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AHCCCS Targeted Investments ProgramJustice Quality Improvement CollaborativeMatthew Martin, PhDTIP Justice Year 6: Session #2May 17, 20221

General Housekeeping Zoom Meeting Format vs. Zoom Webinar Format– More interactive– All participants can mute/unmute their own audio Please mute yourself when not presenting or speaking2

AgendaTIMETOPICPRESENTER11:30 AM – 11:35 AM11:35 AM – 11:50 AMIntroduction & Agenda ReviewSpectrum Initiative Update Process Map Review DiscussionCommunity Health Associates Initiatives Initiative Update DiscussionSouthwest Behavioral Health Services Initiatives Initiative Update DiscussionValleywise Initiatives Initiative Update DiscussionTerros Initiatives Initiative Update DiscussionNext Steps Follow-up workgroup meeting (June) Session #3: Virtual Justice QIC (September 20, 2022)Kailey LoveJessie Peters11:50 AM – 12:05 PM12:05 PM – 12:20 PM12:20 PM – 12:35 PM12:35 PM – 12:50 PM12:50 PM – 1:00 PMStephanie CrawfordVictoria AlarconApril ThorntonMelissa ThomasJose MaderaRay Young, Lori Jones, LaniHoriuchiMatthew Martin3

TIP Justice Y6 InitiativesJessie J. Peters, FNP-BCProject StrategistSpectrum Healthcare Group5.17.22

Initiative Changes and Updates SHG is involved in 5 areas of concentration Adult BH (3 locations)Adult PC (2 locations)Pediatric BH (3 locations)Pediatric PC (2 locations)Justice (2 locations) 5 processes for the same goal Improve A1c Capture across all populations, to include Justice TI success, population health outcomes, & post-TI sustainability

Initiative #1 (all TI concentrations) –DM screening for all populations on antipsychotics Mission Improve overall health of the communities we serve, while decreasing riskfactors of disease Improve gap closure for TI, VBP, KPI Progress StakeholdersProcess MappingSME and frontline staffPOC addition to venipuncture

Next Steps Internal audits of POC claims, to ensure proper revenue cycle Monthly review of internal and ASU data progress Ongoing audits of gap closure and appropriate care management

JUSTICE-INVOLVED TARGETED INVESTMENT CLINICS:YUMA – CASA GRANDE – TUCSON

Initiative #1Improve AOD34-dayperformanceGiven our inability to benefit from data harmonization assistancefrom the ASU team on the AOD 34-day measure (due to Part IIrestrictions), CHA will work to improve our internal ability totrack, monitor and report out our own performance on themeasure.

Barriers toOvercome CHA had planned to utilize data harmonizationMinimal ability to track our own performanceA lack of formal processes for re-engagementLine staff will need to be trained in new processesStaffing shortages & COVID surgesCommunication & coordination with justice partneragencies like probation and parole will be essential toimproved performance.

Steps&Strategies Improve ability to track AOD measure internallyDevelopment of data warehouse reportDetermine if outside AOD Dx & tx is attributed toTIPConvene clinical, admin and justice teams toimprove process workflows.Improve awareness of, and targeted response to,members who miss initial weeks of txTrain staff and teams on new workflows; getcreative in how trainings are convened/offered

Progress,Problems&Plans Improved ability to track AOD measure internallyDeveloped data warehouse reportBrain Trust - Convening clinical, admin and justiceteams to standardize process workflows.Improved awareness of, and targeted response to,members who miss initial weeks of txOngoing training of teams on workflowsGreatest barrier at this point is staffing shortageand turnoverTeams are working with new HR Director and HRRecruitment Specialist.

To date, CHA’s PFRO partners have proven unwilling and/orunable to provide direct peer support services to TIP clientele.Initiative #2Peer Support&ProbationOutcomesCHA will increase peer support provision internally to supporttreatment engagement, limit program attrition and improveprobation outcomes (as measured by successful completion vsrevocation).

Barriers toOvercome To date, CHA has relied entirely on PFRO partneragencies to provide direct peer support services.Staffing patterns have been dramatically impactedby COVID and the great resignation.A lack of start-up or sustainable funding tosupport peer positions within the team.New line of service and team organization willrequire planning and re-training.Yuma County Adult Probation has already agreed topull and provide us with reports on successfulprobation terminations vs revocations.

Steps&Strategies CHA will no longer rely on PFRO’s to provide ourclientele with much needed peer support.Certified Peer staff need to be identified, reassigned and trained on new role within team.Increase staffing levels to allow for caseload andstaff reassignment.Identification of eligible peer staff and supportthem in getting peer certifications.Train and improve Peer Support staff’s ability tomeet production standards to cover costs.Train staff and teams on new workflows; getcreative in how trainings are convened/offered.

Progress,Problems&Plans CHA will no longer rely on PFRO’s to provide ourclientele with much needed peer support.Certified Peer staff need to be identified, reassigned and trained on new role within team.Increase staffing levels to allow for caseload andstaff reassignment.Train and improve Peer Support staff’s ability tomeet production standards to cover costs.Train staff and teams on new workflows; getcreative in how trainings are convened/offered.Greatest barrier at this point is staffing shortageand turnoverTeams are working with new HR Director and HRRecruitment Specialist.

THANK YOU!

TIP Justice Y6 QIC 2Initiatives

TIP Justice Initiative 1Goal: Enhance Vocational Coordination and HousingOutcomes for Justice Involved Members.Implementation:Barriers: Position for vocational housing coordinator posted Develop a community partners and stakeholders directory Identify current housing options within internal agency 1- Kingman and 2- BHC Identify and secure grant dollars and/or other non-Medicaid funding opportunities through NorthernArizona Municipalities and other sources. Recruitment for position Workflow and data collection plan Funding for additional housing options

Roadmap to SuccessSecureFundingGrants andreimbursable servicesHousing OptionsObtain varioushousing options thatmeet the need ofindividuals andfamilies.Data CollectionMaintenanceContinuedassessments andimplementation.AssessDetermine what datato collect and how totrack efficiently.Assess the currentplan and revise asneeded to improvequality outcomes.VocationalHousingCoordinatorIdentify, Hireand RetainCommunityPartnersIdentify and Collaborate

Progress:Community Partners Initial meeting with MohaveCounty Supervisor District 2,Hildy Anguis, to discusscollaborations and funding. Mohave County Consortiumsponsored by RCORP Development of ServiceDirectoryHousing VocationalCoordinatorWorkflow and DatacollectionSecure Housing andFunding Position open and candidatesare being screened Workgroup Goal for nextmilestone Initial 3 apartments identified

TIP Justice Initiative 2Goal: enhance community re-entry after jail release for justice involved membersthrough identifying and establishing key performance indicators related to coordinationof care for members that are booked into jail at any time throughout the course oftreatment.Implementation:Barriers: Outreach Navigator Workflow Collaboration with MCSO Stakeholders involved for treatment support options Data collection High volume of requests Limited means to engagement while incarcerated Limited resources: transitional living, sober living, housing, etc. Tracking of Outcomes

Jail Transitions to date:DATAJail IntakesClosed6312826171613JANUARYFEBRUARYData to be collected:IntakeClosureResidential TreatmentOP/MAT ServicesMARCHAPRILMAY

TIP Justice Initiative 3Goal: develop a reoccurring meeting with justice stakeholders andTI Justice engaged providers in the Mohave County region with theobjective of defining and accomplishing shared goals.ImplementationBarriers Rural Communities Opioid Resources Program (RCORP) initiated first Mohave CountyConsortium that included all stakeholders. Consortium to take the place of multiplesmall meetings and host one large group meeting/discussion. Relationship established with Mohave County Supervisor District 2, Hildy Anguis,who works diligently to secure funding for out specific needs. Continued collaboration on a large scale Addressing gaps in care vs. individual service provider goals. Overdose Fatality Review Team identified coordination of care as the mostsignificant factor in overdose fatalities in Mohave County.

Target Goals:Short-TermHire housing vocational coordinatorExtract data for jail transition to include: Residential and OP/MATservices receivedDevelop stakeholder/community directoryDevelop workflow and data collection for Initiative 1 withworkgroupsLong-TermAssess and analyze data collection with workgroupsSecure housing fundsMaintain consistent collaborative meetings with justicestakeholders.Partner directly with MCSO at the jail re-entry building

January 2022, Revised May 2022Valleywise HealthTargeted Investments ProgramJustice Initiative Tracker 2019 Valleywise Health. All rights reserved. Internal use.

Justice Initiatives Recap1) Improve data collection with Peer Run Organizations2) Automate reporting capabilities3) Elevate importance of connection to whole health services toinmates and offenders 2019 Valleywise Health. All rights reserved. Internal use.31

Initiative 1:Improve DataCollection with PeerRun Organizations 2019 Valleywise Health. All rights reserved. Internal use.32

1) Improve Data Collection with Peer Run Organizations Valleywise Health (VH) partners with 3 Peer Run Organizations(PROs) – CHEEERS, Hope Inc. and Hope Lives to engage inmates andoffenders recently released from prison The PROs jointly designed a shared spreadsheet that they usesecure through Google docs to gather member informationPROFamiliarEasy to access andenter data 2019 Valleywise Health. All rights reserved. Internal use.CONNo restrictions on what isentered33

QC ExampleRemindProject manager remindsPROs to double check thetracker to include all entriesfor the month, and to QCtheir work, especially thefields that are submitted toAHCCCS, CHiR, and internallyto VH IT 2019 Valleywise Health. All rights reserved. Internal use.ExamineFixProject manager downloadsthe spreadsheetFix all obvious errors (e.g.dates)Deletes the color coding thePROs use for trackingAttempts to fix non-obviouserrors by looking up:Uses formulas andconditional formatting toidentify outliers (e.g. dates,AHCCCS ID character length,etc.) ADC numbers on theInmate Datasearch AHCCCS IDs throughAHCCCS portalPRO HelpGo back to PROs to ask themto fix all remaining errors34

1) Improve Data Collection with Peer RunOrganizationsOur goal is to decrease manual processes and improve qualityof informationIn process as of May 2022.We will:Tasks Completed:Work with the PROs to complete indepth research and analysis regardingwhat is available within thespreadsheets we are already using, orotherwise available in the market Explored options internally to allowaccess to EHR for PROs Shifted oversight and QC of PROtracker to VH staff, with goal of fullautomation Complete training Shift to new data collectiontool/methodologyCreated new template with edits thatdisallow invalid entries (e.g., date,AHCCCS ID length) Provided ongoing TA to PROs throughregular meetings (every other Friday) 2019 Valleywise Health. All rights reserved. Internal use.35

Initiative Two:Automate ReportingCapabilities 2019 Valleywise Health. All rights reserved. Internal use.36

2) Automate Reporting CapabilitiesAfter the data is collected by the PROs andmanually cleaned, staff spend hours manipulatingthe data for proper formatting for:CHiRTemplateVH SeniorManagementand otherstakeholders 2019 Valleywise Health. All rights reserved. Internal use.VH IT template to look requests37