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  • Improving Health Home Capacity to Serve Homeless Clients By: NYSHealth Priority Areas: Special Projects Fund Date: March 2017 Type: Grant Outcome Reports, Grantee Name: Corporation for Supportive Housing

    The Affordable Care Act gave states the option to provide coordinated services for Medicaid patients with multiple chronic conditions through health homes—networks of providers across communities that facilitate access to various medical, behavioral, and social services. Health homes have the potential to reorganize how care is delivered, managed, and coordinated for high-need and high-cost patients, which in turn could lead to lower emergency room use; reductions in hospital admissions and readmissions; reductions in higher health care costs; and improved quality of care. However, health home patients who are unstably housed often cycle through emergency rooms, detox facilities, hospitalizations, and shelters, resulting in enormous costs and poor health outcomes. To address this issue, NYSHealth awarded Corporation for Supportive Housing (CSH) a grant to improve coordination of care for health home patients with the supportive housing sector.

  • Developing the Community First Choice Program in New York By: NYSHealth Priority Areas: Special Projects Fund Date: March 2017 Type: Grant Outcome Reports, Grantee Name: New York Association on Independent Living

    In March 2011, New York State made an express commitment to implement the Community First Choice (CFC) an option under the Affordable Care Act that offers states enhanced Medicaid matching funds to enable people who would be eligible for institutional level of care to stay in their homes and get services in the community. This option was a win for both the State and its most vulnerable residents, with the potential to expand access to community-based services for approximately 1 million New York Medicaid recipients, generate an estimated $90 million a year in net Medicaid savings to the State, and rebalance incentives away from institutional care settings. NYSHealth awarded New York Association on Independent Living (NYAIL), in partnership with the Center for Disability Rights (CDR), a grant to work with the State on developing and adopting the CFC program in New York.

  • Scaling Up a Model to Prevent HIV Transmission in New York City By: NYSHealth Priority Areas: Special Projects Fund Date: January 2017 Type: Grant Outcome Reports, Grantee Name: Housing Works, Inc.

    Despite advances in medicine, the AIDS epidemic continues to be a major public health concern—especially in New York City, which remains an epicenter of the disease. During 2013, New York City recorded 2,832 new HIV diagnoses and 1,784 new AIDS diagnoses. Currently, more than 117,000 people are living with diagnosed HIV infection in New York City, many of whom come from vulnerable populations. Federal guidelines recommend antiretroviral (ARV) medication for all people living with HIV. ARV treatment suppresses the level of HIV in the blood to an undetectable level, which enables HIV-positive people to live healthy lives while making it virtually impossible to transmit the virus to others. Although ARV is highly effective and is now the established standard of care, only 43% of HIV-positive New York City residents have achieved viral suppression. In 2015, NYSHealth awarded Housing Works a grant to scale up a successful viral load suppression model, The Undetectables, to help those living with HIV manage the disease and prevent its further transmission. This evidence-based model has been shown to successfully suppress the virus in 82% of participants. Under this grant, Housing Works aimed to expand The Undetectables model and form a consortium to collectively adopt, refine, and scale up the model throughout New York City.

  • Improving Services for Dual Eligibles with Disabilities By: NYSHealth Priority Areas: Special Projects Fund Date: September 2016 Type: Grant Outcome Reports, Grantee Name: Center for Independence of the Disabled in New York, Inc.

    Approximately one-third of New York’s 700,000 dual eligibles—individuals who qualify for both Medicare and Medicaid—are under the age of 65. Many of these individuals have physical and cognitive disabilities that create significant barriers to accessing health care. As New York State moved to implement the Fully Integrated Duals Advantage (FIDA) program, dual eligibles would receive a comprehensive package of physical health care, behavioral health care, and long-term services through both Medicare and Medicaid. Because FIDA plans will be created by managed long-term care plans that currently serve elderly and disabled Medicaid beneficiaries, these plans must increase their capacity to serve a wider disabled population. Furthermore, federal and State laws, including the Americans with Disabilities Act (ADA), require that affirmative steps be taken to ensure that people with disabilities are treated in a nondiscriminatory manner and have access to health plans with providers in their networks. NYSHealth awarded the Center for Independence of the Disabled in New York (CIDNY) a grant to work with six plans and the New York State Department of Health to support the implementation of FIDA, improve ADA compliance, and enhance access and outcomes for people with disabilities.

  • Establishing a Mental Health Clinic for Criminal Justice-involved Individuals By: NYSHealth Priority Areas: Special Projects Fund Date: September 2016 Type: Grant Outcome Reports, Grantee Name: Center for Alternative Sentencing and Employment Services, Inc.

    Responding to the comprehensive treatment needs of criminal justice-involved individuals with mental illness is a major challenge for both criminal justice and mental health officials. Individuals with mental health diagnoses are admitted to jail more frequently than people without mental illnesses for the same offenses, and nearly half of people with mental illness who are incarcerated return to jail within a year. Of youth held in New York State detention, 54% have mental illnesses, 63% have substance use disorders, and 54% have physical health disorders. Many New York City mental health clinics have long waiting lists for treatment and little or no experience serving individuals involved with the criminal justice system. In 2013, NYSHealth awarded a grant to the Center for Alternative Sentencing and Employment Services (CASES) to open the first mental health clinic in New York State that is specifically designed to meet the needs of youth and adults involved with the criminal justice system.

  • Improving Scheduling for Home Health Visits By: NYSHealth Priority Areas: Special Projects Fund Date: August 2016 Type: Grant Outcome Reports, Grantee Name: Loyola University of Chicago

    Home health care is an important component of New York State’s health care system. To make the best use of their providers, home care agencies must have a strategic and clear process to deliver care and services efficiently. Past approaches to scheduling and routing home care visits have often been manual, inefficient, and cumbersome. Software tailored to home care agencies had potential to increase efficiencies, but much of the developed software systems were expensive and difficult to integrate with other existing systems. Further complicating matters, previous tools also had been unable to take into account the needs and preferences of patients and caregivers. In 2011, NYSHealth awarded a grant to the Rochester Institute of Technology to partner with four home health care agencies to develop and test an intelligent routing software system that would help New York’s home health agencies improve their processes for assigning and scheduling home health visits. The project’s lead manager subsequently left Rochester and joined Loyola University of Chicago (LUC); the grant was then transferred to LUC so he could complete the already underway project.

  • Improving Family Planning Services at Community Health Centers By: NYSHealth Priority Areas: Special Projects Fund Date: August 2016 Type: Grant Outcome Reports, Grantee Name: Public Health Solutions

    As a result of the Affordable Care Act, federally qualified health centers (FQHCs) were expected to double the number of patients they serve. FQHCs provide comprehensive primary and preventive care regardless of a patient’s insurance status or ability to pay. Although FQHCs are required to provide family planning services to patients, many do not receive funding through the U.S. Department of Health and Human Services Title X Family Planning Program, and are therefore neither properly equipped nor trained to provide the same scope of services as their funded counterparts. NYSHealth awarded Public Health Solutions a grant to pilot a quality improvement collaborative model to close the gap and integrate evidence-informed best practices in contraceptive care at non-Title X-funded FQHCs in New York City. Under this grant, Public Health Solutions educated and trained health center staff to ensure the operational changes at each site align with evidence-based standards of care. The project aimed to measurably improve FQHCs’ contraceptive service provision and reduce unintended pregnancies through high-quality family planning services—offering counseling on a wide range of approaches from abstinence to pharmaceuticals.

  • Addressing the Needs of Staten Island Residents in Hurricane Sandy’s Aftermath By: NYSHealth Priority Areas: Special Projects Fund Date: August 2016 Type: Grant Outcome Reports, Grantee Name: Community Health Action of Staten Island, Inc.

    The one-year anniversary of the Hurricane Sandy disaster was a particularly vulnerable period for some disaster survivors. It was a time when people who had suffered loss and trauma were most likely to experience trigger events, which can contribute to the emergence or re-emergence of conditions such as depression, post-traumatic stress disorder, and alcohol and substance use. NYSHealth awarded the Community Health Action of Staten Island (CHASI) a grant to help identify residents of impacted communities on Staten Island who may be developing serious mental health and/or substance use conditions and connect them to appropriate and timely health care and mental health services. 

  • Improving Long-Term Care and Services in Rural New York By: NYSHealth Priority Areas: Special Projects Fund Date: July 2016 Type: Grant Outcome Reports, Grantee Name: Foundation for Long Term Care, Inc.

    The six-county Eastern Adirondack region is a reflection of the aging trend currently unfolding in rural New York State: 14.8% of the region’s population is over the age of 65, with 9% of those having incomes at or below the poverty level. With limited transportation, the expansive and rural geography of the region creates formidable challenges to developing, operating, and financially sustaining long-term care services and supports (LTCSS). As a medically underserved area, only four long-term home health care programs and eight certified home health care agencies serve the region. In 2013, NYSHealth awarded the Foundation for Long Term Care (FLTC) a grant to develop a multifaceted action plan to ensure access to a range of high-quality LTCSS. Under this grant, FLTC sought to establish and convene a core group of partner organizations to determine options for sharing and potentially integrating services and functions. The goal of the action plan was to effect organizational mergers and restructuring; reimbursement changes and regulatory modifications; quality improvement processes; and recommendations on statewide strategies to improve LTCSS.

  • Helping Homebound Patients Reconnect with Primary Care By: NYSHealth Priority Areas: Special Projects Fund Date: July 2016 Type: Grant Outcome Reports, Grantee Name: Home Aide Service of Eastern New York, Inc., dba Eddy Visiting Nurse Association

    By 2030, the number of permanently homebound individuals in the U.S. will increase by 50% to reach 2 million. These highest-need and sickest patients are also the ones who bear the greatest financial burden on the health care system. In 2011, Samaritan Hospital privately launched a small home-based care pilot program to determine whether a medical house call service could help patients with frequent hospital readmissions. The results were promising—the majority of patients were not re-hospitalized, and the conclusion was that the medical house call model warrants further study on a larger scale. In 2012, NYSHealth awarded a grant to Eddy Visiting Nurse Association (Eddy VNA) and its affiliate St. Peter’s Health Partners Medical Associates to test the medical house call model in four upstate New York counties: Albany, Rensselaer, Schenectady, and Saratoga.

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