New projects

• Evaluation of Health Information Tool for Empowerment (HITE) (Gerry Fairbrother, PhD, - PI). HITE is an on-line tool being developed by the Greater NY Hospital Association Foundation to enable health care and social service professionals to identify and access health care resources for their under-and uninsured clients. NYAM will evaluate the effectiveness of HITE, by comparing differences in health service utilization before and after the implementation of the HITE network. HITE will be pilot-tested at three community-based health care sites in New York State

• Consolidating Data from Multiple Managed Care Organizations to Improve Management and Enhance Quality of Care at Institutions (Gerry Fairbrother - PI). The ability of health plans to bring about quality improvement has been limited in the past by the undifferentiated nature of their physician networks, with physician groups participating in many plans and plans contracting with many physician groups. Yet, the quality monitoring tools, notably HEDIS standards developed by the National Committee for Quality Assurance (NCQA), are plan specific. While this plan-level quality data is useful in providing population-based measurements of outcomes, it is limited in ability to bring about quality improvements at the level of an individual provider because sample sizes from any given plan are often too small to be useful.
  This project builds on prior work that identified the need for provider oriented reporting of data and engaging the institutions’ quality management system to bring about quality improvement. The purpose of this project is to develop a procedure for reporting consolidated quality related data from multiple managed care organizations to large institutions and to describe how they will use the data to affect quality and what barriers they anticipate, using Montefiore Medical Center and Columbia Presbyterian Medical Center as prototype institutions.

• An Evaluation Of An Effort To Increase Access To And Use Of Health Care In New York City By Newly Insured Families (Gerry Fairbrother - PI). The purpose of this project is to implement and evaluate a pilot project aimed at increasing access to and use of health care by newly insured individuals. The pilot project consists of adding a new health consumer education component to current enrollment in health insurance programs. This project is being conducted in partnership between the Bureau of Health Care Access at the New York City Department of Health (NYCDOH), which will implement the intervention, and New York Academy of Medicine (NYAM), which will assist in the project design and conduct the evaluation.
  The education component will focus on how to be a good consumer of health care, with an emphasis on patient rights and health care access and utilization. Facilitated enrollers will teach consumers that enrollment in health insurance gives them a right to access and use of health care, and that they should not hesitate to contact their doctor at any time for either preventive care, sick visits, or general health questions. Facilitated enrollers will also assist the consumers in choosing an appropriate primary care physician that meets their specific language, cultural and health needs. There will be a control group that does not receive enhanced services. We will utilize a survey to assess the differences between the control group and the intervention group in access and utilization six months after enrollment in health insurance.

• Health Care and Health Insurance: The Experiences of Children in Immigrant Families in NYC (Forum for Child Health). This is a qualitative study of the use of public health insurance and health services among children in immigrant families. We are working with three community-based organizations in the Haitian, Russian and Latino communities to recruit immigrant parents with children who are currently uninsured or who have public insurance but have had a gap in insurance coverage in the past two years. A major aim of the project is to explore the challenges immigrant parents face in obtaining health care for their children including; language barriers, complexities of the public insurance system, interactions with providers and parents' attitudes about coverage and care.

• Comparative Analysis of Mental Health Reimbursement Rates for Children (Forum for Child Health). A shortage of outpatient mental health services in New York City and statewide is widely considered to be one of the critical access problems facing children, their families, and the pediatric and mental health communities. The shortage existed before September 11th, but has been exacerbated by the heightened need for children’s mental health services since that time. One factor that is closely linked to the question of capacity is reimbursement. Attractive rates historically have increased the supply of providers, while the converse is likewise true. Although comprehensive information on this issue is not available, we do know that rates of reimbursement for outpatient mental health services in New York vary widely, across plans and insurance programs. For example, mental health clinics can be reimbursed from $20 to over $100 for a child visit, depending on factors including their eligibility for state subsidies, their location, and whether the child is in fee-for-service Medicaid, Medicaid managed care, Child Health Plus, or commercially insured. Notably, Child Health Plus reimbursement rates are thought to be on the low end of this range, between $20-50 per visit. Similarly, reimbursement for individual mental health practitioners are reported to be as low as $17 and as high as $150 for an outpatient visit for a child.
  In collaboration with the Citizen’s Committee for Children, we are analyzing reimbursement rates for outpatient mental health services for children on CHP B in New York. We will also explore the rate-setting mechanism used by plans, and seek to determine if there are barriers to provider participation in the public and private programs that are linked to rate issues, such as administrative burdens involved in the billing process. We will obtain this information through the following methods: • Review of relevant state laws, regulations and policies regarding reimbursement for mental health services; • Telephone survey a sample of mental health professionals and plans that provide mental health services to children. • Individual interviews with managed care plans and providers.

Ongoing Projects

• Welfare Reform Study (Forum for Child Health)
• Improving Health Care for Children (Gerry Fairbrother - PI)
• Providing Health Insurance Isn’t Enough: Children’s Access To And Use Of Health Care Services In New York City Under Medicaid And Child Health Plus Why Families Fall Out Of the System (Gerry Fairbrother - PI)
• What does it Cost to Enroll Children in Medicaid and SCHIP? (Gerry Fairbrother - PI)
• Development of An Enabling Service Database At Community Health Centers An Evaluation of Enabling Services for Asian Pacific Islanders at Community Health Centers (Heidi Park - PI)
• Intergovernmental Personnel Act (Gerry Fairbrother - PI)
• The Impact of the World Trade Center Disaster on the Mental Health of New York City's Children (Gerry Fairbrother - PI)
• Learning from Immigrants' Experiences with NYC's Disaster Relief Medicaid (DRM)(Forum for Child Health)
• Impact of Mental Health Services in NY after WTC Disaster (Joe Boscarino - PI)