Expanding Health Care Coverage

Grantee Name

Center for Health Care Strategies, Inc.

Funding Area

Expanding Health Care Coverage

Publication Date

September 2015

Grant Amount


Grant Date:

December 2015 – November 2016


A small proportion of patients accounts for a disproportionate share of health care utilization and costs. These patients are at high risk not only for hospitalization but also for readmission to the hospital.

To address these patients’ long-term health needs—and reduce their rate of hospital readmissions—hospitals need to develop new types of interventions.  In 2007, Bellevue Hospital Center (Bellevue), the oldest public hospital in the United States and the cornerstone of the New York City public hospital system (Health and Hospitals Corporation or HHC), launched a pilot study to identify patients at high-risk for readmissions to Bellevue.

In 2009, NYHealth awarded Bellevue a grant to help develop the model at Bellevue and at two additional HHC sites: Elmhurst Hospital Center, in Queens, and Woodhull Medical and Mental Health Center, in Brooklyn.

Outcomes and Lessons Learned

  • Linked patients to necessary medical providers and community-based organizations;
  • Connected more than 100 patients to the program’s primary care physician;
  • Enrolled Medicaid patients into the program,  of which their average Medicaid costs dropped from $71,146 annually ($5,928 a month) to $57,064 annually ($4,755 a month); and
  • Reduced, on average, inpatient admissions by 47% per month and ED visits by 53% per month.