William F. Ryan Community Health Center, Inc.

The William F. Ryan Community Health Center (Ryan Center) operates in some of New York City’s most vulnerable neighborhoods, serving medically underserved patients in Northern Manhattan-Upper West Side, Central Harlem, Washington Heights, the Lower East Side, and Chelsea/Clinton.

Many of these communities have a shortage of primary care providers, which results in emergency room visits for non-emergency and treatable primary care conditions. These types of visits account for 39% of overall emergency room visits in New York City, according to the New York City Health and Hospitals Corporation. As many as 11% of patients in Central Harlem and 9% of patients in Inwood and Washington Heights use emergency rooms as a source of primary care. Widespread poverty further exacerbates the problem—in Central Harlem, more than 59% of residents have incomes that are 200% below the poverty level. Patients living in poverty have a more difficult time getting high-quality medical care and maintaining healthy lifestyles. While community health centers (CHCs) can serve as a crucial source of care and other safety-net services to underserved communities, many primary care doctors are not familiar with and do not have experience working in a CHC environment. This leads to difficulty in recruiting and maintaining a community health care provider base. In 2011, the New York Health Foundation (NYHealth) awarded the Ryan Center a grant to fund the relocation of St. Luke’s-Roosevelt Hospital Center’s (SLRHC) Internal Medicine Program to the Ryan Center. By serving as a teaching and primary care rotation site, the Ryan Center would play host to dozens of medical residents, further increasing their exposure to community-based care. In addition, thousands of patients would have increased access to affordable, comprehensive care.

The Ryan Center trained and educated 50 medical residents on community-based care to ensure that they have the knowledge to work in a CHC environment and care for a high-need, multi-racial/ethnic population. Two medical preceptors were retained to provide continual guidance and mentoring to the medical residents. The Ryan Center reconfigured and streamlined health center operations (e.g., patient flow, appointment scheduling, space utilization, additional licensing for electronic health records use); reviewed and revised quality assurance and improvement policies; trained and prepared current Center staff for the cultural and logistical changes; and created a resident training booklet and other training tools for dissemination.

The Nelson A. Rockefeller Institute of Government

Governor Cuomo established the Spending and Government Efficiency (SAGE) Commission in one of his first acts (Executive Order No. 4) to create a more efficient and effective state government.

In the health arena, the SAGE Commission is examining how to better manage care for patients across similar agencies, and how to reduce unnecessary and redundant regulatory burdens on care providers. Under this project, the SAGE Commission is completing a reorganization plan for health-related agencies that has the potential to significantly impact health care delivery in New York State for many years, particularly with Medicaid—a $53 billion program that must be run more efficiently. The reorganization plan has the potential to not only create efficiencies and better coordination among the agencies that operate Medicaid-funded programs, but to create better coordination of care that will benefit consumers of these services.

The SAGE Commission supported an experienced and knowledgeable researcher and assistant who collected information and conducted analyses and briefings for the SAGE Commission’s health reorganization task force. The health reorganization task force is charged with analyzing the problems that arise from the existing organizational structure, as well as determining how to remedy shortcomings. It produced a detailed analysis of current agency functions and where functions overlap; organized the work of other task force participants on these issues; compared New York’s agency structure with best-practice solutions found in other states; and articulated and quantified the benefits and costs of alternative organizational structures.

As part of this grant, The Nelson A. Rockefeller Institute of Government also hosted a workshop on November 22, 2013, entitled Open Health Data, Open Opportunities.

University of Michigan

The Institute for Leadership (IFL), a nonprofit organization whose mission is to develop leadership capacity at faith-based organizations, leads the NYHealth Diabetes Campaign’s Faith Fights Diabetes initiative.

The purpose of this initiative is to spread the implementation of Defy Diabetes, a six-week diabetes prevention and management program, in places of worship across New York State. IFL will assess the program to understand its overall impact, including strengths and weaknesses of the leadership consortium developed under this initiative; characteristics of congregations that have been successful in establishing the program; and elements associated with both programmatic and behavior outcomes. NYHealth funded the University of Michigan’s Department of Medical Education (U-M) to develop and establish the reliability and validity of two survey questionnaires designed to the program.

U-M staff worked with NYHealth and IFL staff to review existing diabetes-related surveys and establish a set of survey parameters. U-M then developed the initial drafts of the volunteer and participant surveys. It piloted test each survey at four sites, and reviewed and discussed pilot test results with NYHealth and IFL staff. Results included changes in participants’ health knowledge and behavioral changes as a result of the program as well as their experience with the trainings, materials, and support received while participating in the program. In the final stage of the grant, the reliability and validity of the data obtained from the surveys and focus groups was tested. The data was compiled into a report for IFL and NYHealth; its use helped determine the extent to which program participants learned about diabetes and experienced health improvements.


University of Rochester

For many parents, particularly those in impoverished, inner-city communities, the emergency department is their only access point for medical care for children with acute illnesses.

However, limited primary care access often leads to exorbitant costs for non-emergency conditions, and for care that is frequently inconvenient, impersonal, and inefficient. To ultimately change this paradigm, the University of Rochester piloted the Health-e-Access program over the course of nine years, beginning in 2001. The program enables children with acute or ongoing health care needs to be evaluated by a remote clinician via telemedicine in convenient, community-based access sites, which include childcare programs and schools. The program facilitates early access to care within a primary care medical home, and reduces unnecessary and costly emergency department visits. This in turn allows working families and single parents to more effectively balance their personal and professional needs. Previous research shows that the Health-e-Access model cuts down on workplace absences due to sick children by 63%, retains 87% of primary care medical home patients, and reduces health system costs by 22% due to fewer emergency department visits. A grant from NYHealth in January 2009 enabled the University of Rochester to expand the Health-e-Access program and reach more patients.

More than 6,400 telemedicine visits have been completed to date in those settings through the HeA Program. The service fosters high-quality, cost-effective care and is accepted by families and clinicians. It has been proven to reduce school/program absenteeism for illness by 63% and reduced costly emergency department visits by 24%. This project expanded a successful program to increase health care access for children in four inner-city Rochester neighborhoods. HeA is newly available after-hours and on holidays and weekends (when schools and day programs are closed) in convenient community sites such as 24-hour pharmacies, fire stations, and community centers. The primary care practices currently participating in HeA provide approximately 75% of the primary care for inner-city children, and additional physicians are encouraged to join. HeA trained physicians to manage telemedicine visits from home and were reimbursed for these services.

Planned Parenthood of New York City

More than one in four U.S. 14- to 19-year-olds has a sexually transmitted infection, and rates of teen pregnancy remain exceptionally high among girls in low-income families.

Many young people—especially those at highest risk—lack access to reproductive health services, including birth control counseling and services, abstinence education, and HIV/sexually transmitted infection screening, counseling and testing. In Staten Island, a lack of accessible health services and privacy concerns prevent many young people from seeking such care.

To expand access to safe and affordable reproductive health services for these young people, Planned Parenthood of New York City (PPNYC) established a new clinic at Community Health Action of Staten Island (CHASI), a nonprofit organization that provides social services for young people. The clinic provided family planning services and helped clients apply for health insurance benefits. It served a target population that is more than 70% minority and primarily from the low-income neighborhoods of St. George/Richmond. CHASI and PPNYC worked together to engage key Staten Island stakeholders, such as community-based social service and health providers as well as elected officials. These community leaders identified opportunities for outreach to targeted populations and spread information about the clinic. The clinic provided 3,000 visits per year when reached full capacity.

For more than 90 years, PPNYC has provided affordable and confidential reproductive health care to New Yorkers. It operates three health centers—in Manhattan, Brooklyn, and the Bronx—that offer a wide array of women’s health services and counseling. More than 42,000 clients visit these centers every year.

Institute for Leadership, Inc.

Diabetes prevalence in New York State has doubled since 1994 and is expected to grow; 1.8 million New Yorkers suffer from diabetes and 4.2 million have prediabetes.

To address this crisis, the New York Health Foundation (NYHealth) invested in a $35 million Diabetes Campaign with the goal of reversing the epidemic. The Campaign focuses on improving clinical care and patient outcomes; mobilizing communities to prevent diabetes and support diabetes self-management; and promoting policies that sustain comprehensive and effective care for people with diabetes. NYHealth funded the Institute for Leadership (IFL) to further the Campaign’s goal of mobilizing communities to spread programs that help prevent, identify, and manage diabetes in places where people live, work, and worship.

Targeting the regions hardest hit by diabetes in New York State (the Finger Lakes, Hudson Valley, Long Island, New York City, and Niagara County), IFL expanded its efforts to achieve the following goals:

  • identifyed at least 7,500 people at risk for diabetes using the American Diabetes Association Risk Assessment Survey; and
  • established at least 125 diabetes management programs in congregations throughout New York State.

To achieve these goals, IFL recruited additional congregations from its membership to participate in the initiative; training volunteers to implement diabetes self-management programs; and developing linkages between faith-based organizations and local health centers, outpatient departments, and medical practices.