H4C and You An Orientation for New Response Team Members September 2015 This presentation was developed by H4C faculty to be used as a tool to train new Response Team members to join you in your state! As we know, it has been a very active and productive two years and we want everyone to get off on the right footing!

Orientation Framework Overview of H4C What is H4C? Where did we start and what was the timeline? Key Resources Our State and H4C Our state history in H4C Our state roles, expectations, and timelines H4C Next Steps Overall Coming activities and deadlines Where have we been as a national project? Where have some of our successes and challenges been seen? Where are we with our own state in this work? What are the next steps for H4C overall and within our states? 2

Overview of the HIV Cross-Part Care Continuum Collaborative Let’s talk about this collaborative and its genesis 3

What is H4C? Federal funding from 2013-2015 to establish a self-sustaining learning collaborative across five states that: Aim 1: Builds state-wide capacity for closing gaps across the HIV Care Continuum to ultimately increases viral load suppression rates for individuals living with HIV Aim 2: Aligns quality management goals across all Ryan White HIV/ AIDS Program Parts to jointly meet legislative quality management mandates Aim 3: Implements joint quality improvement activities to advance the quality of care for people living with HIV within a region and to coordinate HIV services seamlessly across Parts Maintain this structure once formal prompts/cues wind down H4C was developed with 3 primary aims in mind. These aims are consistent across NQC and HAB collaboratives – to increase communication among Ryan White HIV/AIDS program grantees in your state, to provide opportunities to learn together and to ensure the minimum quality management expectations in the RWHAP are met in the context of national priorities.

Learning Collaborative Premises There are gaps between knowledge and practice There are large variations in practices “Best practices” exist all over the world We need to accelerate improvements We can learn a lot more working together than we can working separately The Collaborative Model is NOT: Research for new knowledge Single-setting (team) focus Small changes to existing systems The power of many hearts and minds working in concert cannot be understated. It’s essential that we work together and talk about what we’ve tried, our successes and challenges. This makes us far more efficient as a group than as individuals! Importantly Quality is not Reearch!! 10 3 6

Learning Collaborative Model* This diagram shows the cycles for this collaborative – it is based on the Institute for Healthcare Improvement Breakthrough series. Each learning session brings participants from the across the states together for sharing and group learning. In between, during action periods, the state teams return home to put their new learning and skills to use. Instead of summative congresses and publications, NQC and HAB works with regional partners to sustain the work and many of the activities beyond the formal transition from active to sustained phase. *Based on IHI Breakthrough Series

H4C Participating States Arkansas AR ACHIEVERS Mississippi Southern Hospitality Missouri MO CAN New Jersey NJ CPC Ohio Quality Crusaders This collaborative involves AR, MS, MO, OH, and NJ… note that they are almost in a ring around the greater SE US! Also, when you think about these states, they are extraordinarily diverse in terms of: Geographic size Population size Population density HIV Epidemic severity Political Culture Economy of Scale These states were initially selected for participation in this collaborative based on all the above and based on 2011 RSR performance data submitted by these states.

H4C States’ Proportion of National HIV Cases % of New HIV Diagnoses in the US: % of Persons Living with Diagnosed HIV: % of AIDS Cases in the US: 9% These five states, together account for 9% of new HIV diagnoses, PLWH and diagnosed AIDS cases in the US. Source: www.statehealthfacts.org - HIV/AIDS Surveillance Report: Diagnoses of HIV Infection and AIDS in the United States and Dependent Areas, 2011, National Center for HIV, STD and TB Prevention, Centers for Disease Control and Prevention, Department of Health and Human Services, 2013.

H4C Quantitative Outcome Goals Patients who remained in care and who were reengaged in care during the Collaborative Retention Patients who became viral load suppressed during the Collaborative Viral Suppression Our two overarching quantitative goals for the collaborative are associated with the care continuum – retention and viral suppression

How Do We Set Quantitative Health Outcome Goals? Retention RWHAP Retention Performance Results (2011 RSR data) RSR initial baseline in five states: 79.40% National HIV/AIDS Strategy Goal Increase to 80% Increase by 20% Increase by 3,022 patients in 5 states For retention, the quantitative goal was created using the 2011 RSR data as baseline and applying the retention goal from NHAS – increase to 80%. Since baseline was 79%, H4C faculty decided to push states to see how far they could go and to improve by 20%. The 20% improvement in performance translates to an absolute impact of 3,022 more retained PLWH across these five states. Goal across participating states

How Do We Set Quantitative Health Outcome Goals? Viral Suppression RWHAP VLS Performance Results (2011 RSR data) RSR initial baseline for five states: 66.20% National HIV/AIDS Strategy Goal Increase by 20% to 79.44% Increase by 2,270 patients in 5 states For viral suppression, the quantitative goal was created using the 2011 RSR data as baseline and applying the retention goal from NHAS – increase by 20%. The 20% improvement in performance translates to an absolute impact of 2,270 more virally suppression PLWH across these five states. Goal across participating states

H4C Timeline: Overall   Activities 2013 2014 2015 2016 AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL Planning Group Formed Planning Group Calls Draft Concept Paper Selection of Grantees Selection of Measures HAB Invitations Vanguard Meeting Pre-Work Assignments Learning Sessions PM Reporting Cycles Progress Reports Closed Cohort Reporting Care Continuum Reporting Improvement Sharing Operational Calls Affinity Calls Educational Calls Final Report H4C has been a very active collaborative. Kicking off in late 2013, the collaborative active phase was the entire 2014 and 2015 calendar years. The pre-transition months are marked purple and the post transition months are marked cyan. During this time period the amount of direct access to technical assistance from NQC coaches and programming will be scaled back.

H4C Timeline: Face-to-Face Meetings Bring together state representatives to share updates on tests of change and action plans. Meet with H4C faculty for QI coaching and to identify necessary and appropriate support. Vanguard: 9/23/13 Learning Session 1: 4/1/14 Learning Session 2: 8/26/14 Learning Session 3: 2/4/15 Learning Session 4: 6/9/15 Learning Session 5: 1/13/16 H4C includes a number of face to face meetings for participants to interact consistently for 2-day periods of time. The Vanguard meeting was the kick off where the states came together and helped NQC and HAB put forward general expectations and put together some aims. Each Learning Session built on the learning and progress made states since the previous learning session. Visit glasscubes to get a sense of what each meeting entailed.

H4C Timeline: Types of Measurement Standard Measures (e/o month) Submitted to NQC for aggregation every other month Four Care Continuum-related HAB core measures HIV Viral Non-Suppression Cohort (annual) Updated by states annually and submitted to NQC for aggregation and discussion HIV Care Continua (annual) 3 types of continua developed by states: statewide, RW-specific, agency-specific Comparison of these in-state continua H4C is the most measurement-intensive collaborative HAB and NQC have produced to date. In addition to 4 standard measures that are segmented by key demographic factors (gender, race, age), a new viral non-suppression cohort and a set of care continua were expected from states through this collaborative. Each of the reports has a different purpose that relates to HIV quality of care, quality improvement, and learning.

H4C Timeline - Webinars Educational Calls Affinity Calls new assessments, tools, and techniques Affinity Calls consumer engagement, data management, QI projects, etc Operational Calls team leader, data liaison, etc Webinars are a virtual way for the teams to interact with one another. There are an array of calls that have different purposes. Educational calls are open to all HIV providers and consumers in your state and invitations should be circulated widely. The content is variable and has to do with requests made to NQC by state teams and in relation to recent submissions of performance measurement data. Affinity calls are also open to all HIV providers and consumers in your state who are interested in a certain topic – these calls are more like workgroup calls in that they have a stated purpose and goals as opposed to learning objectives (like we see in educational calls). Operational calls are designed to bring together people who fulfil different functions in your state together with similar folks from other states to encourage cheer leading and support but also rapid learning through shared experience.

H4C Performance Measurement Results These are examples of the performance measurement data that is reported back to states using the pivot tables NQC staff generate. NQC and HAB strongly encourage states to continue to produce and submit performance measurement data to NQC so that it can be shared back in this excellently aggregated fashion.

Key Resources – Clickable Links! HAB Staff – access to Federal partners NQC Staff – access to subject matter experts and peer learning beyond H4C NQC Glasscubes – an private online bulletin board and repository for H4C materials and guidance NQC ShareLab – an online community to share and interact with each others’ QI strategies You can click the blue text to be taken to these content areas. These resources will help you all get your bearings with the current status of the collaborative staff at HAB and NQC are both willing and wanting to help you start off on the right foot. Click the link to say hello! The glasscubes and share lab resources are online repositories for H4C participants to interact and share with each other!

FUN IMAGE FOR YOUR STATE TEAM TO INSPIRE YOUR NEW TEAM MEMBER STATE TEAM NAME --- UPDATE WITH YOUR STATE TEAM NAME AND EITHER YOUR LOGO, FLAG, OR SOMETHING ELSE FUN/ENGAGING FOR YOUR STATE 18

Our Statewide QM Plan, Our Guiding Light! General QM Plan Components Infrastructure Performance Measurement QI Goals and Activities Stakeholders Evaluation H4C Considerations Communication Plan Capacity Building Plan Sustainability Plan Each new team member should have a good foundation of your state quality management plan. Many of you didn’t have these before starting the collaborative, so as much history of how this was assembled and the differences it has made will be important to unraveling the next steps that need to be taken. It is essential that communication, capacity building, and sustainability are included in this plan making it a little more comprehensive than the average quality management plan.

Our State and H4C A narrative of what H4C has meant for your state – this can be 1-3 slides focusing on areas such as cross-partness, community projects, capacity building, and more… include pictures if possible to help new members feel connected to the work. Michael has pictures of LS if you need them! --- PUT IN INFORMATION ABOUT YOUR STATES JOURNEY IN H4C

Our State Team Roles List each response team role here. Don’t list peoples’ names, make sure to send around an excel file or access database that includes all the name and contact information for members of your team. This way you can keep one document for contacts in constant circulation! Team norms is another good item to consider including here. If you have included QM Plan, don’t worry about this --- TELL YOUR NEW TEAM MEMBERS ABOUT YOUR TEAM… WHAT ARE THE ROLES, HOW DO THEY INTERSECT? What are the expectations?

Our State Timelines Develop a gantt chart to show what you have been up to and what you are working toward. It’s important to show past activities for context and reference. These are examples of questions your team will answer… You may have additional questions of your own! Do we have training needs? Do we want to have an annual / semi-annual conference? What data do we want to collect, trend, and feedback? Are we experiencing any issues with Buy-in? Do we have all the necessary players at the table? Michael and others are available to help if you are feeling stuck! --- TELL YOUR TEAM MEMBERS ABOUT YOUR UPCOMING EXPECTAITONS AND HOW THEY RELATE TO OVERALLGOALS OF h4c

Our State Resources Create a list of resources relevant to your state team process that has clickable links like above. Things to consider are your own internal guidance resources and links to external training like QM 101 and more. Michael and others are available to help if you are feeling stuck! --- THIS LIST OF RESOURCES SHOULD BE BASED ON WHAT YOUR STATE TEAM MEMBERS HAVE ALREADY Identified TO YOU HAVE BEEN HELPFUL OR ESSENTIAL TO THE WORK.

H4C Overall Next Steps Now we’ll talk about what to expect in the coming months! 24

Overall H4C Deadlines 2015-2016 LS5 registration by 12/1/15 LS5 pre-work completed by 1/6/16 Performance Measures Due: 10/1/15, 12/1/15, 4/1/16 Cohort Update Due: 10/1/15, 10/1/16 Care Continua Due: 12/1/15, 12/1/16   Activities 2015 2016 SEP OCT NOV DEC JAN FEB MAR APR MAY JUN Learning Sessions PM Reporting Cycles Progress Reports Closed Cohort Reporting Care Continuum Reporting Improvement Sharing Operational Calls Affinity Calls Educational Calls Coming up through the transition period, there is 1 more learning session and several more submission periods for performance data.

Our State Activities 2015-2016 These are examples of questions your team will answer… You may have additional questions of your own! (fill in chart!) Do we have training needs? Do we want to have an annual / semi-annual conference? What data do we want to collect, trend, and feedback? Are we experiencing any issues with Buy-in? Do we have all the necessary players at the table?   Activities 2015 2016 SEP OCT NOV DEC JAN FEB MAR APR MAY JUN Activity 1 Activity 2 Activity 3 Activity 4 Activity 5 Activity 6 Activity 7 Activity 8 Activity 9 --- POPULATE THIS YOURSELVES BASED ON WHAT YOUR TEAM IS INTERESTED IN PURSUING… ONLY YOU WILL KNOW WHAT IS BEST FOR YOU!

Beyond 2016 These are examples of questions your team will answer… You may have additional questions of your own! (fill in chart!) Do we have training needs? Do we want to have an annual / semi-annual conference? What data do we want to collect, trend, and feedback? Are we experiencing any issues with Buy-in? Do we have all the necessary players at the table?   Activities 2016 2017 JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN Activity 1 Activity 2 Activity 3 Activity 4 Activity 5 Activity 6 Activity 7 Activity 8 Activity 9 --- POPULATE THIS YOURSELVES BASED ON WHAT YOUR TEAM IS INTERESTED IN PURSUING… ONLY YOU WILL KNOW WHAT IS BEST FOR YOU!

H4C and You Thank You! For Questions: State Team Leader- email Michael Hager – NQC Michael@NationalQualityCenter.org Emily Chew – HAB EChew@hrsa.gov --- UPDATE WITH THE NAME OF YOUR CURRENT STATE TEAM LEADER 28