1. 1 in+care Campaign Webinar November 19, 2012

2. 2 Ground Rules for Webinar Participation Actively participate and write your questions into the chat area during the presentation(s) Do not put us on hold Mute your line if you are not speaking (press *6, to unmute your line press #6) Slides and other resources are available on our website at incareCampaign.org All webinars are being recorded

3. 3 Agenda Welcome & Introductions, 5min Retaining Aging HIV+ Patients in+care, 30min Data Review and Discussion of Retention Strategies Collected Through the Campaign, 15min Q & A Session, 5min Updates & Reminders, 5min

4. HIV and Aging Presented by Emily Tsuchida, RN, MSN, PHN, FNP-C Center for AIDS Research, Education & Services (CARES) Sacramento, CA

5. Comprehensive Clinical Care MedicalDental Psychiatry Nutrition Mental Health counselingSubstance Abuse Case Management Health Education Pharmacy Laboratory Services Clinical Trials/Research STD/HIV Testing Risk Reduction CounselingPrevention

6.  2600 HIV+ patients  Over 74% are below 200% of poverty level  Approximately half have substance abuse and mental health issues.  African Americans are impacted at an alarming rate.  Young people are our fastest growing group. Who We Serve at CARES :

7. 7 Audience Responses What proportion of your caseload is aged 45 years or more? 25% of fewer Between 26% and 50% Between 51% and 75% Greater than 75% I have no idea / I do not have an HIV patient caseload

8. 8 Audience Responses PROVIDERS In the chat room, tell us what you have done at your sites to prepare for an aging population if you serve HIV patients. CONSUMERS / ALLIES In the chat room, tell us what special concerns you see as HIV+ people grow older and have more complex health needs.

9. An Aging Population at CARES

10. Point# 1: Important to get all ages tested for HIV.

11. Point #2 Treatment for all as being over 45 is an indication for treatment.

12. Point #3 You must have expertise in poly-pharmacy.

13. Point #4 Develop connections with home care and skilled nursing facilities.

14. Point #5 Elderly alone… HIV+ people feeling alone… The combination of the two.

15. Point #6 Need expert in geriatric patients to assist with the care of these aging patients.

16. Point #7 Nutritional needs for elderly are different.

17. 17 Audience Responses PROVIDERS In the chat room, tell us what you have found most useful as training for Geriatric concerns and Nutritional counseling. CONSUMERS / ALLIES In the chat room, tell us what special concerns you can identify in terms of aging and nutrition as they relate to People with HIV?

18. Point #8 Issues around dementia and normal loss of cognitive functioning.

19. Point #9 Assistance with insurance coverage to maintain HAART coverage: ACA provisions and Medicare/Medicaid.

20. Point #10 Retaining people in care is important for all ages but more urgent for those with diseases associated with aging.

21. In summary: Woman infected at HS reunion. 86 year old woman from India.

22. 22 Thinking about Emily’s 10 points and the resources participants list in the chat room, which resources have you found to be the most useful? Let us know your experiences LIVE! Speaking from Experience: Brief Peer Learning Exercise Are there are any resources in the literature you recommend?

24. 24 Improvement Strategies Exercise Michael Hager, MPH MA NQC Manager

25. 25 in+care Campaign National Data Snapshot December – October Data as of 11/16/2012 Dec Average (Patients) Dec Sites Feb Average (Patients) Feb Sites Apr Average (Patients) Apr Sites Jun Average (Patients) Jun Sites Aug Average (Patients) Aug Sites Oct Average (Patients) Oct Sites Measure 1: Gap Measure 16.19% (124,462) 207 16.15% (130,231) 201 14.71% (129,910) 206 15.03% (116,888) 185 14.19% (110,810) 171 15.79% (108,669) 159 Measure 2: Visit Frequency Measure 63.44% (84,213) 155 65.74% (87,068) 152 62.20% (103,351) 175 64.20% (92,495) 166 64.32% (91,561) 159 62.32% (89,541) 148 Measure 3: New Patient Measure 55.87% (7,789) 194 58.25% (8,802) 190 58.54% (8,421) 195 59.67% (7,220) 179 59.64% (7,074) 169 58.95% (6,931) 156 Measure 4: Viral Suppression Measure 69.69% (135,806) 199 69.46% (147,223) 192 70.41% (156,089) 198 71.87% (139,967) 183 71.80% (129,933) 167 71.49% (127,207) 155 Coming Soon – new analyses at AGM!

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30. 30 Improvement Strategies Discussion Take Home Points – Interventions! HIV Testing Routine testing of all ages Treatment Treat all PLWH > 45 years of age with ARVs Training Understand specific MH issues, social-psychology and cognitive impairment Experience with treatment with multiple meds for multiple conditions Experience in geriatric concerns, treatments and referrals Experience in nutrition and nutritional counseling

31. 31 Improvement Strategies Discussion Take Home Points – Interventions! Connect Leverage Health Information Exchanges (HIE) / Regional Health Information Organizations (RHIO) in your region Link your service to skilled nursing facilities / Visiting Nurse Association (medical care) and Patient Navigation Systems (other supports) Patients with appropriate payer resources and systems to support PLWH engagement (increasingly important with Affordable Care Act implementation)

32. 32 Submit Improvement Updates!

33. 33 Announcements

34. 34 Next Meet-the-Author Webinar: L.Gardner – Low-Effort, Clinic- Wide Intervention December 12, 2012 at 1pm ET Next Partners in+care Webinar: Optimal Wellness for PLWH December 13, 2012 at 2pm ET Next Campaign Webinar: Sustainability of Retention Projects in Unsure Funding Environments January 9, 2013 at 2pm ET Campaign Webinar: Mental Health and Retention Date Pending – to be announced! Upcoming Events

35. 35 Campaign Office Hours: Mondays & Wednesdays 4-5pm ET Monday, November 19 - Open Space, no set topic Wednesday, November 21 - National Holiday, no office hours Monday, November 26 - Open Space, no set topic Wednesday, November 24 - All Grantee's Meeting, no office hours Monday, December 3 - Open Space, no set topic Wednesday, December 5 - Sustaining Retention Projects Over Time Data Collection Submission Deadline: December 3, 2012 Improvement Update Submission Deadline: December 17, 2012 Upcoming Deadlines and Office Hours

36. 36 Wednesday, November 28, 2012 12pm ET Thurgood Marshall Ballroom South in+care at AGM

37. 37 MedScape Retention in HIV Care Series Technical Working Group working on articles for a new Medscape Today News Series. We recommend that you subscribe to HIV/AIDS MedPlus to be informed of new and exciting articles in this series! Published Pieces: Monitoring Rates of Retention in HIV Care Across the State How Health Departments Promote Retention in HIV Care Improving Retention in HIV Care: Which Interventions Work? Engaging in HIV Care: What We Learned from AIDS 2012 How Should We Measure Retention in HIV Care? Retention In HIV Care: The Scope of the Problem http://www.medscape.com/index/section_10285_0

38. 38 Partners in+care Partners in+care Private Facebook Group is live! Share tips, stories and strategies Join a community of PLWH and those who love them Email michael@nationalqualitycenter.org for more detailsmichael@nationalqualitycenter.org Partners in+care website is live! http://www.incarecampaign.net/index.cfm/77453 Join our mailing list (a list-serv version of the FB Group)

39. 39 Time for Questions and Answers

40. 40 Campaign Headquarters: National Quality Center (NQC) 90 Church Street, 13 th floor New York, NY 10007 Phone 212-417-4730 incare@NationalQualityCenter.org incareCampaign.org youtube.com/incareCampaign