This Year's Highlights

Grantee Efforts to Simplify and Streamline Medicaid

Making public programs work better is a fundamental strategy of NYSHealth’s program to expand coverage to the State’s uninsured population. In New York State, such programs are a cornerstone of the insurance system. Collectively, approximately 4.9 million New Yorkers are covered by Medicaid, Child Health Plus, and Family Health Plus. At least another 1 million New Yorkers are estimated to be eligible for public coverage but not enrolled.

NYSHealth grantees worked to ensure that all eligible people receive and retain their coverage and that the programs operate on a cost-effective and financially sustainable basis. Quick-strike, technical analyses provided program officials with practical, actionable information to enable wise programming and implementation decisions and policy changes.

  • Georgetown University developed options for collapsing and simplifying Medicaid’s multiple and overlapping eligibility categories; many of the recommendations were subsequently proposed in the Governor’s 2009-2010 budget and adopted into law.
  • Lake Research Partners conducted focus groups to understand why so many eligible people fail to renew their coverage. The results received broad attention and reinforced the State’s decision to implement telephone renewal procedures.
  • PMB Healthcare Consulting subsequently provided technical support to help build the phone renewal system.
  • Manatt Health Solutions recommended ways to streamline the Excess Income Program, which allows individuals with large or ongoing medical expenses access to Medicaid coverage even though their household incomes are too high to meet the regular Medicaid income eligibility standards.
  • New York University helped shape the $30 million Chronic Illness Demonstration Project, a major effort to manage and improve the care for some of the sickest and most expensive Medicaid patients.
  • The Rockefeller Institute of Government reviewed the prevalence of denials for Medicaid-funded nursing home care and found wide variation in reported denial rates across the State’s counties.
  • Finally, Spitfire Strategies designed and conducted focused enrollment drives for the State’s public health insurance programs and reached thousands of New Yorkers.

NYC Health Insurance Link: Connecting New Yorkers with the Right Health Insurance

New York’s uninsured overwhelmingly belong to working families who have difficulty finding affordable coverage and confront a maze of confusing choices. NYC Health Insurance Link is a Web-based tool to help small business owners, freelancers, and other independent or unemployed workers find a health insurance plan that best fits their needs and budgets. Developed by the NYC Office of Citywide Health Insurance Access with NYSHealth support, users can search for and compare health plans, including those with low and high deductibles; those with and without particular benefits like prescription drugs; and those with open and closed provider networks. The tool provides users with a full range of comprehensive health plans available in the City from every carrier, including plans available through specialized purchasing alliances and Healthy New York products.

Mayor Bloomberg launched the tool at a press event held at a small business in Brooklyn. When basic business information (such as the number of employees to be covered, preferred benefits and other information is entered) NYC Health Insurance Link generates a list of possible health plans and provides a direct comparison of the costs and benefits of each. Users can also use a premium calculator on the Web site to vary their contribution amounts, and to determine the best premium contribution they can afford to offer their employees. For individuals, it asks basic information about household size, income, and work status to help them determine whether public health insurance may be an option, as well as to show them private health insurance plans.

Seton Health’s Defy Diabetes Initiative

As a comprehensive, integrated Catholic health care system in Troy, NY, Seton Health provides regional-based services to residents of Rensselaer, Southern Saratoga, and Northern Albany counties. The mission of Seton Health is to commit itself to serving all people, with special attention to those who are poor and vulnerable.

With the support of NYSHealth, Seton Health’s Defy Diabetes project has advanced this mission through the formation of an interdisciplinary Defy Diabetes working committee, collaborative partnerships, faith community parish nurses, and nurse champions and physicians within the primary care system. This team is working to reach 1,000 people through Seton Health’s Faith Community Parish Nurse Program via health fairs, church talks, and healthy living classes. The team also is engaging 25 primary physician practices to achieve both American Diabetes Association guidelines and National Committee for Quality Assurance certification through quarterly practice assessments and regular chart reviews. Defy Diabetes will serve as a replicable model for the partnership between the faith community and health care systems.

Seton Health shared the work of its Defy Diabetes project at the August 2009 American Association of Diabetes Educators conference in San Antonio, Texas. Seton Health’s presentation was received with great enthusiasm by certified diabetes educators interested in replicating Seton Health’s Defy Diabetes Nurse Champion model in both faith communities and primary care sites throughout the country.

Primary Care Grantees: Success Stories

Over the last decade, hospitals and health centers have begun to work together to stay financially viable, and to maintain quality and continuity of patient care. Many hospitals are transferring the management of the ambulatory primary care clinics that feed their specialty and inpatient services to federally qualified health centers (FQHCs). FQHCs’ favorable Medicaid reimbursement rates and lower professional liability insurance costs allow them to operate more cost-effectively.

NYSHealth is committed to helping preserve the primary care safety net in New York State. In 2009, the Foundation funded several projects that either assisted hospitals and community health centers with forming partnerships that facilitated the transition of hospital outpatient clinics to the auspices of FQHCs, or brought primary care services to New York State’s underserved and vulnerable populations by establishing satellite clinics associated with regional FQHCs. Please click the below links to learn more about these projects:

The Success of the Medicare Rights Center

Many New York seniors who are eligible for programs that can save them money on their Medicare benefits are not enrolled in these programs. With NYSHealth support, the Medicare Rights Center conducted an aggressive, targeted outreach campaign to identify and enroll qualifying seniors in Medicare Savings Programs and the Medicare Part D Low-Income Subsidy program.

The Medicare Rights Center sent letters and information about these savings programs to potentially eligible seniors, and set up a hotline where seniors could receive additional information and help with their applications. These efforts led to approximately 3,500 seniors enrolling in Medicare programs, saving them more than $17 million. This work also generated nearly $5 million in savings for New York State. Savings will be enjoyed year after year for those seniors who retain their enrollment in these programs.

Due to the success of this grant, NYSHealth awarded a follow-up grant to the Medicare Rights Center to reach the remaining seniors believed to be eligible for savings programs and to ensure enrolled seniors maintain their benefits. New York State is co-funding this effort and is now pursuing these enrollment strategies.

Establishing the Center of Excellence for Integrated Care

In January 2009, NYSHealth announced a milestone $3.7 million grant to National Development and Research Institutes, Inc. (NDRI) to oversee the first statewide Center of Excellence for Integrated Care(CEIC) to transform the system of care for 1.4 million New Yorkers suffering from both mental health and substance use conditions.

At a press conference in the Legislative Office Building, top officials from the New York State Office of Mental Health and the New York State Office of Alcoholism and Substance Abuse Services joined NYSHealth to announce the grant. NYSHealth’s initiative aims to achieve the integration of mental health and substance use services throughout all phases of the recovery process for patients at all of New York’s 1,223 licensed mental health and substance abuse outpatient treatment centers.

To date, CEIC has engaged in leadership forums and provider trainings in five regions in New York State. CEIC has also provided technical assistance to and conducted Dual Diagnosis Capability Assessments for several organizations throughout the State. In addition to the NYSHealth Web Resource Center on Integrated Care, CEIC has launched a website that provides detailed information and resources particularly for mental health and substance use providers in New York State.

Launch of the Diabetes Social Marketing Campaign

With diabetes patients receiving only 45% of recommended clinical care based on national guidelines for screening, diagnosis, treatment, and follow-up, NYSHealth’s Diabetes Campaign launched a statewide social marketing initiative in November 2009. The “Half the Care” campaign urges physicians to provide more comprehensive care to their patients with diabetes.

The “Half the Care” campaign features images of doctors split in half to dramatize the fact that patients receive half the care they need, and promotes a rallying message that “We can do better.” Print and Web-based banner ads are running in professional medical publications, including the Journal of the American Medical Association and the New England Journal of Medicine, and on popular medical Web sites, reaching a subscriber base of more than 1.5 million. Educational materials are also being distributed directly to more than 11,000 physicians across New York State. Doctors and other health care providers can access resources and tools on a dedicated Web site, www.FullDiabetesCare.org. The “Half the Care” campaign has been covered in national, consumer, and trade media outlets, including ReutersCrain’s Health Pulse, and The Bronx Times.

NYSHealth Conference: “Having it All: Can New York State Control Health Costs While Improving Access and Quality?”

Rising health care costs continue to put pressure on state budgets across the nation, and most experts agree that Federal reform will further increase the amount states spend on health care. Faced with this reality, states are searching for methods to contain costs. This is particularly true in New York, which has the highest per capita expenditures on Medicaid and the third highest total health care costs (both public and private) per capita among states.

To bolster New York’s efforts to contain rising costs, NYSHealth held a conference with more than 200 attendees on October 28, 2009 that explored cost containment efforts in Massachusetts and Maine, as well as some pilot programs around the State, and considered the ways they could be expanded. The conference, entitled “Having It All: Can New York State Control Health Costs While Improving Access and Quality?” touched on a range of cost-cutting strategies, including reforming payment structures, reducing hospital readmissions and improving care management and efficiency.

As a whole, the conference demonstrated that it is possible to contain rising health care costs without jeopardizing the quality of care. In some cases improved care and lower costs went hand-in-hand. However, what was also clear is that true cost reform will not come easily and will require the collective effort of the entire health care sector.

To download the panelists’ PowerPoint presentations, please click the links below:

NYSHealth’s “A Conversation With…” Series

In 2010, NYSHealth continued its efforts to convene State and local government policymakers, industry leaders, and health care advocates. Throughout the year, we hosted five events with experts in areas ranging from models to improve care for people with chronic illnesses, to health information technology, to veterans’ issues.

The format of the series provides an intimate discussion with health experts, and features an interview with a special guest and NYSHealth President and CEO James R. Knickman. This year’s installments included:

  • Dr. Edward Wagner, Director of the MacColl Institute for Healthcare Innovation at the Center for Health Studies’ Group Health Cooperative and creator of the widely used Chronic Care Model
  • Colonel (Retired) James McDonough, Director of the New York State Division of Veterans’ Affairs, and Paul Rieckhoff, founder and Executive Director of Iraq and Afghanistan Veterans of America (IAVA), who discussed veterans health and mental health issues
  • Michelle Mello, Ph.D., J.D., national expert on medical malpractice and Professor of Law and Public Health at the Harvard School of Public Health, who discussed health reform options and lessons learned from the success and failure of reform in other states
  • Rachel Block, Deputy Commissioner for Health IT Transformation for New York State, who led a discussion about the State’s current efforts to encourage wide-scale adoption of health information technology
  • Marion Nestle, Paulette Goddard Professor of Nutrition, Food Studies, and Public Health at New York University who discussed obesity policy issues, particularly with regard to children and regulating school food marketing and food served in schools

NYSHealth’s First Economic Recovery Fund

2009 ushered in an economic recession that adversely affected every state in America. As the home of the financial services industry, New York State continues to be hit especially hard by the decline.

The recession also caused a rise in demand for nonprofit services during a time when institutional philanthropic support diminished as a result of reductions in endowments. In the past year, many foundations that were connected to financial institutions have either ceased funding or reduced their funding commitments. With reduced philanthropic resources, government contract cuts, and a decrease in individual giving, nonprofits experienced difficulty financing core projects and expanding new ones.

In response to this time of increased need, NYSHealth developed an Economic Recovery Fund to assist New York State’s nonprofit health sector during the economic crisis. NYSHealth allocated $2.3 million in grant funding to facilitate organizations’ transition to new and reorganized forms (mergers, partnerships, and internal restructurings) that will be more sustainable over time. Through its 2009 Economic Recovery Request for Proposals, NYSHealth funded the following nine projects to promote fundamental, lasting changes in organizations that comprise New York’s health services delivery system: