Mario responds

Mario responds with:

• Background & context: on occasion John Freeman facilitates a conversation between Commission leadership & OAPP because there are issues (including MOU, reference about my comments at last COH meeting).
• Mario asked Dr Green to share his perspective because of his unique position in terms of how the 2 bodies are working together.  In short order there will be 33 less staff at OAPP to help us address our charge. See “freeman effect”.
• Balance:
  • consumer need (who are not shy about telling us what is not working at provider level)
  • provider realities (asking providers to do more with less). We go through waves in which agencies contracted portfolios. 18 months ago this summer, more in the near future. Sense that providers are really struggling to meet some of the basic contractual deliverables we have laid out. There is an incongruence between our perspectives and their abilities
  • planning council & standards of care: there is debate. Is what we put into print the gold standard or the minimum standard? COH has the higher possible standard, OAPP looking at minimum standards
  • financial realities
• @ last COH I said gap bet SOC and Service Provider realities is growing. There are stds in place which we can not afford or deliver. Our TMP expectations are 4 viral loads/client/year. Natil guidelines say 2 if you’re stable.  Just got rid of medical nutrition therapy in our county and now we expect our medical providers to do an nutritional eval on all of our clients every year?
• Let’s assume best case scenario that adap is flat-funded. We need $32mill to meet everyone’s asap need? What is going to go, or do we just expect providers to just meet higher standards?
• Coh has done outstanding job developing standards, but they have not done a good job in establishing standards in developing standards in relationship to funding.
• Coh should focus on ensuring that the overall system is effective but don’t micromanage or repeat exercises that have been done. Let medical directors guide medical SOC for this county.
• Dr green recently did a survey of all oapp chiefs. In atypical month how many hours do you spend responding to coh requests/activities  182 hours a month .  so when I say that oapp can not continue with the sustained demand of our time, this is what I’m talking about.
• There is a need for us as a planning body in the NEXT EW WEEKS about what our contingency plan is when/if ADAP is unable to meet need. How much Part A/B resources are we willing to divert? $10m? $15m? what services as a system are we prepared to do without to meet the hiv rx needs that are going to be growing and not going away?
• STD programs: many opptys for efficiencies. NAT testing – 2 high volume sites: AHF/GLC – 1/250 test positive. People who are seroconverting and highly infectious.
• What gives the system the greatest bang for the buck. The commission needs to have these conversations.
• My goal reminds me that if coh, given all the wonderful work you’ve doe, did very little above your core duties you’d still be head & shoulders above most planning groups in America. My challenge is: let’s be strategic  and thoughtful about what demands we place on one another to meet the consumer need. And if consumer need is really a driver – at the end of the day (of a half or full day meeting) did what ewe do benefit a single hiv+ person?