Borinquen Health Care Center_Ryan White Conference_DRAFT 5.25.22[100] - Read-Only.pptx

Rapid Start and Entry to Care for newly diagnosed HIV patients

1. Borinquen Health Care Center, Inc 1 Diego Shmuels, MD, MPH

2. 2 Introduction

3. Overview of Borinquen health care center Summary Large FQHC, with 9 locations, located throughout Miami, FL Began implementing Rapid Access in 2016 Rapid Access program implemented in partnership with FL RWHAP Part B program and Miami-Dade County RWHAP Part A program Services available: Infectious Disease, Family Medicine, Endocrinology, Neurology, Chiropractor, Podiatry, Mental health, including psychiatry, SUD, Women’s health, Dental care, Outreach and nutritionist services for RW clients. Have onsite 340 B (discount pharmacy) and labs at all locations. Serves around 1,000 clients with HIV per year Provides rapid ART to around 80-130 newly diagnosed clients each year.

4. 4 Planning for Rapid ART Implementation

5. Planning process Initially started as a FL Part B initiative (Test and Treat) to promote same-day access to medication After successful pilot, Miami-Dade Part A program required all subrecipients to implement rapid ART – including Borinquen Health Care Center Test and Treat protocol helped guide providers in implementation Each subrecipient adjusted protocol for their own internal processes and context Borinquen worked closely with Test and Treat pilot site, Jackson Medical Center Continue to meet monthly to discuss client needs and outcomes

6. Payment for Rapid art services FL is a non-Medicaid expansion state FL State Part B program covers the cost of medication for 30 days using emergency financial assistance (EFA) dollars Providers purchase medications and state reimburses them at 340B price, plus dispensing fee Miami-Dade Part A program covers the cost of medical care for people who are uninsured Includes mental health and counseling services Borinquen Part C funds the position of Rapid Access patient navigator

7. 7 Best Practices for Rapid ART Implementation at Borinquen Health Care Center

8. Staffing model for rapid ART Linkage coordination Single patient navigator dedicated to linking newly diagnosed clients into care Benefits coordination Patient coordinator or case manager assists with enrollment into RWHAP Part A, Part B, and/or ADAP applications Patient care support Patient navigator walks client through various components of first visit and also refers clients to wraparound services (e.g. mental health, psychiatry) as needed Clinical care NPs and infectious disease MDs prescribe ART and provide HIV education

9. Workflow

10. facilitators for rapid art program implementation Collaboration and synchronization between county-level Part A program and state-level Part B program facilitates rapid delivery of care Implementation of RapidA [email protected] email and protocol, to ensure timely response to requests from DOH and other agencies, including internal diagnoses. Patient navigator role is essential to the process One designated navigator oversees linking clients to care, walking them through the process, and assisting with picking up the medication at the end of the first visit. Clinic appointment availability As a PCMH, Same Day Appointments are available, usually used for Rapid Access clients, this includes PCP visit, lab, MCM and sitting with the patient to take its first pill. During that visit, the Patient Navigator ensures that there is a flow and coordinates if a physician is busy. If the patient is being tested late after 4 pm, will be coordinated first thing next day.

11. 11 Client Outcomes

12. Outcomes from 2017 Date to 2021 YEAR 2018 2019 2020 2021 2022 (May) RAPID ACCESS PTS and AVG DAYS 49 <10 days 105 < 72 hrs 116 <48 hrs 108 24 hrs 10 24 hours VIRALLY SUPPRESSED IN 90 DAYS 35 77 102 82 N/A RETAINED IN CARE** 32 89 116 103 10 ** Retention in Care usually is associated with moving out of the county or deportation