NYHealth Testimony on Strengthening the New York State Division of Veterans’ Services

On October 21, 2021, the New York State Assembly Committee on Veterans’ Affairs held a hearing on restructuring the New York State Division of Veterans’ Services (DVS). NYHealth’s President and CEO, David Sandman, testified before the hearing to outline opportunities to strengthen New York’s DVS.


Thank you to Chair Barrett, Chair Hunter, and members of the committee for the opportunity to testify today. I am David Sandman, the President and CEO of the New York Health Foundation (NYHealth). The Foundation is a private, independent, and statewide charitable organization dedicated to improving the health of all New Yorkers. That includes the more than 700,000 veterans who call New York home. Our staff has been honored to participate in the Governor’s Challenge to Prevent Veteran Suicide, and we’ve worked closely with the New York State Division of Veterans’ Services (DVS) on that program and several others throughout the years.

I am heartened and excited by the interest in strengthening and restructuring New York State’s Division of Veterans’ Services. We also strongly support its elevation to Department status, and I’ll elaborate on that in my testimony.

My testimony is based on a Foundation report titled “A Strategic Roadmap to Enhance the Role and Impact of the New York State Division of Veterans’ Services.” It was prepared by the Institute for Veterans and Military Families (IVMF) at Syracuse University.

The report examined what high-performing state veterans’ agencies across the country look like, compared and contrasted New York to those, and made detailed recommendations. Specifically, it breaks things down into three categories: (1) organizational structure, (2) financial stability, and (3) service delivery innovation.

The full report is available on the Foundation’s website.

New York’s Veterans
In the next few weeks, the Foundation will release a new and in-depth profile of New York’s veterans. New York has the fifth-largest veteran population of any state in the nation.

Most veterans return from deployments and transition to civilian life relatively smoothly; they’re healthy, ready to work or go to school, and eager to settle back into life at home. But for some, the adjustment isn’t so easy. They may struggle with physical injuries and disabilities, and they may also be dealing with the invisible wounds of war: mental health issues including PTSD, suicidal ideation, and substance use. They may also be challenged by food insecurity, lack of employment, or homelessness.

The needs of New York’s 700,000-plus veterans are many and varied. A robust, stable, well-funded Division of Veterans’ Services is required to serve them well.

Elements of a High-Performing Division of Veterans’ Services
What does a high-performing DVS look like? The analysis we commissioned from IVMF identifies several characteristics.

  • First, in the area of organizational structure and political standing, one of the most important takeaways is that leadership matters. The strongest DVS organizations across the country have steady leadership, with directors in place for three or more years. New York, of course, has not had stable leadership at DVS, with numerous vacancies and interim leadership that make it hard to gain and maintain momentum. I commend the efforts of the entire staff at DVS. They have worked with purpose and dedication to serve veterans, and especially to connect them with benefits. Yet, the lack of stable leadership is a disservice to New York’s veterans.

    In leading states, the Division of Veterans’ Services is an independent agency—rather than being folded into a broader department like Military Affairs—and its director has a seat in the Governor’s cabinet, as is the case in New York. Where New York is behind top-performing states is that the director does not report directly to the Governor. That matters when it comes to DVS effectiveness. Elevating the Division of Veterans’ Services to a Department could make a meaningful difference for New York’s veterans. On this point, the experience of New York City is highly instructive. In 1987, Mayor Ed Koch created a Mayor’s Office of Veterans Affairs. For decades, it remained a small office. As recently as 2015, it had an annual budget of only $600,000 and only six employees.In 2016, leadership by the City Council elevated the office to a full-fledged agency led by a Commissioner. That move immediately increased its size and expanded its role. In its first full fiscal year, in 2017, the Department had 33 employees and a budget of $3.8 million annually. Today, in fiscal year 2021, its budget is around $6.4 million and it has 49 staff positions. That supports an enhanced portfolio of work that includes benefits enrollment, employment and housing assistance, mental health services like Buddy Check calls and referrals to mental health resources, and food and nutrition programs.

    To better serve all of New York State’s veterans, establishing a permanent Department with stable and highly qualified leadership must be the starting point.

  • Second, money matters. New York’s DVS is substantially underfunded, with an annual budget of less than $20 million. By comparison, states with similarly-sized veteran populations have budgets around $90 million—more than a 400% difference.New York, unlike leading states, has also not enjoyed stable federal or state funding over the years for general or special funds. Reliable funding would allow DVS to conduct long-term planning and set priorities.Today, the services delivered by New York DVS are limited, with an almost exclusive focus on benefits and claims assistance, rather than service delivery and coordination, whereas other states offer a wide variety of direct services, from employment counseling to mental health programs. Greater parity in funding for New York’s DVS could support critical enhancements like public-private partnerships in communities, new programming, an updated assessment of New York veterans’ needs, and a robust communications strategy.
  • Third, there needs to be alignment and coordination of roles, missions, and responsibilities with stakeholders across New York State. Understanding how DVS fits in with other public and private entities throughout the State that are also focused on veterans’ issues—and even those that could be, but aren’t currently—is an important step to maximizing the division’s impact. What are its unique strengths, and where might others be better positioned to take the lead? In the highest-performing states, for example, the department of veterans’ affairs serves as a central coordinating body, but decentralizes the actual administration of benefits and claims assistance to the county level. New York could take a similar approach, or possibly a hybrid that makes the most of our State’s and counties’ particular strengths.
  • Next, we need to improve cross-sector/agency collaboration and community coordination for health care. Top DVAs across the country have carved out a role as a statewide health care coordinating body. These collaborations can help identify and address gaps in veteran services, ensure coordination, and facilitate veterans’ connections to local resources. (In Michigan, a model state, these are known as VCATs, short for Veterans Community Action Teams.) This approach may be increasingly important as more veterans seek out care in community settings, rather than through the VA.
  • Another critical element is getting an accurate, current understanding of New York’s veterans’ needs by listening directly to them. As they say, “Know your audience.” DVS needs to understand what New York’s veterans need and want in order to provide the most appropriate services. A needs assessment would inform the priorities, resource allocation, and engagement strategies not only of DVS but also of other organizations throughout the State who care about the veteran population.
  • Finally, DVS needs a tailored communications and outreach strategy. As the committee’s notice for today’s hearing pointed out, only 17% of New York’s veterans are estimated to be accessing their earned benefits. Veterans need to know about available resources in order to take advantage of them. New York could do a better job of ensuring that its communication and outreach activities are tailored to the specific media channels and platforms that different demographic groups (for example, older vs. younger veterans) are most likely to use. Florida offers a good model, with dedicated resources to engage veterans who are difficult to reach, such as those in rural communities. They maintain a strong online presence to engage with younger and middle-aged veterans, but at the same time, go as far as purchasing signage on top of gas pumps in rural counties to reach older rural veterans.

That’s a concise summary of the Foundation’s strategic roadmap. I encourage you to review the full report for more details and case studies.

My colleague Derek Coy, a Marine veteran who served in Iraq, often reminds me of a common saying in the military: “Don’t see things as problems, only opportunities.” Today, we have the opportunity to restructure, revitalize, and strengthen DVS. I have described some of the areas where New York falls short when compared with other states. More importantly, I’ve also described a path forward to make New York State a national leader in providing veterans with the services and supports they need. I ask that you consider the recommendations I’ve outlined today.

Thank you again for the opportunity to testify. I deeply respect and appreciate the commitments to New York’s veterans that we all share and I hope you’ll continue to look to the New York Health Foundation as a resource for your important work.

Watch the video of Dr. Sandman’s testimony.

NYHealth Testimony on Health Care Prices

On October 15, 2021, the New York City Council Committees on Hospitals and Health held a joint hearing on the impact of hospital costs on access to care. NYHealth’s Director of Policy and Research, Mark Zezza, testified before the hearing to share relevant findings on health care costs and price variation in New York.


Thank you, Chairperson Rivera and Chairperson Levine and members of the Committees, for the opportunity to testify before you to discuss hospital prices and health care price variation.

I am Mark Zezza, Director of Policy and Research at the New York Health Foundation.

The Foundation is a private, independent, charitable organization that operates statewide and has the mission of improving the health of all New Yorkers.

The Foundation believes that information transparency is a gateway to improving affordability, quality, and competition in the health care system.

New York State has been consistently shown to have high health care spending in comparison to the rest of the country, with the growth in prices being the main driver of spending levels. Historically, there has been little transparency in prices. When prices are revealed, we see a great deal of unwarranted variation.

In a recent publication, we analyzed the variation in prices for births in New York City from 2015 through 2017. We found that:

  • There is wide variation in prices for childbirth across New York City boroughs. For example, in 2017, there was a 30% difference in median prices for vaginal deliveries between Brooklyn and the Bronx. In Brooklyn, the median price was about $12,700, compared to the Bronx, where it was about $16,600.
  • We also see substantial variation within boroughs.
  • Of course, you expect to see some variation in prices—sometimes there are patient differences and complications that require more intensive and costly health care. But the price variation we’re seeing is well in excess of what we’d expect to see based on those types of differences.

And we know from other research that variation in prices is generally not correlated with the quality of care—not only for childbirth, but also for services like radiology exams, office visits, and surgeries.

In 2016, the Foundation funded a study by Gorman Actuarial to investigate the main drivers of price variation within the hospital industry. Gorman worked with the State to obtain price data, including the actual negotiated prices, as well as copies of contract provisions between hospitals and health plans.

The analysis focused on several markets throughout New York State, including in the downstate area of New York City, plus Suffolk and Westchester Counties.

  • The study found that the highest-priced hospitals are 50% to 170% more expensive than the lowest-priced hospitals in the same region.
  • And as we’ve seen in other research, this study found that hospitals with higher prices do not necessarily have higher quality.
  • Rather than quality, the primary factor driving high prices is market share. Hospitals that are part of a hospital system with a large market share are generally higher-priced as a result of the power of that hospital system in contract negotiations.
  • The report also found certain contract provisions that impede health care competition and transparency for consumers. These include anti-steering language which can limit the information available about high-quality, lower-priced providers. These contract terms can compromise a patient’s ability to seek out more affordable or better care options.

In conclusion, the lack of transparency combined with high and variable prices is anti-consumer. It can lead to higher premiums, health care related taxes, and even higher prices for non-health care related goods. Excessively high prices, especially when they come as a surprise to a patient, can also undermine the patient-provider relationship. The lack of transparency also undermines the ability of employers, patients, and other health care purchasers to shop for more efficient health care.

More information about both of the studies discussed are on our website, www.nyhealth.org. Thank you for your attention to this important topic; I’m happy to answer any questions you may have.

Watch a video of the hearing (Dr. Zezza’s testimony begins at 03:02:51).