1. H4C Pre-Work Assignments December 5 th, 2013 Webcast and Conference Call Clemens Steinbock Director, National Quality Center Clemens@NationalQualityCenter.org 212-417-4730

2. Agenda Overview of H4C Overview of H4C timeline Details of pre-work assignments Introduction of Coaches & their Role Upcoming milestones and due dates

3. Invited H4C States Arkansas Maryland Mississippi Missouri New Jersey Ohio

4. 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: 12% 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.www.statehealthfacts.org

5. Overall H4C Aims Build regional capacity for closing gaps across the HIV Care Continuum to ultimately increase viral load suppression rates for individuals living with HIV Align quality management goals across all Ryan White HIV/AIDS Program Parts to jointly meet legislative quality management mandates Implement 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

6. Benefits of H4C Participation Increased capacity of HIV providers and selected consumers for quality improvement Alignment with Presidential Care Continuum Initiative Improved viral suppression and retention rates Strengthened regional partnerships across Parts Routine measurement of key performance measures Implementation of national quality improvement priorities

7. H4C Timeline

8. Pre-Work Assignments 1.Formalize State Team 2.Select a Response Team 3.Draft State Aim Statement for H4C 4.Complete the Health IT Assessment Survey 5.Create Story Board for Learning Session 1 6.Submit Inventory of HIV Care Continuum Improvement Initiatives and Strategies 7.Join GlassCubes for H4C Participants 8.Build Excitement and Commitment within your State to Participate in this Initiative

9. Formalize State Team Letter of Commitment –Submitted by your state team –Expresses commitment to H4C Attached to letter, include a roster of agencies “signing on” to H4C –Names, phone numbers and email addresses of the individuals that will represent agencies during state team meetings –Identify the agency representatives on your State Team Create a State Team name –Should represent the spirit and aspirations your team has for this improvement collaborative

10. Select a Response Team Identify Response Team members and their various roles and responsibilities –Report them to the H4C Faculty –Your H4C coach can help you think through considerations for the Response Team –Your Response Team should meet at least once before the first Learning Session –The Response Team (or a subset) will attend all Learning Sessions

11. Response Team Responsibilities Have regularly scheduled team meetings (via teleconference, web conferencing, in person if possible) to jointly achieve the objectives of the Collaborative Develop a routine process to update and share information with Collaborative participants in the state and with other Response Teams Gather the self-reported data from participating agencies and share benchmark reports on the progress of the Collaborative work within their constituencies Provide technical assistance to participating agencies in the state and/or refer them to identified quality champions in the state Learn the models used in the Collaborative and assist programs in improving their quality improvement competencies

12. Response Team Membership Membership should be cross-Part, cross-agency, cross-provider category, and consumer-inclusive Team composition and core team roles will be refined and redefined as the RT develops. Team roles that have been useful in past Collaboratives have included: –Team Leader(s) –Quality Improvement Liaison –Consumer Liaison –Data Liaison –Communication Liaison –QI Trainer –Secretary/Recorder

13. Draft Aim Statement for H4C Create a draft aim statement –An Aim Statement is an explicit statement summarizing what your state plans to achieve during H4C and outlines the concrete goals and objectives for participation in this 18-month initiative –Your assigned coach is available to provide feedback and input –Should include 2-4 specific goals toward the Aim your state wants to concretely accomplish. These should be “stretch goals” that would be otherwise unachievable and that will push you and your state to get the most out of the Collaborative –Should be as concise as possible

14. Example Aim Statements [State Team] will improve its HIV Care Continuum to provide improved care for our patients living with HIV. We will focus initially on improving viral load suppression within our patient population. This will be evidenced by: –At least 80% of patients viral load suppressed by Jan 2014 from baseline 72% in Dec 2012 –At least 80% of patients provided with consistent messaging on the importance and benefits of viral load suppression –At least 70% of patients who are ART adherent but remain not viral load suppressed are genotype or phenotype tested for drug resistance –90% of patients have a viral load test at every 6 months

15. Example Aim Statements [State Team] will improve its HIV Care Continuum to provide improved care for our patients living with HIV. We will focus initially on short term retention in care resulting in a viral load suppression rate of 85% by June 2014. This will be evidenced by: –Follow up with 100% of patients who missed a medical appointments in the last 30 days via phone –Reschedule medical appointments with at least 80% of patients who missed their medical appointments –At least 80% of patients provided with consistent messaging on the importance of retention in care –90% of patients with upcoming appointments provided with 2 forms of reminders: by mail and by phone

16. Complete the Health IT Survey Ryan White grantees of record should complete the Health IT Assessment Survey to evaluate the ability of participating agencies to report the H4C measures and the individual data systems –For network lead agencies, the option is available to forward the survey to subgrantees. A survey should still be completed for the entire network by the grantee of record to reflect all subgrantees, even if the survey is forwarded. Review H4C performance measures prior to completing this survey –Available on NQC website and GlassCubes The survey link is available in the Pre-Work Announcement and in the Pre- Work Manual

17. Instructions for LS 1 Story Board: Meet the H4C State Teams Each Story Board should consist of 5 items: –1 item of introduction that identifies your state, team name, your RW providers and your HIV epidemic –4 additional items that highlight your state’s commitment to participate in H4C over the next 18 months –Can be presented in any format: PowerPoint, poster, infographic, etc. Be creative! Personalize your Story Board! Add color, pictures, maps, graphs, designs….anything that helps to tell your state’s story!

18. Describe your State commitment to participate in H4C Item 2: Draft State AimItem 3: Response Team Item 5: State Continuum Item 4: QI Interventions Using pictures, data, and brief narratives, describe/depict your state aims for participation in H4C Who are your state response team members and what are their roles? Showcase up to 3 unique, exciting, or extremely effective interventions or strategies that have been implemented related to retention or viral load suppression. Include your state’s current HIV care continuum. If your state is still working toward this, mention where you are at with development (Item 1 is your introduction that identifies your state team)

19. Submit Inventory of HIV Care Continuum Improvement Initiatives and Strategies Why this activity? –To gain a full understanding of what has been attempted across the state over the years to impact the Care Continuum and what has proven to be more and less successful in impacting performance Outline the local, regional and statewide initiatives that aim to improve the various aspects of the Care Continuum (with a focus on retention, ART prescription, and viral load suppression) and the top 3 most effective strategies for each element of the Care Continuum that can be promoted for wide-scale implementation Can be in any format useful to the State Team

20. Join GlassCubes for H4C Participants What is GlassCubes? –An online platform to communicate and share documents Once you have submitted your list of State Team names and emails, NQC will invite you to join GlassCubes –Accept the emailed invitation NQC can set up state-specific GlassCubes –Each state is asked to identify an individual to manage the state-specific GlassCube account

21. Build Excitement and Commitment within your State to Participate in this Initiative!

22. Pre-Work Due Dates **All documents should be uploaded to GlassCubes and brought in hardcopy to the first Learning Session, with the exception of the Health IT Survey.**

23. Role of Coaches Coaches are here to help! Their role in H4C is to provide support for the Response Team and statewide quality improvement efforts Can answer questions and advise on: –Pre-Work –Forming a Response Team –Performance Measures –Data Collection –Developing QM plans –Identifying QI projects

24. Meet Our Coaches Lori DeLorenzo BJ Boshard MO Nanette Brey-Magnani MS Dan Sendzik NJ Hollie Malamud-Price MD, OH Sherry Martin AR

25. Upcoming Milestones Learning Session 1 January 22 nd -23 rd, 2014 Rockville, MD This Learning Session serves as a forum to engage key stakeholders across states in the H4C, allows participants to articulate their own goals, aims, and needs for this Collaborative, and provides an opportunity for cross- State learning. NQC will provide financial support for up to 7 members of each Response Team to attend Learning Session 1. An agenda was sent out with the Learning Session invitation. It is also available on GlassCubes.

26. National Quality Center (NQC) Michael Hager, MPH MA Manager for Technical Assistance and Dissemination National Quality Center New York State Department of Health AIDS Institute 90 Church Street, 13th floor New York, NY 10007-2919 212.417.4730mth02@health.state.ny.usNationalQualityCenter.org