Nchcmc y2 apps reviewer comments

*CONFIDENTIAL: NOT FOR DISTRIBUTION

HIV in Primary Care Learning Community Reviewer Comments

1

*CONFIDENTIAL: NOT FOR DISTRIBUTION

Health Center Name Adelante Healthcare

Average Reviewer Recommendation Explanation Score 56.75 Reviewer 1: Decline • CMO only 1 year • No current HIV services, even testing • Have not collected HIV data and not included in QI plan • Involved in multiple additional activities that may make attention/focus on HIV Learning Community difficult • No relationships with AETC or correctional facilities

Additional Comments Reviewer 1: None

Reviewer 2: Consider Reviewer 2: • This would be an expansion as there is no None current HIV care and treatment offered.

• Just recently applied for Part A funding.

• No working relationship with AETC, jail, Health Department, etc.

• Applicant did not take advantage of the word limitation to explain program in sufficient detail.

2

*CONFIDENTIAL: NOT FOR DISTRIBUTION AHRC Health Care Inc. dba Access Community Health Center

68

Reviewer 1: Consider • 2 physicians, 1 part-time specialist, 1.58 NP's and one part time PA who are indicated as providing HIV care for patients already. The extent to which is indicated as everything from testing to treatment. Also, established EMR and experience administrative staff.

• The two drawbacks are that they have no additional funding for HIV services and no experience with HRSA related activities. But, I think the clinic should be considered given their ability to provide HIV care and treatment already.

Reviewer 1: • Section 1. PROS. >90% minority population served, 330E, no RW funding CONS. Letter from Board Chair lacks E/O engagement, senior staff experience <3 yrs •

Section 2. PROS. 89 HIV patients seen with excellent f/u care provided, al providers in clinic provide all areas of service for all patients, EMR, 3 QI on strategic plan, CONS. No source funding, no reporting to an outside authority for HIV, little patient level data taken.

•

Section 3. PROS. EMR, in the process of NCQA, CONS. no HRSA collaboration experience

•

Section 4. PROS. onsite mental health, substance abuse, and other counselors, Providers who are experienced in HIV care already, ongoing partnerships with multiple hospitals in the area including established collaboration for some hospitals to accept sliding scale for services. CONS. no RW or AETC partnerships, no jail partnerships, and no

3

*CONFIDENTIAL: NOT FOR DISTRIBUTION

•

Reviewer 2: Accept • More than 50% of the patients are racial and ethnic minorities.

• HIV screening is provided as routine part of care currently.

• Agency has multiple performance/quality measures included in QI plan.

• Agency has relationships with outside agencies including hospitals.

• Good in-house behavioral health programs.

adolescent care provided.

Section 5. Enthusiastic and sounds quite committed to enhancing service to more and more HIV positives.

Reviewer 2: Accept • Key staff has less than three years at this site; however, both CEO and Medical Director have good and relevant work experience. CEO has experience with FQHCs at 9 sites. Medical Director has worked for an FQHC (in both clinical and admin.) and has HIV prevention and services experience. Board of Directors letter is weak. Several new activities planned for 2012.

• Agency has not participated in HRSA Health Disparities collaborations.

• No collaborations/relationships with Ryan White or with AETC.

4

*CONFIDENTIAL: NOT FOR DISTRIBUTION Betty Jean Kerr People's 65.5 Health Centers

Reviewer 1: Decline • Question #38 incomplete-unclear about current HIV services but reported having 4 HIV + patients • No active Ryan White Program partnerships or collaborations • Very limited description of expansion of services • States in #64, …”that HIV capacity building is at the bottom of the list…”-not sure of intent of applicant’s comment • Previously received Ryan White funding.

Unclear why they no longer funded.

Reviewer 1: None

Reviewer 2: Accept • Almost 90% minority patients.

• Good letter from Board of Directors.

• No relationship with Ryan White programs nor with AETC. However, the agency is well connected and has partnerships with local and state health departments and other programs including clinical trials.

Reviewer 2: • All key staff have the minimum years of service with this organization.

• Agency responded well to Section 2, but left question 38 blank and 39 other funding blank.

• Agency does not include any performance/quality measures in QI plan.

• Agency stated used to have very large HIV+ caseload that dramatically changes – provided no explanation.

5

*CONFIDENTIAL: NOT FOR DISTRIBUTION Brevard Health Alliance, Inc.

48.5

Reviewer 1: Decline • Not located in MSA • Less than 50% racial/ethnic minority • Board letter very limited • CMO less than 3 years • Limited HIV services - however do use EHR • HIV data limited in collection and use • Limited partnerships and no active relationships with AETC • Desire to apply does not appear compelling • Support of leadership not clear

Reviewer 1: None

Reviewer 2: Decline • HIV screening is not offered routinely.

• The minimum client level data is collected.

• It is not reviewed internally.

• The agency does have multiple performance/quality measure in the QI plan.

• Too many additional activities in 2012 which may make it difficult.

• No partnerships with Ryan White agencies nor AETC.

Reviewer 2: • Board letter is very vague.

• 51% of clients are Caucasian.

• Chief Medical Officer has less than 3 years experience with no explanation.

• Participated in multiple HRSA Health Disparities activities.

• No relationship with jail.

• Needs training/TA in all areas suggested.

• No financial plan.

• Did not state why applying, yet gave good reasons why they would be a good fit.

6

*CONFIDENTIAL: NOT FOR DISTRIBUTION Family Christian Health Care Center

49.5

Reviewer 1: Consider • Although clinic does not currently provide services to HIV patients, they might well benefit from technical assistance and staff training. However, they definitely need other sources of ongoing funding to sustain such an effort.

Reviewer 1: • Section 1. PROS. 93% minority population, 77% of clients without insurance or on Medicaid, QI coordinator on site, CONS. all key administrators in positions for 1 year or less, no letter of support from Board Chair.

• Section 2. PROS. 18(?) physicians on staff with 2 NPs and 1 PA, offer HIV testing to all patients 13-64, several patient-level data points collected, state ability of physicians (all) to do all level of HIV care and treatment, reports HIV stats to outside institutions, has an established EMR, 1 QI for STI checks on QI plan, CONS. NO financial support for HIV test kits, other HIV services (?), • Section 3. EMR, Participated in 1 HRSA activity • Section 4. AETC relationship CONS. no other community relationships, • Section 5. Not able to currently care for HIV patients, seeking funding to provide services and clinical training for staff.

7

*CONFIDENTIAL: NOT FOR DISTRIBUTION Reviewer 2: Decline • No formal partnerships or collaborations with Ryan White programs or other entities • No letter of support from board chair • Inadequate description of need for HIV services • Reports no current HIV services but listed having 5 HIV+ patients

Reviewer 2: None

8

*CONFIDENTIAL: NOT FOR DISTRIBUTION Foothill Community Health Center

72.75

Reviewer 1: Accept • In an MSA with a patient population greater than 50%, however chief staff less than 3 years • State that they do not provide HIV care but indicate that they collect CD4 data (?)

• Indicate that they collect data but do not report • Has EHR but have not participated in collaborative

Reviewer 1: None

Reviewer 2: Accept • 42% Hispanic/5% African American • Routine Rapid HIV testing • Strong partnerships with Ryan White Part C and AETC • Great explanation for expansion of services section

Reviewer 2: None

9

*CONFIDENTIAL: NOT FOR DISTRIBUTION Health Delivery, Inc.

70

Reviewer 1: Decline • Already getting part B help. Have established HIV provider.

Reviewer 1: None

Reviewer 2: Accept • Well positioned health center with long term chief staff • Provide services to more than 100% patients • Not an MSA but significant racial/ethnic minority population • Strong community relationships

Reviewer 2: None

10

*CONFIDENTIAL: NOT FOR DISTRIBUTION Health Partners of Western Ohio

83

Reviewer 1: Accept • Great understanding of HIV as a chronic disease and risk of HIV in their population. Strong commitment shown for incorporating and expanding HIV services.

Reviewer 1: • Supportive Board Letter • Staff in place for 73 years • Located near 12 cities (PA) • Multiple patient data collected • PCMH recognized?

• EHR in place since 2008 • (Section II) - does not reflect response in Section V (Q56) • One HRSA collaborative • 50-90% not minorities • No partnership with RWHA grantees noted (Q47) • Strong partnerships

Reviewer 2: Consider • Only 41% African American/Hispanic • Not one of the 12 cities • No active partnerships/collaborations with Ryan White Programs and AETC • Strong explanation for expansion of services-“one stop shop” • No HIV+ pts on 2010 UDS report but cited 1-3 HIV+ pts in narrative • AAAHC accreditation in 2011

Reviewer 2: None

11

*CONFIDENTIAL: NOT FOR DISTRIBUTION MotherLand, Inc.

50.75

Reviewer 1: Decline • According to the Letter from Motherland, Inc.'s Board Chair, the clinic has much experience in substance abuse and provides primary care services, however, there is no full time medical staff at the clinic. Also the request for help in this application is specifically for HIV technical assistance. I think that this clinic is in a prime area of need and adding the provision of HIV care and treatment would be of great service to the area. However, I do not think that they currently have the resources (external or internal) to support ongoing care and treatment. Basically, they would need extensive training in HIV care and money to fund testing and all aspects of continuity of care.

Reviewer 1: • Section 1. PROS. 330E, 90% minority pop served, located in ECHPP area, CEO with 14 years experience, QI site coordinator present. CONS. No full time medical staff, have not cared for any HIV+ patients today, Incomplete information on patient mix.

•

Section 2. PROS. established EMR, Reports in the future?, HIV+ information to local HD and ID clinic. CONS. No experience in care of HIV+ patients, Do not routinely test for HIV infection among their patient population, regardless of age, No current QI for HIV care

•

Section 3. PROS. Has an operational EMR, Has participated in 3 HRSA collaboratives CONS. No current NCQA recognition and non plans to do so in the future.

•

Section 4. PROS. Has relationship with RW parts A,C, and AETC - regional center, Partners with many organizations: Y:me TX Gulf Coast (Breast Health), Volunteers of America (outpatient substance abuse), Council on alcohol and drugs Houston, (refers patients who are

12

*CONFIDENTIAL: NOT FOR DISTRIBUTION substance abusers), etc. as well as other hospitals locally and dental case management services from various organizations have partnered with Motherland, Inc., collaboratively CONS. No HIV related activity has been done at Motherland, Inc., No technical or educational assistance to promote HIV care received at Motherland, Inc. from AETC's for local HD (however indicates they are planning on contacting local AETC to utilize web-based HIV training), No partnership with jails â&#x20AC;˘

Section 5. PROS. Highly motivated to incorporate direct HIV care to patients at this clinic; located in an area of unmet need; already provide substance abuse treatment, and there are a lack of medical professionals working in the Motherland, Inc. area. CONS. Currently all HIV patients are interfacing with Motherland, Inc. clinic are sent to another FQHC nearby that specializes in HIV care and treatment, but current strategic plan does not include incorporating full HIV care into their clinic.

13

*CONFIDENTIAL: NOT FOR DISTRIBUTION Reviewer 2: Consider • CEO and Key staff < 1 year of experience • No current HIV services-offers serum HIV testing upon request by patient and/or provider • Strong explanation of expansion of services • Multiple community partnerships, including existing collaboration with Ryan White Programs

Reviewer 2: None

14

*CONFIDENTIAL: NOT FOR DISTRIBUTION North Texas Area Community Health Centers, Inc.

48.5

Reviewer 1: Consider n/a

Reviewer 1: • They may want to really take care of HIV patients, but the application is weak.

Reviewer 2: Decline • Not at this time.

• CHC was unable to effectively show its commitment and reason for providing HIV services or that the services are needed in their geographic area.

• Luke warm support from board of director.

Reviewer 2: • Exec Mgmt not in position longer than 3 years • Mostly new staff • No EHR (in process) NexGen • Limited patient data captured • Mentions additional activities (4) • Not NCQA recognized

15

*CONFIDENTIAL: NOT FOR DISTRIBUTION Operation Samahan

58

Reviewer 1: Decline Reviewer 1: • Primary need for this clinic includes HIV • Section 1. PROS. Highly experienced training for all staff; technical assistance CEO, COO, and CFO, QI coordinator, to establish protocols for HIV care and receives funding for rapid HIV testing, revenues to provide all services including established EMR, 6 primary care case management and medical care physicians on staff and 2 part time NPs, on an ongoing basis CONS. no current HIV experience, not in an area of great need, patient mix 50:50 between Caucasian and minorities (Hispanic/Asian)

Reviewer 2: Accept • Strong letter! I do think they could expand testing and treatment based on their strategic plan.

•

Section 2. No HIV patient care or treatment provided.

•

Section 3. Plan to apply for CMH recognition in next 18 months, participated in 3 HRSA activities

•

Section 4. Partners with RW part c,d grantees. partners with local HD CONS. No participation with AETC's and no previous training in HIV care for any staff members except one staff member who took a workshop on transgenders and HIV prevention.

Reviewer 2: • n/a

16

*CONFIDENTIAL: NOT FOR DISTRIBUTION San Juan Health Care for the Homeless Program

71.5

Reviewer 1: Accept • Great understanding of local communities, national HIV strategy and great relationships with governmental agencies.

• Lack of EHR and PCMH is concerning but should be a priority if accepted.

• Overall, very strong application.

• Commitment and understanding of community needs.

Reviewer 1: • 12 city • lots of patient level data collected • No EHR • Not PCMH recognize, plans on applying • No HRSA collaborative activities • Indicates intent to engage in multiple additional activities • Weak AETC relationship, no formal relationship with correctionals

Reviewer 2: Consider • Community connections • Long tenure chief staff, however no EHR considering application as PCMH in 18 mos.

• No collaboration experience

Reviewer 2: • In a critical need area working with HIV+ population now.

17

*CONFIDENTIAL: NOT FOR DISTRIBUTION South Dakota Urban Indian Health Clinic, Inc.

84.5

Reviewer 1: Accept • Already have a few patients. Letter sounds committed. In an area of high unmet need (NA). Doing routine testing, established PCMH status, partners in AETC-SD.

Reviewer 1: • Lots of potential at this site, mentoring could be done!

Reviewer 2: Accept • CHC shows commitment to integration of HIV services.

• Involvement with AETC and the level of data collected shows investment into HIV care.

Reviewer 2: • Majority POC. • Not near a 12 cities.

• Lots of patient level data collected.

• Data collected via excel worksheet, has EHR. • QI plan.

• Not PCMH recognized, in process.

• Two HRSA collaborators.

• Indicates intent to engage with other activities.

• Greater partnerships.

18

*CONFIDENTIAL: NOT FOR DISTRIBUTION St Thomas East End Medical Center

79

Reviewer 1: Accept • Clinic is well situated to continue offering HIV care; they need to incorporate an EMR and include HIV quality indicators in their overall strategic plan but otherwise they already receive some funding for HIV care activities.

Reviewer 2: Accept • Comprehensive HIV prevention, care and treatment-has 61 HIV+ pts • Strong description of expansion of services

Reviewer 1: • Section 1. PROS. 99% ethnic minority clinic, rural setting, 4 pcps on staff, administrative staff on board for > 3 years, QI coordinator on staff, Board Letter appears enthusiastic and supportive of grant request • Section 2. HIV testing 13-64, PCP already doing HIV care, Test kits paid for by CDC funding, patient level data collected, HD, BOD, QI comm, AETC, and ID clinic receive HIV reports. CONS. no EMR provided care for 61 patients but no information on visits, etc., no HIV indicators in QI plan.

•

Section 3. Plans to obtain EMR, participated in 1 HRSA collaborative

•

Section 4. relationship with local HD, RW, CDC, and state funding for clinical lab testing. Multiple outside partnerships to provide all level of services.

Reviewer 2: None

19

*CONFIDENTIAL: NOT FOR DISTRIBUTION • •

Current Ryan White Part D subcontract Need to clarify reason for no longer having Ryan White grant that board chair wrote in support letter!!!

20

*CONFIDENTIAL: NOT FOR DISTRIBUTION Westside Family Healthcare, Inc.

71.5

Reviewer 1: Consider • Seem committed but not routinely testing. They do have potential for expansion of services.

Reviewer 1: None

Reviewer 2: Accept • Patient level data is collected.

Application is responsive to the guidance. Application appears to have backing of the Board of Directors and leadership.

Reviewer 2: • CMO has less than 3 years of experience.

The agency did not elaborate additional experience. Rapid tests are not currently used. Agency does not provide HIV care and treatment.

21