NYSHealth's "Best of 2018" Annual Report

In 2018, NYSHealth focused its attention on a few key areas: building healthy communities, empowering health care consumers, improving veterans’ health, and responding to time-sensitive and emerging issues. Through grantmaking, convening, activism, communications, and policy analysis, we made progress in each of these areas. Explore our Best of 2018 to learn about some of our biggest wins.

Supporting Communities in Becoming Healthier

In communities throughout New York State, residents, grantees, and local partners pulled together to improve the health of their neighborhoods. As communities ramped up their efforts, the Foundation also had a chance to reflect on our work to build healthy communities. In April 2018, we released a report on what we learned and accomplished over the first three years of our place-based investments, which have leveraged an additional $181 million in funding and helped nearly half a million New Yorkers gain better access to healthy, affordable food and safe ways to be physically active. The report explores the start-up and early phase of our work in the six communities that are part of our Healthy Neighborhoods Fund initiative: Clinton County; Brownsville, Brooklyn; East Harlem, Manhattan; Near Westside, Syracuse; North End, Niagara Falls; and the Lower East Side of Manhattan. We also produced a companion piece that profiles these communities, including demographic information as well as health status and health care utilization.

More New Yorkers have access to and are consuming healthy, affordable food as a result of efforts by our grantee Field & Fork Network to expand a food nutrition program into Clinton County. The Double Up Food Bucks program lets Supplemental Nutrition Assistance Program (SNAP) recipients use their benefits and receive a matching value on dollars spent on fresh produce at participating farmers markets, mobile markets, and corner stores. Field & Fork had previously brought this program to the western and central regions of New York State with our support. In June 2018, we awarded Field & Fork a second grant to further expand into Clinton County, where more than 16% of residents rely on SNAP. Through this project, more low-income families will bring home healthier food, local farmers will gain new customers, and more food dollars will stay in the local economy. Bringing Double Up Food Bucks to Clinton County also means this successful nutrition incentive program is now embedded in all three of the upstate communities we are working in.

In New York City, places like Head Start programs, senior centers, and homeless shelters provide roughly 50 million meals and snacks each year to the poorest and most vulnerable New Yorkers. The Teaching Kitchen at Lenox Hill Neighborhood House helps train food service staff at these nonprofits to increase the amount of fresh, healthy, local food served—without raising costs. Transforming existing institutional food programs into centers of healthy food has huge potential. In 2016, we recognized The Teaching Kitchen as an Emerging Innovator that over the next decade could improve hundreds of millions of meals served to low-income New Yorkers. In March 2018, we awarded a grant to scale up The Teaching Kitchen’s service model so that it could continue to offer training and technical assistance to 50 nonprofit organizations. In its two-day training program, The Teaching Kitchen provides practical tools to assess and improve four areas: menus and recipes, vendors and ingredients, facilities, and staff development. Over 2018, with an added staff member, The Teaching Kitchen was able to effect more change rapidly. Sustainable change comes slowly, but The Teaching Kitchen has come a long way—a blog post from our CEO shares what he learned from a visit there. Incrementally, The Teaching Kitchen has swapped out pre-made or frozen foods one by one and now uses 90% fresh produce, with one-third of it locally sourced. Providing fresh, healthy food in a sustainable way is no simple feat, but The Teaching Kitchen is making impressive steps toward making New Yorkers healthier, one meal at a time.

In addition to making healthy food more available, our work to build healthy communities also increases safe options for physical activity. More green space leads to more opportunities for physical activity, and in 2018 we continued investing in park renovations and programming. In Niagara Falls, a community participatory budgeting process prioritized Hyde Park and Liberty Park for improvement. Through an NYSHealth grant, Hyde Park is being renovated to make sure that children of all abilities can play safely, and the underused Liberty Park is getting a state-of-the-art athletic playground. Niagara Falls Community Development, our partner leading this work, has also supported programming designed to engage children and increase physical activity opportunities in the community. In the Near Westside of Syracuse, the Center for Court Innovation has continued to work with local residents to increase resident engagement to improve perceptions of safety in Skiddy Park through activities like the Peacemaking Initiative. The Center continued its revitalization work by holding events like Summer at Skiddy and neighborhood block parties to position Skiddy Park as a safe and fun place for children in the community.

Empowering Health Care Consumers

Forging partnerships between patients and providers and supporting uptake of price and quality transparency tools are key strategies of our work to empower health care consumers.

In 2018, we issued a Request for Proposals to support projects that will give New Yorkers a more meaningful role as partners both in their own health care and at the policy level. In the fall, we selected four organizations for grant awards to amplify the voice of New Yorkers and rebalance the health care system so that patients have more influence over their health and health care. The grantees are working on a range of projects that seek system improvements, practice innovations, or policy reforms designed to benefit and empower patients and consumers. For example, Gay Men’s Health Crisis will use its funding to expand the reach of its Action Center—a platform for underrepresented New Yorkers to directly contribute to advocacy and public education on health care. Meanwhile, Columbia University will directly engage patients by gathering their ideas for health care improvement and promoting uptake of those ideas in health care systems across the State.

A project that is pushing the envelope on transparency is our “Connecting Consumers to Information” initiative, which kicked off in 2018. This statewide effort aims to put price and quality tools into the hands of primary care physicians and office staff and encourage their use among patients. A prior NYSHealth-supported study by Public Agenda found that doctors are the most trusted messengers of price and quality information: 77% of respondents say doctors are their top choice for providing this information and 70% welcome doctors or their staff to discuss price information before ordering tests or making referrals. With our support, the New York Academy of Family Physicians (AFP) and the New York Chapter, American College of Physicians (ACP) are tapping their member networks—with a combined reach of more than 25 clinical and nonclinical practices in New York State—to educate them on available price and quality tools and connect their patients with these resources. A 2018 survey of physicians in New York State showed that 59% of AFP respondents and 68% of ACP respondents did not know there are price and quality resources online; only 19% said that they did. As part of our initiative, early adopters from the networks will act as information ambassadors to spread the uptake of consumer information tools among other practices, particularly those that serve Medicaid patients and other vulnerable populations. Avalere Health also helped inform this initiative, providing us and the member networks with counsel and expertise on how to engage patients in conversations about cost and quality choices. Through this initiative, more New Yorkers will have better access to the resources and information they need at the most critical time that they need it to inform their health care decisions—in the doctor’s office.

We also saw some important policy advancements in 2018. In May, our grantee MergerWatch, now part of the Women’s Health Program of Community Catalyst, released a report analyzing New York State’s Certificate of Need (CON) process, which provides oversight of hospital transactions, and how that process can be modernized for increased consumer engagement. Consolidation in the health care provider market can reduce competition and consumer choice, lead to cuts in services, and foster higher prices. The report offers policy and process recommendations to improve the transparency of New York’s CON process, as well as enhance consumer engagement and preserve access to care. The recommendations have picked up steam among key stakeholders and policymakers in New York State. In October 2018, the New York City Council Health Committee included the MergerWatch report in a paper on hospital transformation. The lead author of the MergerWatch report spoke at a joint public hearing before the New York City Council’s Hospital and Health Committees, where she suggested that the Council ask Governor Cuomo to appoint two consumer representatives to vacant positions on the Public Health and Health Planning Council (PHHPC), which reviews the most important CON applications. She also presented at a meeting of the New York Health Plan Association about the effect hospital consolidation has on prices. As a result, this specific recommendation was also taken up by New York State Senator Brad Hoylman, along with 14 other elected officials, in a letter to Governor Cuomo, urging him to fill the PHHPC vacancies with consumer advocates.

Flexing Our Activist Muscle

In 2018, we continued to grow our role as a change-making, activist organization, by positioning ourselves as a credible voice in multiple public health conversations. Below are some moments when we flexed our activist muscle.

Public Comments

Price Transparency
Price transparency is a cornerstone of our work to empower health care consumers. In March 2018, we submitted public comments in response to a bipartisan group of U.S. Senators inviting feedback on a new initiative to improve health care price and information transparency. In June 2018, we made additional public comments on a rule proposed by the Centers for Medicare & Medicaid Services (CMS) affecting health care information transparency. We submitted comments to CMS with ideas on how best to make health care price and quality information fully available to health care consumers.

Association Health Plans
In March 2018, we weighed in on a proposed rule by the U.S. Department of Labor to broaden the availability of health insurance sold through associations of employers, otherwise known as Association Health Plans (AHPs). Through our robust body of work to expand health care coverage to New Yorkers, we knew that this proposal could erode consumer protections, destabilize insurance markets, and raise health care prices for Americans. To help protect consumers’ health care access, we submitted public comments to the Department of Labor, coming out against the proposed rule and offering suggestions for consumer empowerment and protections.

“Public Charge” Rule
In December 2018, we came out against the proposed rule by the U.S. Department of Homeland Security for changes to the public charge criteria in immigration policy. Previously restricted to the receipt of cash assistance, the rule’s proposed changes would expand the list of programs that would be considered in public charge determinations to include Medicaid, Supplemental Nutrition Assistance Program, and housing. Recognizing the negative impact that this would have on the health of New Yorkers and Americans across the nation, NYSHealth submitted public comments urging that the proposed rule be withdrawn in its entirety.

Diabetes Prevention
We also exerted our voice on diabetes prevention, drawing on our earlier work to connect people who have prediabetes with the Diabetes Prevention Program (DPP), an evidence-based lifestyle intervention that helps reduce a person’s risk for developing the condition. We had previously supported the spread of the DPP to 70 sites across New York State. In 2018, we submitted public comments to CMS, urging it to reimburse a larger share of the costs of DPPs. Coupled with this effort, we co-authored a paper on Medicare reimbursements for DPPs, adding our voice and expertise to the conversation on the affordability and availability of the DPP. We also prepared a letter of support for New York State to fund DPP services under its Medicaid program. The letter was shared with key State government and industry stakeholders.

Veterans Treatment Court Activism

In 2018, we continued our efforts to ensure that every New York veteran has access to a high-quality Veterans Treatment Court (VTC) if they need one. VTCs were first started in New York State in 2008 as an alternative to incarceration for veterans who have committed low-level crimes and have mental health or substance use issues. After producing a policy brief in 2017 about the expansion and progress of VTCs in the State and nationally, we prioritized access to VTCs as a cornerstone of our commitment to veterans’ health in 2018. Our grantee, Justice For Vets, spearheaded a series of workgroup meetings with representatives of the New York State Unified Court System, district attorneys, State officials, law enforcement, veterans themselves, and other important stakeholders to develop an initial plan for universal access to VTCs in New York State. Looking ahead to 2019, NYSHealth and our partners will push for the adoption of the proposed plan.

Informing the Field

NYSHealth is committed to supporting timely, unbiased, credible analyses of the pressing health policy issues facing New York State. We aim to advance knowledge and learning about critical health issues and to inform health care policy and practice in New York State and even nationally.

In 2018, the Foundation and our grantees produced a number of reports and briefs that are informing the fields of public health and health care by answering a range of questions:

What would be the impact of a single-payer health plan in New York State?
The RAND Corporation found that a proposed single-payer health care plan in New York State could expand coverage for all New York State residents, but would require significant new tax revenue. The study was the first independent, rigorous, and credible analysis of an issue that has taken center stage for New York State and the nation. NYSHealth commissioned the research to ensure that, with a fair and factual assessment in hand, the public and policymakers could make up their own minds about the merits of a single-payer approach. And that came to pass: editorials, blog posts, and commentaries from advocates, policymakers, and a range of health care leaders expressed a wide range of opinions on the implications of the study. It attracted substantial media coverage throughout New York State and nationally, was cited in the debate between Democratic primary candidates in the New York Gubernatorial race, and sparked conversations about the best options for New York State to achieve universal health insurance coverage.

How are pharmaceutical payments linked to opioid prescribing patterns?
An NYSHealth analysis found a clear trend: New York doctors who receive opioid-related payments from pharmaceutical companies write more opioid prescriptions. Every dollar a doctor receives in opioid-related payments was found to be associated with at least $10 of additional opioids prescribed. The results add to a growing body of research raising concerns about physician-industry relationships and help shine a light on potential conflicts of interest at a time when New York authorities at the city, State, and county levels have filed more than a dozen lawsuits against opioid manufacturers. This work is also being used to inform lawsuits between county governments across the country and opioid manufactures for their role in the opioid public health crisis.

What is the state of nutrition education, and how can it be improved?
The Laurie M. Tisch Center for Food, Education & Policy prepared a series of groundbreaking reports revealing the complex landscape of nutrition education policy at the federal, New York State, and New York City levels. The first two reports (“Empowered Eaters”) provide road maps to empower New York eaters throughout their lives, in all of the places where they live, work, learn, worship, and play. The final report (“A is for Apple”) and accompanying searchable database studied 40 organizations that run 101 nutrition education programs in schools across New York City, revealing key opportunities to ensure all New York City students have access to high-quality nutrition education. The findings have been shared with policymakers and stakeholders at meetings and conferences throughout the State. The “A is for Apple” report and database have been well-received and noticed at the national and local levels; other states and several regions of New York State have expressed interest in replicating the report in their regions.

What is the landscape of PFACs in New York State hospitals?
An assessment by the Institute for Patient- and Family-Centered Care examined the prevalence and impact of Patient and Family Advisory Councils (PFACs) in New York State hospitals. The analysis found that hospitals with PFACs perform better on measures of quality and patient satisfaction, but only a small percentage of New York hospitals have a high-functioning PFAC. The report was released at the 2018 International Conference on Patient- and Family-Centered Care, where it was distributed to more than 1,000 participants. In addition, a new project led by Island Peer Review Organization (IPRO) and X4 Health, supported by NYSHealth, will pilot a new model that uses virtual technology to improve patient participation and involve a larger, more diverse array of patients and families in PFACs.

Are civilian providers prepared to care for returning veterans?
A report by the RAND Corporation found that only about 2% of health care providers in New York State are fully equipped to provide timely, high-quality care to veterans in their community. Most civilian providers fell short on items such as being familiar with military culture or routinely screening for conditions common among veterans. The findings have shaped NYSHealth’s own work to increase the capacity of those serving veterans, including (1) a statewide program led by SUNY New Paltz to increase health care providers’ readiness and ability to serve returning veterans on college campuses, (2) the expansion of a behavioral health care program by the Headstrong Project that offers mental health treatment to veterans free of charge, and (3) a cultural competency training program through the New York Legal Assistance Group to equip non-VA providers with skills to better meet the needs of veterans.

How can New York encourage healthy, local food in schools?
New York’s State budget for the fiscal year 2019 contains an ambitious “No Student Goes Hungry” program. This program includes raising the State reimbursement rate for school meals from less than 6 cents to 25 cents per meal (the most generous rate in the nation) for every district that spends at least 30% of its food budget on locally grown or produced products. NYSHealth produced a brief highlighting lessons learned from a pilot project in the North Country of New York State, as well as from other states, to help guide effective implementation of New York’s statewide program.

Understanding and Responding to Emerging Health Needs

We’ve continued our efforts to address the opioid epidemic in New York State. NYSHealth research raises concerns about physician-industry relationships and potential conflicts of interest. We also partnered with the American Congress of Obstetricians and Gynecologists (ACOG) to shine a light on the issue of opioid-addicted new mothers and their babies—a facet of the epidemic that hadn’t previously garnered much attention. ACOG has been training providers to help them appropriately treat these new mothers and the babies who are born addicted. As of 2018, ACOG’s recommendations are being piloted at 17 hospitals across the State—including Albany Medical Center Hospital, Glens Falls Hospital, Good Samaritan Hospital Medical Center, John R. Oishei Children’s Hospital of Buffalo, North Shore University Hospital, New York-Presbyterian/Columbia University Medical Center, and Strong Memorial Hospital/University of Rochester Medical Center.

Another pressing health issue is the growing threat of environmental health hazards. Major attention has recently been focused on lead paint hazards in New York City’s public housing, and elevated lead levels in the City’s water supply pose significant health risks. In 2018, we partnered with New York Public Radio (WNYC) to launch a crowd-sourcing project to test water lead levels throughout the City. By involving community residents in testing local water and soil sources, WNYC will be able to gather more data to find out which City parks pose the highest public health risks. The reporting series, “Lead in Our Water,” will air through WNYC and chronicle stories of children who have tested positive for dangerous levels of lead from previous decades to the present day. Similarly, we worked with Clean and Healthy New York to launch a public education campaign about the importance of expanding toxic chemical disclosure requirements. On a daily basis, Americans are exposed to thousands of chemicals—few of which are adequately tested for their effects on health. We released a fact sheet on potentially toxic chemicals in everyday personal care products and disseminated it to State policymakers. As a result of this outreach, new legislation is expected to be introduced that seeks to expand standards for more comprehensive disclosure requirements of harmful chemicals in consumer goods.