One of the major innovations of the New York State Delivery System Reform Incentive Payment (DSRIP) program is the notion that the “social determinants of health” such as stable housing, access to healthy food, and transportation are just as important as traditional healthcare interventions in promoting health outcomes. When patients experience housing instability, can’t access healthy food, and do not have transportation to medical appointments, following up on health issues becomes difficult if not impossible. However, when chronic health conditions like Diabetes and Hypertension are left untreated, they often cause serious and more costly health problems in the future.
In order to achieve its goal of reducing Medicaid costs, the NYS DSRIP program has been encouraging hospital systems, primary care physicians and behavioral health providers to partner with non-profit Community Based Organizations. These agencies, known as “Tier 1 CBOs”, are not Medicaid providers, but they do play a vital role by providing food, housing, transportation and cultural services to Medicaid recipients and the uninsured.
This focus on the “social determinants of health” has presented both healthcare providers and the Tier 1 CBOs with a new set of challenges. Historically, training for healthcare professionals has not included lessons on the role of CBOs or how the social determinants of health impact overall health. Hospitals and primary care physicians may feel that “they do not have the time” to deal with “social” issues. For their part, Tier 1 CBO’s have viewed their role as the provider of direct services, but many have not thought of their work as “healthcare”. Additionally, while hospitals are large organizations with hundreds of employees and sizable infrastructure, Tier 1 CBO’s usually operate with a handful of employees and a limited infrastructure. As a further complication, Hospitals may not know who the CBOs in their area are, what services they provide, or how to make a referral to them.
The Nassau Queens PPS (NQP) is responsible for implementing the NYS DSRIP program in Nassau County and Eastern Queens, and covers about 450,000 Medicaid lives. NQP is a collaborative effort led by the three main hospitals in the region, Nassau University Medical Center, North Shore – Long Island Jewish Hospital / Northwell Health and Catholic Health Services.
In an innovative approach to engaging community based organizations, in 2017 NQP entered into initial contracts with 20 local Tier 1 CBO’s that were designed to help increase the awareness of chronic health conditions as well as healthcare resources for individuals living in Nassau County and Eastern Queens. Incorporating these non-traditional service providers into the broader health care network has allowed NQP to target resources to better connect communities with needed health care, and extended the boundaries of traditional services.
This initial round of funding provided valuable lessons for NQP about working with CBO’s. While some of the CBO’s excelled, NQP observed that not all CBO’s have the desire to participate in healthcare, and some struggled to meet even the most basic contractual requirements.
In 2018 NQP selected 7 CBOs who showed both an aptitude to play a role in healthcare, and contracted with them to engage in more substantial work. These organizations provide a wide mix of services including: housing for homeless individuals, assistance for residents of NYC Public Housing, after school activities, health literacy training, services to the Haitian community, and work done by a local congregation to improve the health of its members. Many are hiring staff such as Community Health Workers or “Navigators” to assist their constituents connect to healthcare. As the 7 CBO’s begin their enhanced work with NQP they are being challenged to stretch and grow their agencies ability to respond to deadlines, to report on outcomes, and to safeguard Protected Health Information.
Many Community Based Organizations struggle as they seek to grow and diversify their services. Some lack basic infrastructure and management systems, and many experience cash flow and funding challenges. In order to assist with these issues, NQP is providing the services of 1811 Consulting to a select group of contracted CBO’s. The President of 1811 Consulting, Doug Apple, is sharing his 30 plus years of experience in NYC government and the non-profit sector with the CBO leadership and their Boards of Directors. Doug is working with these agencies on strategic planning, diversifying funding sources, board development, and organizational change management.
Doug Apple commented on his work saying, “I commend NQP for its leadership and vision in creatively addressing barriers to access in health care by funding community based organizations in Nassau County and Eastern Queens. This innovative approach has the real potential to improve outcomes and address the social determinants of health. I am pleased to be able to support these CBOs by providing technical assistance to support their efforts in the short term and to build enhanced capacity in the longer term“.
Some key lessons learned by NQP in this process have been:
- Insuring that basic needs such as housing and food are met allows patients to take the time to tend to their healthcare needs. This will lead to improved health outcomes and will lower healthcare costs.
- Both healthcare providers and Tier 1 CBOs need to become more familiar with each other’s services and how to make cross referrals.
- While a percentage of Community Based Organizations have the willingness and aptitude to become partners with healthcare systems, a number do not have the inclination to do so.
- In addition to hospitals providing CBO’s with funding for new or expanded services, these CBO’s may also require additional support to assist with organizational development so that can fulfill contractual obligations.
In conclusion, NQP believes that, with financial and technical support, a certain percentage of Community Based Organizations will be able to take the step of becoming effective partners with health systems.