New York University Grossman School of Medicine

A core strategy of NYHealth’s Primary Care priority area is to elevate the non-clinical workforce—specifically, Medical Assistants (MAs) and CHWs—and integrate them into primary care teams to improve patient health outcomes, reduce clinician strain, and support equitable career advancement.

Previously, NYHealth supported the New York Alliance for Careers in Healthcare to design a statewide scan of the current functions and desired roles of MAs on care teams. Similarly, an understanding of on-the-ground experience is needed to effectively scale models of CHWs’ integration. In 2024, NYHealth awarded New York University (NYU) a grant to conduct focus groups with primary care providers and community health workers regarding CHW integration into care teams across New York State.

Under this grant, NYU will conduct a series of focus groups both upstate and downstate to elicit experiences and information from both CHWs and the clinical and community-based providers that employ and partner with them (e.g., academic medical centers, community hospitals, community health centers, physician practices). NYU will distill the findings into a research brief that summarizes themes and offers recommendations, share related materials with researchers and CHWs in other states, and promote its work through webinars and publications.

 

Project Renewal, Inc.

In recent years, New York has invested significant resources in expanding mental health care access, but an acute mental health workforce shortage is stymying those efforts.

The shortage affects hospitals and outpatient settings across the State, at all levels of the mental health care workforce, including for entry-level positions like psychiatric social health technicians (psychiatric technicians). Psychiatric technicians play a role in caring for patients with mental illnesses and/or developmental disabilities. They alleviate the burden on nurses and other clinical staff and promote safety by assisting patients with activities of daily living, providing coverage for 24-hour monitoring of high-risk patients, and conducting wellness checks. While demand for this work is forecasted to grow, the employee pipeline is inadequate. The workforce development sector has long recognized the value of supporting individuals with lived experience (e.g., homelessness, mental health disorders) to fill frontline positions, but these workers often face discrimination in the employment process and lack the training and support to manage their personal challenges. In 2024, NYHealth awarded Project Renewal a grant to pilot a workforce development training program to help address mental health workforce shortages in New York City while also creating a career pathway for individuals who have lived experience with homelessness, substance use disorder, justice system involvement, and/or mental illness.

Under this grant, Project Renewal will partner with NYC Health + Hospitals (H+H) to launch a first-of-its-kind psychiatric technician work training program. Project Renewal will recruit participants for a training program focused on patient care, health care settings, and executive functioning. To ensure participants can complete the training program, Project Renewal will provide comprehensive wraparound services such as housing support and transportation. H+H will host an intensive internship program that will create a pipeline for employment; successful participants are expected to be hired for technician positions upon completing the internship. Project Renewal will use the training program as a proof of concept to advocate for a New York State-approved program model paving the way for Project Renewal and other health systems to expand the program.

 

Health Care for All New York (fiscal sponsor: Hispanic Federation)

Historically, primary care has not been a core focus for consumer advocates in New York, but the landscape is changing.

Consumer advocates’ priorities are gradually moving toward those that align with NYHealth’s strategies to expand access to primary care and advance racial health equity. In 2024, NYHealth awarded Health Care for All New York (HCFANY) a grant to develop and implement a new consumer advocacy agenda focused on primary care.

Under this grant, HCFANY will focus on three core policy areas: expanded coverage, enhanced affordability, and improved accessibility of primary care services. Advocates will also explore opportunities to advance policies focused on rebalancing health care spending toward primary care, transforming the health care payment and delivery system to prioritize primary care, and strengthening the primary care workforce. HCFANY will educate and activate consumer advocates on primary care issues and use policy research and analysis; communications; grasstops leader mobilization; and administrative policy advocacy to advance its efforts.

Community Service Society of New York

NYHealth has a long history of investing in and partnering with New York’s consumer advocates, including successful efforts to (1) ensure that New Yorkers stay enrolled in health insurance and (2) protect them from crippling medical debt.

Coverage rates rose to historically high levels during the COVID-19 pandemic and the State is undertaking a massive effort to preserve those gains. NYHealth worked with the New York State Department of Health (NYSDOH) and the Community Service Society of New York (CSS) to stand up the Keep New York Covered initiative—an effort by community-based enrollers to conduct outreach and marketing to millions of New Yorkers to help them stay covered. New York now ranks among the top 5 states in keeping families enrolled in Medicaid, with close to 80% of those required to recertify remaining enrolled. Simultaneously, medical debt continues to be a crushing burden for New Yorkers; a recent NYHealth-commissioned study shows that approximately 740,000 New Yorkers had medical debt in collections on their credit records. But New York is making progress:  a coalition of partners, including CSS, has run the highly successful End Medical Debt NY campaign, with NYHealth support. Most recently, New York became only the second state in the nation to prohibit credit agencies from including medical debt of any amount on credit reports. Even with all this progress, there is more work to be done. In 2024, NYHealth awarded CSS a grant to maintain consumer advocacy and programmatic infrastructure to support statewide efforts to keep New Yorkers covered with health insurance and protected from crippling medical debt.  

Under this grant, CSS will harness momentum and continue to lead two signature campaigns. For the Keep New York Covered Initiative, CSS will lead a learning collaborative for community-based navigators and coordinate partners to lead on-the-ground outreach campaigns. It will also track and synthesize outreach and enrollment data and identify best practices. For the End Medical Debt NY Campaign, CSS will coordinate and strengthen the campaign to educate the public and policymakers about proposals to address medical debt. It will generate public engagement and earned media through consumer stories, presentations, social media outreach, and opinion pieces. CSS will also work to ensure effective and expedient implementation of existing medical debt reform policies.

Southern Tier Health Care System

While the prime responsibility of EMS providers is to stabilize patients in crisis and transport them to the hospital, community paramedicine enhances their role to include community-based health care delivery—allowing them to respond to chronic disease management and quality-of-life issues without diverting resources away from emergency medical services.

This type of in-home service is needed, especially in rural areas of New York State like the Southern Tier. Older adults comprise close to 20% of the State’s population, and the number of older New Yorkers living below the poverty line increased by 37% over the past decade. In rural health care shortage areas with insufficient health care providers and facilities, residents often encounter long travel times, a lack of transportation options, and extended appointment wait times. In the Southern Tier, these barriers have led to higher emergency department use and calls to 911 for non-urgent needs. In 2024, NYHealth awarded Southern Tier Health Care System (STHCS) a grant to develop and test a community paramedicine program to provide at-home health services and coordinate care with local providers in the Southern Tier.

Under this grant, STHCS will lay the groundwork for the paramedicine program, identifying patients who would benefit from coordinated and continuous care outside of a hospital setting and deploying trained community paramedics. Once dispatched to a home, the paramedics will assess each patient’s basic physical, mental, and emotional health; conduct non-medical health screenings; and facilitate primary care and social services referrals. With guidance from the patient’s medical provider, the paramedics will review patients’ medication lists, reconcile discrepancies, and provide education on proper medication usage, potential side effects, and the importance of adhering to prescribed regimens. The paramedics will also offer personalized education on self-monitoring and disease management techniques and participate in workshops and community education events to raise awareness about common health issues, prevention, and available community resources. STHCS will collect and analyze data on program activities, patient outcomes, and resource utilization to assess the program’s impact, identify areas for improvement, and support an ongoing funding model.

 

Research Foundation for the State University of New York

In New York State, more than 410,000 older New Yorkers have been diagnosed with Alzheimer’s disease and other forms of dementia, and 50,000 more older adults are projected to develop the condition by 2025.

While there is no cure for Alzheimer’s disease, early detection allows for treatment to manage symptoms and disease progression; enables older adults to make their own care decisions before cognitive decline; and promotes planning to maximize independence and quality of life. But there are many gaps in identifying older New Yorkers at risk, and too many do not receive proper support until they are in crisis. These negative effects are particularly acute for people with low income, people of color, and rural New Yorkers. New York State’s Office for the Aging sites are well-positioned to be part of the solution. Syracuse University’s Aging Studies Institute, in partnership with SUNY Upstate’s Department of Geriatrics and with support from the Health Foundation of Western and Central New York, launched a successful pilot in 2019 to train case managers from the Onondaga County Office for Aging to administer an evidence-based tool to screen for early signs of cognitive impairment. In 2024, NYHealth awarded the Research Foundation for the State University of New York (RFSUNY) and SUNY Upstate a grant to expand and embed this comprehensive screening and referral model for early cognitive impairment into New York State’s Office for the Aging sites throughout Central New York. Syracuse University will lead the project’s evaluation.

Under this grant, SUNY Upstate and Syracuse University will build on the success of the pilot and partner with the Office for the Aging to embed the screening and referral protocols into case managers’ workflows at sites in seven additional counties in Central New York. It will train case managers and site staff to screen clients using an evidence-based tool to assess for early signs of cognitive impairment and dementia. Each office will formalize a referral system with SUNY Upstate’s Center of Excellence for Alzheimer’s Disease (CEAD) to refer older adults who screen positive for cognitive impairment for a comprehensive evaluation. Using evaluation findings and feedback from participating sites, SUNY Upstate will create a publicly available training manual and video and share results with policymakers, area agencies on aging, and others to support the replication of the program.

 

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