This Year's Highlights
Setting the Stage for Healthy Neighborhoods
Eight years ago, NYSHealth identified diabetes as a critical health issue affecting millions of New Yorkers, and began working both to improve care for patients who already had diabetes and to prevent diabetes among New Yorkers at highest risk for developing the disease. But with 60% of New Yorkers (8.7 million people) overweight or obese, and a growing body of research showing the impact our neighborhoods have on our health, we recognized a need to shift our approach a bit.
We know that where we live affects our health in multiple and complex ways. In neighborhoods with easy access to nutritious, affordable food; safe and walkable streets; and active playgrounds and public spaces, residents are more likely to have good health outcomes. Residents of neighborhoods without these essentials are more likely to be burdened with high rates of obesity, diabetes, or other chronic illnesses.
In 2014, we began to develop a focus on efforts that build on our experience with diabetes prevention and emphasize community-level interventions that make it easier for all residents to lead active, healthy lives. Over the summer, we invited organizations to respond to a Request for Proposals for our new Healthy Neighborhoods Fund initiative, a $2 million program to help New York State communities increase access to healthy affordable food; improve access to safe places where residents can exercise and be active; and connect children and adults to programs that support healthy behaviors.
Early in 2015, we announced grants to six communities across New York State to participate in the program. Our partners at the New York Community Trust launched a complementary initiative, South Bronx Healthy and Livable Neighborhoods, to support three communities in the South Bronx.
We are excited to continue to develop this important new area of work to build healthy communities in 2015 and beyond. Ultimately, we want to see an increase in the number of New Yorkers of all ages in these communities who lead healthier lives and experience fewer chronic health conditions.
Spreading Diabetes Prevention Efforts
An estimated 4.5 million New Yorkers have prediabetes—a condition that puts them at high risk for developing diabetes and its complications. To help reverse this epidemic, NYSHealth supported a range of activities in 2014 to help spread the National Diabetes Prevention Program (NDPP), a lifestyle intervention program that has been shown to help participants lose 5–7% of their body weight and reduce their risk of developing Type 2 diabetes by 50%.
Through our Laying the Groundwork initiative, NYSHealth awarded grants to 25 organizations across the State to help them implement, expand, and secure the sustainability of the NDPP in community-based settings. The grantees are concentrating their efforts to make this effective program available to New Yorkers in communities with high rates of diabetes and prediabetes.
With NYSHealth support, Viridian Health Management is offering in-depth, tailored technical assistance services to Laying the Groundwork grantees to ensure that their efforts to grow the NDPP in communities are successful.
Through a grant to American Diabetes Association (ADA), NYSHealth supported a summit for health care providers in Rochester to foster communication, outreach, and education about the NDPP. Another grant is helping ADA build referral networks among primary care providers in Monroe and Erie counties to help increase demand for the NDPP. A grant to Center for Excellence in Aging & Community Wellness also is supporting health care provider organizations across the State to offer the NDPP, connect patients to it, and sustain the program in the long run.
Advancing New York State’s Prevention Agenda
NYSHealth furthered our work to support the health of communities through a new grant initiative, “Advancing New York State’s Prevention Agenda,” to help 27 local health departments improve health and reduce health disparities in their communities.
All 58 local health departments were required to submit a Community Health Improvement Plan to the State outlining their strategies to advance the goals of New York State Department of Health’s Prevention Agenda 2013–17. To help energize the implementation of these plans, NYSHealth launched a matching grants initiative in 2014 and selected the health departments with the most innovative and feasible projects for grant awards of up to $50,000 to improve the health and wellbeing of their communities.
For example, Delaware County had identified that none of its municipalities had a Complete Streets policy in place. It has since worked with three municipalities to adopt Complete Streets policies and has launched a countywide Prescription Trails website for residents, which identifies safe and accessible walking routes; gives walking tips; provides a walking log; and offers a prescription pad for physicians to prescribe walking to their patients and families. Oswego County has partnered with schools to implement the Healthy Highway program, which uses traffic metaphors to educate children on how to eat right, exercise, and maintain a healthy lifestyle, reaching all 700 students targeted through this project.
This grant initiative gave NYSHealth a timely opportunity to build upon our work in diabetes prevention by helping support projects that tackle the root causes of a range of chronic conditions, such as diabetes and obesity. The grantees are working with a wide range of community partners to implement evidence-based, sustainable projects that align with the Prevention Agenda’s priorities to prevent disease, reduce health disparities, and promote healthy and safe environments.
Expanding Health Care Coverage
Ensuring that people can understand their health insurance coverage options and enroll in an affordable plan is critical to expanding access to health care. Individual assistance is particularly crucial for people seeking to understand their options as they enroll in health coverage for the first time.
2014 marked the second year of implementation of the Affordable Care Act (ACA), from the end of the first open enrollment season through the beginning of the second. An NYSHealth poll found that assistance was key to expanding coverage: 81% of New Yorkers who became newly insured during the first open enrollment season received help with enrollment, whether from the New York State of Health Marketplace website or call center, family or friends, a health care provider, a navigator or application assister, brokers, or other sources. Our Foundation joined many other nonprofits across New York to add assistance to the crucial outreach and enrollment activities.
NYSHealth’s key consumer-focused coverage initiatives, the statewide Enrollment Network and Ambassadors for Coverage programs, worked throughout 2014 to ensure that New Yorkers have the help they need to get covered. Our Enrollment Network consists of community-based organizations that conduct education, outreach, and enrollment, with a focus on communities known to be uninsured at disproportionately high rates: low-wage workers, immigrants, and LGBT New Yorkers. The Ambassadors for Coverage program, administered by the Empire Justice Center, supports organizations statewide to educate consumers and raise awareness about coverage options at the community level.
Through the end of 2014, more than 11,000 New Yorkers enrolled in health coverage with assistance from NYSHealth’s Enrollment Network, and the Ambassadors directly reached more than 71,000 New Yorkers with information and referrals. Many of the New Yorkers reached identify as low-wage workers, immigrants, and members of the LGBT community.
In early 2014, NYSHealth collaborated with New York State to host a “spring training” program of continuing education for in-person assisters across New York State. The training helped to ensure that Enrollment Network counselors and other assisters statewide could do an even more effective job in the 2014–15 open enrollment season. Funding from NYSHealth supported trainings on immigration rules, cultural competency and young adults, and health plan selections; as well as a recognition and awards program for assisters who successfully complete the training program and show innovative ideas to support enrollment.
Through 2014, the Ambassadors for Coverage program successfully reached people in communities that continued to have high rates of uninsurance through 837 outreach events, 363 community presentations across the State, a variety of media outreach, and distribution of culturally and linguistically appropriate materials. Ambassadors also partnered with the Marketplace on campaigns including weekly outreach at pharmacies across the state. The Ambassadors program was highlighted at the Enroll America Annual Conference as an innovative and effective model, and will be featured at the upcoming World Health Congress Summit to spread best practices and demonstrate the effectiveness of this replicable outreach program to a national audience.
In November 2014, NYSHealth sat down with three New Yorkers who got covered with assistance from the Enrollment Network. Watch the videos about their personal experiences with Obamacare.
Making the Case for Payment Reform
The cost of health care affects lives in many ways that go beyond determining how much you pay your doctor. Consequences of rising health care costs include cross-sector impacts on wages, employment, the price of goods and services, and the ability to fund other public services like education and affordable housing. New York’s health care spending is among the highest in the nation and is projected to increase further, outpacing both inflation and overall economic growth.
The fee-for-service system drives up these costs because it encourages for the delivery of more care, tests, and treatments, rather than incentivizing more effective care. Moreover, fee-for-service perversely penalizes many excellent providers who keep people healthy and avoid unnecessary and expensive care. Alternative payment methods, moving away from fee-for-service reimbursement, can drive meaningful change in health care costs and also improve health outcomes.
Restructuring the delivery of health care and associated spending in New York will require understanding the drivers of health care costs and the state of existing payment methods. In early 2014, NYSHealth released a new chart book prepared by Health Management Associates. “Health Care Costs and Spending in New York State” pulls together information on health care costs, spending, and payments based on existing State and national research. The charts synthesize a wide range of data and create a resource that explains the impact of rising costs, drivers of spending growth, variations in spending, and the relationship between quality of care and spending. The chart book is intended to facilitate ongoing research on health care costs and generate continued conversation on payment reform in New York. The chart book has been used by a variety of stakeholders, including State officials in the development of the State Health Innovation Plan.
Across the country, providers and payers are experimenting with new payment arrangements to improve health outcomes and reduce costs. To provide insight on the current payment landscape in New York State, NYSHealth awarded Catalyst for Payment Reform (CPR) a grant in 2014 to support the first-ever New York State scorecard on payment reform. The scorecard will allow New York State to set goals and measure progress toward payment reform. CPR will identify health care expenditures in New York State that are paid using fee-for-service and alternative payment methods (e.g., bundled payments, shared savings, and global payments) to identify potential savings. The scorecard will also feature differences between fee-for-service spending in the Medicaid and commercial markets, going beyond scorecards previously produced to rate payment reform performance in other states. The scorecard will be publicly available online in spring 2015.
Preserving Primary Care Access
NYSHealth continued to play a role we are proud of to preserve and expand primary care access and capacity across New York State. For example, in Suffolk County, on Long Island, primary care health centers serving 53,000 mostly low-income patients in six locations were at risk because of budget deficits. With support from NYSHealth, Hudson River HealthCare began the process of transitioning the six health centers into its federally qualified health center (FQHC) network to preserve care for Suffolk County residents.
An earlier primary care grant, to CohnReznick, showed impressive results in 2014. FQHCs that had historically served disproportionately large numbers of uninsured and/or commercially insured patients faced new financial challenges as more patients gained health insurance coverage through the implementation of the Affordable Care Act. To help community health centers prepare for these challenges and ensure their viability, NYSHealth supported technical assistance for five FQHCs with the largest proportions of uninsured and commercially insured patients in New York State.
While all five centers benefited from the support, the assistance was especially transformative for one center, Oak Orchard Health, which serves patients in the Finger Lakes region. Over the course of the project, CohnReznick discovered a Medicaid billing rate error and filed a successful rate appeal. The approval of the appeal translates to an additional $750,000 per year in Medicaid reimbursements for Oak Orchard, which has achieved financial stability as a result.
Learning from New York’s Health Homes
Medicaid health homes provide states like New York with a mechanism to support better care management for patients who have multiple chronic health conditions and intensive, high-cost service needs. Ultimately, the goal of health homes is to improve health outcomes and reduce health care costs. In 2014, several NYSHealth-supported analyses shed light on best practices, opportunities for improvement, and lessons learned as health homes were implemented as part of the Affordable Care Act.
A key challenge is identifying and enrolling eligible patients into health homes. A report from the Center for Health Care Strategies focused on innovative solutions and lessons from early-adopter health homes in New York State to inform future outreach and engagement efforts. The report includes list of “Top 10 Must-Dos for Health Homes to Improve Outreach.”
A related report, by Joslyn Levy & Associates, examined approaches in New York State to expand and improve care management for health home members. The report identifies nine topics that affect the design and delivery of care management in health homes, including the health home network structure, staff member training, caseload balance, and collaboration with care providers. It identifies common challenges and promising practices across the State’s health homes to inform the field.
Finally, a report from the RAND Corporation looked at a range of New York State programs, including health homes, that focus on integrating primary care and behavioral health services for adults with serious mental illness. Taken together, these reports provide valuable insights on a range of issues for health homes and others focused on taking a comprehensive approach to caring for the most vulnerable New Yorkers.
Addressing Mental Health Needs of Justice-involved People
Mass incarceration is a major public health problem—38% of New York City’s overall jail population suffers from a mental health disorder. Among youth held in New York State detention, 54% have mental illness, 63% have substance use disorders, and 54% have physical health disorders. A lack of mental health clinics with experience serving this population has compounded the problem. To help address this issue, NYSHealth, through our Special Projects Fund, helped support 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.
A Special Projects Fund grant to Center for Alternative Sentencing and Employment Services (CASES)supported the planning and implementation of Nathaniel Mental Health Clinic in Central Harlem, which opened its doors in September 2014. The clinic, licensed by the New York State Office of Mental Health, provides outpatient behavioral health care to youth (13 years old and up) and adults. Its services include counseling/therapy; medication management; psychiatric evaluation; health assessment and monitoring; integrated treatment for substance use; complex care management; and crisis intervention. Operated by CASES, the clinic helps justice-involved youth and adults recover from past trauma and improves their emotional and physical health. This in turn allows clients to strengthen their relationships and social networks with family, friends, and the community, which can help reduce future criminal involvement.
Supporting Veterans and Their Families
In 2014, NYSHealth partnered with the Syracuse University Institute for Veterans and Military Families (IVMF) to help 21 organizations develop community-based programs to serve veterans and their families. IVMF worked with all 21 organizations to help secure $41 million in federal funding from the Supportive Services for Veteran Families (SSVF) program, which supports community-based services to help prevent low-income veterans and their families from becoming homeless.
New York State received the second-largest allocation of 2014 SSVF grants in the United States, with some of the funding going to communities in New York City and on Long Island—where more than 80% of all homeless veterans in New York State live.
IVMF and the organizations worked together to create programs using the NYSHealth-funded “Coming Home to Caring Communities: A Blueprint for Serving Veterans & Families,” developed by the Veterans Outreach Center (VOC) in Rochester. Communities receiving the SSVF support created VOC lookalike programs to expand health and social services to veterans and their families.
This grant built upon our past efforts to leverage additional SSVF funding through technical assistance. Since 2012, New York State organizations have received a total of $75 million in SSVF grants.
Convening Key Stakeholders
NYSHealth is committed to fostering discussion among key stakeholders in health care across New York State and engaging participants from other sectors in conversations about health care. We believe that discussion among health leaders helps foster efforts to improve our State’s public health and medical care systems.
In 2014, the Foundation held a variety of conferences, webinars, and other events; from small, invitation-only discussions, to its “A Conversation With…” series, which brings together leaders in the field of health care to discuss issues pertinent to the Foundation’s work, to large conferences on payment reform and population health.
Our most vibrant 2014 events included:
Payment Reform: Expanding the Playing Field
NYSHealth hosted this conference to discuss engaging a broad range of players in payment reform initiatives, including consumers, purchasers, business leaders, community groups, providers, insurers, policymakers, and researchers.
Bridging Health Care and Population Health: Payment and Financing Models
NYSHealth sponsored a population health summit, cohosted by New York Academy of Medicine and New York University, to discuss opportunities and approaches for health care providers and payers to invest more broadly in improving the health conditions of communities.
Behavioral Health and Delivery System Reform: A Conversation with Harold Pincus
NYSHealth hosted a conversation on better integrating physical and behavioral health care and addressing some of the key challenges to care coordination. As part of this discussion, Dr. Pincus reviewed findings from an NYSHealth-funded RAND Corporation report, “An Examination of New York State’s Integrated Primary and Mental Health Care Services for Adults with Serious Mental Illness.”
Addressing Health Inequities in the 21st Century: A Conversation with Thomas LaVeist and Garth Graham
NYSHealth and our Community Advisory Committee hosted a conversation about the challenges of health inequities and how places and organizations are tackling this problem by working alongside communities, using media to raise visibility of the issues, and partnering with foundations.
Controlling Health Care Costs and Investing in Community Hospitals: A Conversation with David Seltz
NYSHealth hosted a conversation with David Seltz, executive director of the Health Policy Commission. Mr. Seltz described Massachusetts’s legislative path to health reform, how price transparency served as a crucial building block for these efforts, the establishment of a dedicated fund for community hospitals, and how the Commission will monitor health care system transformation.
A Conversation About Housing as Health Care: Can It Be Done?
NYSHealth hosted a conversation about supportive housing as health care to discuss how this important topic is being addressed, how it can be fully implemented, and how it can be financed in New York State.