Retention Week at AHF is all about getting an inside look at how we engage with AHF senior leadership and figure out how to better serve our patients, the foundation of everything we do. Hear from five senior leaders at AHF with their thoughts on a range of topics all centered around the best possible patient care.
Retention Week 2022
A slew of special guests help us highlight this year’s Retention Week messages
GUEST BIOS:
CORE TOPICS + DETAILS:
[1:21] -- Why Client Experience Matters
AJ Alegria answers the question of why client experience is so central at AHF
Reputation is central at AHF, because if patients don’t trust an organization, that organization can’t deliver them lifesaving care. Patients are more inclined to do business with an organization that makes them feel good, respected, and appreciated, and the better a patient feels, the more services they use. The more services they use, the more they stay in care.
[8:05] -- Radical Collaboration at AHF
Donna Stidham: Transformative collaboration principles can and should be applied at an organization like AHF
Donna uses the use case of a patient who has been receiving consistent care but is moving to a new region. Close collaboration across regional offices could ensure that this person doesn’t get lost in the shuffle and is able to access continued care even as their geographical location changes. Constantly thinking about making a patient’s experience positive wherever they are is one of the most central forms of collaborative principles at AHF.
[12:11] -- Reducing Stigma and Reaching Undocumented People
How Western Region sales director Jose Ramos is working to bring healthcare to marginalized groups
The entire sales team in the western region knows that educating and talking to people out in the field is central, particularly in cities close to the border. Active outreach is key in letting undocumented people know there are services available to them when they’re in need.
[15:06] -- Linkage and Retention: Two Specialties, One Mission
Whitney Engeran on how linkage and retention specialists can work together
Communication is key when various specialists are working towards the shared mission of enhanced patient care. When there are indications that people might be falling out of care, turning their first encounters with team members into lasting connections is key— positive, patient-centric, and communicative from one interaction to the next.
[23:43] -- Finding Patients on the Move
Dr. Laura Boudreau on tracking down patients in need of care
Community health workers are an essential tool in locating patients, with some even acting as retention specialists who can go so far as to make house visits to track down patients. Another promising strategy being tested is using patients’ comfort with pharmacies over clinics in order to deliver messages through that outlet.
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Lauren Hogan:
Get unfiltered lessons from our leaders at AHF as we uncover real, raw stories of where we came from and where we are going. Join us for an unscripted look at the connections our senior leadership have to our mission core values and hot initiatives.
Lauren Hogan:
AHF is the world's largest HIV-AIDS service organization, operating in 45 countries globally, 16 states domestically, including DC and Puerto Rico. Our mission is to provide cutting-edge medicine and advocacy, regardless of ability to pay.
Lauren Hogan:
Hello and welcome to the After Hours podcast. I'm your host, Lauren Hogan, serving as your liaison to take you through this journey to learn more about AIDS Healthcare Foundation. This week, we will be talking about AHF unfiltered with episode seven of retention week 2022. Take an inside look of how we engage with AHF senior leadership and figure out how we better serve our patients. We will hear from senior leaders such as what [Whitney Cordova, Donna Siam, AJ Allegria, Jose Ramos and Laura Boudreau. 00:01:08] Before we start the show, please make sure to remember to check out the show notes so you can follow along. Now, let's get started.
Speaker 3:
AJ, please let us know what is client experience?
AJ:
So, I was really excited to have to present on this topic because it's something that's near and dear to my heart. And before I actually talk about what is client experience, it would be wrong of me not to recognize and congratulate all of our service lines that we measure client experience scores on, even despite a lot of the curve balls and challenges that COVID has presented us over the last two years now, a little over two years. We've managed to be able to accomplish some of our highest client experience scores to date since we started measuring client experience scores as an organization. And so, that is a result of all of the hard work that everybody on this call and out in our sites and in our communities have done. And our patients are saying that they really appreciate us still being there for them, even despite everything that everyone is going through.
AJ:
So, congratulations and thank you on behalf of your management team and myself and other leaders. So, what is client experience? I want to talk about client experience from the scope of AHF as an organization. So, it's not going to be just talking about healthcare centers. Client experience is... There's different elements to it but the simplest way that I can put it is a patients experience is the feeling that they're left with after an encounter with an AHF staff member, regardless of the service that they may be utilizing. It could also be the experience they have with technology. Electronic type of patient experience. So, when you think about it, it's really important for us and I think we've done a lot of really great work on having some consistency. If a patient goes into OTC, they're getting an AHF experience just like if they go to a website or submit a submission form.
AJ:
So, the fact that we've been able to, as such a large organization, a complex organization, to try and streamline that with still some work to do but we've definitely come a long way. It really is impressive. So, it really is about how we leave patients feeling after they have an encounter with us. One other thing that client experience is, it's a major component but it's not the only component of patient retention. So, at the start of our client experience journey as an organization, we thought that if we significantly improve client experience, then that's going to solve all of our patient retention challenges. And what we've learned is that, that's not necessarily the case. So, this is why we're having this whole retention week with all of these different components because it's definitely multi-layered to really keep patients retained in care and client experience is just one piece of that.
Speaker 3:
So, my next question for you, AJ, why is client experience so important?
AJ:
So, right out of the gate, it's our reputation as an organization. When you think about some organizations that aren't necessarily known for how they make people feel, they're not really talked about in the best of ways. So, reputationally, it really is important for AHF, for all of us, to continue to provide the best patient experience so we can continue to have patients seek us out when they need us. In addition to that, we did a lot of analysis when I first started the organization about six and a half years ago with Gallup. For those of you have been around longer than that time, you probably remember this but we learned a lot when we actually asked patients, "What does client experience mean to them," and, "What were the impacts to their care," and us as an organization?
AJ:
One of the things that we learned is that patients are more inclined to do business with an organization that make them feel good, respected and appreciated. And the better a patient feels, the more services they use. The more services they use, the more they stay in care. So, there's this cascade of what we learn from that data. And so, this is why client experience just at the healthcare centers, we can't just do that well. We have to do client experience well in linkage and in a case management OTC because when patients think about us as an organization, they see one overall AHS.
Speaker 3:
Can you explain why it's important to always have client experience at top of mind, regardless of what business line employees may be in? I think sometimes we get siloed in our own day to day jobs and don't really think of how everything is interconnected. So, can you speak to that?
AJ:
Yeah.
Speaker 9:
AJ, even if you're not a person that interacts with clients.
AJ:
And that's one of the great things about client experience is that it's transferable. You have internal clients within the organization and then you have external clients, which is traditionally what we would consider our patients. Coming from the outside to AHF because they have a need but how we deliver on that external or patient client experience, a huge factor in that is how we provide client experience to internal clients.
AJ:
So, I'll use marketing, for example. You guys, we need you in order to be able to communicate and provide the services that we provide in the healthcare centers. If there's not a strong client experience internally, that could have a positive or negative impact on the client experience externally. I'll even use another department like finance. If accounts payable isn't doing their part to provide a good client experience for the wellness centers and making sure their lights stay on and the invoices get paid, that trickles down and could have an impact on external client experience. So, it really is all around us, no matter who we're interacting with within the organization or outside with our clients and patients.
Speaker 3:
We do a lot of surveys. We engage with a lot of different patients. Is there a universal ask from them saying that this is what they feel like is missing from our AHF model of care? Is it more than one thing? What has the feedback been like?
Speaker 4:
The feedback has been a little... I don't want to say siloed but it has been a little incongruent and that's why I presented the slide where we were linear to each other and we're moving towards, and we have been moving towards this whole year, to a circular that we're all one moving in concert with each other. In order to retain patients, that's what we want to do and we also want to be able to extend our reach outside of the office. And that's why applying the care management and making sure that all sites will also have care management staff available when we have completed the rollout across all of our sites. We're starting in California and we're doing a pilot to make sure that we do this smoothly and we will be rolling it across all of our bureaus. We'll have pilots in each bureau and as those succeed, by midpoint this year, we will have staff to help support and link and collaborate with all of the disciplines within each healthcare center and we'll all be one.
Speaker 3:
How can we take these lessons of radical collaboration and apply them to our respective departments?
Speaker 4:
Maybe I can answer that by best giving an example. Let's say we have a phlebotomist who is drawing blood and the patient is sitting there waiting and they're making small talk in the phlebotomy room. And the patient says, "I'm going to be moving in a couple weeks. So, I'm going to miss you." And frequently what happens now is everybody's like, "Oh, I'm going to miss you too." And that might not get transitioned or even thought about like, "Oh, I wonder if we could make sure this patient went to our healthcare center," wherever they're moving. And asking that next question and then sharing that and then moving it to either a linkage person or a case manager or a salesperson or the front office to be able to make arrangements that, that patient gets transferred to our new site where they're moving. So, it's constantly thinking about, "What can I do to make this patient's experience a positive one," but also to make our experience with the patient, a collaborative and whole one?
Speaker 3:
Adherence starts from day one. Our goal is not to just address the PTs medical and pharmacy needs but to provide assistance in identifying and reducing and/or removing obstacles to care. How do we help our team turn on their anticipatory guidance caps? If we can retain people in care, we can prevent them from being back in care patients.
Speaker 4:
Part of the care management function will be to work in collaboration with our benefit counselors and do patient-needs assessments and risk assessments when they enter care or when they are referred or when our data identifies those patients as I described earlier, that we consider at risk for falling out of care. So, if in any of those assessments, those things are identified then those patients will be worked with and asked to participate in care management to resolve whatever social determinant or barrier there is to the care.
Speaker 3:
Do we have a major directory of the staff we can reach out to that can assist our patients in need?
Speaker 5:
So, we do. When it comes the sales team, I do have a master list and I can send it to Lauren. We can even send it to this group but it has the city, the location and the sales rep that's attached to all the locations nationwide. So, we do have the directory that anybody can have access to that we can send to you guys so that you have it, in case somebody needs something.
Speaker 3:
How do we ensure that undocumented people know that we can not only provide services but they can also enroll in Ryan White?
Speaker 5:
That is a good question. Our sales team, they know that so they usually educate people as they go out and they talk to people. In places like San Isidro and San Diego, because we are close to the border, we do more active outreach by letting people know about that. We haven't done any kind of marketing materials or anything nationwide but that could be something I can take because right now, we don't have anything that... Besides the knowledge that we have as a sales team... Also, linkage. They know this information but we can provide probably more if needed. But I do know for a fact that we do talk to community partners and we let them know that AHF and where we have Ryan White, we're able to take care of people undocumented.
Speaker 3:
Hearing the term, substance abuse, is kind of stigmatizing and just because people are using substances doesn't necessarily mean that they're abusing them. So, is there a way or a certain term that we should be using when we engage with clients? So, that way it's not as stigmatizing, especially if they're in the room. What is your feedback?
Speaker 5:
I don't know who said it but I totally agree and one hundred percent. So, the way we refer to drug use, we just say, "Drug use," because first of all, a lot of people... Let's say, addiction. Addiction is what we use in terminology and medical and addiction is the disease. So, I just wanted to put it out there because there are people who are addicts and they need help.
Speaker 5:
And there's no shame. It is a condition. It's a need but we don't use those terms because also, even abuse. Who says what abuse or addiction looks like? We can't determine that as a sales team. A lot of us, unless we are a doctor, therapist or psychiatrist... So, we usually just engage by, "How's your drug use? Is your drug use impacting your care or impacting your health or your environment?" So, we try to assess their use and if it's making an impact on their lives. Unwanted and they can't stop, we tend to recommend different resources in the community but we for sure do not assume that they're addicts or call them such or even abuse. We don't really say that. We just say, "How is your use," and see if we can help them based on that.
Speaker 3:
How can linkage specialists and retention specialists work together to better serve our patients?
Speaker 6:
That's a good question and I think a lot of that has to do again with communication. I think with retention specialists, you are really looking at how that is working over the arc of their stay with us. Are there indications that people might be falling out of care, whether they're not making their appointments, they're not showing up or they're not communicating. Whatever those things are that start to happen. Some of the trajectory of what a patient goes through really starts with the first encounters they have. And often, those first encounters they have are with our testing team or with our linkage team or the beginnings with the HCC team when they first come in. And I think that it's just really important for us to focus in making our encounters with our patients to be as positive as they can be and making them know that we know that we care about them and that we want to help them.
Speaker 6:
And hopefully if they are starting to waiver or they're going to move or whatever it is that's going to happen with them, that it gives us a chance. They feel like we have their back and that we're with them and they are going to want to talk with us about it. And hopefully that means that they'll talk with the retention specialists but I also think the retention specialists can reach back to the linkage specialists, go over those notes and be able to see if they're particularly looking at one particular patient. They can go back and look at those notes, talk to the linkage specialist and see if there's any insight that, that person might have that might help the retention specialist have a positive impact on that encounter.
Speaker 3:
What is the best way to reach a linkage specialist from a patient sense? What's the best way for our patients to reach our linkage specialists?
Speaker 6:
So, the best way for our patients to reach our linkage specialists is through... We have a linkage hotline, which I should have had ready for myself here today, which I don't. So, if somebody can find the linkage hotline, that would be lovely so that we can give the number but we have different numbers for different areas, depending on the geography. As staff, you should have access to linkage hotline as well as to hand people off to our linkage specialists or to just contact the director or associate director, deputy director of linkage that's in your region. They should be able to really help you to figure out who it is that you can give a call to.
Speaker 3:
Is there a reason linkage only works with new positives for only two visits? Most new positives might need assistance for the year of diagnosis.
Speaker 6:
Yeah. That's a great question. When we're talking about linkage, we're really talking about getting that person in for their first two visits. And that's really where we have set the bar because after that second visit, more than likely they've gotten their treatment plan from the doctor. They've started their prescriptions and they've been handed off to case management or they've been handed off to nurse case management. They've had some assessment done with the doctor. And so, they're really ready to engage in their treatment plan. And so, we really felt like that's the place where we are disengaging because at that point, their treatment plan has been fully engaged.
Speaker 6:
And so, that's really where our colleagues from healthcare center, mental health, managed care and the nurse case management and all the other kind of resources that AHF has, that's really where that team comes to bear. So, once all the tests are done, once we've gotten the lab results back and once we know that our patient is on treatment and ready to go, then that's where we disengage. That just seems to be the most logical place for that part of our service to stop and for the treatment team and the team members that are at the HCC and part of the other service elements of AHF. That's why they really engage. So, that's why we stop after the second.
John:
Hey Whitney, great presentation.
Speaker 10:
Hi, John.
John:
Rank can file employees who aren't involved in services. What's our role to support the linkage process? I have a really brief story. A friend of mine called me from out of the country and he was very desperate. He recently was diagnosed with an HIV diagnosis and wanted care and I obviously referred to him. He had a fabulous experience as a new linkage client and then as a patient. Every now and then, I contact him and I say, "So, how's it going? Are you still getting care?" So, that's kind of what I do but in my job, I'm not licensed to do anything but drive my car. So, what do you advise the 200 or so people that are on this call that aren't necessarily working in clinics?
Speaker 10:
200? I thought there were like five people on here. There are 200?
John:
Well, I don't know but what would you say to us about how we can support the linkage program? Just rank and file office employees like myself?
Speaker 10:
Well, one, I hope you just know about it, right? First knowing that linkage is part of the continuum of care. It's really the beginning of our interaction with patients. I think one of the biggest things that all of us need to know, no matter what our role is across the organization, is that we have got to, as a team, one big team, one team. We have got to prioritize making sure that our patients have the best possible experience they can have with us. And what that means is not only do we have to know what we're doing in terms of our professional work that we're good at what we do and I think, pretty much across the board, AHF is pretty much the best at what we do in the world. We have got to listen to our patients. We've got to engage with them. Whatever's going on in our lives, because God knows now is a very complicated time for us, right? All of us. Our personal and professional lives are coalescing in ways that I'm not sure we've ever felt before.
Speaker 10:
We have got to know that whatever we're going through, whatever's happening to us, we've got to tap that empathy that I think all of us truly have for the people who are living with HIV and the people who need our help. We need to tap that and we need to use it to make sure that the experience that our patients are having are the best possible experiences. The one that makes them feel safe, that makes them feel as though we know what we're doing and that we're going to take care of them and that they can come to us with anything they need to in the course of their care and that we're going to do what we must to make sure they're taken care of.
Speaker 10:
And if we all embody that, whether it's when we're out on a protest or holding up a sign, all of us are in one way, shape or form, whether we're an accountant, whether we're a lawyer, whether we're a doctor, whether we're a tester. No matter what role we play in this organization, we need to exhibit that energy. And that energy is we are here for you, we're here to take care of you, we're here to make sure that your experience is one that will enhance your health and enhance your life. And that's what we're here for. That's what our job is. And I think we can all exhibit that, daily, across all of our disciplines and across all of the work that we do across the organization. And that, ladies and gentlemen, is your Whitney speech for the day.
Speaker 3:
We're going to start with my favorite doctor out of Chicago, Dr. Danica Wilson. She's asking, "Many of my patients are very transient, which adds to my number of drops. As it relates to retention, it is difficult to connect with many of my patients due to them not having access to a phone or changing their phone numbers on a regular basis." Not sure if anyone has any suggestions, however, when it comes to her 104 report or finding those loss to care, that's a major issue for her and her patients.
Speaker 3:
So, any advice, Laura?
Laura:
Yeah. You've just put your finger on it. That's the name of the game. The goal for these clients to recognize them and value them as much as the clients that do keep their visits. So, I'm delighted that you're already ahead of the game by working so hard to try to locate these patients.
Laura:
In this upcoming year, we do want to give more tools and more resources. This community health worker can be a help in locating patients. That's one of the things they do. Some of our sites are ready. We have it in trial basis. We have community health workers and retention specialists who can even make house visits to try to track down patients. We are trying strategies like, what we find for example is sometimes the patients aren't being responsive when the clinic calls but they're responding to the pharmacy because they are receiving their meds. So, some innovative strategies have involved getting the PSL, getting the pharmacy drivers to deliver messages to the patients. Maybe converting patient to a telehealth appointment if that's their barrier.
Laura:
Other exciting things coming down the pike are more and more use of HIE, health insurance exchanges. We're finding that health insurance exchanges have a wealth of information. In the states where we've got them and we're developing them, they are a resource where you can look up a patient and see where they've had care at other places, largely hospitals. So, maybe they haven't shown up to the clinic a while but you look in the HIE and you can see that they were in an emergency room. And sometimes there's better information there, in the hospital system, than in our system.
Laura:
We've also, for those of you who haven't tried it yet and you work in the clinic environment, we have what we created this patient profile in Salesforce and what it is it's a place where we've pooled all the different patient contact information. From Cerner, from pharmacy, from the HCCs, from PhD, because sometimes we find, for example, the patient is showing up at wellness. They're not coming to their office visits but they are showing up at our wellness sites.
Laura:
So, it's important that we capture that. We know when the patient shows up at wellness for an STD check. Somebody can identify and say, "Hey, you haven't had your labs for a while. You haven't seen a doctor for a while. Can I help facilitate getting you back into care?" So, that patient profile is a place where it pools that information so you can see in one stop. Maybe the patient isn't showing up to the clinic but maybe you can spot them somewhere else or some other part of AHF has current information on them. So, you're going to see a lot of emphasis in 2022 on collaboration with other departments, pharmacy, linkage and sales for back in care. Again, this new cadre of community health workers to help us with exactly what the doctor was mentioning about when we have these patients that are really hard to find and taking those extra steps to really try to locate them. They're the ones that need us most at the end of the day.
Speaker 3:
From Dr. D, again. She's asking, "Do we have any suggestions to help with factors in terms of patients that may fall out of care due to COVID or that they don't return phone calls or emails?" How are we addressing these things in terms of them staying in care?
Laura:
That's been the source of so many conversations and so many innovative approaches at the site level. And so, I applaud all the site level staff who are figuring out how to handle this.
Laura:
I know of a site that has retention specialists going out to a home visit or a case manager who can go out to a home visit. I know not every site has retention specialists or case managers but where they do, that's one way. Again, utilizing the PSL, your drivers, to help cope with these people who are fearful because of COVID. Fearful of coming to the healthcare clinic. That was more of a problem in the beginning of the epidemic, for sure but I'm sure it still lingers, especially with this latest surge. Telehealth, we have just reinvented ourselves in terms of telehealth now. We did it with very little time. We had to be able to turn to that and provide that as an option. That's certainly a viable option for patients who are concerned about COVID and coming into the clinic because of COVID.
Speaker 3:
Is AHF accounting for socioeconomic factors like housing and food insecurity? Those with transportation issues, is there a game plan in place to tackle these issues since there are major factors affecting patients ability to seek and retain care?
Laura:
Huge issue in retention, which is exactly what you point at. And this national care model, which I said to be hearing more about this year, spearheaded by Donna in managed care. We have a fantastic case management model for Ryan White patients. Ryan White program in general has done a great job of recognizing that if you want to keep people with HIV healthy, especially if they're struggling with lots of social determinants, you need strong case management.
Laura:
So, our commitment in 2022 is to extend those, a version of those case management services to all our patients, regardless of whether Ryan White or not. And so, to be more specific, we'll be piloting in the beginning of the year. We're going to be piloting at some sites, embedding these community health workers and that's going to be their primary job, which is to be working with that subset of the population at the clinics. Working very closely with the medical director, the providers, the nurses, the whole care team and identifying those patients who are struggling and being in a position to help facilitate them getting housing and help facilitating them getting food. Of course, in some of our sites, we're opening up food services. In LA, we've got this wonderful food project that we're opening up. So, there's that as well. The short answer to your question is absolutely. Trying to find ways to help patients overcome social determinants is a top priority for 2022.
Lauren Hogan:
Thank you so much for joining us. If you enjoyed this episode and you'd like to help support the show, please subscribe. Share it with your friends. Like and post about it on social media or leave a rating and review. Follow us on Instagram at AfterHours and see you next time.