Local Planning

HEAL 9 - Local Health Planning Initiatives Grant Program

The Department awarded 18 grants to support collaborative local health planning efforts, with the goal of developing an accessible, affordable, high-quality and cost-effective health care delivery system. These 18 awardees are engaged in innovative approaches to health planning that identify and prioritize community health needs and result in recommendations for aligning the health care delivery system with those needs.

Awards under HEAL 9 - Grantee Updates as of August 2010

The following is an update on the status of the HEAL 9 grants based on reports provided by the grantees:

1. Allegany/Western Steuben Rural Health Network (AWSRHN):

This grant is intended to develop an integrated health plan that contributes to improving the health status of Allegany County's population. AWSRHN HEAL 9 collaborated in the Allegany County Community Health Assessment to help identify opportunities for data expansion and resources for the priorities of the local health unit and hospital Joint Strategic Plan; including:

  1. Decreasing Unintentional Injury through Falls Prevention
  2. Decrease Tobacco Use
  3. Improve Physical Activity and Nutrition for Obesity Prevention
  4. Adolescent and Young Adult Sexual Activity
  5. Improved Dental Health

Qualitative and quantitative data gathering is under way focusing on unintentional injury due to falls and access to services. Focus groups with health and human service providers identified key themes across the health care system as priorities. These included: need for behavioral health service coordination and integration in relationship to ER use, primary care access, and non-emergent emergency room utilization. Healthcare professional shortages and overall recruitment and retention were also significant concerns.

AWSRHN is conducting community forums on the selected priorities: chronic disease, medication reconciliation, mental health-physical health integration, and healthcare professional shortage. The HEAL 9 Steering Committee will be delivering the focus group and data analysis results at each community forum, and community teams will be formed to establish goals and develop work plans to address the topics.

2. Catskill Hudson Area Health Education Center Inc.:

Catskill Hudson Area Health Education Center (Catskill Hudson AHEC) has created a community-specific healthcare provider recruitment and retention program, known as HealthMatch. The demonstration project in the communities of Ellenville/Wawarsing, New York has convened the Ellenville/Wawarsing HealthMatch Development Council (Development Council), comprised of community leaders, representing hospital, local business, local government and economic development, which meets on a monthly basis. This Council set a goal of raising $200,000.00 locally to develop incentive programs to attract healthcare providers to the community. To date, $183,125 has been raised from the investment prospect list established by the Development Council with additional pledges yet to be received.

Catskill Hudson AHEC has developed a database of over 500,000 healthcare provider names and addresses from 23 states and established social network sites and email lists to minimize the prohibitive cost of direct mailing recruitment. To date, these approaches to promoting practice opportunities have succeeded in recruiting a physician and two nurse practitioners to the community, who are being provided scholarships and loan forgiveness through the local incentive pools. Nurse practitioners are a vital component of the health professions team in this community, as Ellenville Regional Hospital credentials nurse practitioners to admit and follow their patients in the hospital.

3. Center for Health Workforce Studies:

The grantee is conducting a comprehensive primary care assessment of New York City using small area analyses in the five New York City boroughs. Primary care service areas will be developed as part of this project, based on commuting patterns of patients to their primary care provider. Insurance data from various sources, including both the zip code of the patient and the primary care provider were used to analyze patient commuting patterns. Based on the commuting patterns, preliminary Rational Service Areas (RSAs) have been developed, and primary care capacity in each RSA was assessed using current health professional shortage area (HPSA) designation rules and 2007 Medicaid provider and physician data. Community meetings will be convened this fall to gain local input on conditions that may affect primary care access and thus the configuration of RSAs. Commencing in the winter of 2010, the grantee will also collect mid-level data via surveys to midwives, nurse practitioners, and physician assistants. The proposed RSAs will be further assessed using newer data and HPSA designation rules.

4. Chautauqua County Health Network (CCHN):

For the purposes of this project, Chautauqua County was divided into five communities based on the existing hospital service areas. Quantitative data from a variety of sources were analyzed using the Community Health Data System, and qualitative findings from eleven focus groups and the Community Health Assessment/Community Service Plans were incorporated into a Health Status and Services Summary Report. In addition, profiles were completed for each service area and distributed to the corresponding hospital. An aggregate report was shared with CCHN's Board of Directors and Citizen Advisory Board to generate discussion and feedback.

One challenge addressed was the complexity of searching the Community Health Data System. A searchable tool was developed using Microsoft Excel that made these data much more user friendly, and the team is proficient at using it.

Key findings to date include: hospital-based inpatient use rates are similar to NYS norms, but emergency department reliance is much higher and warrants further analysis; access to primary care should be improved in specific service areas; access to reproductive health for the entire county should be improved; high rates of heart disease, diabetes, and genital/breast cancers indicate need for additional prevention and early detection programs; and physicians are disadvantaged by a payer mix comprised largely of Medicaid and the uninsured. The focus of the project is now on the development of a primary care vision statement, and identification of key long term care data sources and the framework for a future system for this sector.

5. Chenango Health Network (CHN):

The grantee is coordinating planning activities around three New York State Prevention Agenda issues in order to improve the health status of Chenango County residents and prevent duplication of services. CHN completed three assessment reports (Community Health Status, Local Public Health System, and Forces of Change). The Local Health Planning Group is using data from these reports for its strategic planning activities. CHN is working with NYSDOH to develop a county-specific GIS planning tool for use by late 2010/early 2011. CHN is working with group members on new community health projects specific to DOH's Prevention Agenda as a direct result of this project. Projects include chronic disease prevention through environmental change; satellite mental health clinics; and medication therapy management.

6. Columbia County Community Healthcare Consortium Inc.:

This grant is intended to improve preventive and primary care in Columbia and Greene counties by data collection and analysis, an assessment of access to preventive and primary care services, and the input of stakeholders. The grantee: (1) convened a Task Force on Preventive and Primary Care; (2) developed and completed a report -- A Vision for Better Health: Improving Preventive & Primary Care in Columbia and Greene Counties, describing a vision with goals for better health and a more effective, well-funded preventive/primary care system in the two counties; (3) completed another document entitled, " How Far…How Close," which reflects extensive data collection to measure the gap between the goals enumerated in the "Vision" document referenced above and county residents' current health status/healthy lifestyles; (4) identified five top priorities after reviewing the "How Far…How Close" document (cardiovascular disease, obesity, tobacco use, substance and alcohol abuse, and poor mental health), which reflects some of the most costly medical conditions and unhealthy lifestyles; and (5) developed preliminary recommendations on these priority areas to close the gap between the Vision and residents' current status.

During the fall and early winter, the recommendations will undergo an extensive public process to ensure that they reflect local concerns, creativity, and support. The public process will include multiple points of input - involvement of two advisory groups; surveys of households, businesses, local officials and health care providers; focus groups; web site submissions and commentary; and, public meetings. These points of input will be publicized in public media and on the web site to further ensure wide public participation.

7. Community Health Care Association of New York State:

The grantee is conducting a comprehensive primary care assessment of the following New York State regions: Western, Central, Northern, Hudson Valley, and Long Island. In collaboration with the Center for Health Workforce Studies, it is developing primary care service areas in each region based on patient commuting patterns for primary care. Insurance data from various sources, including both the zip code of the patient and the primary care provider, were used to analyze patient commuting patterns. Based on the commuting patterns, preliminary Rational Service Areas (RSAs) have been developed, and primary care capacity in each RSA was assessed using current Health Professional Shortage Area (HPSA) designation rules and 2007 Medicaid provider and physician data. Community meetings will be convened this fall to gain local input on conditions that may affect primary care access and thus the configuration of RSAs. Commencing in the winter of 2010, the grantee will collect mid-level data via surveys to midwives, nurse practitioners, and physician assistants. The proposed RSAs will be further assessed using newer data and HPSA designation rules.

8. Finger Lakes Health System Agency:

The grantee intends to produce a replicable model of health care planning through three project initiatives: (i) developing the processes and infrastructure to support the FLHSA's 2020 Performance Commission (2020 PC) and its work to reduce preventable hospitalizations (PQI related hospitalizations) and sub-optimal emergency department visits and to strengthen the system of regional hospitals; (ii) developing a person centered integrated health care service system for older adults through the FLHSA's SAGE Commission; and (iii) engaging community leaders and resources in identifying and addressing community health priorities and health disparities.

The most significant milestones achieved have been the approval and community report of the 2020 PC and the first phase of the SAGE Commission's report. For each report, FLHSA developed extensive data sets and provided analysis which allowed the members of each Commission to understand utilization and policy trends. In doing this work, FLHSA also assessed and documented health disparities, identified underserved/hard to serve populations and convened workgroups. Specific to SAGE, FLHSA contracted with Larsen Allen to create a model for projecting aging services need. Community engagement has included the convening of the African American and Latino Health Coalitions. The work of the African American and Latino Health Coalitions in defining community approaches to reducing hypertension-related health disparities has been strengthened through the launch of FLHSA's High Blood Pressure Initiative, a collaborative project of FLHSA and the Rochester Business Alliance (RBA). This initiative also aligns with the PQI and SAGE projects through its focus on the management of chronic disease and readmissions related to disease.

The most significant challenge FLHSA has faced relates to data. At this time, the outpatient healthcare data needed to explore and track changes in the demand for services, evaluate community interventions, and identify unmet needs are located in individual healthcare providers' patient medical records. FLHSA is currently working with the major private insurers in the Finger Lakes region (Excellus BlueCross BlueShield and MVP Healthcare) to develop a community healthcare claims database.

9. Fort Drum Regional Health Planning Organization:

Fort Drum Regional Health Planning Organization: The grantee is developing a business and implementation plan for an innovative and replicable Emergency Medical Services (EMS) system to align fragmented and unsustainable pre-hospital emergency medical care resources under a single high-functioning, county-wide cooperative system and eliminate unnecessary or duplicative services. The grantee has completed the Community EMS Cooperative preliminary feasibility analysis; provider interviews to obtain feedback on issues identified in feasibility analysis; and located a web vendor to keep all stakeholders, media, and the public informed of the progress. The grantee has received the draft plan from a sub-contractor and is working with EMS agencies, county officials, and EMS committee members to incorporate changes and address concerns.

10. Healthy Capital District Initiative:

Healthy Capital District Initiative (HCDI) has brought together a diverse group of organizations in the Capital District to focus on reducing sub-optimal emergency department (ED) use. Groups involved in helping HCDI evaluate its research and develop regional priorities for reducing sub-optimal ED use include area hospitals, physician groups, federally qualified health centers, employers, consumers, elected representatives, and other health providers. An analysis of non-emergent ED use in the Capital Region was completed in Spring 2010.

Findings are generally consistent with other analyses of ED use in that women, minorities, and Medicaid insured residents are more likely to use the ED, but privately insured patients comprise the largest patient population. Residents living close to EDs, particularly from low income areas were also high ED users. These issues are being researched further and HCDI has shared findings with the collaborating groups in the region through workgroups, a website, and a monthly newsletter. Health system gaps that don't support residents' use of the most appropriate care have also been investigated and a consumer survey of ED use has been completed. Based on these research findings, HCDI is working with its partners to identify and implement interventions that will reduce sub-optimal ED use.

11. Jefferson County Public Health Service:

Jefferson County Public Health Service (JCPHS) has developed a regional consortium of all 4 hospitals, providers and the 2 local health departments in Jefferson and Lewis Counties. The consortia has updated health data and assessed rural health challenges, including primary care capacity and access to care, identified community health priorities, and is addressing infrastructure and health system improvements in Jefferson and Lewis Counties. Key informant interview surveys were developed and health insurance providers, seniors, and businesses from a variety of industries were surveyed; barriers to care have been examined as a result of survey, and data was ranked based on need. The project has held the following symposiums: "Continuum of Care for our Elderly," which delineated the unique characteristics of the rural community as applied to the senior population; "Delivering Care through Telemedicine in 2010," which was for medical providers to learn about telemedicine to increase rural access to care; and an intensive network training to North Country Telemedicine Project members.

From the data collected and analyzed and from these symposiums, the project is addressing the region's top three NYS-DOH Prevention Agenda priorities: Nutrition and Physical Activity, Access to Care, and Chronic Disease. In order to address all three priorities the project has developed the following work plan goals and associated interventions: (1) Raise public awareness about the risk factors and complications of diabetes and the role that a healthy lifestyle, screening and diagnosis, education, treatment and support services play in controlling the disease; and (2) Ensure that all Jefferson and Lewis County residents diagnosed with diabetes have access to quality services, equipment and supplies.

12. The New York and Presbyterian Hospital:

The New York and Presbyterian Hospital HEAL 9 project aims to develop and implement a model of community health assessment and planning that can enhance the State's ambulatory CON process. The model will focus on health disparities, delivery system capacity to address public health priorities, access to primary care, and over-use of emergency departments. It will include a standard data set for an ambulatory Certificate of Need (CON) planning process within the Northern Manhattan/Western Bronx selected planning area, including: Washington Heights/Inwood, Central Harlem and Riverdale/Kingsbridge.

The grantee has collected all pre-intervention data including a demographic profile of the Northern Manhattan/Western Bronx residents. The baseline data has defined major health challenges within the community and morbidity and mortality rates. There is a project governance team in place, who meet regularly to oversee the implementation and data collection. Focus groups and stakeholder interviews are in progress.

13. North Shore - LIJ Health System:

The grantee is sponsoring the creation of the Long Island Center for Health Policy Studies (LICHPS) in order to collect, analyze and disseminate healthcare information and data to formulate sustainable and cost effective strategies to meet identified community healthcare needs. The grantee convened an Advisory Council composed of over 70 community stakeholders, including consumers, business leaders, providers, and county officials. A subcommittee on needs of seniors was created.

Key findings from data presentations to the Advisory Council included Long Island's Preventable Quality Indicators trends from 1997 to 2007 (Diabetes up 158%, Cardiac Related down 21%) and actual/projected data on Long Island's growing senior population (projecting an increase of 85% in Nassau and 178% in Suffolk between 1980 and 2035). Advisory Council members concurred with the development of a survey of the healthcare and psycho-social needs of seniors. The Council also suggested an exploration of common priorities based on the community health assessments conducted by the Nassau and Suffolk County's Department of Health. Both counties and all the hospitals are collaborating towards achieving two common Prevention Agenda goals: Tobacco Use - Prevention and Cessation, and Unintentional Injury- Prevention of falls among those aged 65+.

LICHPS staff developed a 45-item senior needs survey which was reviewed and finalized by the Advisory Council's Senior Needs Subcommittee. LICHPS staff also submitted and received approval from the Institutional Review Board for the survey. A Request for Application for bids to administer the telephone survey was sent out on and responses by 4 survey companies were received. The survey is expected to start in early Fall 2010.

14. P2 Collaborative of Western New York:

The Western New York Community Health Planning Institute (WNYCHPI), through the P2 Collaborative of Western New York, commenced its community health planning work with initiating development of an organizational and data analysis infrastructure seeking to address the two New York State Prevention Agenda Priorities of appropriate emergency room use and appropriate hospital admissions/readmissions.

The grantee is currently working with the FLHSA to support both the emergency room (ER) and hospital admission areas of focus. At the same time, P2 is in discussion with local health plans to use the aggregated health plan claims data base supporting more robust data analytics across the continuum of care.

In addressing appropriate ER use and hospital admissions, WNYCHPI is analyzing data for hospital admissions and will be convening workgroups to review the data, understand what is occurring in the market along with best practices, and prioritize next steps relative to improvement opportunities. In addressing appropriate ER use, WNYCHPI has reviewed data from a geographic, age, gender, clinical condition, disparity, and payer perspective. The data show that there are no simple solutions in addressing inappropriate ER utilization. It is best summarized as driven by cultural or behavioral mindsets, convenience, lack of access to primary care, and financial considerations.

Next steps are to convene and engage communities with focus groups and surveys at a neighborhood level to understand underlying use patterns and identify specific initiatives to change use of the ER. WNYCHPI continues to develop web capability for communications and has initiated planning efforts to support a sustainable business model.

15. The Research Foundation of the State University of New York (SUNY Downstate Medical Center):

The grantee intends to develop a comprehensive community health planning process with diverse stakeholders to articulate the vision for health care in Central and Northern Brooklyn; study emergency department over-use; collect data as it pertains to high rates of ambulatory care sensitive hospital admissions; and develop information reservoir that can be updated and used in the future. Over thirty partners including all the major insurers, School of Public Health, Central and northern Brooklyn Hospitals, community-based organizations, behavioral health agencies, 1199 and the NYCDOH are among the members of our coalition. Three new members have joined the Coalition: HealthPlus, Novartis Pharmaceutical, and the Brooklyn Center for Health Disparities.

The Coalition meets regularly and is active in development and implementation of the project studies. To date, the block by block canvassing of Central and Northern Brooklyn neighborhoods for the comprehensives health resources inventory has been completed. The data will be compiled into the GIS system along with other pertinent information for the needs assessment. The Emergency Department utilization study is undergoing IRB review by each participating hospital and expected to begin in the fall. Proprietary claims information for the primary care service analysis and ACS analysis is under a lengthy review with our insurance partners' corporate legal and compliance divisions. It is expected that all approvals for data should be obtained in the next quarter.

16. Rockland County Department of Health:

The grantee intends to develop a comprehensive assessment of health care needs in a seven-county region focusing on access to care, chronic disease prevention and control, maternal and child health, and make recommendations for the alignment of resources with those needs. To facilitate identification and monitoring of priorities, the project has developed and implemented a Regional Performance Monitoring Tool (RPMT). The RPMT was successfully used to collect input from 6,911 consumers across the region. Data has been incorporated into the 2010-2013 Community Health Assessments. Analysis and reports of the survey data continues to be provided in the seven counties by the New York Medical College. Further input was garnered through the use of consumer and provider focus groups as key stakeholders in this health systems approach to planning.A regional HEAL 9 Summit was held June 10, 2010 in Newburgh, NY with 150 health care leaders from the seven counties of the Lower Hudson Valley in attendance focusing on the need for regional planning and the New York State Prevention Agenda. The keynote address was given by Commissioner Richard Daines and break-out sessions led by county health commissioners focused on possible interventions, best practices, and barriers. More than one-third of participants indicated a willingness to participate in a regional coalition or taskforce. Recommendations based on the summit, surveys, and focus groups are under development.

17. United Hospital Fund (UHF):

UHF has been working on two complementary projects with HEAL 9 financial support:

  • (1) A survey of families in Medicaid managed care that have multiple members with frequent emergency department (ED) use in the south Bronx and southwest Brooklyn to better understand their decision-making processes and to test their responsiveness to certain messages regarding appropriate ED use. The grantee's survey research firm had concluded these interviews and reported the results in September 2010.
  • (2) UHF's partners in this work have been Health Plus PHSP, Lutheran Medical Center , and Lincoln Medical and Mental Health Center. UHF's analysis of the survey results and data will be shared with stakeholders and recommendations concerning inappropriate use of EDs will be developed.

18. Village Center for Care:

The grantee seeks to transform long-term care in downtown Manhattan and minimize need for institutionalization by developing on-the-ground data including counts of at-risk seniors; developing means to identify seniors at risk; and building access to needed interventions and health services. The grantee has identified the top health needs and disparities for seniors in downtown Manhattan, which include: falls, untreated mental illness and substance use, 'go-outside-the home' disability, and hypertension. The most significant barriers for seniors in downtown Manhattan were identified as fear and distrust, lack of knowledge about resources and how to access such resources, and language/cultural barriers. The grantee has identified the following best practices for access improvement interventions: care coordination with physician offices; community health outreach workers; local, up-to-date comprehensive resources directory; access through "natural points of contact;" and direct mail.

The grantee has also identified other important considerations: geriatric mental health resources, especially home-visiting resources, are insufficient; successful interventions involve in-person communication; advice/referral from a physician is often more trusted than advice from other sources; and local social services agencies bring valuable expertise and resources for seniors in the community, which need not be recreated within health care provider organizations.

Next steps include the selection and operation of brief learning pilots to inform recommendations concerning interventions.

Awards under HEAL 9

1. Allegany/Western Steuben Rural Health Network

Utilizing a strategic planning tool known as Mobilizing for Action through Planning and Partnership (MAPP), develop strategic partnerships and enhance local data to identify community health priorities, gaps in services, opportunities to restructure the delivery system, and promote best practices.

2. Catskill Hudson Area Health Education Center Inc

Develop a community-specific physician recruitment program within an 11-county region and identify community health priorities, barriers to care, and healthcare trends that impact the availability, affordability, and quality of care.

3. Center for Health Workforce Studies

Conduct a comprehensive primary care assessment of New York City by conducting small area analyses in the five New York City boroughs.

4. Chautauqua County Health Network

align disparate public health, long term care, and hospital assessment activities to identify common local and regional health priorities. Using a combination of quantitative and qualitative data, the project will identify health priorities, benchmarks for future trending, and infrastructure issues.

5. Chenango Health Network

Coordinate planning activities around three New York State Prevention Agenda issues in order to improve the health status of Chenango County residents and prevent duplication of services.

6. Columbia County Community Healthcare Consortium Inc.

Utilize Mobilizing for Action through Planning and Partnership (MAPP) to collect data and assess access to preventive and primary care in Columbia and Greene Counties; grant will also assess the strengths and weaknesses of MAPP as a strategic planning tool.

7. Community Health Care Association of New York State: Conduct a comprehensive primary care assessment of the following New York State regions

Western, Central, Northern, Hudson Valley, and Long Island, and develop Rational Service Areas (RSAs) to determine access and barriers to primary care as well as determine which areas face shortages and which have an excess of primary care capacity.

8. Finger Lakes Health System Agency: Produce a replicable model of health care planning through three (3) project initiatives

(i) Regionalize a high-performing health care delivery system in Rochester and the Northern Finger Lakes Region that improves community-wide access to care, avoids unnecessary hospitalization and eliminates disparities in health status; (ii) Develop an integrated system of best practice care for seniors and their families in a nine county region; (iii) Assist county health departments, hospitals and other stakeholders to identify jointly community health priorities within the nine county Finger Lakes region.

9. Fort Drum Regional Health Planning Organization

Implement an innovative and replicable Emergency Medical Services (EMS) system plan to align fragmented and unsustainable pre-hospital emergency medical care resources, under a single high-functioning, county-wide cooperative system, and eliminate unnecessary or duplicative services.

10. Healthy Capital District Initiative

Analyze and respond to data regarding the over use of emergency departments for non-urgent care in the Capital Region to understand its root causes and develop strategies for expanding use of primary and preventive care.

11. Jefferson County Public Health Service

Update data and assess rural health challenges, including primary care capacity and access to care in Jefferson and Lewis Counties; identify community health priorities; and address infrastructure and health system improvements for these two rural counties.

12. The New York and Presbyterian Hospital

Focusing on health disparities, delivery system capacity to address public health priorities, access to primary care and over-use of emergency departments, develop a standard data set for ambulatory care planning and implement a model of community of health assessment and planning within the Northern Manhattan/Western Bronx selected planning area.

13. North Shore - LIJ Health System

Create the Long Island Center for Health Policy Studies (LIHPS) to collect, analyze and disseminate healthcare information and data to formulate sustainable and cost effective strategies to meet identified community healthcare needs.

14. P2 Collaborative of Western New York

Develop a data analysis infrastructure and planning framework for specific community health improvement activities, new health delivery initiatives, and other community-driven projects within 8 counties of Western New York.

15. The Research Foundation of the State University of New York (SUNY Downstate Medical Center)

Develop a comprehensive community health planning process to articulate the vision for health care in Central and Northern Brooklyn; study emergency department over-use; collect data as it pertains to high rates of ambulatory care sensitive hospital admissions; develop information reservoir that can be updated and used in the future.

16. Rockland County Department of Health

Develop comprehensive assessment of health care needs in a seven-county region focusing on access to care, chronic disease prevention and control, maternal and child health, and disparities and make recommendations for the alignment of resources with those needs. To facilitate identification and monitoring of priorities, the project will develop and implement a Regional Performance Monitoring Tool (RPMT).

17. United Hospital Fund

Evaluate the nature and causes of Emergency Department (ED) over-use by communities throughout NYC; conduct an in-depth analysis of ED over-use in two high level service communities to help determine why patients use EDs for non-emergencies.

18. Village Center for Care

Transform long-term care in downtown Manhattan; develop on the ground data including counts of seniors by block and building; develop means to identify seniors at risk; build access to needed interventions and health services.

Health Systems Agencies

Health Planning Resources

Data Resources

Community Health Assessment and Health Planning