Minnesota HIV Services Planning Council
Planning Council Meeting minutes for
September 11, 2001
Minnesota AIDS Project
Attending:
Council members Staff
Bob Tracy co-chair Clarence Charles Mary Doyle
Jerry Moss co-chair Don Anderson Barbara Simpson Epps
Mary May Sheila Brunelle Juan Jackson
Debra Smith Frank Guzman Becky Kroll
Judi Marshall David Bergquist Christian Fredrickson
Michelle Sims Willie Bridges (minutes)
Ron Falcon
Linda Atlas Julia Hidalgo Helen Reed
IGA Meg Hargreaves Jim Huber
Jennifer ThompsonJerri Anderson Mary Sonnen
Michelle McCafferty Bill Seed
Julie Hanson Norma Atuesta
Steve Riendl
Unexcused John Whalen
Linda Brandt
Keith Lentz
Steve Moore
I. The meeting was called to order by Bob Tracy at 4:55pm.
Regret was expressed for this morning’s incident and a moment of silence was observed.
Barbara Simpson Epps appealed for support and unity as a nation under our government.
Introductions were made around the table.
II. Any revisions for the previous meeting's minutes were solicited. Approval of the minutes were motioned and seconded.
III. Co-chairs/operations update
The Planning Council has been discussing a strategy for moving forward on both the statewide and linkage task forces. This had been discussed at the Executive Committee meeting; they feel they are ready to start assembling those committees. This issue will be addressed at the next meeting of the joint co-chairs of the Planning Council and the Task Force at their meeting on September 20.
Clarifying the roles and responsibilities for HIV+ Committee, Planning and Priorities and Community Participation Committees was an issue it also decided by planning a series of two meetings between the co-chairs of those committees. At the first meeting a tentative plan will be developed, then the co-chairs will meet with their committees to gather input and return to the second co-chair meeting to finalize the roles and responsibilities. The plan would be brought to the Planning Council; a revision of the bylaws may be necessary. Bob cited the reason for this work is a lack of clarity in the committees and an overlap in missions.
Operations update: Mary presented our ad in the City Pages: we’re mandated by HRSA to put out this ad to broadcast our meeting’s times and locations. Mary also indicated that sign up sheets are available if members would like to change their committee membership. The Planning Council's website is about to go online very soon: http://www.mnhivplanningcouncil.com. For now the site will feature: meeting times, locations, the approved minutes from previous meetings and upcoming agendas. It will also include a list of Planning Council members and affiliations. Graphic design is being done for our brochure, letterhead, etc. by Hennepin County Public Affairs.
David asked if the Planning Council was going to get an 800 number; Mary said we're currently researching the cost of this. Bob thought that because we are a statewide organization we should be accessible by phone to individuals around the state.
Jerry asked about the update on staffing; Mary said we were very close and could make a job offer within the next week.
Tonight we will elect Planning Council co-chairs and committee co-chairs members. This is to formalize and elevate the role of being a planning council member, to recruit and approve of members.
Title I – Jennifer
She is currently in the process of writing the Title I application (deadline is Oct 22). She is happy to answer questions about Quality Management, but we can talk about this after the budget discussion. Bob related this was a new activity we have to implement that will affect our budget. David asked about difference between Needs Assessment and Quality Management:
· Needs Assessment determines what the target population needs
· The Planning Council prioritizes these problems and
· Evaluates how successful the services provided have been in terms of meeting those needs
A new HRSA requirement- Quality Management- requires us to look at the efficacy of our services by constantly looking at ways to improve services. This is connected to service provision and focuses more on providers. David believes this process should have been going on all along. Bob pointed out a related Pioneer Press story about political upset in San Francisco that is assuming national proportions, creating the impression that HIV Prevention Care dollars are misused by HIV service organizations.
Title II – Julie
Reminder: we’re starting process to set up statewide meetings to work on the Statewide Coordinated Statement of Need. There are three meetings scheduled. The first meeting will be September 13; the last meeting date is Monday, Oct. 8 from 1-4pm.
IV. Uncompensated Care: Jennifer Thompson introduced Julia Hidalgo.
Since Title I has been funding HIV services in the metro area for the past four or five years, people wonder why Title I doesn’t pay for more medical care. When they do a Needs Assessment, clients always say they have sufficient services. Clients may not have insurance but there are some places you can go without insurance. When the Planning Council looked at the needs of people with HIV, medical care rarely came up in terms of how to use the Ryan White dollars. Title I’s philosophy has been to make sure customers have medical insurance. It has been pointed out that clinics are under pressure over the fact that much of the work they provide is unpaid for. Due to problems in managed care and how HIV care has evolved, this group meets occasionally to talk about HIV issues and to get a handle on this issue before the Planning Council starts throwing money at the problem. We need to get a sense of the specific problem and maybe figure out a way to give the clinics on-site technical assistance with billing or understanding revenue sources. They've hired a consultant to study this problem: from George Washington University, Julia Hidalgo is here to help out with this financing problem. These things need to be decided in time for the next reprioritization process.
Julia Hidalgo –
"To give you a sense of who we are: the staff of the Center for Health Services is a think-tank of community activists, lawyers, HIV rabble-rousers, kindred spirits that work in a variety of issues around health care and safety net programs. We (Marsha Wilson and Julia Hidalgo) have been here all summer to work on a program focusing on issues around medical service and care." Julia is trying to assess why there are unpaid-for programs here in the county and the state. Julie indicated her handout and wanted to talk about the project team. She ran down her qualifications and past positions, such as Title II administrator. She also summarized the qualifications of other team members. She covered how they work, what they do in a typical assignment. Each site they visit gets a confidential site report, covering a wide scope of issues related to the department including issues not normally covered in the assessment but that come up anyway. Julie related her impression of MN.
MN is unique in that we have the highest rate of insurance in the population out of the whole country. Many people do not need the wide array of services their insurance plans provide to pay for what they need. Medical visits are longer than they’re compensated for. Folks are being paid and evaluated on the services they deliver day to day and have to meet performance levels tied to volume. Although folks are well insured, the complexity of HIV clients are of great concern. 3rd party insurance does not pay adequately for HIV care. More and more clinics are beginning to complain about this. Examples of care not covered include:
· Meeting and planning time
· Drug adherence counseling
· Phoning to other physicians
· Working on interpersonal issues
· Appointment times over 12 min.
Her team is still assembling the report; they will give it to us as soon as it’s done, sometime around March 2002.
Jennifer – Julia has presented and discussed some of this information with the HIV+ committee. She will also present for discussion at the Needs Assessment Committee. Bob suggested we’d like to have a meeting to discuss some of these issues before the aforementioned report is finished: He cautioned that the medical and social service systems don’t match. He is concerned that the uncompensated care in social services could be lost because it is more difficult to measure. The meeting will be in October, and the report won’t be done until March.
MOTION: A motion was made that we have a special meeting set aside to hear all the information from this report. As far as Needs Assessment and change of leadership goes, the Planning Council should come back for another meeting to hear the outcomes of this report. Bob asked if this could be held as a retreat topic, or whether we should set time apart in one of our other meetings? The motion was made to have a winter retreat to hear about the results, seconded, and approved.
V. Service Area Reviews (SARs)
Juan provided an abbreviated report. He will be back next month to do more of a Q&A session; there was also little time for more discussion at the last meeting. The SAR on Case Management was handed out to group. First page identifies who uses Case Management. 2nd page is Outcome information they’re collecting: being two years into the process they're starting to get repeat information, getting a clear picture of what happens with Case Management. One SAR provides five different sources’ data. Their goal is to look at this information before the next meeting. Juan broke down the information: looking at the Epi is looking at living HIV+ cases reported to the state, not all HIV+ people are in and out of the system.
Judi pointed out the two sets of data all have real people in them but the services data are not necessarily the same people, there’s no matching that occurs between the cases of surveillance and the cases in services.
Juan answered the data is collected around two outcomes: one chosen by service providers and one chosen by the grantee. Provider chosen outcome is meeting basic needs. Data is collected using the double-sided survey: Services Outcome for utilization of health care is filled out by case manager; Meeting Basic Needs is filled out by client, client and case manager, or client and someone else. 703 people answered this survey last year; 531 in Time 2; Time 3 is still being processed. We’re usually only collecting data two months out of the year, so we’d never expect it to mirror the service utilization data exactly in number - it’s a snapshot. He broke down the results in the SAR. Case managers say they work with people in unstable housing or with chemical dependency issues. When you look at people that are in one of those groups or both, there are huge differences between them making it to medical appointments compared to people in neither group. Only about 50% of aforementioned of either group were making appointments; only 30% of people in both groups were. The upshot is that people on drugs or the homeless have a harder time making and keeping appointments. Most people were positive about the service they received. Case managers are great access points for information about other kinds of services, even those not paid for by Ryan White. Bob asked if there was something about how we set the service up that makes it difficult for us to address how many people sign up for our service.
Judi would like to say, from Needs Assessment committee, as you get the SARs there’s a back page for the issues at hand. Needs Assessment produced what you see in the SAR but hopefully the other committee members will take an approach on the data presented that Needs Assessment didn’t think of.
We must first recognize that this data comes from different places. The front comes from Tracy Sides. The second page comes from evaluation of the service area and is dependent upon clients filling out survey forms. The forth page looks at previous studies and pulls out relevant pieces. The consumer survey is currently biased. The comprehensive Needs Assessment is based on interviews of 220 HIV+ people who may or may not be in any services, were asked several questions about various services, and at the end received a set of index cards bearing the names of all available services and were asked to pick the top five services they liked best. The last page of the SAR shows these results. Foods and Nutrition is a stabilizing service. Someone asked if Food and Nutrition has monitored medication intake; Juan stated this was within the jurisdiction of the new service Medication Adherence.
Bob would like to note that our next SAR presentation, we’ll set aside ten minutes to capture questions about Case Management and Nutrition, to give us time between now and next meeting to come up with questions.
When determining the budget for the next year, Julie tries to determine what the budget award might be and then sets up a budget based on that guess. In January the actual award is presented and revisions are made to the budget accordingly. The cover page of the budget Julie handed out covers principles, similar to those of last year. Applied Cost of living Adjustment (COLA) = +2%. Early Intervention was increased. ADAP will pay for Drug Adherence. Amounts on the handout have been rounded to the nearest thousand. Carryover dollars to be applied to Capacity Building. If services were voted to be maintained or decreased, and there was no funding for them previously, they wouldn’t receive any new funding. Dave brought up his concern with Transportation: we need to push as a council for the services we want, not just concede or take what service providers think they can provide. He suggested looking at CAP for a Transportation model. Jennifer said that someone would have to write the proposal for the money; David suggested she do that. The issue revolves around rural transportation services, because in rural areas finding transportation to medical services may be difficult, especially if they are in another area. Every Council member will receive a notice of funding availability.
Re: Capacity Building – some programs were successful and moved into higher categories that dealt with their individual targets, rather than being housed under Capacity Building.
Julie ran down other services being increased in the proposed budget. HRSA has changed the definition of Early Intervention. We called it caring for people who were about to receive insurance, whereas HRSA considers it closer to what we do in Outreach. The money proposed for Early Intervention is really going towards short-term early intervention, and the other money is being put into Outreach.
Outreach funding has to be used to get people into ADAP programs. We did vote to increase Priority Care's funding, but we have a new program this year. Priority Care didn’t seem to get the 10% in addition to the COLA bonus.
MOTION: A motion was made to accept this as proposed budget, seconded, accepted.
MOTION: A motion was made to authorize expenditure above 15% this year, seconded, accepted.
Bob Tracy was recognized as outgoing chair, presented with gift and card. A number of Planning Council members expressed their appreciation for Bob as co-chair.
Mary handed out the ballots to Planning Council members.
Candidates for HIV+ Council co-chair took their turns announcing their future vision for the Planning Council:
Clarence Charles (Planning Council co-chair) spoke to monitor or increase adherence to HRSA guidelines, maintain systems for quality control, establish emergency plan for high-risk communities. Assure best performance possible and accomplish concurrent database to maintain effective quality controls to assure compliance with new regulations.
Jerry Moss (Planning Council co-chair) related his goal to increase communication between members and decrease overlap between committees. Priorities: to understand allocation process so he can explain it to others and get the community involved more, and look at prevention and services activities to get more integrated.
Judi Marshall (Planning Council co-chair) read her statement as nominee. Feels we should see quality information on needs and services to determine unmet needs. Identify service areas to be added to adequately service the HIV+ populations. Improve internal and external communication and increase input from HIV+ people. Use the continuum of care to address disease as chronic disease. Participate in development and implementation of statewide plan for service and move forward with integration of services. Be informed of changes in science of treatment.
Bob brought up issues the HIV+ Committee needs to deal with. Current bylaws say that the Planning Council approves each of the committees and performs a rubber stamp approval or removal of members of committee. Dave affirmed it was standard practice for a committee to choose its own co-chairs.
Helen did not present.
Jerry and Clarence ran for the HIV+ co-chair seat. Jerry was elected.
Clarence, Helen and Judi ran for the second co-chair seat. Judi was elected.
The Operations Committee had three candidates, Jim Huber, Helen Reed, and Frank Guzman. Only Frank presented because Helen and Jim were not present.
Frank Guzman (co-chair for Operations) spoke: supports target areas like drug users, inmates, trying to find a place for them. Discovered dissatisfaction with productivity of meetings and would like to fine-tune the recruitment process.
Bob ran down the list of candidates and, as no new nominations were proposed, systematically elected people for each office with no competition.
Election Results
Planning Council co-chairs
· Jerry Moss
· Judi Marshall
Operations Committee co-chairs
· Helen Doris Reed
· Frank Guzman
HIV+ Committee co-chairs
· Bill Seed
· Debra Smith
Planning and Priorities Committee co-chairs
· Linda Brandt
· Michelle Sims
Community Participation Committee Co-chairs
· Bob Tracy
· Clarence Charles
Needs Assessment and Evaluation
· Lorraine Teel
· Sheila Brunelle
No major action items, most are already done. Planning Council members should stay at last hour of meeting at the Council meeting on Oct. 9th when the Forum will be held. Sheila ran down objectives for the meeting. Jerry asked about getting HIV+ people to the forum. We don't yet know where it will be held or how many will attend, but as people call for the location we can get an idea of the number of attendees.
Judi related that, now that we're familiar with how SARs will appear, Needs Assessment hopes to maintain their schedule of reviewing two topics and presenting them to the Planning Council meeting each month. The topics chosen for presentation will be those with the most data at the time. Needs Assessment will also add questions about the perceived quality of medical care to the Consumer Satisfaction Survey.
Looking forward to meeting with other committees to discuss overlap. Recruitment and retention of new members was high priority for committee, and we are developing a calendar and Structure & Strategy process for next year.
The meeting was adjourned at 7:26pm