Mullan Institute for Health Workforce Equity at George Washington University

High-quality primary care is best delivered by a diverse team of professionals—including unlicensed professionals such as Medical Assistants, or MAs—who collaborate and combine skills to address the needs of patients and communities. But New York State lags other states in using MAs effectively; for example, unlike 49 other states, New York prohibits MAs from administering vaccinations. Because New York State does not license or define a scope of practice for MAs, primary care practices vary widely in how they use MAs and face barriers to using them in enhanced ways. With a 2023 NYHealth grant, the New York Alliance for Careers in Healthcare (NYACH) and the Mullan Institute for Health Workforce Equity at George Washington University (GW) worked together to develop a research plan focused on variations in MA roles, barriers to expanding MA responsibilities, and MA recruitment and retention. NYACH and GW are now ready to implement the research plan. In 2024, NYHealth awarded GW a grant to assess how Medical Assistants (MAs) are used, trained, and retained within primary care teams across New York State.

Under this grant, GW will use surveys with primary care practice administrators, key informant interviews, and focus groups with MAs to yield practical ideas to inform primary care delivery and policymaking. These may include innovative models of team-based care; on-the-ground insights about policy solutions to expand MA responsibilities; gaps in training and opportunities for standardization; effective uses of State funding; and feedback on apprenticeship models and other professional development programs.

New York University Grossman School of Medicine

A core strategy of NYHealth’s Primary Care priority area is to elevate the non-clinical workforce—specifically, Medical Assistants (MAs) and CHWs—and integrate them into primary care teams to improve patient health outcomes, reduce clinician strain, and support equitable career advancement.

Previously, NYHealth supported the New York Alliance for Careers in Healthcare to design a statewide scan of the current functions and desired roles of MAs on care teams. Similarly, an understanding of on-the-ground experience is needed to effectively scale models of CHWs’ integration. In 2024, NYHealth awarded New York University (NYU) a grant to conduct focus groups with primary care providers and community health workers regarding CHW integration into care teams across New York State.

Under this grant, NYU will conduct a series of focus groups both upstate and downstate to elicit experiences and information from both CHWs and the clinical and community-based providers that employ and partner with them (e.g., academic medical centers, community hospitals, community health centers, physician practices). NYU will distill the findings into a research brief that summarizes themes and offers recommendations, share related materials with researchers and CHWs in other states, and promote its work through webinars and publications.

 

Health Care for All New York (fiscal sponsor: Hispanic Federation)

Historically, primary care has not been a core focus for consumer advocates in New York, but the landscape is changing.

Consumer advocates’ priorities are gradually moving toward those that align with NYHealth’s strategies to expand access to primary care and advance racial health equity. In 2024, NYHealth awarded Health Care for All New York (HCFANY) a grant to develop and implement a new consumer advocacy agenda focused on primary care.

Under this grant, HCFANY will focus on three core policy areas: expanded coverage, enhanced affordability, and improved accessibility of primary care services. Advocates will also explore opportunities to advance policies focused on rebalancing health care spending toward primary care, transforming the health care payment and delivery system to prioritize primary care, and strengthening the primary care workforce. HCFANY will educate and activate consumer advocates on primary care issues and use policy research and analysis; communications; grasstops leader mobilization; and administrative policy advocacy to advance its efforts.

Independence Care System

Primary care is often a patient’s first and most regular point of contact with the health care system.

High-quality primary care provides ongoing, relationship-based care that meets the health needs and preferences of individuals, families, and communities, according to the National Academies of Sciences, Engineering, and Medicine. It is a rare “win-win” in health care that improves individual and community health, enhances health equity, and saves money. Despite the benefits, too little is invested in primary care and too many New Yorkers, especially New Yorkers of color, have difficulty getting care when and where they need it. In 2023, NYHealth issued a Request for Proposals (RFP), “Primary Care: Expanding Access and Advancing Racial Health Equity,” to test replicable models to improve the accessibility, quality, and equity of primary care in regions across the State. NYHealth awarded Independence Care System (ICS) a grant to participate in this initiative.

Under this grant, ICS will establish a Center of Excellence for primary care for people with disabilities at Woodhull Hospital, evaluate its impact, and support replication across the New York City Health + Hospitals (H+H) system and beyond. ICS will conduct focus groups in Brooklyn with 100 patients with physical disabilities to identify specific care needs and experiences with primary care providers. It will adjust care protocols based on patient feedback and evidence-based practices, and it will improve Electronic Medical Record documentation to better identify patients’ needs for accommodation. ICS will train primary care providers, clinical staff, and administrative staff and offer on-site consultation to support the delivery of more accessible and equitable care. In partnership with leading national researchers, ICS will analyze the model’s impact on enhancing uptake of screenings and preventive care, reducing hospitalization, and improving patient health outcomes. It will create resources to enable replication across H+H, including policies and procedures, disability competency training curriculum, and continuing education opportunities. It will also disseminate learnings through peer-reviewed publications and online patient and provider educational resources.

See a full list of grantees working to expand access to and advance racial health equity in primary care across New York State.

Manatt, Phelps & Phillips, LLC

The use of telehealth skyrocketed in New York State during the COVID-19 pandemic.

While telehealth has tapered off some, it is here to stay as an option for patients. Research shows that telehealth can expand access to care, lower no-show rates, increase patient satisfaction, and improve patient outcomes. However, uneven telehealth use during the pandemic has exacerbated—not reduced—disparities in health care access. Since the Public Health Emergency (PHE) expired in May 2023, the State and federal government have been reconsidering telehealth policies. In some cases, commercial and public payers are considering removing coverage for phone visits—a primary way that many patients of color and low-income patients access telehealth. The end of the PHE offers an opportunity for New York State to recalibrate telehealth policies to capitalize on successes and address pain points. Careful examination of telehealth policies is needed to ensure that all patients have equitable access to primary care. In 2023, NYHealth awarded a grant to Manatt, Phelps & Phillips to examine emerging telehealth policies, regulations, payments, best practices, and case studies to recommend changes that will preserve and expand equitable access to telehealth in New York State.

Under this grant, Manatt will produce a comprehensive and up-to-date analysis of telehealth in New York State. It will interview stakeholders, representing diverse perspectives and expertise, to generate a State-specific understanding of issues and opportunities in telehealth policy and identify case studies on high-impact telehealth service delivery models. Manatt will also analyze the telehealth policy landscape at the State and federal levels to find examples of effective policy solutions from other states, with a focus on promoting equitable access. It will delve into State-specific telehealth issues including coverage and reimbursement; virtual care modalities; regulations; originating site requirements; and policies affecting access to telehealth services. In addition, Manatt will present data on telehealth utilization to demonstrate uptake of telehealth across the State and highlight remaining gaps and disparities in access. Data will depict trends before, during, and after the PHE and be disaggregated by patient demographics, payer type, and care specialty, as available. Manatt will disseminate its findings to the media, policymakers, providers, consumers, advocates, and other health care-decision makers across New York State to inform timely policy conversations.

Community Health Care Association of New York State

High-quality primary care is best delivered by a diverse team of professionals who work together and combine skills to address the needs of patients and communities.

Members of this team include medical assistants (MAs), who are unlicensed personnel who perform various administrative and limited clinical tasks under the supervision of a physician. In New York State, the MA workforce of nearly 36,000 is expected to grow by 27% by 2030. With the fast growth of MAs and the shift to team-based care, MAs can take on enhanced roles in areas such as care coordination, patient navigation and education, and disease management. Because MAs are often members of the communities they serve, they are well-positioned to build relationships with patients—particularly patients of color and those from other historically marginalized groups—and earn their trust. But varying state regulations pose barriers to MAs taking on even greater responsibilities. More than 40 states formally define the scope of practice for medical assistants or empower clinicians to delegate tasks to unlicensed MAs, but New York lacks clear guidance. Health centers also struggle to use MAs because their education, training, skills, and experience vary considerably. In 2023, NYHealth awarded the Community Health Care Association of New York State (CHCANYS) a grant to expand the MA workforce in community health center settings through a statewide apprenticeship program and policy advocacy to expand the scope of practice for MAs in New York State.

Under this grant, CHCANYS will adopt a workforce development and policy strategy focused on MA advancement on the care team. It will launch a statewide MA apprenticeship program at 10 community health centers. This program will pair an MA apprentice with an experienced MA coach and a practice administrator champion to offer supervised practice and instructions. This curriculum has been recognized by the New York State Departments of Labor and Education and aligns with national accreditation competencies. CHCANYS will also lead skill-based trainings; provide technical assistance in hosting apprentices; offer peer-learning sessions; cover fees for accreditation exams; and perform site visits to help integrate MAs into care teams at participating health centers. Additionally, it will launch a statewide advocacy campaign to encourage stakeholders to define and expand the scope of practice for MAs.

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