Priority Setting and Resource Allocation – Service Utilization Nanette Benbow

PSRA Committee Members Roman Buenrostro Perry Maier Cheryl Potts Doug Ryan Atara Young All CAHISC Committees were represented as a part of the Cascade on the PSRA Committee Carl Jenkins Kathy McLoyd Evelyn Rivera Cynthia Tucker Sara Zamor

PSRA Committee Recommendations for Resource Allocation for FY2016 Part A Funding: Flat Funding (same as current program year) Best Case (additional 5% or more funding) Worst Case (decrease of 5% or more funding) MAI (Minority AIDS Initiative) Funding:

Info Considered Priority ranking Unspent funding by delegate agencies Service Utilization Data 75%/25% requirement by HRSA Challenges noted by providers Barriers noted by providers Testimony provided by Forum attendees How the service categories impact the Cascade Funding by other Federal/State to ensure Ryan White is “payer of last resort” Various factors and how categories have been impacted by the ACA (Affordable Care Act)

Directives Increase communication and access to PSRA data for entire membership (e.g. webinar) Medical Case Management – requiring that the provider allocates resources for medical benefits coordinator staff CAHISC to serve as a catalyst to assist mental health provider agencies in finding and retaining qualified staff

FY14 Unduplicated Clients by Service Category Tons of Data Ryan White Part A & MAI - FY14, FY13, FY12, FY11 and FY10 Comparative Data Analysis   S e r v i c e U t i l i z a t i o n E x p e n d i t u r e s S c o p e s P a r t A FY10 Units FY10 Clients FY11 Units FY11 Clients FY12 Units FY12 Clients FY13 Units FY13 Clients FY14 Units FY14 Clients FY14 Unduplicated Clients by Service Category FY10 FY11 FY12 FY13 FY14 FY10 Proposed Units FY10 Actual Units FY10 Proposed Clients FY10 Actual Clients FY11 Proposed Units FY11 Actual Units FY11 Proposed Clients FY11 Actual Clients FY12 Proposed Units FY12 Actual Units FY12 Proposed Clients FY12 Actual Clients FY123 Proposed Units FY123 Actual Units FY13 Proposed Clients FY13 Actual Clients Ambulatory 61,726 27,266 67,738 34,528 108,086 38,239 52,186 30,921 41,159 24,356 9,934 $7,844,306 $8,933,281 $8,096,443 $7,679,619 37,829 8,708 61,552 20,851 71,190 ###### 30,030 23,171 37,022 38,693 56,853 Medical Visit 56,389 24,091 35,024 17,061 80,631 25,061 34,779 20,444 29,521 16,359 33,420 6,619 49,164 12,305 42,972 21,991 13,092 23058 26237 36405 Early Intervention Risk Assessment 34 23 4,052 2,071 3,553 1,961 5,124 3,261 1,542 1,122 140 266 567 421 613 577 1,023 1,146 1,059 1,242 Preventative Care 857 12,470 5,716 5,169 2,757 3,428 2,271 1,136 830 1,688 478 3,374 2,152 2,270 1,226 2,014 3996 2562 6515 Practitioner Exam 296 215 8,887 4,943 3,036 1,734 2,192 1,439 2,431 1,624 1,344 224 1,346 234 1,040 520 953 1470 1690 2195 Provision of Specialty care 2,564 2,768 1,887 10,360 3,683 2,011 815 5,491 3,730 1,160 1,060 2,488 2,422 20,855 2,221 1,150 2345 1738 3420 Referral to Specialty care 1,586 958 2,864 2,177 1,664 1,114 849 315 77 61 2,762 1,817 2,468 2,090 3,387 3113 3659 4611 Prescribing Medications 1,672 779 3,160 1,379 3,538 1,842 617 376 1,851 1,500 972 1,405 1,552 1894 1748 2465 Oral Health 9,247 5,586 10,245 6,537 12,592 6,016 7,437 4,680 9,173 4,908 2,193 $1,038,726 $1,232,843 $1,131,258 $1,041,245 6,361 3,974 3,348 7,363 6,094 4,129 3,350 4,483 6,502 7,256 Diagnostic Visit 1,805 1,363 2,386 1,874 1,694 1,298 3,021 2,155 3,980 2,727 1,629 853 1,055 867 806 1,570 2020 3218 2890 Preventive Visit 2,957 2,032 2,131 1,608 2,633 1,650 1,127 980 1,140 840 1,550 1,237 675 1,178 3,501 2,332 776 1037 1201 1264 Therapeutic Visit 4,485 2,191 5,728 3,055 8,265 3,068 3,289 1,545 4,053 1,341 3,182 1,108 1,820 5,130 991 1,004 1426 2083 3102 Mental Health 13,873 5,851 11,513 5,070 12,478 5,235 21,545 6,388 9,181 4,080 2,383 $1,463,552 $1,476,288 $1,335,552 $1,122,688 8,070 2,916 11,605 4,555 9,966 5,920 6,734 9,799 14,821 25,670 Assessments/Screenings 1,642 1,937 1,476 2,012 1,643 7,293 2,848 604 481 1,512 1,381 1,604 1,385 1,359 2,451 1,990 3200 2673 5572 Individual Counseling Session 7,614 3,093 6,420 2,669 7,590 2,693 10,174 2,670 6,414 2,968 4,294 1,116 8,772 2,795 7,034 2,695 3,659 5060 9289 14526 Group Counseling session 3,988 3,156 925 2,876 899 4,078 870 2,163 631 2,264 419 1,229 375 1,573 774 1,085 1539 2859 Substance Abuse Outpatient 34,569 3,050 12,456 3,047 25,716 3,057 24,746 3,207 22,872 2,976 1,066 $1,461,276 $1,388,748 $1,245,267 $1,167,589 12,365 4,757 41,257 3,343 24,463 3,564 4,517 4,137 26,011 27,741 Screenings 6,693 332 1,208 639 686 846 160 157 704 28,964 1,644 1,742 1,214 2,214 1646 2694 2740 Assessments 308 263 618 423 384 259 410 210 248 202 406 260 532 464 330 281 422 Individual Counseling session 6,430 1,163 4,004 995 3,665 934 3,485 962 4,418 1,558 4,205 2,683 3,465 587 644 918 4459 4131 9,215 1,147 6,626 990 6,362 1,062 6,702 994 6,528 880 5,970 3,183 9,132 822 7,444 1,139 1,189 1134 10504 9746 Methodone Treatment 11,923 145 11,896 190 14,619 225 13,158 195 11,518 179 1,080 30 11,280 158 7890 10702 Early Intervention Services 3,464 2,290 7,350 3,767 5,571 3,473 5,236 3,353 1,159 $0 $377,440 $357,573 $357,775 3,544 2,924 1,736 1,248 3,393 4,420 4,586 6,165 HIV Counseling & Testing 1,197 2,190 1,731 1,728 1,676 1,800 1,741 2,038 1,814 1,815 1,615 1,940 2351 1940 Health Education & Literacy 465 2,416 871 2198 900 3,336 1557 54 60 676 548 647 963 1603 Referral Services 441 272 1,130 908 458 86 41 984 936 2,170 1,156 800 819 1333 Linkage to Care 538 356 1,614 552 737 439 14 468 114 527 710 622 864 878 Psychosocial Support Services 25,502 4,960 22,351 4,905 25,167 5,547 15,959 4,271 4,141 2,263 $975,209 $1,040,926 $958,127 $929,348 9,098 4,537 15,137 3,457 14,695 3,500 3,163 4,333 14,493 15,547 13,466 2,962 11,510 3,059 13,892 3,416 7,292 2,803 7,737 2,574 2,690 1,232 6,661 2,637 6,220 2,244 2,248 2556 7305 6743 Group Counseling Session 11,846 1,870 10,702 1,740 10,960 1,933 8,413 1,375 8,134 1,253 6,070 8,254 677 8,137 1,088 755 1452 6852 8217 Nutritional Counseling 108 80 68 59 171 207 331 10 40 63 98 88 84 389 Pastoral Care Counseling 82 48 71 47 56 27 13 135 328 159 240 76 123 228 198 Substance Abuse Residential 4,803 295 4,989 287 4,985 249 3,594 213 2,625 204 $687,109 $821,765 $648,930 $452,836 5,501 270 3,760 206 153 212 3,922 3,826 Residential Treatment = 1 day 4,431 3922 3826 Outreach 888 235 1,177 484 1,609 536 5,937 3,528 2,811 $207,039 $157,891 $130,439 $128,218 360 2,387 728 3,090 6,008 3,596 5,215 Public Awareness 170 167 657 304 64 128 1,890 2758 3290 4560 Health Education 854 1,007 317 952 232 300 600 1,200 3250 306 655 Face-to-Face Clinic 377 Face-to-Face CM Care Conference 211 Face-to-Face Home 39 Face-to-Face Office Face-to-Face Telephone 3,954 2,327 Face-to-Face Other 101 Other 440 348 Medical Transportation 27,121 3,753 22,392 2,878 16,835 2,668 12,381 1,972 8,037 1,426 669 $426,341 $435,495 $413,210 $421,513 18,846 2,001 20,582 3,305 20,216 3,121 2,252 1,963 16,628 10,963 Taxi Vouchers 6,824 898 8,859 634 4,497 649 3,976 557 2,733 444 500 4,864 941 4,542 757 560 539 5200 3764 Bus Cards-CTA/RTA 16,314 1,986 9,997 1,534 9,709 1,396 5,322 884 4,739 765 15,400 1,100 12,600 950 901 8100 4208 Metra Cards 390 120 181 21 122 25 528 44 214 546 42 20 148 55 Gas Cards 596 294 1,233 289 564 264 365 339 185 200 220 205 660 399 Transportation-CV 1,555 1,267 166 1,294 168 1,873 1,400 70 1,104 130 340 176 1460 1799 SAVE Program Rides 1,349 262 777 173 590 132 784 818 87 824 150 1060 738 PACE Cards 104 7 LETZ-Go Program Rides 93 12 Non-Medical Case Management 11,399 4,064 13,981 5,110 28,912 6,820 29,334 5,399 496 $480,658 $491,570 $467,188 $481,548 12,784 8,006 5,668 8,042 9,075 12,787 26,798 Community Service 1,352 610 1,928 764 4,792 1,052 700 2,402 1,602 1,096 1428 3288 7096 Legal Service 280 147 113 1,102 162 957 174 154 221 Financial Service 1,176 588 2,794 906 4,588 1,036 5,587 902 1,636 409 865 2910 2742 Social Services 1,373 579 1,765 2,389 3,152 751 1,666 392 886 851 1772 3057 Medical Services 2,404 893 3,608 1,168 7,069 1551 8711 1214 4,350 580 1,000 1,551 720 1445 1320 6116 Other Services 4,760 1,212 1,402 4,296 1137 4000 1,002 334 1,137 930 852 926 1225 Referrals 35 2,286 875 4,676 1154 3891 752 734 3,200 928 1,154 3,386 3458 2350 6314 CM Care Conference 246 Face-to-Face Care Conference 110 31 6 9 1,272 197 Telephone Conference 2,088 CM Other 1,830 Medical Case Management 34,599 12,831 23,269 9,833 27,519 10,231 40,401 8,360 23,004 3,936 1,353 $3,211,266 $3,178,468 $2,980,017 $3,006,195 57,231 14,278 27,571 17,951 16,129 10,039 34,369 35,782 Assessment of Service Needs 1,581 570 523 508 503 325 311 1,700 480 393 Development of Individualized Service Plans 1,502 965 938 1,331 1,223 1,047 1,225 1183 1238 Coordination of Services 13,142 3,247 6,572 2,364 7,107 2,062 11,124 1,707 38,856 6,028 4,560 2188 11400 10747 Client Monitoring 15,422 4,835 10,773 3,335 12,089 3,260 18,787 2,554 1,450 13,320 6,660 2698 14002 Evaluation 487 373 1,015 1,206 724 1011 Treatment Adherence Counseling 2,081 1,293 3,481 1,772 5,469 2,182 7,736 1,989 8,925 2,960 2566 9120 8391 855 209 5 4,299 9,104 1,296 1,440 Legal Services 2,055 1,783 1,892 1,561 1,733 1,424 1,774 1,464 $699,996 $757,388 $685,754 $734,421 976 1,241 2,063 1,138 967 1,024 1,113 1,468 Phone Consultation 977 890 1,028 920 771 742 785 679 526 352 640 451 362 470 In-person Consultation 1,078 863 769 989 825 702 711 366 516 662 998 Food Bank/Home Delivered Meals 348,073 3,669 345,264 3,613 264,552 3,311 209,650 2,725 241,519 2,883 $1,031,289 $1,076,092 $1,013,514 $950,004 6,944 5,936 4,116 4,866 223,411 250,883 Food Pantry 347,093 344,480 3,605 196,978 2,481 19,632 3,347 299,564 2,058 2433 6223 7361 Home Delivered Meals 8 12,672 244 320,906 3,597 8,904 217188 243522 Emergency Financial Assistance 1,251 4,823 2,541 904 2,427 826 2,426 763 463 $78,881 $82,614 $115,671 $80,921 5,272 872 4,160 1,310 3,607 921 2,910 2,742 Food grant 3,181 1,172 4,732 2,444 833 810 5,200 4,100 1,250 3,536 850 790 2820 2688 Utilities grant 79 91 97 16 72 90 Housing Services 203 242 241 137 $206,239 $203,969 $218,927 $199,787 126 Health Insurance Premium/Co-Pay Short-term Housing Grant Total Part A 576,430 74,562 545,507 81,041 539,900 88,184 428,710 74,530 389,386 58,102 27,084 $19,811,887 $21,654,778 $19,797,870 $18,753,707 96,981 ##### 24,061 68,773 62,641 74,263 80,171 81,962 76,799 93,889 397,542 469,781 M A I 4277 2261 7,589 4333 6288 4077 6912 4290 8562 2927 337 $1,094,550 $1,313,715 $1,197,658 $1,216,550 3210 1625 3000 7,301 1057 4456 2574 4,077 4,002 4,287 4,464 6,913 1034 1515 394 1337 357 1276 1500 445 51 $94,175 $106,664 $107,081 $101,736 431 693 1,896 1,988 443 725 302 1353 572 2800 1127 $186,678 $208,941 $201,663 $197,690 310 100 1,460 255 1486 435 415 551 1,537 1,354 515 138 43 326 3736 117 $74,684 $69,746 $70,392 $72,414 1142 507 345 49 142 92 134 327 559 955 2161 2144 1749 1734 735 694 760 $70,000 $63,218 $71,829 922 758 1,749 475 689 733 420 99 $73,770 $93,015 $93,463 $94,120 387 603 585 544 708 832 1,112 753 748 447 412 83 $54,162 $61,050 $62,265 $54,369 4,142 3,550 19,855 Total MAI 6,724 2,956 12,900 6,883 12,042 7,600 12,789 7,801 17,879 1,407 $1,578,019 $1,923,131 $1,795,740 $1,808,708 5,049 5,682 2,079 2,743 7,636 11,097 5,241 2,865 8,595 10,705 4,653 7,243 Total Part A & MAI 583,154 77,518 558,407 87,924 551,942 95,784 441,499 82,331 407,265 63,830 15,084 $21,389,906 $23,577,909 $21,593,610 $20,562,415 26,140 71,516 67,882 77,128 84,824 89,205

FY14 Unduplicated Clients by Service Category

Service Utilization: Core Medical Services

Service Utilization: Core Medical Ambulatory Outpatient Service Types

Service Utilization: Other Core Medical Service Types

Service Utilization: Essential Services Food Bank: FY13 – 209,650 FY14 – 241,519

Service Utilization: Essential Services - Service Types