United Hospital Fund announced 12 grants, totaling $597,193, for projects to build a more effective health care system for every New Yorker.
The Medicaid Institute/Children's Health
Schuyler Center for Analysis and Advocacy ($61,708)
To help ensure that the unique health needs of children are considered in New York's health care reform efforts, by assessing the impact on child health of various approaches to value-based payment, and disseminating findings to policymakers and other stakeholders.
New York's Medicaid program is in the middle of a significant transformation, in which substantial populations and services are moving into managed care, and the Medicaid payment system is being adjusted to reward the value of health care services over the volume of services.
Discussions in New York State about the move to value-based payment have primarily focused on high-cost conditions, high-volume services, and high-need adult populations. Children, a generally low-cost population with relatively few avoidable hospitalizations compared to their adult Medicaid-insured counterparts, have not been a focus of discussions. However, focusing only on adults poses the risk of creating a system that ignores the developmental trajectory of children and the opportunity for health care providers to address developmental and other challenges that have significant effects on children's long term physical health, mental health, and cognitive outcomes.
Through research, analyses, and interviews with stakeholders, including policy makers, providers, insurers, and academics, the project team will examine which value-based approaches may be applicable to payment for services provided to Medicaid-insured children—and will then produce and disseminate a final report.
Family Caregiving/Quality Institute
New Yorkers for Patient and Family Empowerment ($80,000)
To improve patient care through a learning collaborative of up to 20 New York City hospitals focusing on supporting visiting policies that recognize, engage, and support family caregivers as partners in care.
Strong evidence shows that the presence of family caregivers has a significant impact on the quality of care and safety of patients in the hospital. Yet research shows that many hospitals have restrictive visiting policies that give families limited access to the bedsides of loved ones during a hospital stay.
Through this project, two nonprofit organizations—New Yorkers for Patient and Family Empowerment and the Institute for Patient- and Family-Centered Care—will work together with a group of New York City hospitals to change visiting policies from those that restrict family presence and participation to policies that are more welcoming and recognize that families are essential members of the care team.
Invitations will be sent to the leaders of all New York City hospitals, and up to 20 hospitals will be selected to participate—with teams of four to five staff from different disciplinary areas. Participating hospitals will assess their current policies and practices, participate in training sessions, receive tested toolkits and guides to help them change policies and practices, and attend an international conference (held in New York City) on the topic. The project's products will include a report on a comparative survey of hospitals' posted “visiting policies” on their websites to measure change that has occurred over the time of the project, both for participating and non-participating hospitals.
UHF Outpatient Antibiotic Stewardship Initiative ($310,180)
Interfaith Medical Center ($30,000)
MediSys Health Network ($60,000)
Memorial Sloan Kettering Cancer Center ($15,000)
Montefiore Medical Center ($35,000)
Mount Sinai Health System ($35,180)
Northwell Health ($45,000)
Wyckoff Heights Medical Center ($30,000)
To address the critical issue of antibiotic resistance—to date a focus of work primarily in inpatient settings—by engaging hospital-owned outpatient practice sites in analyzing the factors affecting prescribing practices and developing a comprehensive action plan to test, implement, and evaluate appropriate antibiotic stewardship best practices.
Antibiotic misuse and overuse has emerged as an important health care quality and patient safety issue. Studies show that up to 50 percent of antibiotic prescribing is inappropriate, resulting in increased rates of serious infections and contributing to the spread of antibiotic resistance.
Health care institutions can rely on antibiotic stewardship programs to optimize antibiotic prescribing to improve patient care, reduce costs, and slow the spread of antibiotic resistance. Although antibiotic stewardship practices have predominantly been prioritized within inpatient hospital settings, there is a critical need to consider their applicability in outpatient settings, which is the source of 262.5 million courses of antibiotic prescriptions per year, and where formal stewardship programs are much less common.
Through this grant initiative, United Hospital Fund will work with a group of 24 outpatient sites from 8 hospitals and health systems to better understand the primary factors that drive prescribing practices, and to identify appropriate interventions for the sites to test and implement to improve the appropriateness of antibiotic prescribing. UHF will work with participants to analyze prescribing practices for a sub-set of adult patients with acute respiratory infections, as this is a major condition in which antibiotics are misused. The practices will use a set of structured data collection tools, to be developed by UHF and an advisory group (composed of infectious disease physicians, pharmacists, and outpatient clinicians) that will be formed as part of the initiative. UHF will engage two key infectious disease physicians, from two of the participating hospitals, to provide clinical expertise to help shape this effort.
Data & Society Research Institute ($70,000)
To generate an overview of New York-based activity to develop relevant apps, clinical decision tools, connected devices, and other assistive digital health technology for patients with multiple chronic conditions, and to create a framework for evaluating such technology.
Digital health technology is a rapidly developing field in which new health apps, clinical decision tools, and connected devices are being designed to meet the health care needs of providers, payers and patients. There are few new digital tools, however, that aim to manage the needs of complex patients with multiple chronic conditions—patients who drive substantial health spending and are at risk for greater morbidity and mortality than their peers.
Based on a review of the literature, social media, and technology reviews, as well as structured interviews and discussions with key stakeholders, the project team will produce a report that helps identify the key challenges and opportunities for developing digital tools that focus on the needs of the most complex patients. The focus will be on digital development activities based in New York, with an emphasis on those that are being developed or tested with New York providers or patients. The technology examined will focus on medication management, care coordination, and self-management.
Health Insurance Project
Medicare Rights Center ($75,305)
To enhance organizations' capacity to promote the interests of consumers within new health system transformation models in New York State, and help consumers become better informed and active participants in shaping new models. Medicare Rights Center will assess the care landscape, including payment and delivery system innovations and next steps for education and policy.
In New York State and across the country, the way health care is paid for and delivered to patients and consumers is changing. And these changes affect the relationships and dynamics between patients, providers, and payers in ways that are complex.
This project aims to improve the capacity of the Medicare Rights Center and other consumer–oriented stakeholders to promote the rights and needs of consumers—particularly older consumers with disabilities, the Medicare population—to become better informed and active participants in shaping new models.
The Medicare Rights Center will convene a workgroup to develop criteria for assessing New York's health system transformation landscape and will develop plans for educating consumers about—and engaging them in—new models. The project team will also work with policymakers to help ensure that new models are responsive to consumer needs. The project will culminate in a report on New York's Medicare-related health system transformation landscape.
About the United Hospital Fund: The United Hospital Fund is an independent, nonprofit organization working to build a more effective health care system for every New Yorker.