Interfaith Community Health Center Bellingham Washington What We Decided In February 2014 the ICHC Board of Directors voted unanimously to relinquish the clinics Part C grant effective March 31 2014 ID: 137610
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Slide1
Continuing HIV Care Services in the Absence of Ryan White Funding
Interfaith Community Health Center
Bellingham, WashingtonSlide2
What We Decided
In February 2014, the ICHC Board of Directors voted unanimously to relinquish the clinic’s Part C grant effective March 31, 2014.
Grant amount was approximately $400,000.
ICHC was an April 1 start date with one year left in grant cycle before re-competition.
ICHC had been a Ryan White grantee for 11 years.
ICHC’s Ryan White Program offered a comprehensive program of primary care, dental, case management, behavioral health, and nutrition services.
One Ryan White patient is a ICHC Board Member
.Slide3
However…
Board
also voted unanimously to continue the same array of services offered through our Ryan White Program using other funding sources (e.g., 340b and Medicaid expansion revenue) Slide4
Why We Did It
Unique nature of ICHC clinic
FQHC with approximately 14,000 patients
Only about 170 HIV patients
No stand-alone HIV program, so…
Different eligibility process for HIV patients vs. other clinic patients (e.g., income verification every 6 months, even if insured, and residency documentation – not required of any other clinic patients)
Different Ryan White sliding fee scale rules vs. 330 rules (e.g., no charge for patients below 100% FPL, slide beyond 200% FPL)
Clinic EMR with
CAREWare
double entry
Considerable drain on Finance, Front Desk, and Medical
RecordsSlide5
Why We Did It (continued)
ACA implementation
Fewer
uninsured
patients
Likely grant underspend into the future
S
trong
safety net in Washington State through state’s Early Intervention
Program (although Medicaid patients are categorically ineligible)
Coverage for undocumented patients
Comprehensive dental coverage
Assistance with co-pays/premiums/deductiblesSlide6
Why We Did It (continued)
Increasing administrative burden
Eligibility verification twice annually
Very likely to have required a core services waiver
Had increase administrative staffing .2 FTE to handle eligibility documentation
Administrative
requirements were becoming an impediment to quality care
Paper chasing by medical staff
Frustrated
patients
Frequently changing requirements meant frequent “system change,” which was disruptive to program effortsSlide7
Why We Did It (continued)
Cost shifting – We were covering more of the costs of care with non-grant funds anyway
Guidance that more costs (e.g., medical records, referrals, front desk) categorized as administrative costs
Patients with lapsed eligibility documentation couldn’t be billed to grant
Compliance concerns
Retroactive policy clarificationsSlide8
What Has Happened
Continue to provide same services we have historically provided – same staff, same services
Continue to contract with our case management partners
If anything, the relationship has become stronger
They have been understanding of our decision
Continue to have a Consumer Advisory Group
Continue to track HAB measures, with a few slightly modified, for QI program
No change in number of HIV patients servedSlide9
What Has Happened (continued)
Time to “drill down” into quality measures and refine systems that should have been addressed long ago
Moving towards implementation of a Hepatitis C program
Focusing
more on engagement/retention
Expanding some RW benefits to other clinic patients (e.g., HIV nutritionist will start offering classes to patients with HIV and other chronic conditions)Slide10
What Has Happened (continued)
Plans to work more with community partners on prevention and moving to opt-out HIV testing
Patients have rolled with the change
Those with incomes above 200% FPL are no longer eligible for the sliding fee scale, in compliance with 330
rulesSlide11
What Has Happened (continued)
If there’s a gap, it’s dental
Medicare and privately-ensured patients have strong dental coverage through Early Intervention Program
Medicaid adult dental program is not as generous
Working through gaps in care for Medicaid patients in partnership with our case management contractor