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Raising the Bars: Strategically Using Data Across Programs

Raising the Bars: Strategically Using Data Across Programs. John Furnari, MA NC Department of Health & Human Services Division of Public Health, Communicable Disease Branch NASTAD ADAP TA Meeting August 1, 2014 Washington Dc. N.C. HIV Disease Rates (per 100,000 ), 2000-2012.

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Raising the Bars: Strategically Using Data Across Programs

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  1. Raising the Bars: Strategically Using Data Across Programs John Furnari, MA NC Department of Health & Human Services Division of Public Health, Communicable Disease Branch NASTAD ADAP TA Meeting August 1, 2014 Washington Dc

  2. N.C. HIV Disease Rates (per 100,000),2000-2012

  3. NC HIV Cascade, Population in CareDiagnosed through 12/31 of Given Year and Living as of 12/31 of Following Year Cases 36% Communicable Disease Surveillance Unit Division of Public Health Data Sources: NCEDSS (data as of 4/1/2014), and ADAP (data as of 12/26/2013) *2012 data are overestimates due to reporting delays for death information.

  4. Routine ADAP Reporting • Program Monitoring Includes • Enrollment, Eligibility, Utilization, Expenditures, Avg. Cost per Enrollee, Monthly Projections, Sustainability, Medication Costs, Cost Comparisons • ADAP Data Report (ADR) • Regular Reporting for NC DHHS • Requires Matching Across Several Data Sources within ADAP • Eligibility/Demographics Database • Pharmacy Program Dispensing Data • Medicare Wrap Around Program Claims Data • Wholesaler Pricing Data for Pharmacy Program

  5. Using ADAP Data to Improve Health Outcomes Use ADAP Dispensing and Claims Data to • Identify Inconsistent Patterns in Medication Refills to Track Adherence Use Enrollment and Eligibility Data to • Identify ADAP Clients who Did Not Recertify Use Enrollment and Eligibility Data to • Identify Inconsistent Patterns in Lab Values to Track Viral Suppression Follow up with Client, Case Manager, Provider to • Identify Causes, Assist with Resolution, Make Referrals Limitations: • You can only Track What You Pay For • Analysis Requires a Lot of Time (Not completely Automated) • Follow Up Requires a Special Skill Set NC ADAP Viral Suppression: 79% NC ADAP Retention: 90%

  6. Annual Unmet Need Analysis • Unmet Need Requirement in the Yearly RW Application • Match Surveillance Data with CAREWare, ADAP, Medicaid Data • Identify: • Number of Care Visits in CAREWare • Labs in CAREWare • Dispenses (Count of Type by Program per client) from ADAP • Labs in ADAP Eligibility/Demographics Database • Medicaid Services and Diagnosis Codes • Moving Toward: • Improving and Utilizing Out of Care Lists • Building an Integrated Database NC RW Program Viral Suppression: 76%

  7. Medical Monitoring Project HIV Surveillance Initiative Sponsored by the CDC Goal: • Learn about the Experiences and Needs of People Receiving HIV Care Questions: • How many PLWHA are receiving care? • How Easy is it to Access Care? • How Easy is it to Use Prevention and Support Services? • What Are the Needs of PLWHA and What Needs are Unmet? • How is Treatment Affecting PLWHA? NC Data: • 90% of NC Sample is on ART • 78% of NC Sample is Virally Suppressed

  8. SPNS System Linkages and Access to CareNC LINK (NC DHHS, Duke, UNC) 4 Year (Sept. 2011 – Aug. 2015) HRSA Grant Population: Unaware of HIV Status & Aware but Not in Care Enhance the use of Surveillance Data Increase Testing Improve Linkage and Retention to Care Enhance Bridge Counseling Develop: • Out of Care List (from multiple data sources) • Protocols for • Defining and Identifying Patients that are Out of Care • Engaging and Re-engaging Patients that are Out of Care • Identifying and Resolving Problems • Integrated Data Warehouse (Surveillance, Lab, CW, ADAP, Medicaid)

  9. Care and Prevention in the United States (CAPUS) 3 Year (Sept. 2012 – Aug. 2015) CDC Grant Reduce Morbidity & Mortality Among Racial/Ethnic Minorities Reduce Health Disparities Among Populations Affected by HIV Goals: • Increase Targeted Testing and Prevention • Improve Linkage, Retention, Re-Engagement, Treatment • Enhance Navigation Services • Increase Efficient Use of Surveillance Data • Identify and Address Social, Economic, Clinical, Structural Factors Associated with Health Disparities Interventions: • Testing Campaign, Expanded Testing Capacity, MSM Task Force, Safe Spaces, Men's Health Clinic, Patient Navigators, Bridge Counselors, Tele-Health Consultants, Cultural Competency Training

  10. Other Program Data Available in NC • Prevention, Testing, Jails & DOC, PSA Responses • Challenges • Matching Data • Working within Large Bureaucracies • Breaking Down the Silo (Data Silos and Structural Silos) • Recommendations • Identify Where to Start, Start Small, Build Gradually • Identify Who Should be Involved • Be Patient and Flexible • Ask For Help

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