Center for Health Care Strategies, Inc.

In 2014, Congress authorized the development of Certified Community Behavioral Health Clinics (CCBHCs) on a demonstration basis.

The purpose of CCBHCs are to provide mental health and addiction services for low-income Americans with serious behavioral health needs. One-year federal planning grants were awarded to 24 states, including New York, to develop certification criteria and processes for designating CCBHCs, as well as to design a prospective payment system for reimbursement of qualified providers. Given New York’s other multiple health care reform efforts—including the Delivery System Reform Incentive Payment program, rollout of integrated managed care models, and value-based payment arrangements—it was important for the State to consider the CCBHC project in the context of its other reforms. In 2015, NYHealth awarded a grant to the Center for Health Care Strategies (CHCS) to provide New York State officials a useful platform for exchange with other states facing similar alignment issues, as well as with individualized technical assistance to support CCBHC design and implementation throughout the State.

Under this grant, CHCS supported New York and other planning grant states in their work to align CCBHC implementation with overall state efforts to integrate physical and behavioral health services and move toward value-based payments. CHCS identified proposed ways to align CCBHC implementation with other state-based delivery system and payment reforms, along with technical assistance needs that needed to be addressed to support this alignment. It convened a small group consultation to review key findings, recommend approaches for alignment, and put together a technical assistance agenda to support alignment efforts, all to be summarized in an issue brief. CHCS offered New York and other planning grant states some technical assistance and a series of webinars to help them think through and address individual CCBHC alignment needs. It developed a second issue brief highlighting key issues and approaches identified during technical assistance activities.

Rapid Results Institute, Inc.

To tackle some of the underlying problems that have affected the health of neighborhoods, NYHealth launched the Healthy Neighborhoods Fund initiative to help New York State communities become healthier and more active places.

Through the Healthy Neighborhoods Fund, NYHealth is investing $2 million over two years to support six communities across the State in their efforts to increase access to healthy, affordable food; improve access to safe places where residents can exercise and be active; and connect children and adults to programs that support healthy behaviors. Although all the communities are working toward the common goal of improving the health of their residents, each community may face challenges particular to their region. In response, NYHealth is supporting these communities with more specialized technical assistance to help them meet their goals. In 2015, NYHealth awarded Rapid Results Institute a grant to provide technical assistance to Clinton County Health Department (CCHD), a Healthy Neighborhoods Fund grantee.

Under this grant, Rapid Results Institute trained and supported CCHD staff to develop strategic objectives for their grant goals using the Institute’s 100-day challenge plan, which strives to help organizations and communities accomplish an initiative in 100 days. Rapid Results Institute conducted a series of interviews and planning sessions with key stakeholders in the region to develop a 100-day challenge tailored to CCHD’s goals. It then launched a workshop to set the project in motion. Rapid Results Institute provided mentoring and support to participating organizations through weekly calls, one-on-one follow up, and bi-weekly peer-coaching sessions. A midpoint review was also conducted to ensure the project was meeting its goals. Finally, Rapid Results Initiative developed a sustainable strategy for CCHD beyond the 100-day challenge in support of CCHD’s long-term agenda to build a healthier Clinton County.

Medicare Rights Center

Half of all New Yorkers with Medicare live on yearly incomes of $24,150 or less. Given that people with Medicare on average spend 15% of their household incomes on health care, it is imperative that this population is receiving all public benefits that it is eligible for.

Medicare Savings Programs (MSPs) are Medicaid-administered benefits for low-income Medicare beneficiaries. MSPs pay for Medicare Part B monthly premiums, covering services that include outpatient care, preventive services, and doctor visits. They also lead to automatic enrollment in the Medicare Part D Extra Help drug subsidy program, which saves enrollees in out-of-pocket drug costs. Currently, an estimated 200,000 New Yorkers are eligible for but not enrolled in MSPs, in part because of a lack of education about MSPs, a negative stigma associated with them, and difficulty navigating the enrollment system. In 2015, NYHealth awarded the Medicare Rights Center (MRC) a grant to increase access and enrollment into MSPs throughout New York State.

Under this grant, MRC pursued a series of policy and education solutions to sustainably increase MSP enrollment. It identified the challenges to MSP enrollment and developed actionable solutions needed to simplify and streamline enrollment procedures statewide. It conducted analysis and stakeholder interviews, as well as held State convenings, to develop a set of concrete policy and education actions. MRC developed a report on its findings and recommendations for distribution throughout the State and to other states seeking to simplify MSP enrollment procedures.

Read the report: “Medicare Snapshot: Stories from the Helpline: Improving New York State Access to Medicare Savings Programs.”

Claybridge Health Education Fund

Black Americans live sicker and die younger than any other ethnic group in the United States—they are 65% more likely to die of prostate cancer, 50% more likely to have hypertension, and 79% more likely to live in neighborhoods that pose an environmental health threat than white Americans.

Despite thousands of articles documenting these health inequities, little progress has been made to eliminate them. The Claybridge Health Education Fund (the Fund) produces and disseminates public health education and training materials on the impact of these health inequities and solutions to address them. The Fund launched a national campaign to translate existing academic research into a platform that can empower individuals and communities to make a difference. One element of this campaign was the documentary film, The Skin You’re In. The film gives a first-hand account of the health disparities between black and white America. In 2015, NYHealth awarded the Fund a grant to devote a chapter of the film to Brownsville, Brooklyn, a grantee of the NYHealth Healthy Neighborhoods Fund initiative.

Under this grant, the Fund filmed in Brownsville to display what is being done to improve the public health of the neighborhood. Brownsville has the largest concentration of public housing in the nation, as well as the lowest life expectancy in New York City. One of NYHealth’s Healthy Neighborhoods Fund sites, Brownsville has many initiatives involving residents, community leaders, and organizations working to restore the community. The filmmakers highlighted these positive examples of change. After completing footage of Brownsville, the filmmakers worked with NYHealth grantees and other partners to organize community viewings of the film, in advance of its official release. After each screening, there was opportunity to participate in a discussion on the film’s topics and themes, explicitly on Brownsville and the work of the Brownsville-based individuals and organizations that are making a difference. Discussions were framed around actionable items and facilitated by Brownsville leaders who could engage residents to join the positive movement for change.

New York University

Approximately 1.3 million students attend one of the 271 institutions of higher education in New York State. Though often overlooked, a large proportion of these students are unvaccinated for preventable diseases, such as influenza, hepatitis B, and meningitis.

Factors, such as a lack of regular preventive visits, financial barriers, misperceptions of risk, and no uniform method of vaccination record-keeping, lead to the potential of disease outbreaks among college campuses. Although many students enter college missing age-indicated vaccinations, the campus environment provides an opportunity to provide annual, indicated, and catch-up vaccinations. In 2015, NYHealth awarded New York University (NYU) a grant to implement a peer-based learning network focused on increasing vaccination rates among college campuses across New York State.

Under this grant, NYU established the first learning collaborative to engage colleges in increasing vaccination rates among their student bodies. Specifically, the collaborative convened college student health centers to develop sustainable, system-level improvements to increase immunization rates and learn and apply quality improvement methods. NYU engaged a diverse set of 60–90 institutions of higher education, including public, private, and community colleges statewide. Participating student health centers collected data and measured test techniques they use to increase immunizations. Through learning sessions, student health centers reported on successes, barriers, and lessons learned from these tests and share their reports and assessments. Upon completion of the collaborative, the colleges developed an implementation toolkit on best practices for increasing vaccinations among college students across the State.

Research Foundation of the City University of New York (CUNY)

New York hospitals that provide care to patients who are unable to pay are compensated by supplemental payments through an indigent care pool (ICP).

ICP payments cover hospital losses incurred from free care provided to uninsured patients, as well as from insufficient Medicaid rates. Supplemental payments constitute a major source of stability for safety-net hospitals, which serve a high proportion of low-income patients; however, ICP funds are not consistently allocated based on need or indigent patient volume. In 2015, NYHealth awarded Research Foundation of the City University of New York (CUNY) a grant to conduct a study of New York City hospital ICP allocations in relation to the care provided to uninsured and Medicaid recipients.

Under this grant, CUNY conducted research and published a report documenting the current ICP allocation methodology and recommendations for improvements to better serve safety-net hospitals. Specifically, CUNY gathered current data on Medicaid and uninsured patient volumes at New York City hospitals; documented the costs for individual hospitals of providing care to these patients; and documented allocations of funds to individual hospitals. The report was shared with State and City policymakers to help inform them on better ways to allocate ICP funding to safety-net hospitals serving the bulk of low-income patients.

Read the report “An Examination of Indigent Care Pool Allocations.”