NYSHealth's "Best of 2019" Annual ReportIn 2019, NYSHealth focused attention on 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 2019 to learn about some of our biggest wins.
Improving Community Health
Through our Building Healthy Communities program, neighborhoods across the State made healthy, affordable food and safe places for physical activity more available to residents. Our grantees teamed up with residents and other community partners to connect adults and children to a wide array of programming and activities that encourage healthy behaviors.
Clinton County residents now have more opportunities for walking, biking, and hiking coming their way. The Foundation of Champlain Valley Physicians Hospital began revitalizing 26 miles of trails as part of the Saranac River Trail Greenway, including through the development of a children’s playground and adult physical activity stations. Clinton County residents struggling with food insecurity and hunger now have better access to healthier, more nutritious items at food pantries throughout the region. A survey by the Clinton County Health Department (CCHD) had found that many of the county’s food pantries lacked the equipment and space for storing fresh fruits and vegetables. In response, CCHD worked with 13 county food pantries—including 11 of those in the most rural reaches of the region—to improve their ability to receive, store, and distribute fresh produce and other perishable items of better nutritional quality. Nine food pantries have since received new refrigeration units, and all the food pantries have steadily improved the quality of food products for clients. Additionally, more than 30 county organizations that routinely organize food drives, such as churches, schools, and post offices, are now educating donors on and accepting healthier food donation items. By the close of 2019, Clinton County food pantries served more than 27,000 food-insecure individuals, who are now able to choose healthier food options for themselves and their families.
In the Near Westside neighborhood of Syracuse, about 250 children and youth participated in Missio Church’s wide range of year-round programming—from Summer Fun at Skiddy Park’s softball league and soccer and baseball clinics to arts and crafts activities and homework assistance at a teen-mentored afterschool kids’ club. Now serving about half of the youth in the Near Westside, these programs provided regular physical activity for kids who would otherwise not have access to free, healthy activities in their neighborhood. City officials, including the Mayor of Syracuse and Chief of Police, also regularly attended Missio-sponsored events; their presence is helping to change safety perceptions about the Near Westside.
Local artists from around the Niagara Falls area painted vibrant murals along the Walk to Freedom Trail as part of a larger effort to increase the appeal of public spaces and provide more opportunities for physical activity for residents. The Walk to Freedom Trail connects the Highland Avenue neighborhood of the city to the Niagara Falls Underground Railroad Heritage Center. The murals feature figures of historical importance to the Underground Railroad, such as Harriet Tubman and the Cataract House Hotel, and have started bringing visitors and residents alike to the walking trail. (Learn more about the murals and other points of pride for Niagara Falls residents in this video.)
The Brownsville Community Justice Center (BCJC) in Brooklyn worked to expand peacekeeping practices and activation of public spaces in the neighborhood, where concerns about physical activity continue to be a significant barrier to physical activity. This summer, BCJC hosted a “Be on Belmont” series of street festivals that featured an outdoor garden healing space, bringing more than 930 community members together. The healing space, a first of its kind in Brownsville, served as a way to help residents feel connected to their neighborhood and learn stress reduction techniques. Each resident who attended was connected to at least two resources for things like legal services, housing, health services, and education. In light of a traumatic shooting in Brownsville this year, this programming remains crucial for continued community healing.
Policy-level efforts to improve community health also continued to bear fruit. In 2017, alongside key partners such as Community Food Advocates, NYSHealth successfully advocated for universal free school lunch for all 1.1 million students in New York City schools. Two years after that hard won policy change, an additional 26,000 students are now eating lunch at school. Recent research also found that making free lunch available to all students boosted academic performance among New York City middle school students, and that universal school lunch may increase the likelihood of students having a healthy weight. Making lunch universally free removed many barriers to health and learning, but it was just the beginning. Efforts are now underway to ensure that more students are eating lunch at school. The New York City Department of Education committed an additional $25 million in the 2019–20 school year to redesign up to 70 middle school and high school cafeterias throughout the City. And, as schools look to expand fresh, local, culturally appropriate healthy food options, a new report from the Laurie M. Tisch Center for Food, Education & Policy found that it is feasible for the New York City school district to prepare and serve scratch-cooked meals to students. Together, these efforts are adding up to healthier schools, healthier students, and healthier communities.
Making the Health Care System Work Better for Patients
Our grantees’ efforts to spread OpenNotes in New York State picked up speed—engaging and sharing visit notes with patients and implementing innovative projects. NYC Health + Hospitals’ (H+H) work to pilot OpenNotes continues to grow; as of spring 2019, more than 2,000 providers across 280 departments were participating in the project, and 18,000 patients were enrolled through H+H’s online patient portal to have access to OpenNotes. New York and Presbyterian Hospital saw its OpenNotes project spark a systemwide transformation, following a successful pilot among elderly Medicare patients enrolled in its accountable care organization. Northwell Health has more than 3,500 providers at more than 450 partner sites creating almost 120,000 OpenNotes each month for patients, and Roswell Park Cancer Institute has fully implemented OpenNotes, with all its providers sharing a combined 28,000 notes with patients to date.
To spread OpenNotes to all settings where New Yorkers receive care, we selected six primary care organizations across the State to implement OpenNotes at their facilities. Through these combined efforts, more than 1.1 million New Yorkers have access to their notes—giving patients and their caregivers more control over their care. And we are keeping up the momentum, with a new RFP targeting more hospital systems across the State, expected in early 2020.
A range of efforts to empower patients to advocate for policy change also took off in 2019. MergerWatch, now part of the Women’s Health Program of Community Catalyst, had a significant win in its campaign to make the Certificate of Need (CON) process more consumer-friendly and transparent for New Yorkers—achieving its goal to increase the number of consumer representatives on the Public Health and Health Planning Council (PHHPC). Governor Cuomo has now directed the New York State Department of Health to appoint two additional consumer representatives to vacant positions on the PHHPC, which advises decision-making with respect to New York State’s public health and health care delivery system.
Medicare Rights Center (MRC) counselors are answering questions and providing help with issues like how to enroll in Medicare for the first time, cost/coverage of prescription drugs, and how Medicare works with other types of insurance. MRC also began creating detailed advocacy guides for Medicare beneficiaries and their caregivers to help them troubleshoot a range of issues, such as Part B enrollment for individuals over and under 65.
The Community Service Society of New York launched its We The Patients NY campaign to empower consumers to speak for themselves about their health care experiences and their preferences for policy solutions. Since its launch, more than 3,000 New Yorkers have become involved in the campaign, including engaging through 8,000 posts, likes, shares, and retweets via Facebook, Twitter, Instagram, or e-mails. Consumers are also sharing their stories and gathering support through dozens of personal blog posts, relaying their experiences with issues like surprise medical bills, facility fees, and patient safety education. More than 30 New Yorkers have also been trained to effectively advocate for policy change that addresses health care affordability, medical debt, and medical billing issues; 7 more trainings across New York City and upstate New York are slated for early 2020.
Ensuring veterans get quality health care
A theme in the Foundation’s work is considering ways that the Department of Veterans Affairs (VA) and the private sector can work together to best address the needs of New York State’s veterans. We hosted the Honorable Robert A. McDonald, 8th U.S. VA Secretary, at our annual veterans’ health conference to discuss how VA and community-based care can coexist. We also hosted a public event with Dr. David Shulkin, the 9th U.S. VA Secretary, who shared his experience transitioning from the private sector to the White House and discussed what it would take to provide high-quality health care to veterans through public-private partnerships.
We examined where VA hospitals lead and lag in New York State, finding that VA hospitals and non-VA hospitals perform similarly on most measures. The implementation of the VA Mission Act this year brought into sharp relief the need for the private sector to be prepared to serve veterans and their families. A RAND Corporation study in 2018 found that only 2.3% of private providers in New York State fully met the readiness criteria to provide high-quality care to veterans. Recognizing this gap, the Resilience Center for Veterans and Families in 2019 implemented cultural competency trainings for health care providers across the State. The New York Legal Assistance Group trained and educated private, non-VA health providers about the unique health and social needs of veterans. Similarly, SUNY New Paltz delivered veteran and military competency trainings to 198 professionals from 62 public and private colleges across the State. And the Headstrong Project recruited 22 more mental health care professionals to provide free, high-quality services to veterans in upstate New York regions.
Responding to Emerging Health Issues
The Foundation’s work to address the opioid epidemic in New York State further evolved in 2019. Weill Cornell employed behavioral economics to reduce opioid over-prescribing by changing the default settings for providers in the hospital’s e-prescribing system. Early results show the system has succeeded in doubling the rate at which providers followed recommended prescribing practices. Weill Cornell’s success has engaged other hospital systems in learning about and implementing similar models. We have also been working to address the epidemic from a justice-related perspective by expanding on a successful harm-reduction model to divert low-level, nonviolent offenders (such as those charged with low-level drug-related offenses) from incarceration and into behavioral health treatment programs. We previously supported the LEAD (Law Enforcement Assisted Diversion) program’s successful expansion into Albany and Staten Island; this year, the Partnership for the Public Good expanded the program into Buffalo, where more than 35% of arrests are for low-level charges.
Another growing health crisis is the increasing number of suicides among vulnerable populations, especially populations of color. The Steven C. Rose Legacy Fund expanded mental health and suicide prevention programming on college campuses, specifically for students of color in New York City. In November, the Fund engaged more than 230 participants (representing all 25 CUNY campuses) in a convening that highlighted the latest research and insights on reducing barriers to mental health and fostering a learning environment that promotes wellbeing for students of color. Moving into 2020, NYSHealth will be exploring more opportunities to prevent suicide among another vulnerable population—returning veterans.
A significant issue that permeated the public health landscape in 2019 was the increase in vaccine hesitancy. New York State alone saw approximately 900 confirmed cases of measles, a dangerous resurgence of a disease that was declared eradicated in 2000. The Public Good Projects created a media surveillance system to help public health officials combat misinformation on vaccines. The surveillance system went live in fall of 2019; active users now include the New York City Department of Health and Mental Hygiene, the Centers for Disease Control and Prevention, Community Health Care Association of New York State, and New York State Association of County Health Officials. The American Academy of Pediatrics NY Chapter 1 (AAP) is addressing the high prevalence of human papillomavirus (HPV), which infects 2,375 New York State residents each year. To date, AAP has trained 120 physicians in 34 practices on the value and effectiveness of the HPV vaccine and strategies for talking to parents about its importance. Since the project’s launch, participating providers report a 15% increase in the HPV vaccine series initiation rate among their patients.
Informing the Field
Informing health care policy and practice is a cornerstone of our mission. In 2019, the Foundation and our grantees weighed in on a number of important topics with impact on New York State and beyond.
NYSHealth and the Health Care Cost Institute (HCCI) issued a joint report on health care spending in New York State, examining spending, utilization, and prices for New Yorkers covered by employer-sponsored health insurance from 2013 to 2017. The report found health care spending is both higher and rising more sharply than the national average. Health care price increases, rather than increases in health care utilization, accounted for the overwhelming majority of spending growth. The report garnered extensive media coverage, including in The Wall Street Journal, and the President and CEO of HCCI shared the findings at a public NYSHealth event.
On the heels of a new law that eliminated religious exemptions for school vaccination requirements in New York State, we published an analytic brief on the law’s potential impact. The brief included county- and school-level data showing where the most students were unvaccinated because of religious exemptions. Among the findings, more than 26,000 students in public and private school and preschool programs statewide had documented religious exemptions from required vaccines. As court cases unfolded and schools moved to comply with the new policy, NYSHealth’s findings were regularly cited in news stories to provide context and demonstrate the scope of the law’s impact.
As a national outbreak of illnesses linked with vaping products continued to rise and health officials grew increasingly concerned, we released an analysis of youth vaping in New York State. The analysis found that more than half of high school seniors have tried vaping, and vaping has been growing quickly among young people since 2014. Additionally, more than 80% of students who have tried vaping used a flavored product the first time they vaped. Those who first used a flavored product are especially likely to believe that vaping is less harmful than cigarette smoking. These findings helped affirm that policymakers should be especially focused on flavored vape products to have the most impact on young people.
From $2,000 for three stitches to more than $11,000 for a 27-mile air ambulance ride to the hospital, surprise bills continue bedevil health care consumers and dominate the headlines. We shared details on New York State’s own groundbreaking surprise bills legislation in an issue brief. The brief gave an overview of the law’s impact, as well as further enhancements that can be made to continue New York’s leadership on an issue that is increasingly receiving attention as a pro-consumer and pro-price transparency priority.
Over the course of 2019, we submitted public comments on important national issues that could have a big impact on New Yorkers, including some of our most vulnerable residents. Related to our consumer empowerment work, we responded to proposed rules that would require more transparent, useful information about prices and for making health care information more easily available to patients. These are good ideas that could be strengthened. On the other hand, a series of proposed rules that would limit SNAP eligibility and restrict states’ flexibility in this area should be withdrawn entirely. In public comments, blog posts, e-mails, letters to the editor, and speeches, NYSHealth spoke out against these policies that would take food out of the mouths of hundreds of thousands of New Yorkers.
In 2019, we also held 33 convenings to bring together grantees and other health and health care experts on a range of issues—from meeting the needs of New York State veterans to involving patients in health care decision-making to supporting resident-led efforts to improving community health. Among the topics discussed were how to build a more just, sustainable food system, the rights and health of detained immigrants, and the challenges that arise in hospital discharge planning for patients and their families.
We also continued to support nonprofit organizations in New York State to elevate their work and inform key stakeholders across the State and nationally. Through a Request for Proposals, we sponsored 44 organizations to attend and present at local, State, and national conferences related to building healthy communities, empowering health care consumers, and meeting the needs of returning veterans and their families. The support enabled nonprofit leaders to share their findings, build networks, inform other leaders’ thinking, shape projects, raise professional awareness, and set the stage for future work.