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Data Transparency and the Democratization of Analysis

In New York, healthcare delivery system data and the useful information that can be derived from it frequently remains siloed and confined within each of the multiple governmental agencies that collect it. This in turn hinders the ability of healthcare providers to serve individuals in an integrated fashion and inhibits efforts by policymakers across the State to design policies that promote healthcare access, provider sustainability and affordability, as well as integrated healthcare treatment. New York does not have to imagine what a robust infrastructure of health data, information and policy analysis would look like. It just has to adopt the infrastructure that exists in Massachusetts facilitated by three related entities: the Center for Health Information and Analysis, the Massachusetts Health Data Consortium, and the Massachusetts Health Policy Commission.

Affordability of Healthcare in New York

The affordability of healthcare in New York is a complicated topic. Given the vast differences in the cost of healthcare depending on income and age, the threshold question of healthcare affordability is, “affordable for whom?” The affordability of healthcare in New York needs to be addressed in terms of three distinct groups – individuals, taxpayers, and employers. Within the category of individuals, there are another three distinct groups – individuals receiving publicly funded healthcare, individuals purchasing individual health insurance policies, and individuals with employer-sponsored coverage. In addressing the question of healthcare affordability for these distinct groups and categories, one of the challenges is the way data is presented, which typically is based on averages that can easily obscure the actual experience of those who fall on the wrong side of the median. The crisis of affordability may well be beyond the capacity of government at any level to solve, much less the capacity of any individual state. But it is a challenge that must be managed even if it cannot be solved.

Financial Sustainability of Safety Net and Community Hospitals

The financial performance of safety net and community hospitals has deteriorated significantly since 2019, the year before the COVID-19 pandemic began. Changes in technology and business models have enabled many more procedures to be performed outside of the hospital. This shift in site of service is being reinforced by insurance payer policies that condition reimbursement on the service being delivered in a less expensive outpatient setting.

At the same time, hospital expenses have been rising inexorably. The workforce shortage among nurses has led to a surge in temporary staffing agency costs. Nursing homes have reduced admissions due to their own workforce shortages, which has increased the number of patients who cannot be discharged from the hospital even though they no longer require an acute level of care. The structural financial challenge is that the fixed costs of operating an acute care hospital represent a large percentage of the total cost, and total expenses do not adjust commensurately with declining patient volume relative to the conditions described.

Recommendations by the Step Two Policy Project to identify strategies that improve the financial sustainability of hospitals will build on work done within the State's health portfolio over the last eight years. We will need to include “thinking outside the box” to identify policy prescriptions that match the scale of the deep structural challenges safety net and community hospitals face today.

Care for People with Complex Needs

Individuals with complex needs are a broad category that include those who are frail and elderly, those with intellectual and/or developmental disabilities, serious mental illness, substance use disorders, and those who have both complex medical needs and significant underlying social needs that affect health. In short, these are high needs, high-cost patients who require complex services and supports. New York's healthcare delivery system is often siloed in terms of where these individuals can receive services, how those services are reimbursed, the staff types eligible to provide those services, and how data is shared across different provider types. All these factors make it difficult to find appropriate care and service settings for individuals with complex needs.

The Step Two Policy Project and SUNY’s Rockefeller Institute of Government is collaborating with providers who successfully serve these complex populations to share information about innovative models and interventions and build policy recommendations to scale these approaches.

Access to Dental and Oral Care

Poor dental and oral health is related to cardiovascular disease, complications with pregnancy, respiratory illness, nutritional issues, and diabetes, among other serious conditions. Poor dental and oral health can impact a person’s self-esteem, school performance, and attendance at work or school.

There are many barriers to accessing dental and oral care in New York, including lack of comprehensive private dental insurance coverage, low reimbursement for dental services in public programs such as Medicaid, uneven geographic distribution of dental care providers, limited access to fluoridation, and a lack of integration between dental care and physical health care. This is a multifaceted problem that will not be fixed overnight. Our objective will be to make incremental progress in this area, particularly where relatively small investments can be heavily leveraged in terms of their improvement in health outcomes.

Maximizing the Healthcare Workforce

Shortages in the healthcare workforce existed before COVID-19, but the pandemic created a breaking point from which the healthcare system is still struggling to recover. The current state of the healthcare workforce greatly hampers efforts to ensure access to high quality, cost effective, and equitable healthcare while supporting a financially sustainable healthcare delivery system. Allowing more flexibility in the scope of practice would help address healthcare workforce shortages. Many commonsense arrangements that were made possible during the pandemic were terminated when the COVID-19 public health emergency ended. Our focus will be in examining how adjustments to scope of practice, enhancing training, and exploring innovative models for recruitment and retention can impact this fundamental component of healthcare delivery.

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