS funding. The programs work together for common performance goals to increase successful outcomes and maximize resources. The session will outline the three initiatives that make up RUSH-Link: (1) CDC-funded Expanded Testing Initiative: opt-out testing +; (2) HRSA- funded Linkage to Care: ARTAS model for short-term intensive medical case management +; (3) AETC: training for providers. These sibling programs CAN work together and result in long-term success.

Learning Objectives:

• Understand how multiply funded initiatives work under one collaborative (RUSH-Link) to identify and engage HIV+ into care
• Identify core components of opt-out testing, linkage to care, and provider education that can be replicated in any region.
• Participants will receive materials such as clinic flow charts, provider training agendas, and sample policies to help implement elements of the program in their organization.

The HIV Performance Measure Module (PMM) is a reporting tool in the existing Ryan White Services Report (RSR) online database which will allow Ryan White providers to enter aggregate data on the HIV/AIDS Bureau (HAB) Performance Measures (records reviewed, numerator, and denominator) on a voluntary basis. Providers are able to obtain reports that compare their performance regionally (by Public Health Service Regions) and nationally. The database allows reports to compare performance with those providers that submit data in the database. Data from two cycles will be presented on a national and regional level with a discussion on the areas for improvement of HIV care and the challenges in improving performance.

This workshop focuses on baseline and longitudinal outcomes at three sites of a 5-year HRSA demonstration grant that enhanced linkages to care for HIV-positive jail detainees. To a far greater degree than prisons, jails are porous facilities engaged in dynamic interactions with their communities, much like emergency rooms, shelters, or train stations. Twenty-five percent of all HIV-infected Americans pass through the U.S. correctional system annually. We present the case of three jail-based programs (RI, MA, OH) that enhanced HIV testing and medical services, established mental health and case management, and successfully linked inmates to services after they were released. These programs illustrate the effectiveness and best practices for creating successful linkages to critically needed services for inmates once they are released, and ultimately to reducing viral load and improving the overall health of this vulnerable group.

Learning Objectives:

• Participants will become knowledgable about best practices for successful linkages from jail to community.
• Participants will be informed about various approaches to integrating case management, mental health, and medical care.
• Participants will become informed about outcomes of the HRSA/SPNS enhanclink demonstration project.

The session will provide a narrative timeline on the development of cross titles (Part B, C, and D - totaling more than $1.5 million) collaboration among three human services agencies in a rural nine-county section of southeastern North Carolina. The session will highlight the development of complimentary services with each Ryan White provider, reducing cost and maximizing consumer service capacity, engaging and securing buy-in from other regional providers--including those involved in HIV primary or specialty care, prevention, identification and education--fostering community support, and developing joint quality initiatives to measure quality of care and improve consumer recruitment and retention.

Learning Objectives:

• This workshop will enable participants to understand the nature of cross- collaboration and strategies to foster collaborations, particularly in rural areas. Participants will be guided in comparing and contrasting collaborations in rural an urban settings, as well as in developing incentives to bring multiple parties into a collaborative model.
• Participants will learn how to develop "synchronicity" between prevention and care services within a region or service area, and how to effectively link the two services into a seamless continuum of care.
• Participants will be guided in developing a regional CQI initiative for collaborations, planning for HIV services funding, and streamlining Ryan White and other funding to maximize benefits and reduce costs (and service duplication).

Ryan White Programs are often financially limited. Health costs continue to rise and funding is always at risk. However, the one asset that appreciates and increases in value in an organization is its most important assets: people (team). People can grow, develop and become more effective if appropriately mentored. Workshop participants will explore topics such as: a leader's key question, a leader's toughest challenge and a leader's primary responsibility. In small groups, participants will answer 3 key questions : What is my Role in the organization? What is my work environment? and How will I develop and grow? Participants will discuss essentials to developing a leadership tool kit to use in their home organization. Through didactic and small group participation, attendees will develop a vision, redesign an organization and foster a culture of excellence.

Learning Objectives:

• Participants will discuss the need for growing successful team members and developing future leaders. The qualties of a dream team coach will be discussed as well as charateristics that prevent leaders from becoming great coaches.
• Participants will discuss the need to create an appropriate climate for mentoring, growing, and nurturing team members. Leaders must be enironmental change agents. Small groups will discuss leader qualities. Approaches to providing growth opportunities for employees will be explored. The development of the appropriate "culture" for growth will be discussed.
• Participants will identify key responsibilities of leaders who mentor and discuss three key things all employees care about (Role, Environment, and Development) and how these items fit in the coaching/ mentoring environment. An assessment inentory will be shared that participants can use and adapt. Particpants will be asked to assess themselves as a learning exercise. Finally, qualities found in successful leaders will be compiled with audience particpation.

Early entry, retention in care, and loss to follow- up are well established challenges in care and treatment services. Over the last several years the District has implemented innovative programs to improve linkage, engagement, and retention in care. This workshop will offer a decription of the strategies and the impact of expanding peer-based services through early intervention services.

Learning Objectives:

• Successful program components will be discussed and how they can be implemented in different jurisdictions Strategies for using surveillance data to minimize loss of follow-up clients as well as building a multi-layered prevention- to-care network will also be shared.

The purpose of this 90-minute panel presentation is to present findings and recommendations from the final report of the 2012 Potential Impact of the Affordable Care Act (ACA) on the Ryan White HIV/AIDS Program (RWHAP) Study. The presentation describes key ACA reforms in six areas (insurance eligibility (including Medicaid expansion), health insurance exchanges, insurance benefits, insurance costs, service delivery models, and provider payment reforms), reviews the status of the implementation of each reform, discusses its implications for RWHAP and people living with HIV/AIDS (PLWHA), and makes recommendations about what can be done by the HIV/AIDS Bureau, RWHAP grantees, providers, clients, and other PLWHA, to address the provisions’ challenges and opportunities. The findings are based on a comprehensive scan of the ACA literature, consultations with technical experts, and interviews with selected state Medicaid programs. The session will be organized as three slide presentations of ACA provisions and recommendations, followed by a panel discussion with three states sharing innovative ACA initiatives.

Learning Objectives:

• Participants will gain a better understanding of how key ACA provisions will likely affect RWHAP grantees, providers, clients, and other PLWHA.
• Participants will learn about important milestones in the ACA implementation process and key leverage points where stakeholders can make a difference in the implementation of the law.
• Participants will learn about what states have done to prepare RWHAP grantees, providers, clients, and other PLWHA for the transition to the ACA.

Connecting to health care can mean different things for different people. For some people it means survival, or having access to information needed to make vital decisions. For other people, it means transportation to an appointment, or having a safe environment to express fear or receive a laboratory test result in a language that is understood. This workshop will familiarize participants with two Connecting to Care resources developed to assist Ryan White grantees in engaging and retaining clients in HIV/AIDS medical care. Seventeen activities will target general popualtions, and twenty-five activities are offered targeting rural and formerly/currently incarcerated populations.

Learning Objectives:

• To introduce participants to 17 general population interventions in a Connecting to Care workbook to assist Ryan White grantees in engaging and retaining clients in HIV/AIDS care.
• To introduce participants to 25 interventions targeting rural and formerly incarcerated populations in a Connecting to Care II workbook, in order to assist Ryan White grantees in engaging and retaining clients in HIV/AIDS care.
• Participants will be able to identify the methodology necessary to identify special strategies for engaging and retaining clients in HIV/AIDS care.

How do we find the missing link in the test-and-treat continuum? In order to realize the impact of expanding testing and treatment in our communities, we need to find out who and why we have difficulty keeping in care. This workshop will show you how we used existing local lab and clinic data to evaluate and improve our linkage, retention and viral load suppression rates. We determined the demographic characteristics of those out of care and those not virally suppressed, then focused our quality improvement activities on interdisciplinary strategies to reach those populations. You will have the opportunity to explore how you would conduct similar analyses, prioritize strategies to address gaps in the care continuum, and develop a work plan that you can implement.

Learning Objectives:

• Understand the impact of using clinical data, especially linkage rates, retention rates and viral loads, to evaluate and improve patient and population-level test-and-treat outcomes.
• Explore and prioritize strategies to improve linkage to and retention in care on a local or regional population-level.
• Develop a work plan to implement at least one strategy for improving linkage and retention rates in the community served by your work.

This workshop will be presented using a combination of lecture and discussion. We will describe the implementation of a novel HIV testing strategy at the Department of Motor Vehicles (DMV), which provides driver’s license and automobile tag services to more than 150,000 Washington, DC, residents annually, and the recent replication of the program model at an Income Maintenance Center (IMC) in Washington DC, the Government office that provides residents with public benefits including food stamps, financial assistance, and health insurance. We will present the primary goals of the program and describe FMCS’s Promote, Offer, Test, and Link to Care (POT-Link) implementation model and identify barriers to implementation. We will present data describing the HIV testing outcomes from the programs’ inception in October 2010 to the present. We will share data from a sample of individuals who declined testing about their reason for refusal.

Learning Objectives:

• Key components of the integrated HIV testing model that is appropriate for non-clinical public service siteswill be described.
• Identify the key factors in identification and selection of a non-clinical public service HIV testing site.
• Identify barriers to the implementation of HIV testing in non-clinical settings.

Demonstration of the new CAREWare ADAP fields and features and a discussion of some important issues that affect ADAP grantees, especially importing data from pharmacies and other sources. This session will serve primarily as a training session for ADAP grantees who elect to use CAREWare for their activities in this area and who will be exporting data for the ADR.

 Learning Objectives:

• Understand new fields and functions added to CAREWare to meet new ADR client-level reporting requirements.
• Gain understanding of how ADAP grantees are able to import data from pharmacies and other sources.
• Understand process for entering data and producing the ADR.

Dental care is one of the greatest unmet needs among PLWHA. Dental insurance is not as common as medical coverage, and Medicaid dental coverage varies widely, with some States offering no coverage at all. The Affordable Care Act will expand access to health insurance but will not cover adult dental benefits. The Ryan White program is a vital source of oral health funding for PLWHA. This workshop will review oral health funding streams and provide tools to estimate the cost of ongoing and expanded oral health coverage for PLWHA. Some of the questions addressed include: What is the cost per person for dental care? What services should be covered? What is the difference in cost between serving new patients and ongoing patients?

Learning Objectives:

• Participants will describe public and private financing sources for oral health care.
• Participants will identify strategies for purchasing cost-effective oral health services.
• Particpants will use the cost and service utilization worksheets to estimate the costs of providing different scopes of service.

The TARGET Center is an online resource developed to capture and disseminate the knowledge and expertise of the Ryan White Community. The Ryan White Community is experiencing exponential growth in the use of online technologies, and the TARGET Center is in a position to facilitate collaboration and knowledge exchange within the community. This workshop will review the TARGET Center’s 7-point plan to keep pace of changes in technology and then shift to an open forum discussion on future directions by the TARGET Center Advisory Group and participants. Key discussion items include New Media strategies and coordination with broader HHS Web coordination initiatives to achieve cost efficiencies and improve user experiences (e.g., HRSA, AIDS.GOV, cross-agency Web sites such as data.gov and healthcare.gov).

Learning Objectives:

• This session will help participants locate high-value resources in the TARGET Center to support Ryan White Program administrative, fiscal, and clinical activities.
• Participants will learn to access five different ways to keep themselves and their providers informed about the Ryan White Program.
• Participants will learn at least one new method for contributing to the Ryan White Community online.

Patient activation is the moment when patients have the skills, knowledge, and self-efficacy to not only self-manage their chronic disease but also participate in quality management activities. Q-PAC is a newly funded group of patients in the DC EMA who, through participation in a HRSA- sponsored learning collaborative, created infrastructure to develop and sustain improved partnerships with providers of RW-funded HIV Care. This workshop will introduce participants to the concept of patient activation by sharing the stages of Q-PAC’s development, which included changes in engagement of consumers in quality activities, improvements in government-citizen models of partnerships, and improved involvement of patients in quality management activities by consumers. Lessons learned, “Aha” moments, and a panel discussion of providers, patients, and administrators will aim to disseminate a replicable model that participants can implement at the local or regional level.

Learning Objectives:

• Introduce patient activation as a method for improving consumer involvement in quality management activities at the clinical and systems levels.
• Provide techniques for utilizing data and data reporting with consumer quality advocates.
• Provide participants with a replicable model of consumer involvement in quality management activities.

ActionAIDS in partnership with Pathways to Housing-PA, developed the Philadelphia Harbor Project, to provide permanent supportive housing for people with a diagnosis of HIV/ AIDS and who experience multiple barriers to achieve stable housing. The project is based on the “housing first” model. Harbor Project is for homeless single adults living with HIV/AIDS and mental illness and/or substance abuse. This project began on April 1, 2012. Pathways to Housing, holds the master lease for 20 rental apartments in Philadelphia. ActionAIDS administers the financial aspects of the program. The HIV medical case manager works as part of a team of workers at Pathways to Housing. The team consists of a psychiatrist, nurse, three master’s-level service coordinators, two bachelor-level case managers, and a program assistant.

Learning Objectives:

• Increase knowledge of the Housing First model.
• Describe how various psychosocial issues create barriers for people living with HIV/AIDS.
• Illustrate how supportive housing impacts people living with HIV/AIDS.

The Planning Council of New York presents its implementation of an online tool used to educate and certify planning council members and staff, providing a more flexible way to learn, and an objective scoring tool to ensure a minimum level of understanding of members and staff. The online tool, using the eCOMPAS e2Community platform, consists of an interactive educational component, a user-friendly quiz for each lesson, a printable certificate of completion, and an administrative reporting module. The tool supplements the current training processes and allows users to take multimedia courses at their own pace at home or anywhere with the Internet, while giving them real-time feedback on their knowledge levels. Using data instead of anecdote, the Council is able to identify strengths and weaknesses of participants’ knowledge for continuous training program improvement. Presenters share an interactive demonstration of the tool and lessons learned on the implementation process.

Learning Objectives:

• Workshop participants understand how a paradigm of online planning council education helps ensure minimum levels of knowledge important to the mission and operations of the council.
  By end of workshop, participants will be able to describe how to adopt and adapt strategies and tools to deliver Web-based training to their planning councils and staff.
• Participants will understand the challenges and benefits of an innovative program for Web-based online training.

As part of NASTAD’s cooperative agreement with HRSA, NASTAD has convened an advisory group of several health department staff, and a Professional Expert Educational Roundtable (PEER), with the primary purpose to provide expert, peer-based advice and guidance to ADAP coordinators on current issues. This committee consists of ADAP coordinators with diverse experiences and expertise in financial forecasting, cost containment and waiting list management, coordination with other payers, compassionate use programs and client- level data systems, with geographic and program composition diversity. This session will provide an overview of the technical assistance (TA) opportunities available to ADAP coordinators through NASTAD, including PEER. This session will also provide an in-person TA opportunity for ADAP coordinators and staff by allowing individuals a chance to ask questions about ADAP programmatic issues.

Learning Objectives:

• Participants will become familiar with the technical assistance opportunities available through NASTAD’s cooperative agreement with HRSA.
• Participants will learn about the Professional Expert Educational Roundtable (PEER).
• Participants will have an opportunity to participate in an in-person PEER session, gaining practical knowledge on current topics of interest to ADAPs.

All sizes and all parts of Ryan White grantee programs continue to experience an "up and down battle" with improving cervical cancer screening rates among HIV-positive female patients. Many grantees have experienced the frustration of achieving improvement goals and then, when they re-measure the results 6 months to a year later, they find the rates declining. The experiences of two HIVQUAL-US Quality Management Groups, located in Mississippi and Eastern Pennsylvania, will be shared highlighting their patient population characterisitcs, the range of results, the most effective interventions, and the difficulties in sustaining their rates. Results from both groups ranged from a low 17 percent to a high of 91 percent. Additionally, specific QI tools used for identifying causal factors to low rates will be shared and discussed.

Learning Objectives:

• Learn to identify successful interventions for improving cervical cancer screens as measured by HIVQUAL-US Regional Groups.
• Engage in a dialogue with presenters and other participants about their own experiences with (1) improving cervical cancer screening rates, (2) the challenges involved in helping female patients get their annual exams and (3) sustaining improvement gains.

This workshop will vividly describe a 10-year retrospective of a Part D- funded women's support group. The group was born from a need identified by the agency’s staff psychiatrist to give disenfranchised women who had been under his care a place to find support, connection, and community. Common denominators of the women in the group include extreme poverty, multiple co-morbid medical conditions, homelessness, addictions, sexual abuse. and histories of incarceration. Many of the women have lost children to illness and gun violence. Key factors to success have been group leadership, transportation, and food and child care on site. The group has seen women come and go, but there has been continuity. It has provided a safe, connected place that gives participants a sense of community and support, and has become an extended family to many. We hope that it will live long and prosper!

Learning Objectives:

• Participants will understand key elements for success in creating and sustaining a group for disenfranchised women living with HIV/AIDS.
• Participants will be able to identify the formats that allow for success of a support group for women living on the fringes of society, with great medical and social service needs.
• Therapeutic techniques used to provide guidance and structure to the suport group environment will be discussed, including but not limited to: motivational interviewing and psychoeducational sessions.

The 340b Drug Pricing Program was a result of the Veterans Health Care Act of 1992. The program allows various federally-qualified programs to have access to cost saving measures that can save up to 50% on drug costs as compared to other programs. Incorporating 340B into your organization has many benefits for both the patient and provider. With budgets cut and grants expiring, the 340B program is able to empower various facets of your organization.

Learning Objectives:

• Benefits the Pharmacy Provides- With state budget cuts and grants not being renewed, a 340B program in your organization may be able to fill in some of those gaps. In this section how to properly adjust financially for a 340B pharmacy will be covered.
• Starting and Maintaining the Pharmacy- There is a large learning curve to operating an in house 340B pharmaceutical program. Proper record keeping, organizing medications and communicating with the patient are some issues of concern when first starting the program. Pharmacy functions will be covered in this section.
• Patient outreach- By operating a 340B pharmacy in house, keeping up to date with patient needs it of utmost importance. Communicating with the patients and learning their needs and habits become a part of business in the pharmacy. In this section proper communication will be covered.

Learning Objectives:

• Participants will learn the steps involved to ensure continuity of care and access to medications for Ryan White patients migrating to various newly available medical care options from health care reform.
• Participants will learn the priority and allocation process used to estimate costs during the move toward health care reform.
• Participants will learn the planning considerations surrounding meeting Ryan White requirements in the health care reform environment.

The Medicare and Medicaid EHR Incentive Programs provide a financial incentive for the "meaningful use" of certified EHR technology to achieve health and efficiency goals. By putting into action and meaningfully using an EHR system, providers will reap benefits beyond financial incentives–such as reduction in errors, availability of records and data, reminders and alerts, clinical decision support, and e-prescribing/refill automation. HAB has coordinated with CMS and CDC regarding HIV measures to ensure wide adoption and use and to identify gaps within the set of endorsed performance measures. In addition to the measures proposed for Stage 2 of Meaningful Use, HAB has submitted performance measures through the NQF endorsement process in order to prepare for Stage 3 of Meaningful Use.

Regional Quality Improvement (QI) groups provide a unique and valuable approach for peer learning, local support, and opportunities for regional community of practice. The groups combine active learning and involvement through exchange of ideas, problemsolving, and successful strategies for improvement. New concepts and techniques for improvement are discussed with the added relevance of the local and/or regional environment. The forum provides an opportunity for cumulative conversations, highlighting local expertise and building on shared knowledge across multiple priority topics. Group projects related to prioritized quality indicators reinforces accountability and provides motivation to spur the groups and the regions overall performance. Local and national facilitators provide access to tools, articles, and training. Targeted technical assistance by a quality expert and peer coaching are primary components provided.

Learning Objectives:

• Learn about the purpose and structure of regional quality groups.
• Understand the power of peer learning and local impact on HIV care improvement.
• Learn about existing successful regional quality groups and their shared quality projects

Fenway Health has provided care for individuals with HIV for more than 20 years and currently serves 1,800 patients living with HIV/AIDS. We will analyze a dashboard we created in October 2010 that scores providers and patients based on 16 clinical indicators associated with best practices for caring for patients with HIV. Utilizing a HIV dashboard to score providers and patients on a quarterly basis on different clinical indicators has helped identify high-risk patients who are being lost to follow-up and subsequently our team nurses are able to reach out to them. Additionally, it has led to improved data capture and documentation that has led to improved reporting on the RSR. The dashboard provided a “snapshot” of provider progress as well as patient clinical outcomes.

Learning Objectives:

• Understand how to create a dashboard that analyzes data from a provider and patient perspective.
• Understand how to utilize dashboards to improve clinical measures and to identify gaps in data capture.
• Understand how integrating multiple systems can improve clinical outcomes and client-level reporting.

This is a three session institute where each session can stand alone or participants can attend all three sessions. Session I will focus on fiscal requirements for monitoring and oversight. The second session will offer best practices for monitoring and oversight as well as methods for monitoring subgrantees. Session II will be interacting allowing grantees to share their own success stories. The final session will focus on the restricted drawdown process used by HRSA for higher level monitoring. Grantees will learn how to submit documents for approval, effective TA interventions to improve deficiencies and discuss the importance of working with the project officer on the development and review of the corrective action plan.

Learning Objectives:

• Participant will increase their knowledge of Ryan White Part A and B fiscal reporting and monitoring requirements for grantees and subgrantees.
• Participants will learn best practices for Ryan White Part A and Part B fiscal reporting and monitoring for grantees and subgrantees.
• Participants will gain an understanding of HRSA’s use of restricted drawdown for Ryan White Part A and Part B grantees and the use of corrective actions plans to improve programmatic and fiscal performance.

The session will give participants an overview of the MAPP process and explain how MAPP is a community-driven, strategic planning process for improving health. More than 900 communities have used the MAPP process to mobilize partners and constituents; create overarching community visions; conduct comprehensive community health assessments; apply assessment data to create community health improvement plans; coordinate collaborative implementation of their plans; and evaluate their community improvement efforts.

Learning Objectives:

• Review the overall purpose of the MAPP process.
• Explain why MAPP is a paradigm shift in local public health assessment and planning.
• Describe how communities can access MAPP resources.

Adopting effective strategies for assessing and collecting client charges is important to adhere to HAB monitoring standards. Legislative requirements to determine clients’ sliding fee scale charges, collect payments, and cap annual accrued payments are complex. Grantees and subgrantees report challenges in implementing those requirements. In this workshop, we review HAB’s client charge monitoring standards, key information needed to determine clients’ Federal Poverty Level (FPL), steps in setting sliding fee charges, establishing charge schedules, effective practices in assessing and collecting charges, clients’ roles and responsibilities in documenting payments, methods for capping payments, best practices in conducting these activities, and grantee monitoring methods. The Houston Part A grantee will discuss methods adopted to implement HAB’s client charge policies.

Learning Objectives:

• Increase trainees’ knowledge of HAB’s client charge monitoring standards.
• Trainees will learn to assess clients’ FPL, set sliding fee scale charges, and collect and cap client payments.
• Grantees will gain sufficient knowledge to monitor subgrantees’ performance in adhering to HAB standards.

In this workshop, we will describe an approach to addressing health literacy needs in our Ryan White Part C Clinic. After a discussion of need, we intend to present our methodology for health literacy screening in this population, including selection of a tool for measurement. We will then present and summarize the results of our measurements. We will discuss strategies which may be employed to address health literacy as found through review of the literature. We have selected “Teach Back” as the intervention which we have used with individuals found to have low health literacy scores; and we will explain our selection of this method as well as discuss our results thus far.

Learning Objectives:

• Participants will learn how low health literacy impacts a patient encounter.
• Participants will learn of current tools available to screen and measure individual health literacy.
• Participants will learn about evidence-based strategies to employ with individuals who have low health literacy scores.

The Health Reform Law expands health coverage and funds to many new grant programs. At the same time, the Health Reform Law also strengthens the Government’s ability to pursue fraud and abuse enforcement and makes significant changes that intensify the risk and consequences of failing to implement an effective corporate compliance program, such as relaxing requirements for whistleblowers to bring suit. Accordingly, it is critical that grantees establish effective compliance programs that include internal reporting systems to encourage staff to report potential non-compliance within the organization.

Learning Objectives:

• Recent Government enforcement actions and initiatives wil be described.
• New compliance requirements included by Health Reform will be identified.
• Risks to grantees created by the Health Reform Law will be explained.

Beginning in 2010, the District of Columbia expanded Medicaid eligibility to include individuals with an income at or below 200% of the federal poverty level. Early expansion of Medicaid – in preparation for implementation of the Affordable Care Act – offers an opportunity to describe and discuss some of the challenges associated with expansion. The District of Columbia has deployed CARE Act Part A and Part B program funds in ways that coordinate with Medicaid reimbursement and permits implementation of a “whole program” approach. Based on that foundation, the District is developing a medical home model for people with HIV/AIDS, and anticipates that will be in place by 2014. Preliminary plans for the implementation of a medical home will be described, along with activities designed to ensure ongoing provision of crucial support services. Current and potential sources of federal and local funds for this effort will also be described.

Learning Objectives:

• Recognize the critical importance of effective fiscal coordination;
• Opportunities to leverage Medicaid and other public funding sources for services to people with HIV/AIDS;
• Strategic use of CARE Act service categories to create and sustain a medical home.

In 2006 Massachusetts enacted a healthcare reform law containing most of the same elements as the Federal Affordable Care Act. Since that time, the Massachusetts Ryan White Part B program has had the unique opportunity to experience the impact of changes that will affect the rest of the States in 2014. This workshop will explore the successes and challenges that Ryan White administrators in Massachusetts have faced in a “post healthcare reform world." The primary focus of the workshop will be the impact of a multipayer environment on ADAP, but other areas discussed will include the important role of non- reimbursable support services and benefits coordination for people living with HIV.

Learning Objectives:

• Describe impact of changes in payer environment on existing Part B services.
• Outline the ongoing need for Ryan White services despite the high percentage of citizens with health insurance access.
• Identify administrative challenges of dealing with multiple payers.

Though HIV treatment is effective in improving health and reducing transmission, studies show that only a fraction of those diagnosed ultimately engage in care and achieve virologic suppression. Coordinating effort across the spectrum of care to support patient retention and engagement is key to the national HIV/AIDS strategy. We review a model for supporting retention developed through participation in the National Quality Center In+Care Campaign. This model includes active review of retention measures, community team meetings, and regular communication between the medical provider and case management providers to develop a care plan for those at risk for loss to follow-up, or with detectable viremia, and features targeted interventions for those at highest risk. We will engage participants in discussing their experiences and addressing retention in their communities.

Learning Objectives:

• Participants will learn to identify risk factors and high-risk groups for treatment failure and loss to follow-up
• Participants will learn to develop strategies to support retention in care through coordinated outreach and interventions of medical and case management providers.
• Participants will be engaged in sharing local challenges and best practices in support of retention in care.

Through the SPNS Information Technology Networks of Care Initiative, six demonstrations projects developed innovative electronic health information exchanges (HIE) to improve quality and coordination of HIV care for patients seen in regional areas around the country. We present findings from across projects with in-depth cases presented by three. Each employed unique techniques to encourage use of the local HIE, including (1) integrating the electronic system in formal quality improvement activities, (2) using HIE development as an opportunity to foster information technology capacity in small support agencies, and (3) integrating data-sharing systems into routine provider activities. We will explore how each approach ensured active use of the local HIE and examine the HIV clinical care indicators that improved as a result of the enhanced systems.

Learning Objectives:

• Understand how an electronic network system can be integrated into formal quality improvement activities.
• Apply strategies for building information technology capacity across diverse provider networks.
• The cross-site outcomes of the SPNS Information Technology Networks of Care Initiative will be discussed.

Early recognition and management of oral conditions are important to sustain the health and quality of life of HIV-positive individuals. In this workshop, we demonstrate use of a client-level information system to assess the quality and outcomes of HIV oral health care. We describe use of the Provide Enterprise System by the Fort Lauderdale Part A grantee to conduct a longitudinal cohort study of 4,693 HIV-positive oral care adult patients. We present assessment findings including the extent to which funded subgrantees met HAB and Part A oral health standards, disparities in use of oral health care, and the relationship between use of medical and oral health care. Methods to address challenges in using information systems to conduct quality assessments are discussed.

Learning Objectives:

• The application of information systems to improve oral health services will be discussed.
• Trainees will learn methods to assess quality using client-level data and longitudinal analytic techniques.
• Trainees will learn how to apply these techniques to medical and other core services.

Training and technical assistance resources for HRSA grantees are paramount in supporting HRSA’s longstanding commitment to increasing access and improving the quality of healthcare . The Office of Health Information Technology and Quality supports a variety of training and technical assistance resources designed to assist grantees in the implementation of Health Information Technology (HIT) and Quality Improvement (QI) initiatives. This workshop will inform grantees of newly developed web-based resources and tools that will help to facilitate quality improvement activities, develop a competent HIT workforce and connect with other partners and networks within their community. Additionally, HRSA’s current activities as it relates to the National Quality Strategy and the Centers for Medicare and Medicaid EHR Incentive Program will be discussed. The workshop will highlight the new HIV/AIDS clinical quality measures that providers will be eligible to report on as part of the program.

Learning Objectives:

• Participants will know where to go to access web-based training curricula and quality improvement resources.
• Participants will learn about the National Quality Strategy and HRSA Quality Measurement and Alignment Strategy.
• Participants will become familiar with HRSA Health IT workforce development efforts.

Through the process described in the 201 session of this institute, an interagency workgroup selected quality indicators for Care Coordination. Whereas the EMA previously relied upon chart review for quality indicator measurement, this project utilized provider electronic reporting of client-level data. Analysis was limited to clients with sufficient opportunity to meet the performance standards, which required receipt of the following services at expected frequencies: (1) case conferences, (2) health education, (3) home or field visits, and (4) adherence assessments. Baseline results highlighted challenges in the areas of convening quarterly case conferences (29.4%) and maintaining health education sessions for clients in intensive service tracks (51.5%). Customized reports, comparing agency performance results with overall performance and performance by different agency types, were discussed at a provider meeting.

Learning Objectives:

• To translate standards of care, as contained in a service model protocol, into specific, measurable, realistic and time-bound performance indicators.
• To recognize challenges in the implementation of a medical case management/care coordination program following a complex protocol, with clients selected for intensity of need.
• To identify effective practices for engaging service providers in the integration of performance measurement results into their quality management efforts.

As a result of the Patient Protection and Affordable Care Act, Medicaid programs will turn to managed care to controls costs as Medicaid eligibility expands. Previously uninsured patients are likely to purchase subsidized coverage from managed care organizations (MCOs) operating in the State health benefit exchanges. To participate in this new environment, grantees should consider participating in managed care networks. This session will provide grantees with information on the different types of managed care, the key provisions in managed care contracts, and strategies for negotiating contracts with MCOs.

Learning Objectives:

• Identify the various types and models of managed care.
• Understand the meaning of key provisions in managed care contracts.
• Learn how to negotiate with MCOs for fair payment.

Certification as a patient-centered medical home will require practice change in a number of areas. The areas of change – “change concepts”—are used frequently in the literature and in guidance on becoming a PCMH. What is involved in those changes? What will it look like and how will it feel to the patient when the changes are complete? Working in a small group, this exercise will give the participant an opportunity to think about those key changes and consider how specific concepts will look after changes for practice transformation have been implemented. Additional information will be shared on the building blocks of successful practice transformation.

Learning Objectives:

• Discuss the elements of the eight change concepts in detail.
• Discuss key elements that are already present or must be incorporated into their agency’s services and programs.
• Discuss the ideal order of implementing these change concepts.

In order to address the challenges currently faced by ADAPs, NASTAD has embarked on a project to expand access to care and treatment for individuals living with HIV/AIDS by strengthening ADAPs and providing opportunities for individuals to access care beyond ADAP in a more streamlined approach. NASTAD began this process by analyzing three current options for increased access to care for under and uninsured individuals living with HIV – ADAP, pharmaceutical patient assistance programs (PAPs) and Welvista. Following this analysis, NASTAD has worked to develop a standardized PAP enrollment process and application, common eligibility, and coordinated medication fulfillment. This effort, in conjunction with industry and federal partners, will bring HIV/AIDS care and treatment for the under and uninsured to a new era.

Learning Objectives:

• Participants will become familiar with the process by which ADAPs and/or PAPs provide access to treatment for people living with HIV/AIDS.
• Participants will learn about the progress towards created a standardized process and application for enrollment into PAPs, including outcomes from a May 2012 Consultation conducted in collaboration with the Department of Health and Human Services, federal, pharmacuetical, and community partners.
• Participants will learn how to expand access to care for people living with HIV/AIDS and better address the current unmet treatment needs of people living with HIV/AIDS.

Over the last few years, Federally Qualified Health Centers (FQHCs) have experienced unprecedented growth. From the establishment of new FQHCs to the expansion of existing centers into new communities to the enhancement of services offered, FQHCs are an important component of community-based system of care. If you’re interested in learning how to become a part of the health center program, or are a “seasoned” health center in need of a refresher, this session will provide a primer on the benefits available to FQHCs and the basic requirements for effective governance, management and daily operation.

Learning Objectives:

• Learn what it means to be an FQHC.
• Examine the eligibility requirements for becoming an FQHC.
  Understand key FQHC-related requirements and expectations for governance structure, management, and daily operation.

Advancing HIV care in primary care settings first requires clinical training and education to ensure quality care. Quality clinical care must be supported by effective practice transformation to ensure access to patient focused fiscally sustainable organizations. The Patient Centered Medical Home (PCMH) model is being implemented nationally, and directly supports the second National HIV/AIDS Strategy goal of increasing access to care and improving health outcomes for PLWH. Performance improvement training aligned with the PCMH model on income generation, access, population management, and linkages is fundamental to expand and sustain access to HIV care. Ryan White providers are essential to ensuring the successful expansion of HIV care through primary care providers, as well as to sharing best practices and creating sound partnerships with primary care organizations to enhance quality and ensure equity.

Learning Objectives:

• Describe the fiscal and other non-clinical capacity-related organizational challenges faced by primary care settingswhen improving or adding HIV care services.
• Explain the importance of fiscal and other non-clinical education and training in supporting organizational infrastructure growth and HIV clinical expansion.
• Describe the role of Ryan White-funded organizations in engaging community health centers, primary care associations, and other primary care organizations to support infrastructure growth and HIV clinical expansion for successful integration of HIV into primary care.

A fun interactive learning experience! The first 60 minutes will be used to play Jeopardy to understand basic HIV nutrition and identify nutrition-related problems that will trigger a referral to a registered dietitian for medical nutrition therapy. The last 30 minutes the members of the group will share ways to implement and improve nutrition screening in their clinic setting. HIV nutrition tools/forms will be provided for group interaction and learning.

Learning Objectives:

• Participants will be able to describe components of a healthy diet.
• Participants will be able to identify at least two indicators of HIV malnutrition.
• Participants will be able to implement a nutrition screening program in their clinic setting.

This session will introduce key quality improvement (QI) principles and Ryan White legislation requirements for quality management, targeting those individuals who are new to QI or those who want a refresher on how to apply key QI concepts to their HIV program. Participants learn through interactive activities and real-world presentations by fellow grantees sharing their QI journeys and successes.

Learning Objectives:

• At the end of this session, participants will understand key concepts of quality improvement as well as Ryan White Legislative Requirements for Quality Management.
• At the end of this session, participants will become familiar with key quality improvement models, such as PDSA cycles.
• At the end of this session, participants will develop an action plan to integrate QI strategies from other grantees in their QI programs.

The DC HIV Medical Case Management (MCM) guidelines standardize the linkage of treatment indicators and client health outcomes to acuity assessment and comprehensive case management activities. Tools developed stressed the importance of viral load suppression for clients on antiretroviral treatment. Medical case managers track CD4 and viral load and ensure that clients are engaged in medical care. Medical case managers without clinical background are empowered to ensure positive clinical outcome for clients. Many tools developed ensure consistency in service provision. The active community involvement created a sense of ownership that facilitates adoption of new tools. Any program implementing medical case management or treatment adherence in any setting regardless of the funding stream will benefit from this workshop. This is a panel discussion, giving the speakers opportunity to share various aspects of the critical components while allowing ample time for discussions, and answer questions from the participants.

Learning Objectives:

• Participants will: -Understand the fundamentals of a quality medical case management program
• Participants will Understand the important relationship between the use of newly developed client assessment tools and the achievement of positive health outcomes and outcomes of evaluations will be shared. Participants will be able to learn hands on techniques with using developed tools.
• Participants will recognize the critical role of medical case managers in helping clients achieve viral load suppression and the necessity of a “SMART” approach to developing a client-centered service plan that incorporates treatment adherence techniques.

Florida accounts for the highest number of HIV-infected inmates in the United States, addressing the complex needs of this population is imperative. Moreover, ex-offenders often face numerous barriers, which can be further complicated by their HIV/AIDS status and comorbid conditions. Metro Wellness and Community Centers (Metro) is a non-profit in Central Florida that offers a broad range of services to inmates and ex-offenders, beginning with our Ryan White funded jail case management to our Office of Minority Health funded HIRE Project. Establishing a seamless system of care requires multiple stakeholders to provide continuous care, transition assistance and comprehensive HIV/AIDS-related services. This session provides strategies to optimize and integrate services for the criminally involved living with HIV to ensure that resources are maximized.

Learning Objectives:

• Participants will be able to identify the challenges facing criminally involved clients living with HIV, as well as the service providers, agencies and municipal, state and Federal Government programs serving them.
• Participants will be able to state strategies used to link the criminally involved to care in order to maximize resources unique to this population.
• Participants will be able to create a care plan for criminally involved clients based on case studies.
  
  

The Cultural Interactions workshop 301 will enable participants to create a training using the principles explored in the Cultural Interactions workshops 101 and 201 to address the specific educational needs of their organizations. We will provide two examples of how the training modules previously reviewed have been adapted for a Prison System and an AIDS Service Organization. In addition to providing participants the tools to adapt and offer the training, participants will learn to use the workshop to motivate their staff to connect with agencies that can assist them in making the necessary structural changes to achieve real and lasting improvements in cultural interactions within their organization.

Learning Objectives:

• To create or adapt an interactive workshop using the training modules presented in workshop 101 and 201 for various organizational settings.
• To recognize that concepts such as self-awareness and empathy which are thought to be personality traits can be developed through active learning.
• To utilize the workshops to motivate those organizations trained to connect with agencies that can assist them in making necessary structural changes to achieve cultural awareness.

There can be a substantial gap between the literacy and numeracy required to manage HIV, and PLWHA’s education and skills. In Baltimore, I am piloting three HIV medication adherence support tools appropriate for most literacy levels. These are (1) a graphic presentation on why HIV medicine should be taken on time every day, (2) an HIV-medication-specific pill card adapted from the AHRQ Health Literacy Toolkit, and (3) a CD4/viral load chart that PLWHAs can use to monitor the results of their adherence. As a second health literacy initiative, I will present the concept of multi-media education programs (MMEPs) as an effective way to communicate key health messages, and will discuss storyboards for an HIV MMEP that is under development. Both of these initiatives are being conducted as part of a National Quality Center Fellowship.

Learning Objectives:

• Participants will be provided with three HIV-specific medication adherence support tools. The educational piece has several variations (Spanish language, adapted for young pregnant HIV-positive women) and can be further modified for use with various populations. Participants will form small groups and role play administering one of the tools, followed by a discussion of how each tool might be incorporated into adherence counseling at their agencies.
• Participants will learn about the efficacy of a pilot of the adherence support tools, as we present the results of a quality improvement cycle (PDSA or plan/do/study/act). Participants will have the opportunity to question staff from the agency that conducted the PDSA cycle. Lessons learned will be presented from two less successful attempts to integrate the tools into agency practice.
• Participants will be exposed to three brief multi-media education programs (MMEPs) and asked to assess their effectiveness as educational tools. The topic of two of the MMEPs is HIV, and the third is an award-winning MMEP on diabetes. Participants will then be asked to comment on storyboards for a new HIV MMEP that is under development.

Access to high-quality primary and specialty care by HIV/AIDS-infected patients in rural and underserved areas continues to be a major challenge. The Florida/Caribbean AIDS Education and Training Center (F/C AETC) addresses this challenge through the Project ECHO™ (Extending Community Health Outcomes) program. The F/CAETC model uses Adobe Connect Pro, a live audio-video-based platform, to connect a multidisciplinary team of specialists in HIV/AIDS and community healthcare providers treating HIV patients in rural and underserved areas in Florida, Puerto Rico, and the U.S. Virgin Islands. This innovative telehealth program is aimed at developing capacity among the health care providers to safely and effectively treat patients with HIV/AIDS. Implementation and evaluation of the F/C AETC-Project ECHO™ program is described followed by presentation of preliminary evaluation findings and future direction of the project. The session also highlights the importance of mixed methods approach in program evaluation.

Learning Objectives:

• By the end of this session, participants will be able to describe how F/C AETC-Project ECHO™ was implemented, the challenges encountered in that process, and how they can model the program in their respective centers.
• By the end of this session, participants will be able to describe the impact of F/C AETC-Project ECHO™ on health care providers’ knowledge, skills, attitude, and behavior and other potential outcomes of this educational intervention.
• By the end of this session, participants will be able to articulate the value of mixed methods approach in the evaluation of F/C AETC-Project ECHO™ program.

This 301 workshop will feature free and low-cost evaluative tools for online and social media activities (e.g., Google Analytics, Survey Monkey, social media reports from Facebook and Twitter). Presenters will demonstrate how to use some common tools, and discuss how to select the most appropriate measures for your project. We will then demonstrate some easy-but-useful qualitative approaches to gathering evaluation information. Finally, the panel will pull the pieces together with some case studies of evaluation findings and discussion of how they might and should trigger change.

Learning Objectives:

• Participants wil learn how to use Google Analytics and other Web metric tools to examine the reach and use of their Web sites and social media tools.
• Participants will be able to select five key metrics for their project.
• Participants will be able to describe 1-2 qualitative evaluation methods for online programs.

EnhanceLink was a national, 5-year, 10-site SPNS demonstration SPNS project that developed innovative models for identifying HIV-positive persons passing through jails and linking them to community care. Partnering jails made 822 new HIV diagnoses; linkage services were delivered to 8,056 individuals. Among 1,082 releasees with client-level data, 25.7 percent had suppressed virus 6 months post-release. We will review how working with jails helps communities meet goals of the National HIV/AIDS Strategy. Next, the audience will take a poll and use knowledge gained from personal experience with their communities to predict what factors were associated with linkage in EnhanceLink. While poll results are being tallied, we will showcase one project that used court advocacy to help relink previously diagnosed clients to care. Next, we will review project-wide data regarding what services significantly promoted linkage. We will close by comparing the audience predictions and the actual EnhanceLink results.

Learning Objectives:

• Increase understanding of the role of jail linkage programs in promoting seamless care for HIV infected persons in the community.
• Develop an understanding of intervention models that AIDS Service Organizations, Health Departments and Community HIV Clinics can use to engage and retain HIV infected persons cycling through the criminal justice system in community care.
• Identify best practices in promoting linkage for incarcerated HIV-positive individuals leaving jails and rank what were most important factors.

“Everyone as a Story: Survival and Leadership” (EHAS) is an educational HIV/AIDS treatment and care workshop wherein HIV-positive women use their personal experiences to highlight the issues, challenges, and triumphs of living with HIV. EHAS contains a five-part video series that depicts HIV-positive women discussing treatment options; ways of increasing provider/client communication and provider cultural competency; methods for addressing HIV stigma and discrimination; and the importance of medical adherence. Additionally, the EHAS workshop treats topics such as social networks, stigma, status disclosure, and initiation/adherence to HIV/AIDS treatment, which are important to leadership and involvement of HIV-positive women in changing the HIV pandemic worldwide. The workshop is conducted by members of SisterLove’s 20/20 Leading Women’s Society, whose objective is to engage HIV-positive women by becoming community voices, training them as mentors for young and newly diagnosed HIV-positive women, and increasing meaningful involvement of HIV-positive women in key decision-making roles for advocacy and policy.

Learning Objectives:

• Discuss the need to educate and support HIV-positive women and their health providers about key issues impacting women’s HIV treatment and care.
• Address and reduce HIV-related stigma and shame among women and their communities.

This workshop will offer a more in-depth discussion of what it takes to sustain your Quality Management (QM) efforts over time. Having sufficient capacity for QM is critical in building a 'culture of quality' in your organization. This workshop will provide examples from various Ryan White Program grantees regarding their process for establishing a culture of quality in their organization. Building enthusiasm and buy-in for QM occurs over time and it’s important for all stakeholders to see the importance and success of quality improvement (QI) efforts. This workshop further explores the use of QI tools and how to employ them in developing ideas for improvement and measuring their success. NQC will be moderating a discussion with selected grantees that have drawn the link between continued QI efforts and creating long- term enthusiasm for quality and its sustainment over time.

Learning Objectives:

• At the end of this session, participants will understand the importance of quality management in all funded service areas.
• At the end of this session, participants will understand how to integrate Ryan White legislative requirements in contracts and find the right balance between contract monitoring and quality improvement.
• Participants will learn from successful practices in monitoring quality improvement programs by subcontractors.

One year before the health care coverage expansion is expected to take place in 2014, this session will provide an update on key health care reform provisions and how Ryan White grantees and clients can prepare for them. Presenters will cover three inter-related topics critical to a smooth transition for Ryan White providers and programs. The session will begin with an update on health care reform implementation, focusing on the Medicaid expansion, continue with lessons learned from the California Low Income Health Insurance Program and conclude by highlighting key reform issues and opportunities for HIV medical providers.

Learning Objectives:

• Participants will be able to describe the latest status of health care reform, particularly the Medicaid expansion, and evaluate how reforms may affect access to HIV care.
• Participants will be able to identify recommendations from California providers and advocates for effectively transitioning uninsured people with HIV into health care coverage.
• Participants will be able to describe key reform issues relevant to HIV medical providers.

Since its early authorization, the Ryan White Program emerged to provide an array of medical and social services to people living with HIV/AIDS who are considered marginalized, uninsured and underinsured. Organizations funded by the Ryan White Program have utilized various vehicles to ensure that adolescence, children, women, and men receive appropriate services tailored to their specific needs. Some have implemented funded programs under the one-stop shopping modality. However, some organizations tend to develop programs by contracting with various outside organizations for HIV-related services. As Ryan White grantees develop a network of providers, what are the emerging tools being developed to ensure that subcontractors are collecting the appropriate data to report to funders? How frequently is the grantee of record conversing with subcontracting organizations on developed HRSA/HAB mandates?

Learning Objectives:

• This session will describe various tools developed by grantees to monitor subcontractors to ensure program accountability.
• The process of data collection by the grantee of record to the subcontrators will be described.

Starting in 2011 the NY EMA began planning for HIV-care service delivery changes as a result of the Affordable Care Act (ACA) and New York State Medicaid program expansion. To begin this process NYCDOHMH contracted with an experienced policy Medicaid consultant to conduct a thorough analysis of current and possible future Medicaid reimbursed services in currently funded NY EMA Ryan White Service Categories. Results from this report combined with ongoing grantee and Planning Council staff analysis of ACA and NYS Medicaid service expansion implementation, including Health Homes, were shared with the NY HIV Health and Human Services Planning Council to begin to inform 2013-2015 service planning and the determination to seek a waiver to the 75 percent Core medical services allocation as required by Ryan White legislation.

Learning Objectives:

• Learn about the planning process in the NY EMA to determine the effect of ACA and Medicaid expansion on the RW Part A funded portfolio of services.
• Share tools developed by the NY EMA so that they can be adapted for use by other EMA's and TGA's.
• Discuss varying ACA planning strategies among EMA’s/TGA’s in comparison to NY EMA planning tools to promote shared learning.

According to the United States 2010 Census, the Latino population is the largest minority group in the United States. The Northeast Valley, a Federally qualified health center located in California, provides ambulatory bio-medical and bio-psychosocial services to the growing Latino population. Northeast began to provide specific HIV- related services since 1991. Throughout the years, the team has recognized the difficulties in engaging and retaining older gay Latino men into the developed health system infrastructure. To determine barriers to care, the HIV clinic developed a qualitative study to explore the issues of disclosure and stigma faced by identified gay Latino men living with HIV/AIDS who are 50 years or older. Preliminary findings suggest that respondents experience fear of disclosure to family and friends due to the continued HIV/AIDS- related stigma in the Latino community.

Learning Objectives:

• The socioeconomic conditions of Latino men receiving HIV-related services in a Federally Qualified Health Center in LA County will be described.
• Describes the development of a survey instrument to explore challenges faced by Latino men to disclose HIV/AIDS status to friends and family members.
• This session will review accomplishments of the HIV/AIDS clinic in addressing the needs of the older gay Latino male population including improved health care retention, greater openess to discuss HIV/AIDS status, increased education about community resources, and greater awareness of various cultural values impacting health care outcomes.

The Treatment Adherence Project (TAP) and Win! puts innovative research on increasing treatment adherence into practice. It will help high-need, HIV-positive people improve their health by incentivizing adherence with a lottery. Treatment adherence is critical to improve the quality of life of HIV- infected persons and to reduce the spread of HIV, but is a great challenge for many who are infected. There are formidable barriers that keep some PLWH from adhering to their medication regimen (pill fatigue, depression, side effects) but in many cases, incentives have increased adherence and contributed to improved health. Further, TAP builds upon medication adherence as prevention. PLWH who have an undetectable viral load are healthier and less likely to spread infection. The program empowers PLWH by teaching skills to track medication adherence and educating about its importance for health. Participants who are adherent will be entered into a prize drawing.

Learning Objectives:

• This workshop will discuss barriers to treatment adherence and assess the baseline CD4 and viral load data for the EMA.
• The service model a. Lottery to win prizes for clients who are treatment adherent b. Enrollment criteria, case manager buy-in and facilitation of the program.
• This session will discuss methods for assessing program impact (measured program success).

Workshop is intended to provide grantees with a review of all aspects of a Part C budget. It will step participants through the process of creating a budget that meets all legislative and programmatic requirements. Components of each of the three required budget documents including a line item budget, budget narrative and SF 424A as well as a review of the required elements of a staffing plan will be presented. Recent changes in requirements, including the reallocation of certain line items to different cost categories and salary limitations, will be discussed. Requirements for submitting complete budget modifications and carryover requests will also be reviewed.

Learning Objectives:

• By the conclusion of the workshop participants will be able to: Describe the necessary components of a satisfactory and functional budget that meets Ryan White Part C legislative and programmatic requirements.
• By the conclusion of the workshop participants will be able to: Describe the salary limitation rule that was enacted by the Consolidated Appropriations Act, 2012.
• By the conclusion of the workshop participants will be able to: List the documentation that is required for submitting a request for a budget modification or carryover.

The Houston EMA has conducted joint planning activities between HIV prevention and care since 2002; however, when the guidance for 2012 Comprehensive HIV Plans was released last year, separate plans for prevention and care were still in place. The expectations of 2012 Part A/B Plans, our history of joint planning, and the National HIV/AIDS Strategy’s call for increased collaboration all set into motion Houston’s first-ever joint comprehensive plan. By the end, 111 individuals (27% PLWHA) and 61 agencies contributed to the document, and all grantees and Planning Bodies concurred. The plan itself includes integrated goals, objectives, strategies, and benchmarks. This workshop will describe the process, outcomes, and “lessons learned” from creating the EMA’s first joint comprehensive HIV prevention and care plan. It will present a model for replicating a joint process in other jurisdictions and describe the effectiveness of various engagement strategies with consumers and stakeholders.

Learning Objectives:

• The overall process for developing a joint comprehensive HIV prevention and care services plan will be described as well as outcomes in terms of (1) integrating mission, vision, goals, objectives, and strategies; and (2) participation levels among consumers, partners, and other community stakeholders.
• Participants will be able to list at least three effective strategies for engaging and retaining consumers, partners, and other community stakeholders in a joint comprehensive HIV planning process as determined by the results of a post-process engagement survey and a Planning Council member’s perspective on the process.
• Participaints will be able to identify joint HIV prevention and care benchmarks for use in measuring systems improvements and monitoring progress in plan implementation, including how alignment in goals, objectives, and activities with the National HIV/AIDS Strategy and other local, regional, State, and national plans and initiatives was ensured and coordinated.

The Patient-Centered Medical Home (PCMH) model can foster greater patient retention, higher quality HIV care, and better coordination across medical specialties and support services. Its components include improved data management systems, tools for engaging patients, restructured care teams, and quality improvement activities. The California PCMH Initiative supports the implementation of medical homes at public HIV care sites statewide. Clinics emphasize those components that respond to local context, including web-based resources to promote patient engagement; improved data systems to enhance tracking of services and case management; and panel management to allow mid-level providers, understanding physician orders, to target preventive services to patients. We will describe three clinics’ experiences rolling-out PCMH, and identify key lessons learned for ensuring successful implementation in other settings.

Learning Objectives:

• Describe basic concepts relevant of HIV PCMH.
• Describe best practices to overcome challenges in early PCMH implementation.
• Detail how HIV PCHM is able to improve quality, retention, and care coordination.
  
  

AltaMed Health Services, one of the largest FQHCs nationally, serving primarily the Latino population in LA and Orange county provides care to nearly 1,200 HIV/AIDS patients. As part of reaching out to community members that are HIV+ and are unaware of their status, AltaMed is integrating social marketing strategies to outreach to high risk populations.

Learning Objectives:

• To raise the awareness among service providers on the effectiveness of the use of agency website as a strategy to promote services to increase referrals and raise awareness of the community on HIV issues and resources that are available for them. Creating a referral mechanism through your agency website is one way to increase referrals for HIV services.
• To promote the use of social marketing outreach strategies to help improve increasing the number of clients that is aware of their HIV+ status and links them into care. Methods: Facebook, twitter, YouTube, and AltaMed’s website have been utilized to reach out to the community to engage high risk populations to come in for an HIV test or reengage HIV+ populations.

The Ryan White Part A and D programs in Bexar County partnered with The Health Collaborative, a non-profit organization to conceptualize, produce, disseminate, and evaluate a Fotonovela project. Needing a low-literacy tool to access Latina women, the group embarked on a strategy to produce age-specific educational materials focusing on HIV/AIDS testing, education, and access to care. A Fotonovela is a familial and historically accepted form of delivering health information in Latino communities. It relies on the use of graphics and limited use of bilingual (Spanish/English) text. The three target groups of Latinas were Jovencitas (ages 18-29), Damas (ages 30-45), and Doñas (ages 45 and older). The educational message, getting tested, using condoms, and accessing services was tailored to each age group to enhance utilization.

Learning Objectives:

• Participants will learn steps in the conceptualization of a Fotonovela project to meet the health literacy needs of the target population.
• Participants will learn to identify key health literacy strategies that recognize cultural and familial competencies to ensure greater access to care.
• Participants will become better able to develop recommendations and/or policies for improving access to care for specific marginalized populations to reduce health disparities.
  
  

Community health centers provide comprehensive, culturally competent, quality primary health care services to medically underserved communities and vulnerable populations. Grant-supported Federally Qualified Health Centers (FQHCs) receive operating funds from HRSA Bureau of Primary Care and meet Medicare and Medicaid criteria enabling them to receive enhanced reimbursement rates. FQHC Look-alikes (FQHC LA) receive no grant funding but can benefit from enhanced Medicare and Medicaid rates. This session identifies the advantages Ryan White Part C grantees can leverage by becoming an FQHC or FQHC LA, identifies the components of a successful application including budget development, program and governance requirements. FQHC or FQHC LA status offers Ryan White Part C clinics a sustainable business model for continuing to provide comprehensive, quality HIV care in the changing healthcare environment.

Learning Objectives:

• By the end of the session participants will understand the statutory benefits of becoming an FQHC or FQHC LA and be able to engage their management teams and board members in strategic discussions about becoming an FQHC or FQHC LA or partnering with an established health center.
• By the end of the session participants will understand the application processes for obtaining FQHC or FQHC LA status and be able to determine which model best meets the strategic goals of their Ryan White program.
• By the end of the session participants will understand the financial stability a Ryan White Part C program can gain by becoming an FQHC or FQHC LA or by partnering with an existing health center.

Panel Management (PM) is key intervention to make PCMH effective and practical. Our large HIV specialty clinic is implementing PM to increase our quality of care while reducing the time burden on the clinicians. In PM, a team uses patient registry reports to identify those who have outstanding needs such as immunizations or screenings. Standing orders authorize staff to arrange care independent of physician visits. Initial analysis of data shows increases in quality indicator performance after implementation. Using an open forum, a discussion of maximizing personnel resources through task shifting and the impact of the new practice design on clinical performance along with staff and patient experience using this model will take place. We will share tools such as the registry report, standing orders, and staff huddle scripts and will review workarounds for getting HIV-specific electronic records such as Labtracker and Careware to produce registry reports.,Panel Management (PM) is key intervention to make PCMH effective and practical. Our large HIV specialty clinic is implementing PM to increase quality of care while reducing the time burden on the clinicians. In PM, a team uses patient registry reports to identify those who have outstanding needs such as immunizations or screenings. Standing orders authorize staff to arrange care independent of physician visits. Initial analysis of data shows increases in quality indicator performance after implementation. Using an open forum, a discussion of maximizing personnel resources through task shifting and the impact of the new practice design on clinical performance along with staff and patient experience using this model will take place. We will share tools such as the registry report, standing orders, and staff huddle scripts and will review workarounds for getting HIV-specific electronic records such as Labtracker and Careware to produce registry reports.

Learning Objectives:

• Learners will be able to define Panel Management and describe a typical PM program. 
• Learners will be able to describe the association between the Patient Centered Medical Home Model and Panel Management.,Learners will be able to describe the association between the Patient Centered Medical Home Model and Panel Management.
• Participants will identify barriers and facilitators to implementing this design in their agencies,Participants will identify barriers and facilitators to implementing this design in their agencies

This workshop will discuss emerging initiatives targeting health, housing, and employment outcomes for PLWHA at Federal, State, and local levels in the context of the National HIV/AIDS Strategy with a panel of PLWHA, researchers, providers, and Federal and State officials. The workshop has three components: • Discussion of the relationships between health, housing, and employment outcomes. • Discussion of new employment initiatives of the U.S. Department of Labor, Office of Disability Employment Policy, the U.S. Department of Housing and Urban Development, Office of HIV/AIDS Housing, and the New York State Department of Health, AIDS Institute. • Discussion of survey data that show improved health outcomes and reduced risk behavior (secondary prevention) among employed PLWHA.

Learning Objectives:

• Participants will be able to Identify examples of improved health outcomes and reduced risk behaviors among PLWHA who are employed.
• Describe how emerging Federal, State, and community-based employment initiatives can provide support to meet employment needs of PLWHA at the local level.
• Describe examples of the relationship between health, housing and employment outcomes.

Despite significant reductions in perinatal HIV transmission in the United States, new cases of pediatric HIV occur as a result of missed opportunities in prevention. The purpose of this workshop is to provide an in-depth analysis of systems issues to identify factors that lead to missed opportunities. This workshop will offer participants an update on the revised perinatal guidelines, new testing technologies as they relate to screening for the mother and her newborn, and case presentations on actual missed opportunities in Florida. Break-out groups will focus on a root cause analysis of the issues, use of a perinatal chart review tool (developed in Florida), and consideration of various solutions including new technology in testing, correction of “medical errors” in HIV perinatal care, medical care systems changes, and other strategies to improve prevention. Work group findings will be discussed at the conclusion.

Learning Objectives:

• This session will identify the numerous missed opportunities in failed perinatal HIV transmission prevention.
• Participants will learn how to predict potential missed opportunities and prescribe individualized plans to correct them in "real patient care time."
• Formulate plans to solve the issues of specific missed opportunities on a systems level in their own health care system.

The HRSA Community Based Dental Partnership (CBDP) Program funds twelve programs across the nation to address gaps in oral health care for PLWH and increase the dental workforce to treat HIV and other vulnerable patients. Multi-site evaluation of students’ knowledge, attitudes and practices was conducted with 6 sites over the past two years to determine the impact of this program on students and their intent to provide care for HIV and other vulnerable patients in their future practice. This panel presentation will include results of the longitudinal student study conducted over the past two years. Presenters from three CBDP sites (Nova Southeastern, University of Medicine and Dentistry of New Jersey (UMDNJ), and University of Louisville) will describe their program, including the clinical training for students, education methodologies for HIV and other infectious diseases, and results from student reflective essays about the experience.

Learning Objectives:

• Describe the CBDP program’s role in training dental students in working with HIV infected patients in the dental setting.
• Discuss findings related to changes in students’ attitudes and knowledge in providing dental care to HIV-infected patients.
• Review recommendations for educational methodologies in training future dentists to provide oral health care to HIV-infected patients.

The Ryan White HIV/AIDS Program Services Report (RSR) is an excellent opportunity for grantees and providers to share information about their programs and the clients they serve with HRSA/HAB. Understanding the three components of the RSR–the Grantee Report, Provider Report and the client-level data elements–is integral to a successful submission. This workshop will provide an overview of these three components and will explain the language and concepts of the RSR. Tips on preparing your staff and/or providers throughout the year for the RSR submission and information about available technical assistance resources will also be given.

Learning Objectives:

• Gain general knowledge of the three components of the RSR.
• Understand the RSR process from data collection to preparation to submission.
• Know what technical assistance resources are available to grantees and providers.
  
  

This is a three session institute where each session can stand alone or participants can attend all three sessions. Session I will focus on fiscal requirements for monitoring and oversight. The second session will offer best practices for monitoring and oversight as well as methods for monitoring subgrantees. Session II will be interacting allowing grantees to share their own success stories. The final session will focus on the restricted drawdown process used by HRSA for higher level monitoring. Grantees will learn how to submit documents for approval, effective TA interventions to improve deficiencies and discuss the importance of working with the project officer on the development and review of the corrective action plan.

Learning Objectives:

• Participants will increase their knowledge of Ryan White Part A and B fiscal reporting and monitoring requirements for grantees and subgrantees.
• Participants will learn best practices for Ryan White Part A and Part B fiscal reporting and monitoring for grantees and subgrantees.
• Participants will gain an understanding of HRSA’s use of restricted drawdown for Ryan White Part A and Part B grantees and the use of corrective actions plans to improve programmatic and fiscal performance.

Implementing an effective compliance program takes more than establishing policies and procedures. Has your organization conducted a risk assessment to identify your program’s highest risks? Has your compliance officer developed a compliance work plan to address those risks? Does someone know how to direct an internal investigation when potential problems arise? This session will offer nuts-and-bolts guidance on the steps to take for implementing a compliance program.

Learning Objectives:

• Learn the benefits of conducting a risk assessment.
• Understand the reasons to create a compliance work plan.
• Describe the structure and process of an internal investigation.

The SPNS Systems Linkages and Access to Care Initiative supports the development of systems-level changes to improve linkage to and retention in high quality HIV care. This seven-state Initiative has begun with an initial two-year phase to test potential interventions on a smaller scale through the learning collaborative model, and will be followed by a subsequent two-year phase to evaluate the wider-scale implementation of the most promising interventions. In this workshop, we will explore the range of interventions that are being tested through the learning collaboratives in three of the states (Louisiana, North Carolina, and Wisconsin). Presentations will describe the successes and challenges encountered when implementing the interventions, and identify the critical steps for ensuring successful rollout of similar interventions in other states.

Learning Objectives:

• To describe promising systems-level interventions for improving linkage to and retention in high quality HIV care.
• To characterize the challenges and successes in implementing systems-level interventions in three states.
• To identify the steps that other states and localities can take to ensure successful implementation of interventions to enhance linkage to and retention in HIV care.
  
  

The National Alliance of State and Territorial AIDS Directors (NASTAD) and the National Coalition of STD Directors (NCSD) launched a national survey to examine stigma and to capture the perspectives of individuals embedded in public health systems to better understand how institutional and community-level stigma impacts the level of care available to black and Latino gay men and other men who have sex with men. The Survey was released on December 2011 in English and Spanish to health departments and community service providers. The study findings suggest a high prevalence of stigma across the United States and its impact on public health practice and community support networks.

Learning Objectives:

• Participants wil understand the impact of stigma on black and Latino gay men and other men who have sex with men in the United States.
• Participants will learn the Survey results and their impact on the provision of care, treatment, and prevention in the United States.
• Participant will learn about the technical assistance efforts and additional stigma-specific tools in development to assist health departments and community partners to better address institutional and community-level stigma in their jurisdictions.

Federal funding for the Ryan White HIV/AIDS Program is necessary to carry out all aspects of the program. In a period of constrained fiscal resources and growing caseloads, ensuring sufficient funding has become increasingly challenging. President Obama has proposed to increase funding for some parts of the program in FY13, including $67 million for ADAP. Congress and the President must come to an agreement on the final funding levels. For the future, early in 2013 sequestration is scheduled to take place that is now slated to cut non-defense discretionary programs by an estimated 8 percent. As health reform is implemented and many Ryan White beneficiaries can see their care and treatment paid for by Medicaid and private insurance plans, federal funding needs may change. The workshop panelists will provide an update on each of these issues.

Learning Objectives:

• Workshop panelists will learn of the current federal fiscal environment and proposals to address it through the overall budget process. Within this environment they will learn what the proposals for each part of the Ryan White Program in FY13. The panelists will then offer scenarios on the final funding levels.
• Workshop panelists will learn of possible budgetary actions that are now slated to occur in early 2013 and the possible impact the Ryan White Program. Prospects for funding of the Ryan White Program in FY14 and factors that may influence those decisions will also be examined.
• Implementation of the Affordable Care Act will have a profound impact on how much of the care and treatment provided under the Ryan White Program will be funded. While some care and treatment services will be paid for by new payers, not all services will be covered and not for everyone. Workshop panelists will hear of possible scenarios regarding how Federal funding for the Ryan White Program might be impacted by health reform and how the level of funding needed in the future can be determined.

The Elite Society of the Undetectables is a continuous quality improvement program for people living with HIV/AIDS that celebrate life and success. Our mission is to decrease the spread and stigma of HI'VE/AIDS through community awareness and prevention. This program was founded in 2008 by the staff of the Joye Bradley Health Services Clinic at AID Atlanta. It is an educational/adherence program that was developed to (1) encourage HIV-positive individuals to remain on medication; ( 2) acknowledge those who reach and maintain an Undetectable status; (3) celebrate life and learn how to live with the virus; (4) mentor those who are detectable and encourage them to become undetectable; (5) provide information on services to those who are not in care; and (6) decrease the spread of HIV/AIDS by incorporating prevention for positives.

Learning Objectives:

• Participants will learn how to adopt or implement the program in their area.
• Participants will learn to dentify strategies to improve clients retention in care.
• Participants will learn to educate clients to be able to participate in their own care.

All people living with HIV contend with nutrition issues and deserve expert attention to optimize their diet, immunity, quality of life, and overall health outcomes, and to avoid unnecessary malnutrition, complications, and death. Implementing the HIV/AIDS Evidence-based Nutrition Practice Guideline (Guideline) will be an essential component to establishing a successful HIV nutrition care program. This interactive workshop will help grantees of different settings and capacities prioritize for implementation and improvement the 19 recommendations of the Guideline that was developed by the Academy of Nutrition and Dietetics (found at www.adaevidencelibrary.com or http://guidelines.gov/content.aspx?id=25317). Grantees will identify and share common barriers and solutions to better integrate evidence-based HIV nutrition recommendations into their settings.

Learning Objectives:

• Participants will be able to prioritize the 19 major recommendations of the HIV/AIDS Evidence-based Nutrition Practice Guideline for implementation according to their needs.
• Participants will be able to identify barriers to implementing recommendations.
• Participants will be able to determine at least two practical solutions for resolving barriers.

This session provides a basic foundation in developing a system to measure the quality of HIV care and services and using performance data for improvement. HAB measures and other measurement resources are shared and participants learn about effective data collection strategies. Grantees will present successful data collection efforts, and methods for measuring the quality of HIV care and for applying data results to initiate quality improvement activities. Participants will work on selecting and prioritizing performance measures for their quality management plan at their agency.

Learning Objectives:

• Participants will understand the balance of performance measurement and quality improvement activities and be able to identify and implement key performance measurement steps and link them to quality improvement activities.
• At the end of this session, participants will understand the purpose, definitions, and expectations of the quality measures released by HAB as well as other measures for use.
• At the end of this session, participants will know how to access existing resources on performance measurement including examples of clinical and non-clinical measures, the HAB HIV Performance Measure Module, the CAREWare Performance Module, eHIVQUAL for data collection, and national benchmarking, and other performance measure resources.