Albany Medical College

Racial disparities in maternal health are among the most glaring and persistent of all health disparities.

Recent data show that discrimination was a probable or definite circumstance in almost half of maternal mortality cases in New York State. Although there is no silver bullet solution to this crisis, doulas have emerged as an innovative strategy to address inequities for birthing patients and improve patient outcomes. Doulas are trained, nonclinical childbirth professionals who provide physical, emotional, and informational support during and after pregnancy—often in home- and community-based settings. However, people of color and people with low income are less likely to use doula services because of cost, limited access, lack of cultural sensitivity, and provider resistance. In 2023, NYHealth awarded Albany Medical College (AMC) a grant to provide better access to doulas for people with low income and people of color giving birth in Albany and surrounding communities.  

Under this grant, AMC will partner with BirthNet, a local birth justice organization that focuses on certification for doulas of color, and the University of Albany’s Black Maternal Health Collective to train doulas and launch a doula program. It will expand its patient advisory council to learn about patients’ birthing experiences. It will conduct focus groups with patients and community stakeholders to make sure the doula program reflects their needs and preferences. Feedback will help identify instances of implicit bias and other discriminatory practices to inform quality improvement activities. Once trained, doulas will be fully incorporated into AMC’s birthing clinical care teams and connect with patients who plan to deliver at AMC or who are transferred there for a higher level of care. In addition, AMC will convene birthing hospitals and community providers to identify opportunities to scale and sustain doula programs in the region. AMC will also work with leaders across the State to share best practices.  

Saratoga Community Health Center (Saratoga Care)

Shared visit notes, often referred to as open notes, are an important way to help consumers become active participants in their own care.

When patients have access to their own visit notes written by health care providers, they better remember and act on information discussed during visits, improve communication with their health care team, and better manage their health. The 21st Century Cures Act, a recent federal mandate, requires health care providers to make clinical notes available to patients electronically and at no charge. However, the level of compliance and, most importantly, the proactive use of open notes to improve care vary among health systems. In 2022, NYHealth issued a Request for Proposals (RFP), “From Good to Great: Improving Access to and Use of Patient Visit Notes in Non-Hospital Systems,” to support non-hospital systems across New York State in sharing open notes in compliance with recent federal rules and using open notes to more meaningfully engage patients. In 2023, NYHealth awarded Saratoga Community Health Center (Saratoga CHC) a grant to participate in this initiative.

Saratoga CHC is part of a hospital-affiliated, multi-specialty physician practice, Saratoga Hospital Medical Group in Saratoga Springs and the Capital Region. It provides primary care and dental services to approximately 7,000 patients annually. It is the only community health center in the region, providing care regardless of patients’ insurance status or ability to pay. Under this grant, Saratoga CHC will continue to implement and improve the use of shared notes within its system and participate in a technical assistance and peer-learning network. Saratoga CHC will conduct patient education, outreach, and navigation to increase use of shared notes and install kiosks for patients to access notes on-site. It will also seek patient feedback, develop patient-centered note-sharing workflows, and upgrade its patient portal to integrate medical and dental patient visit notes.

See a full list of grantees participating in this initiative.

Center for Health Workforce Studies (fiscal sponsor: Health Research, Inc.)

Marginalized communities, including low-income and rural communities and communities of color, have less access to an adequate supply of trained health care providers and high-quality care.

New York is among the states with the highest numbers of federally-designated health care provider and primary care facility shortage areas. State and federal agencies have developed service obligation programs as incentives meant to encourage providers to work in shortage areas, but these programs are underused for two main reasons: (1) the process to apply and maintain eligibility is complex; and (2) there is a lack of easily accessible public information about shortage areas and associated incentive program eligibility. In 2022, NYHealth awarded the Center for Health Workforce Studies (CHWS), through fiscal sponsor Health Research, Inc., a grant to build and launch an online portal to improve access to information about health care shortage areas and workforce incentive programs that encourage health care providers to practice in underserved communities.

Under this grant, CHWS will feature up-to-date information about shortage designations and incentive programs in its online portal. Live newsfeeds and searchable tools will offer real-time information that can help providers complete their applications and help organizations develop recruitment strategies. The portal will shorten CHWS’s response time to questions about designations and incentive programs and house user-friendly tools for applicants. CHWS will engage a range of partners to promote the portal and raise awareness among hospital recruiters, schools, and other training programs. CHWS will also provide technical assistance to up to 250 providers and organizations. Ultimately, the goal is that the portal and technical assistance will foster greater willingness among providers to apply for and participate in incentive programs, which will in turn lead to increased primary care access for New Yorkers.

Public Policy and Education Fund of New York

Medical debt is a crushing burden for New Yorkers. A recent survey found that more than half of New Yorkers struggle to pay medical bills.

Low-income communities and communities of color outside of New York City have been particularly hard hit by medical debt, exacerbating existing health and socioeconomic inequities. A coalition of partners has run a successful End Medical Debt in New York campaign, with NYHealth and other philanthropic support, to advocate for solutions. In 2022, NYHealth awarded the Public Policy and Education Fund of New York (PPEF) a grant to advocate for policy changes that protect New Yorkers from unfair medical debt.

Under this grant, PPEF expanded its base of organizers and produced a unified communications plan. With previous NYHealth support, PPEF initiated grassroots organizing for the statewide campaign; this next phase both bolstered funding for organizations already engaged in the campaign and reached new partners. PPEF also formalized the campaign’s communications plan and shared communications tools with organizers.

NYHealth is also supporting two complementary initiatives for ending medical debt in New York State, with grants to the Volunteer Lawyers Project of Central New York and the Urban Institute.

The Food Pantries for the Capital District

The Food Is Medicine (FIM) movement recognizes that nutrition and health are directly linked.

FIM programs are typically targeted to people with chronic illnesses or risk factors, often using a food “prescription” written by a health care provider or plan. FIM usually takes the form of prepared meals or food/produce boxes that are medically tailored to an individual patient. These programs can improve health outcomes, reduce food insecurity, and decrease long-term health care costs. FIM programs have been of interest to New York State’s Medicaid program. The State recently submitted a proposal to the federal government requesting $13.5 billion in Medicaid funding as part of a new waiver demonstration project. The proposed waiver offers pathways to expand FIM services, but the details still need to be defined and operationalized. In 2022, NYHealth awarded The Food Pantries for the Capital District a grant to help New York State FIM programs become eligible for Medicaid reimbursement.

Under this grant, Food Pantries and its partners explored different ways to integrate FIM services into Medicaid. In collaboration with the New York State Community Assistance Network, Food Pantries developed an issue-focused statewide coalition and steering committee of stakeholders, including providers and health care payers. It conducted policy research, consulting successful blueprints from Massachusetts and California, which have developed similar waivers in order for Medicaid to fund these food programs. A blueprint was published for New York State with policy recommendations and actions for Medicaid reimbursement adoption.

Ichor Strategies (fiscal sponsor: Health Research, Inc.)

Although the COVID-19 pandemic is not over, the formal public health emergency is expected to expire at the end of October 2022.

Along with its expiration comes the termination of many federal policies, including a continuous coverage requirement that prohibited states from terminating Medicaid enrollees’ coverage while the public health emergency was in effect. States will need to reassess eligibility and process re-enrollments for all enrollees, and consumers will need to take action to keep their coverage. Millions of people could potentially lose coverage. The New York State Department of Health (NYSDOH) is in the midst of a planning process to redetermine eligibility and re-enroll 8.7 million New Yorkers—either in Medicaid, Child Health Plus, the Essential Plan, or in subsidized coverage on the Marketplace. It is preparing its IT systems to automate as many renewals as possible and training enrollment assistors to resume regular activities. However, NYSDOH needs assistance with launching a community-informed communications and messaging plan for consumers. In 2022, NYHealth awarded Ichor Strategies, through fiscal sponsor Health Research, Inc., a grant to develop communication and outreach strategies for NYSDOH and its community-based partners to help New Yorkers re-enroll in health insurance coverage at the end of the pandemic public health emergency.

Under this grant, Ichor developed comprehensive, tailored plans and messages to reach New Yorkers. Ichor focused on communities in Buffalo, the Bronx, Brooklyn, and Queens—demographically diverse and representative regions with large populations who are at risk of losing coverage. Strategies were transferable to other communities across the State that had similar needs and demographic makeups. It conducted research and analysis in each of these regions on geography, race, ethnicity, language, immigration status, type of coverage, and enrollment status of consumers. It also identified potential barriers for re-enrollment as well as assets in each community. Ichor then conducted interviews and listening sessions with community stakeholders, including navigators, certified enrollment counselors, consumer advocates, and community health centers. Findings were used to identify messaging needs and gaps and to develop tailored outreach campaign plans for each community.