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The Emerging Crisis of Aged Homelessness

January 13, 2019

This report summarizes a multi-site study in three localities - Boston, New York City, and Los Angeles County - of the anticipated future of the aged homeless population, its likely impacts on health and shelter systems and resulting costs, and the potential for housing solutions. Specifically, this report summarizes the following analyses:Forecasts of the size of the aged homeless population to 2030Projected costs associated with the use of shelter, health care, and long-term care by this aged homeless populationSegmentation of the forecasted aged population based on the intensity of health and shelter use by various subgroupsPotential service cost reductions associated with housing interventions based on scenarios from prior literatureThe net cost of the proposed housing interventions based on the potential for shelter, health, and nursing home cost offsetsThe report concludes with some considerations regarding how to pay for potential housing solutions, given the complexity of the various funding streams. Absent new housing solutions, substantial public resources will otherwise be spent unnecessarily on excess shelter, health, and long-term care use.Click "Download" to access this resource.

Still Searching: How People Use Health Care Price Information in the United States, New York State, Florida, Texas and New Hampshire

April 1, 2017

Americans bear a large and growing share of their health care costs in the form of high deductibles and insurance premiums, as well as copayments and, sometimes, coinsurance for physician office visits and hospitalizations. Historically, the health care system has not made it easy for people to find out how much their care will cost them out of pocket. But, in recent years, insurers, state governments, employers and other entities have been trying to make price information more easily available to individuals and families. Are Americans trying to find out about health care prices today? Do they want more information? What sources would they trust to deliver it?This nationally representative research finds 50 percent of Americans have tried to find health care price information before getting care, including 20 percent who have tried to compare prices across multiple providers. Representative surveys in four states— New York, Texas, Florida and New Hampshire—show higher percentages of residents in Texas, Florida and New Hampshire have tried to find price information and have compared prices than New York residents and Americans overall. This variation suggests factors at the state level might be influencing how many people try to find out about health care costs. Nationally and in those four states, more than half of people who compared prices report saving money. Most Americans overall think it is important for their state governments to provide comparative price information. But we found limited awareness that doctors' prices vary and limited awareness that hospitals' prices vary.Public Agenda conducted this research with support from the Robert Wood Johnson Foundation and the New York State Health Foundation. The findings are based on a nationally representative survey of 2,062 adults, ages 18 and older, and a set of representative surveys in four states: one survey of 802 adults in New York, one of 808 adults in Texas, one of 819 adults in Florida and one of 826 adults in New Hampshire. The surveys were conducted from July through September 2016 by telephone, including cell phones, and online.

Project ECHO Evaluation 101: A practical guide for evaluating your program

April 1, 2017

Project ECHO® (Extension for Community Healthcare Outcomes) is a collaborative medical education model that aims to build workforce capacity in rural and underserved areas. Developed by clinicians at the University of New Mexico (UNM), the ECHO model is now being used to address health care shortages all over the world and across diseases and specialties—ranging from autism care for children to palliative care for older adults. With a particular focus on supporting groups with relatively limited evaluation resources, this resource describes evaluation methods that can be used to examine the implementation, outcomes, and value of Project ECHO clinics that aim to address a wide range of challenges related to health care access, delivery, treatment, and prevention, particularly in underserved communities.

Research Brief: A Collaborative Approach to Behavioral Health Care for Veterans and Their Families

January 1, 2016

This NYSHealth-supported study, conducted by the RAND Corporation, examined the viability of a public-private partnership in providing coordinated care in behavioral health services for veterans and their families. RAND evaluated the center's activities to document the implementation of a unique public-private collaborative approach for providing care to veterans and their families. The evaluation focused on documenting the structures of care (the capacities and resources that the center developed and employed) and the processes of care (the services delivered), and also outcomes of care. The evaluation suggests that, overall, the model has been successfully implemented by the UBHC and has great potential to be helpful to the veterans and families it serves.

A Plan for Expanding Sustainable Community Health Centers in New York

April 1, 2013

Federally Qualified Health Centers (FQHCs) are at the center of both federal and State health care reform strategies. FQHCs are located in underserved areas and provide community-based comprehensive primary care to anyone who needs care, regardless of their ability to pay. They provide a range of services including primary and preventive care, behavioral health services, dental care, and substance abuse services as well as enabling services such as transportation, interpretation, and outreach. Successful implementation of federal health reform, the Affordable Care Act (ACA), will require expanded primary care capacity to both care for the influx of newly insured people and ensure a strong safety net for those who remain uninsured. The federal law recognizes this and makes FQHCs a cornerstone of its plan for expanding access to health care. In New York State, FQHC capacity is expected to double to serve nearly three million New Yorkers by 2015.Initiatives in New York State reinforce the need for enhanced primary care capacity. Governor Andrew Cuomo established the Medicaid Redesign Team (MRT) and tasked it with finding ways to reduce costs and increase quality and efficiency in the State's Medicaid program. A central strategy of the MRT has been promoting more integrated and Triple Aim-oriented systems of care that produce better care and better health at lower costs and have community-based primary care as the foundation.FQHCs are well positioned to participate in and lead these transformations and develop their capacity to serve more patients. There are untapped opportunities to derive more capacity out of the existing primary care system by changing how patients access care and how care is delivered. In addition, there are many communities throughout New York that need additional primary care capacity to meet the current and future needs of their communities.

Maximizing Health Care Reform for New York's Immigrants

February 5, 2013

As New York State works to implement health reform, key opportunities exist to expand coverage options for immigrants. This NYSHealth-supported report, written by the New York Immigration Coalition in conjunction with Empire Justice Center, presents the choices New York State policymakers will need to make to preserve and promote immigrants' access to health care coverage and to mitigate disparities between citizens and noncitizens in health care.The report emphasizes the options in areas in which states have a high degree of flexibility, including eligibility classifications; documentation and verification policies and practices; marketing and outreach; and oversight and monitoring. It also includes recommendations for ensuring access to care for those immigrants who will remain uninsured even after health reform is implemented. Among the report's recommendations:Shape the State's eligibility classification to ensure the broadest possible inclusion of immigrants under the Affordable Care Act. Currently, immigration status definitions, and eligibility for public benefits, vary by federal and state program rules. The report recommends the cases in which New York can apply the more expansive eligibility standards.Develop mechanisms for verifying citizenship and immigration status while protecting confidentiality and due process. Enrollment into public insurance programs and the Health Benefit Exchange will require verification and documentation of status. The report recommends specific options for verification that also maintain privacy.Conduct tailored, active outreach and marketing to engage immigrants and enroll them in health insurance coverage programs. Given the tremendous racial, ethnic, cultural, and language diversity of the State's residents, a range of tailored approaches can meet the unique needs of immigrant communities.Secure the safety net and charity care programs. Undocumented immigrants and some others will remain uninsured even after health reform is implemented, so the safety-net system of care will remain important to New York State's health care infrastructure.

Coming Home to Caring Communities: A Blueprint for Serving Veterans and Their Families

February 1, 2012

Communities across the U.S. are grappling with veterans' reintegration issues, but the answers about how best to serve veterans and their families may be elusive, because every region has different resources, service gaps, and needs. Despite these variations, a common core of key community-based supportive services and practices has been identified in order to help communities serve their veterans and families in a more consistent and professional manner. So what can a community do to help? How would service providers, local leaders, and citizens begin to organize their community's resources to support veterans and families effectively? What would that look like? How would it be paid for? Has it been done well in other communities?This blueprint answers these questions as a combination "how-to manual" and toolkit with an inside look at how an existing Center operates. This document provides a blueprint of "what works" to help communities identify and implement the programs their local communities need. The details in this blueprint leverage the knowledge of Veterans Outreach Center (VOC) in Rochester, NY, the oldest community-based nonprofit organization in the nation devoted exclusively to serving veterans and their families. The information in this blueprint will help communities get a jump-start on developing local programs and initiatives of their own. Ultimately, these tools will help increase access to consistently high-quality community-based supportive services for veterans and their families.

Reducing Hospital Readmissions in New York State: A Simulation Analysis of Alternative Payment Incentives

September 13, 2011

Examines strategies to reduce hospital readmissions, including improving discharge processes, post-discharge support, and payment incentives. Estimates payers' and hospitals' cost savings from pay-for-performance and episode-based payments.

Bridging the Gap: Exploring the Basic Health Insurance Option for New York

June 30, 2011

Explores New York state's options, costs, and benefits of creating a basic health plan under health reform, including available federal funding, take-up rates by various population groups, types of plans, and impact on state exchange and uninsured rates.

Sustaining Improved Outcomes: A Toolkit

May 23, 2011

Offers a framework for designing and implementing a plan to sustain organizational improvements by strengthening factors that affect sustainability, including perceived value, monitoring and feedback, leadership, shared models, community fit, and funding.

A Needs Assessment of New York State Veterans: Final Report to the New York State Health Foundation, Summary

January 26, 2011

Mental health disorders and other types of impairments resulting from deployment experiences are beginning to emerge, but fundamental gaps remain in our knowledge about the needs of veterans returning from Iraq and Afghanistan, the services available to meet those needs, and the experiences of veterans who have tried to use these services. The current study focuses directly on the veterans living in New York state; it includes veterans who currently use U.S. Department of Veterans Affairs (VA) services as well as those who do not; and it looks at needs across a broad range of domains. The authors collected information and advice from a series of qualitative interviews with veterans of Operation Iraqi Freedom (OIF)/Operation Enduring Freedom (OEF) residing in New York, as well as their family members. In addition, they conducted a quantitative assessment of the needs of veterans and their spouses from a sample that is broadly representative of OEF/OIF veterans in New York state. Finally, they conducted a review the services currently available in New York state for veterans. The study found substantially elevated rates of post-traumatic stress disorder (PTSD) and major depression among veterans. It also found that both VA and non-VA services are critically important for addressing veterans' needs, and that the health care systems that serve veterans are extremely complicated. Addressing veterans' mental health needs will require a multipronged approach: reducing barriers to seeking treatment; improving the sustainment of, or adherence to, treatment; and improving the quality of the services being delivered. Finally, veterans have other serious needs besides mental health care and would benefit from a broad range of services.

A Needs Assessment of New York State Veterans

January 25, 2011

Provides quantitative and qualitative assessments of services Iraq and Afghanistan veterans and their families need and a resources guide. Calls for broader coordination of care beyond the VA, better outreach, and multi-pronged approach to mental health.