This Year's Highlights
In lieu of a traditional annual report, the New York State Health Foundation has identified 10 achievements in 2010 that represent the best work of the Foundation, our grantees, and our partners to improve the state of New York’s health.
It is a privilege to work with so many innovative, caring organizations throughout New York State to advance the health of all New Yorkers. We are impressed with what they can accomplish and what a philanthropy like ours can help make happen.
The accomplishments included here represent not only activities supported directly through grants, but also the broader efforts that can affect health care practice and policy in New York State when organizations and individuals work collaboratively. As the Foundation matures (we will mark our five-year anniversary in 2011), efforts to inform and shape the conversation about pressing health care system issues; to replicate, spread, and sustain promising and proven approaches to improve health; and to capture and share lessons about effective strategies are paramount.
In 2010, the passage of Federal health reform offered an unprecendented opportunity to expand affordable health care coverage to millions more New Yorkers. At the same time, the imperatives to ensure that all New Yorkers have access to high-quality care and to contain health care costs have never been stronger. This larger context shaped much of NYSHealth’s work in 2010–not only in the health care coverage priority area, but also in the Foundation’s efforts to prevent and manage diabetes, to provide integrated services for people who cope with mental health and substance use disorders at the same time, and to respond to the unique needs of communities across New York State.
As New York State continues to implement the Federal health reform law, the Foundation remains committed to working with our partners and grantees to address timely opportunities and critical needs to improve New York’s health system. Enjoy this look back at the Best of 2010; the Foundation looks forward to building on these successful efforts in 2011 and beyond.
James R. Knickman
President and CEO
Helping New Yorkers Affected by Haiti’s Earthquake
Following the devastating earthquake in Port au Prince, Haiti, in January 2010, NYSHealth staff immediately asked whether our organization could find a way to help that was consistent with our mission to improve the health of New Yorkers.
Staff members reached out to local and national funders and community-based organizations to explore opportunities to help meet the immediate needs of the local Haitian population—many of whom still have family or had lost loved ones in Haiti—as well as newcomers displaced by the earthquake and adjusting to life in New York.
It quickly became clear that there was an unmet need for health care and mental health services, particularly in the Haitian communities of Brooklyn, Queens, Long Island, and Rockland County. For regional impact, the Foundation awarded grants to three organizations providing health and social services in these areas. NYSHealth became a supporting partner in two funding collaboratives (The New York City Haitian Community Hope and Healing Fund and the Long Island Haitian Support Fund) and awarded a grant to the HACSO Community Center.
Learn more about the projects, and read NYSHealth’s President and CEO James R. Knickman’s perspective on the Foundation’s approach to these investments.
Advancing Health Reform Implementation in New York State
Passage of the Federal health reform law in 2010 was clearly a game-changer, but the success or failure of reform will depend largely on how well the law is implemented at the State level. NYSHealth supported a number of efforts in 2010 to ensure that as many New Yorkers as possible will benefit from health reform.
The Foundation commissioned a report, prepared by Manatt Health Solutions and NYSHealth Visiting Fellow Deborah Bachrach, to review and analyze the key provisions of the law. The report, Implementing Health Care Reform: A Roadmap for New York State, also projects the unique implications that each provision of the law holds for New York, and identifies the tasks and hurdles that State government and other stakeholders must confront when implementing reform: creating the insurance exchange(s); reforming the payment and delivery system; and expanding access to care.
The Foundation also awarded grants to:
• Community Health Care Association of New York (CHCANYS), to provide technical assistance to health centers across the State to develop strong, competitive applications in response to Federal requests for funding proposals (the reform law makes available $11 billion to improve access to health care through community health centers);
• Community Service Society of New York, to examine the role of a Basic Health Program in a reformed health care system;
• United Hospital Fund, to explore design issues related to setting up the exchange;
• Manhattan Institute, to highlight market-oriented design issues related to the exchange;
• Medicare Rights Center, to ensure seamless coverage for “dual eligible” New Yorkers who qualify for both Medicare and Medicaid;
• Social Interest Solutions, to conduct an eligibility and enrollment systems inventory, examining the State’s existing information technology assets and deficiencies and identifying improvements needed to launch and operate a functional exchange; and
• Empire Justice Center, to lead a coalition of eight consumer organizations that will develop a framework for implementing the Navigators and Consumer Assistance Programs mandated under the health reform law.
Improving Clinical Care for Patients with Diabetes
A key strategy of the Foundation’s Diabetes Campaign is improving clinical care and health outcomes for patients with diabetes, as demonstrated by a critical mass of health care providers achieving national recognition for excellent diabetes care. By 2013, NYSHealth aims to have 3,000 physicians in New York State recognized under the National Committee for Quality Assurance’s (NCQA’s) Diabetes Recognition Program or Bridges to Excellence’s (BTE’s) Diabetes Care Recognition Program, which focus on improved patient outcomes related to controlled blood sugar, blood pressure, and cholesterol.
By the end of 2010, more than 700 New York physicians—more than in any other state—had achieved national recognition, which translates to excellent diabetes care for approximately 200,000 patients.
The Foundation supports this work through partnerships with grantee organizations (HANYS, the Healthcare Association of New York State; CHCANYS, the Community Health Care Association of New York State; New York State Academy of Family Physicians; and the New York Chapter of the American College of Physicians) to provide technical assistance to help their members achieve recognition.
As a complement to these efforts, the Foundation launched a new request for proposals, Meeting the Mark: Achieving Excellence in Diabetes Care, which invites organizations across New York to apply for funds to improve the quality of care for people with diabetes and to support health care providers in achieving recognition by the NCQA or BTE diabetes programs. Through this program, which continues to accept proposals on a rolling basis, NYSHealth will provide $2,500 per physician who achieves NCQA or BTE diabetes recognition.
Replicating Veterans Treatment Courts
Veterans returning home from the wars in Iraq and Afghanistan are at high risk for mental health disorders, but often encounter barriers to receiving high-quality mental health services. Left untreated, some of these mental health disorders (such as post-traumatic stress disorder and depression) may increase the risk of encounters with the criminal justice system. Too often, the underlying mental health problems remain unaddressed and unresolved.
Recognizing the unique challenges veterans face, Buffalo City Court established a veterans treatment court in January 2008 to intervene in cases for minor criminal acts. This court was the first in the nation to offer services to help rehabilitate veterans and successfully reintegrate them into their communities.
Consistent with its commitment both to returning veterans and to spreading effective models, NYSHealth invested in the replication of veterans courts in 10 jurisdictions across New York State. Through a grant to the New York State Unified Court System, the project also supports the development of a curriculum and a train-the-trainer component that will enable additional courts and their partner agencies to bring the model to jurisdictions throughout the State.
Expanding Dental Services for Children
In Columbia County in upstate New York, a significant number of children in kindergarten through sixth grade are at high risk for oral disease as a result of poverty, lack of dental insurance, lack of water fluoridation, cultural and environmental issues, diet, and limited oral hygiene education. Although a significant number of children in Columbia County are enrolled in Medicaid, only a limited number of private dentists within the county currently accept it, given low reimbursement rates.
With support from NYSHealth, New York University College of Dentistry (NYUCD) launched the Columbia County Oral Health Intervention Program. Based on a successful NYUCD pilot dental outreach model for children enrolled in Head Start, the program provides on-site dental services in grade schools throughout Columbia County. NYUCD dental hygiene students, pediatric residents, faculty, and staff have held quarterly dental clinics, offering care to more than 1,000 grade school students.
Community buy-in has strengthened the program; local dentists have worked with project staff to develop a referral system to ensure that children receive necessary follow-up care between the quarterly clinics. The local Healthcare Consortium, Community Partnership for Children’s Dental Health, Columbia Memorial Hospital, County Department of Health, and Office of the Mayor have also been helpful in spreading the word about the program.
Making the Most of New Office Space
At the end of March, NYSHealth relocated to its new office at 1385 Broadway in New York City. The new, larger space has allowed the Foundation to host more onsite convenings, including the popular “Conversation With…” series and meetings with grantees, partners, and stakeholders from across the State.
The Foundation also hosted technical assistance trainings for grantees, covering topics such as evaluation and financial management, and made the space available to grantees and partners for their own meetings and trainings.
Key NYSHealth convenings in 2010 included conversations with:
Alan Aviles and Art Gianelli, who discussed the impact of Federal health reform on New York’s hospital systems;
Commissioners Michael Hogan and Karen Carpenter-Palumbo, who shared their ideas about integrating primary care, mental health, and substance use services in a reformed health system;
Ann Albright of the Centers for Disease Control and Prevention, who spoke about opportunities to prevent and manage diabetes; and
Peggy O’Kane, head of the National Committee for Quality Assurance, who discussed the role of patient-centered medical homes and other quality improvement approaches to enhance health care delivery.
Bending the Health Care Cost Curve
With annual health care spending in New York State projected to exceed $318 billion by 2020, there is a clear and urgent need to develop solutions to contain costs.
In 2010, NYSHealth released a report, Bending the Health Care Cost Curve in New York State: Options for Saving Money and Improving Care. Prepared by The Lewin Group, the report outlines the estimated impact of 10 scenarios—from a tax on sugar-sweetened beverages to mandatory Accountable Care Organizations—that could potentially save billions of dollars over 10 years and improve health care quality in New York State.
In conjunction with The Lewin Group and a Technical Advisory Panel, NYSHealth released high-level plans for implementing four promising scenarios:
• Expanding palliative care;
• Integrating care for dual eligibles (those who qualify for both Medicare and Medicaid);
• Adopting bundled payment methods; and
• Rebalancing long-term care to focus on community-based services.
These were also some of the key issues discussed at the Foundation’s Fall conference, Paying for Health Reform: The Imperative of Cost Containment. Keynote speaker Dr. Glenn Steele, CEO of the Geisinger Health System in Pennsylvania, spoke about his organization’s approach to quality improvement, care coordination, and cost containment. All of the panelists’ presentations are available here.
Preventing and Managing Diabetes in Community Settings
Ensuring excellent clinical care is essential to reducing the toll of diabetes-related complications on New York State, but equally important are community-based efforts to help people at highest risk to prevent and manage the disease. The Foundation’s Diabetes Campaign is committed to working with community- and faith-based organizations to implement and expand diabetes prevention and management programs where New Yorkers live, work, and worship.
First, the Foundation invested in a faith-based diabetes prevention and management program through a grant to the Institute for Leadership (IFL). This faith-based model is rooted in the Defy Diabetes initiative curriculum, which successfully used parish nurses to provide diabetes education, self-management, and referrals to primary care services for congregants who have diabetes or are at high risk of developing the disease. IFL implemented the training in 29 congregations across New York State and plans to work with 75 additional sites in 2011.
NYSHealth, in partnership with the New York State YMCA Foundation and the State Health Department’s Diabetes Prevention and Control Program, also invested in the replication of the Diabetes Prevention Program (DPP) in YMCAs in 10 regions across the State: Capital District, Binghamton, Buffalo, Long Island, Middletown, Plattsburgh, New York City, Rochester, Syracuse and Watertown (for a full list of participating Ys, click here).
The DPP, which has been found to reduce the risk of diabetes among participating adults by 58%, offers sessions on healthy diets, exercise, and behavioral change in a group environment for community members with pre-diabetes. The model is gaining momentum: the Centers for Disease Control and Prevention provided support for an additional five sites in New York State, and at least one private health plan has begun to reimburse for the program, a key step toward ensuring sustainable funding for this effective community-based prevention program.
Expanding Affordable Coverage for Small Business Employees
Expansion of the Family Health Plus Employer Buy-In program was designed to help New York State’s small businesses offer comprehensive, affordable health care coverage to their employees. With support from NYSHealth, the Community Service Society (CSS) of New York examined key design and implementation issues that could increase the program’s success for small businesses and their employees.
CSS took a close look at other states’ employer buy-in programs; interviewed key stakeholders in New York; conducted an actuarial analysis of premium setting; and identified solutions to implementation and eligibility challenges. The analysis and recommendations were released in a policy brief,Expanding Affordable Coverage for Low-Waged Workers: Fixing the Family Health Plus Employer Buy-In.
As CSS conducted its analysis and identified opportunities to improve the program, the Foundation and CSS convened key stakeholders—representing small businesses, insurers, advocates, and policymakers—to provide input and feedback on the findings.
Ultimately, in 2010, New York State implemented many of CSS’s recommendations to improve the Employer Buy-In program: instituting modest co-payments; adopting an “out-of-network” Medicaid default rate; and targeting the program to businesses and unions that currently do not provide coverage or are in jeopardy of losing coverage. Collectively, these measures lower the previously existing premium of $540 per month by 25%, to approximately $397 per month.
Strengthening Community Health Centers
The Foundation funded a series of grants to support New York State’s nonprofit health centers in their efforts to reorganize, forge partnerships, or merge with other organizations during a time of financial distress. The sector is under growing stress: an NYSHealth report prepared by the Primary Care Development Corporation (PCDC) found that, over a seven-year study period, 43% of New York State’s nonprofit health centers had lost money in all or most years.
One successful outcome of this investment is expanded access to primary health care in Jamaica, Queens. Nearly 4,000 patients were at risk of losing their regular source of health care when St. Dominic Health Center faced imminent closure as a result of its parent organization’s bankruptcy filing. Through support from NYSHealth, PCDC, the New York State Department of Health, and other funders, the Joseph P. Addabbo Family Health Center, a Federally Qualified Health Center, acquired the St. Dominic Center and expanded its operations.
Under Addabbo’s leadership, the center has thrived, preserving a needed source of care and services in Jamaica. In one year, the center saw a 500% increase in patient visits; expanded the range of primary care services available to include pediatrics, HIV/AIDS services, dental care, and an onsite pharmacy; and added 20 new health care jobs in the community.