New York Health Foundation

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Year: 2008

National Urban Fellows, Inc.

To maximize each fellow’s talents while also providing a rich learning experience, NYHealth assigns concrete projects and goals to allow fellows to focus their time and energy. Connecting the fellow’s interests and existing skill set with opportunities to grow, expand, and attain new competencies makes for a fulfilling experience for the fellow as well as for the mentoring organization.

The National Urban Fellows (NUF) Program trains a diverse cadre of potential leaders in public administration and health management. Each fellow—chosen from a national competition—receives full tuition and a living stipend to complete a Master of Public Administration degree at the City University of New York Baruch College, and to spend nine months as an intern in a nonprofit organization in the United States. Every year since 2006, a fellow has interned at NYHealth and this support will continue for 2008 – 2009.

Southern Tier Community Health Center Network, dba Universal Primary Care

Universal Primary Care (UPC) is a critical safety-net provider in the Southern Tier region of New York State.

UPC has filled a gap in access to care for this region’s population of historically uninsured and underinsured individuals, serving more than 13,000 patients a year. Of these 13,000, approximately 40% either are enrolled in Medicaid or Medicare or are uninsured; more than 60% live below 200% of the federal poverty line. UPC originally operated as a hospital-owned clinic until it was restructured into a 501(c)(3) charitable clinic in 2004. UPC was unable to secure federal Section 330 funding that would provide start-up operating capital, and was forced to rely on affiliating hospitals to provide a line of credit for its operating budget. As a result, UPC quickly incurred heavy debts. With support from NYHealth, UPC took significant steps to manage its debts and develop a sustainable model to ensure the growth and continuation of services to its patients.

UPC hired a specialized rate negotiator to work toward increasing its current Medicare reimbursement rate of 105% to the national average of 125%. The rate negotiator first targeted increases with UPC’s major payers, and then moved to those payers who also represent a significant portion of UPC’s business. UPC also hired a practice management consultant to review its current operational model and provided guidance on a more effective and sustainable model. The consultant also examined grant program participation and improvement of quality assurance programs to increase the reimbursement received in pay-for-performance programs. UPC also used funds to serve as a bridge payment for vaccine and medical supply vendors until a decision was made regarding UPC’s application for new Section 330 funding from the Health Resources and Services Administration.

Health Management Associates

The high cost of prescription drugs can prevent people from filling prescriptions. To address this issue, the federal government created the 340B Drug Pricing Program, which allows health centers to offer deeply discounted medications to their patients. However, the 340B program is often underutilized. NYCRx was created to help eligible health centers overcome barriers to using the 340B program. To help safety-net sites fully maximize 340B savings, NYCRx had to determine why fewer sites have applied for the  program than expected; the causes behind delays in program implementation; and why only a small number of uninsured individuals choose to receive discounted prescription drugs through the program. With funding from NYHealth, Health Management Associates (HMA) conducted an analysis of the barriers faced by NYCRx, provideed technical assistance to NYCRx staff, and reported findings to NYHealth.

HMA examined barriers to safety-net site participation and timely implementation; clinic directors’ perceptions about the application process; and operational requirements to 340B program participation. It then used these findings to create recommendations to increase the effectiveness of the 340B program among safety- net providers. It also developed measurable targets for NYCRx to increase participation in the 340B program over the next two years. HMA produced a confidential briefing memo to the Foundation summarizing the key obstacles that resulted in the slow implementation and small number of participants in the 340B program. It also created a second report to be shared with NYCRx summarizing its assessment of the obstacles faced by the 340B program and provided recommendations for the implementation process.

National Urban Fellows, Inc.

To maximize each fellow’s talents while also providing a rich learning experience, NYHealth assigns concrete projects and goals to allow fellows to focus their time and energy. Connecting the fellow’s interests and existing skill set with opportunities to grow, expand, and attain new competencies makes for a fulfilling experience for the fellow as well as for the mentoring organization.

The National Urban Fellows (NUF) Program trains a diverse cadre of potential leaders in public administration and health management. Each fellow—chosen from a national competition—receives full tuition and a living stipend to complete a Master of Public Administration degree at the City University of New York Baruch College, and to spend nine months as an intern in a nonprofit organization in the United States. Every year since 2006, a fellow has interned at NYHealth and this support will continue for 2009-2010.

Hudson Headwaters Health Network

In 2007, 18.5% of Glens Falls Hospital’s Medicare patients were readmitted to the hospital within 30 days of a hospital admission, compared to the national average of 15%–21% and the statewide average of 12.5%–15%. These acute care readmissions are costly, often indicate a lack of care coordination, and threaten the financial viability of acute care institutions, especially under the provisions of Federal health reform. Hudson Headwaters Health Network (HHHN) and the Glens Falls Hospital proposed a collaborative approach to reduce hospital readmission rates among the Medicare population. Analyzing Medicare admissions from 2006, they discovered that 1,353 patients were readmitted within 30 days of a prior admission, representing 2,429 admissions. The resulting analysis indicated that 40% of the patients with specific medical conditions accounted for 80% of the admissions (542 patients). HHHN and Glens Falls Hospital focused on developing a program that targeted this population and more directly addressed patients’ needs. A second NYHealth grant supported implementation and evaluation of this program.

Hudson Headwaters Health Network (HHHN) and Glen Falls Hospital will test an evidence-based discharge planning intervention to reduce hospital readmissions among Medicare beneficiaries (ages 65 and older) at high-risk for readmission.

Using a methodology developed under their previous planning grant, HHHN and Glens Falls Hospital will screen Medicare patients admitted to Glen Falls Hospital based on age, diagnostic condition at discharge, primary care physician and geographic residence in order to identify persons at risk for readmission. Patients meeting the criteria are assigned to an intervention or control group. The intervention, which combines intensive discharge planning with transition supports to the home environment, is closely modeled after tested studies by the University of Colorado and Boston University School of Medicine. Transition coaches will provide comprehensive services including patient assessment, education, medication management, coordination of follow-up visits and coordination of patients’ personal health records.

Fidelis Care New York

With a planning grant from the New York Health Foundation’s “Expanding Coverage Options in the Small Group and Individual Market in New York State” program, Fidelis Care examined the feasibility of expanding the Family Health Plus Employer Buy-in program to employers outside of those belonging to the Section 1199 Benefit Fund.

This grant was one of five organizations that received a planning grant from the 2008 NYHealth request for proposals (RFP), “Expanding Coverage Options in the Small Group and Individual Market in New York State.” The RFP grew directly out of the Foundation’s desire to generate ideas for expanding health insurance options for small businesses and sole proprietors.

Read an NYHealth special report that contains a summary of findings from this RFP.

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