The Price We Pay for Cutting Gym

Photo via Jordan Richmond

According to a Center for Disease Control report 26 percent of New York City public school Kindergarten through 8th grade students are obese. Think about that. One in four New York City public school students are obese. With such a startling statistic you would think physical education is a top priority for the New York City Department of Education. But New York City Comptroller Scott M. Stringer's report, “Dropping the Ball: Disparities in Physical Education in New York CitySchools,” reveals a severe lack of certified physical education teachers, lack of space for physical education classes, and dismal reporting procedures implemented by the New York City Board of Education.

Specifically the report reveals:

- 41 percent of high schools have no physical fitness space

- 35 percent of middle schools have no physical fitness space

- 230,000 students lack a full-time, certified Physical Education teacher

- 91,000 students attend a school that does not have access to an outdoor school yard or nearby park

Bronx Health REACH’s school wellness program, Healthy Schools NY, works with 22 Bronx schools involving school staff, parents, and administrators to change policies and practices on nutrition and physical activity. One of the goals is to achieve the New York State-mandated 120 minutes of physical education per week. When children engage in school-day physical education, results can be seen in improved academic classroom performance such as better concentration, attentiveness and success in the classroom.

This is not the first time a New York City Department of Education audit has been conducted by the NYC Comptroller. A 2011 NYC Comptroller audit revealed that 100 percent of 31 elementary schools examined (at the time) were out of compliance with State PE regulations. A 2001 study conducted by a local non-profit group in partnership with the NYC Board of Education analyzed 391 schools (one third of the New York City public schools in the system that year) and concluded that “physical education [was] among the last areas of the New York City school system to recover from the fiscal crisis of the mid-1970s” and had been “persistently undervalued” and “sacrificed to the push for academic achievement, despite research showing that organized sports and physical fitness improve children’s performance both academically and socially.

Inset of Bronx public schools that lack a full-time certified PE teacher.

So here we are in 2015 and the problems still persist. Spaces for physical education in the schools disappeared as the Board of Education converted gyms and school yards into classrooms and parking lots, permitting athletic facilities to fall into disrepair. Lack of accountability can be traced back to the New York State Education Department failing to enforce its own regulations around physical education. When asked by the Comptroller's Office, State officials responded that they “counted on local school districts to monitor their own compliance.” Without full and complete data the Comptroller’s Office was not able to do a complete analysis of whether New York City schools are meeting New York State physical education instructional time requirements or contractually agreed-upon class size mandates.

According to Department of Education data, 2,216 full-time, licensed Physical Education teachers at general education schools are assigned to 1,072 schools leaving 506 schools citywide (over 32 percent) without a fulltime, certified PE teacher. A parent speaking to the New York Daily News stated, "All our kids are dealing with health and weight issues," said Synthia Bachman, 42, a programmer from Manhattan whose son attends the Children's Workshop School in the East Village. Kids and parents at the Children's Workshop School said the school has no gym. Students said they use an adjacent playground for exercise when the weather is good and the school's lobby for gym class in the winter." Yes, you read that correctly. The school’s lobby is being used as a gym.

Inset of Bronx public schools lacking fitness spaces.

Providing physical education to over 1 million New York City public school students can be a challenge but the New York City Board of Education must take steps to improve students’ access to physical education by implementing a system that tracks and monitors where resources are needed.

With that in mind the Comptroller recommends the following:

- Comply with state regulations requiring that all New York City public school students receive physical education instruction from, or under the supervision of, a certified physical education teacher

- Update the New York City Department of Education’s District Physical Education Plan, submit it to NYSED and post a copy on the DOE website

- Develop instruments for tracking and monitoring schools’ provision of physical education for all students

- Develop internal systems allowing the agency to track and monitor schools’ compliance with State PE regulations

- Post physical education data for every New York City school on the Department of Education website

Lack of physical education in New York City public schools over the long term wreaks economic havoc as children become adults. In New York City alone, obesity is projected to cost the City over $4 billion in health care expenses annually. Eventually we all end up paying these costs that can easily be prevented by holding those accountable and meeting physical education mandates for every school that will improve the health and well-being of all New York City children.

Images used above by NYC Dept of Education, Citizens' Committee for Children used in the Stringer report, “Dropping the Ball: Disparities in Physical Education in New York CitySchools.”

What Really Happens After Enrolling in Medicaid Managed Care?

 

Health & Disability Advocates (HDA) is monitoring the rollout of the Medicare-Medicaid Alignment Initiative (MMAI) and has heard from frustrated case managers working with consumers who are confused about the enrollment process and their rights. In response, HDA developed an enrollment timeline that explains what new enrollees can expect from Managed Care Organizations (MCOs) and plan representatives upon enrollment. To produce the timeline, HDA researched the MMAI demonstration contract developed by the State of Illinois and approved by the Center for Medicare and Medicaid Services (CMS)  HDA also solicited input from health plans on whether their on-the-ground practices were accurately reflected in the timeline.

The finished product outlines important points for case managers and their clients to consider.

One Day Changes Everything

Consumers who are enrolled in a managed care plan after the 12th day of the month will not see their coverage start until the month after next. This is relevant for consumers choosing a specific managed care plan in order to see a particular provider or specialist in that plan’s network. Submitting paperwork after the cut-off date means consumers would have to wait longer than expected for necessary treatment. Helping consumers submit required documents in a timely manner can guarantee they are connected to the medical treatment they need, which promotes continuity of care.

Stratification Sets Up Future Contact Standards

Once enrolled in a plan, all enrollees can expect to complete a Health Risk Screening within 60 days. The screen collects information on the enrollee’s physical and mental health conditions and identifies their current medical providers. This is what IlliniCare’s Health Screen looks like. Health plans use the screen to establish intensity of services and frequency of contact with Care Coordinators by stratifying the enrollee as low, moderate or high risk.

Enrollees stratified as low risk will receive annual follow-ups from their Care Coordinators while those stratified as moderate or high risk will have quarterly follow-ups. Moderate and high risk enrollees will also complete a Health Risk Assessment and create an Individualized Care Plan within 90 days. These enrollees will help form their own Interdisciplinary Care Team of healthcare providers that meets quarterly to review the Individualized Care Plan.

The Care Coordinators’ Role

Care Coordinators focus on enrollees’ healthcare needs by connecting them to necessary tests, doctors and treatment. They also facilitate information sharing among providers by leading the Interdisciplinary Care Team. Addressing enrollees’ medical needs is their priority. Care Coordinators direct less attention to linking enrollees to social supports, like housing and public benefits.

It’s also important for case managers to know that Care Coordinators must manage a substantial caseload of up to 600 enrollees. Caseloads include a blend of low, moderate and high risk enrollees, with each risk level weighted differently.

Understanding what a care coordinator can—and cannot—be expected to do is advantageous to case managers. When roles are clearly recognized, case managers know how care coordinators can be used as a resource. And in what instances an alternative referral would be more appropriate. This establishes a stronger professional relationship between case managers and care coordinators, which ultimately benefits the enrollee.

Case managers and Care Coordinators are on the front lines of healthcare reform and fostering solid working relationships between these two players will be a critical component of the success or failure of these efforts. Knowing what case managers and their clients can expect from managed care plans can lay the foundation for a strong relationship that supports the health of individuals while also furthering the goals of healthcare reform.

Bryce Marable MSW

Health Policy Analyst

Health & Disability Advocates

People With Disabilities Who Opt Out of ‘Voluntary’ Wellness Programs Will Pay the Price, and the EEOC’s Okay With That.

The following originally appeared on the American Civil Liberties Union's Speak Freely Blog.

 Voluntary wellness programs at work can provide benefits to employees, but employers are increasingly adopting “voluntary” wellness programs that unfairly burden workers with disabilities the most of all. Worse, the Equal Employment Opportunity Commission seems to think that’s okay, undermining core antidiscrimination protections it used to defend.

Here’s why.

Imagine a woman living with rheumatoid arthritis and severe depression who, under doctor’s care, has finally returned to work. Her medications — a corticosteroid and an antidepressant — have triggered weight gain. Now imagine this woman facing her employer’s “wellness activities:” She is instructed to fill out a detailed questionnaire about her medical conditions; she is weighed and pronounced overweight; she is told to lose weight. Oh, and the program is voluntary — but if she doesn’t comply, she will have to pay hundreds of dollars more in annual health care premiums. 

This imaginary example is all too real: Persons with disabilities risk discrimination and stigma if their employers gain access to their private medical information. And disabled workers are far more likely to have a condition targeted by wellness programs, such as high blood pressure, high blood glucose, or being overweight. 

Historically, the Americans with Disabilities Act has provided employees with disabilities some protections against overly intrusive and punitive wellness programs. The EEOC has maintained, sensibly, that voluntary medical examinations and inquiries cannot impose penalties on employees who decline to participate. 

Until now.

The EEOC has recently proposed new regulations and guidance language on wellness programs that would allow employers to implement wellness programs that add up to 30 percent of the cost of the employee’s health insurance to an employee’s health care bill. Based on the average annual premium, this translates to an extra cost for disabled employees of about $1,800 per year, either because they don’t want to answer questions that could expose their disability to their employer or because they cannot meet the health goal

The EEOC describes these programs as “voluntary,” but workers with disabilities are the least likely to be able to afford additional health care premiums. According to the U.S. Census Bureau, median household income for people with disabilities is less than half of household income for people without disabilities: $25,974 compared to $61,103. At the same time, there is little evidence that these programs are effective. 

If the EEOC is going to allow employers to charge workers hundreds more each year, it needs to be sure important privacy and disability protections are in place.

Three safeguards matter the most. First, the EEOC needs to provide guidance language that workers with disabilities have the right to request a reasonable accommodation waiver from a wellness program, so that their medical status can be taken into account in their ability to comply. The guidelines should also protect disabled workers’ privacy, so that their decision to join or not join the wellness program doesn’t broadcast the details of — or even the existence of — their medical condition to their employer. Finally, disabled workers should rest assured that the guidelines protect them from disability-based discrimination in the workplace, such as harassment of employees who cannot comply with “normal” health standards. 

Comments on the proposed regulations are due this Friday, June 19, 2015. Tell the EEOC not to permit employers to subject their disabled workers to a Hobson’s choice: Submit to the prescribed wellness activities, or pay hundreds more each year. The EEOC should instead insure that workers with disabilities can opt out of these programs without penalty. 

Claudia Center

Senior Staff Attorney

American Civil Liberties Union

Taking Action for Physical Education

Recent efforts to increase student access to physical education in NYC public schools and obtain data on schools compliance with state mandates for PE have been met with good news: The Department of Education has committed to spending $6.6 million to hire 50 more PE teachers and "conduct a comprehensive needs assessment to address barriers and move schools toward full PE compliance." As part of the city budget, this provision in will address school compliance with federal regulations requiring equal access to sports for girls. School wellness and physical education advocates celebrate this success as a first step to improve the quantity and quality of physical education provided to students in NYC public schools. Still, there is much more to be done in order to make significant changes.


In an effort to work toward these changes, Bronx Health REACH has collaborated with the Phys. Ed. For All Coalition, in partnership with New York Lawyers for the Public Interest, Women’s City Club of NYC, The American Heart Association, and many others to draw attention to the disparities in PE programming our city’s children currently receive, as detailed in Comptroller Scott Stringer’s recent report, “Dropping the Ball: Disparities in Physical Education in NYC Public Schools.” According to the report, more than 400,000 students in NYC public schools do not have access to either a full-time, certified PE teacher, designated gym space, or nearby park for outdoor fitness activities. The Phys. Ed. For All Coalition has been crafting legislation for Intro 644 — a reporting bill that would require the Department of Education to track and report data on which schools are adhering to state mandates for physical education, including the required amount of time and certified teachers dedicated to PE and other demographic information. While the DOE is concerned that this bill could place an undue burden on individual schools, it would bring us one step closer to being able to identify which schools require additional assistance. Such transparency would ensure that all students receive the quality PE program they are entitled to by law.


Recent highlights of this campaign have included a press conference and oversight hearing led by City Councilmembers Dromm and Crowley, and Bronx Health REACH staff members Charmaine Ruddock and Kelly Moltzen featured in the media. Our coalition is optimistic about the future of the reporting bill and the impact it would have on the health of our city’s children. Given the evidencethat high quality physical education is linked with reduced risk for obesity, enhanced focus and memory, and improved academic outcomes in children, increasing access to PE could have important implications for the overall health and success of future generations.

Redoing Redes: Strengthening Communication Procedures in the Illinois Medicaid Redetermination Project

The Illinois Medicaid Redetermination Project (IMRP) is erroneously suspending vital medical care for people who remain eligible. Since the rollout of the IMRP in early 2013, the program has been plagued by inadequate communication from the state that leaves consumers confused and ultimately without healthcare. Consumers report that they are not receiving the required notices by mail and when they call with questions, frontline state staff cannot provide answers. Because of the state’s ineffective communication protocols and inadequate employee training, rightful Medicaid beneficiaries are in the precarious situation of being unable to fill their prescriptions, go to the doctor or receive treatment. The purpose of the IMRP is to save state dollars by trimming the Medicaid program of those who are no longer eligible, not cut people who still deserve services.

Letters Lost in the Mail

Medicaid beneficiaries are cut simply because they never received their redetermination notices in the mail. For example, Health & Disability Advocates worked with a mother whose child had been dropped from Medicaid because IMRP sent the notice to a non-existent address. The fact that IRMP sent the letter to an incorrect address on the same street where the family lived suggests that it was a clerical error. In this situation, a young adult dealing with serious mental illness could not access medication and treatment, because the state, not the individual made an error. Sudden lapses in care can pose serious consequences for people who rely on these supports for their physical and mental health.

This is not an isolated instance. A survey of case managers working with older adults and people with disabilities found that the IMRP fails to adequately notify people of their redetermination responsibilities and inform them when they are bounced from the program. Many get the bad news when they attempt to fill prescription or go to the doctor and are told that they are no longer covered. People deserve clear communication from the state telling them they are no longer covered and the steps to get reinstated.

Confused and Not Covered

Even in cases where Medicaid recipients do receive notices, many consumers find the letters are hard to understand and filled with jargon. Given that the intended audience has never before been required to submit to annual redeterminations and may also have lower literacy levels, the letters must be crystal clear. Reports from case managers suggest the letters are confusing.  One case manager surveyed noted “clients do not understand what documents they need to submit with the form and whether they need to submit anything.” With the potential for people to lose their health coverage, the consequences of this confusion are severe.

IMRP’s own data reveal their communication shortcomings. According to May’s Medicaid redetermination numbers, 81% of cancellations are due to a lack of response. Being cancelled doesn’t mean a person is ineligible. In fact, a substantial portion of these clients should still be receiving services.  Of those dropped, 1/3 were reinstated within three months.  In FY 2015 alone, this translates into 238,025 people being incorrectly cut from Medicaid, and this number could be even higher. People who are less frequent healthcare users may learn of their cancellation when they attempt to schedule a doctor’s appointment. With people who deserve Medicaid cut from the program, the IMRP is not achieving its main objective of reducing state expenditures by eliminating those who no longer qualify. Cutting eligible people will actually result in higher costs. Without access to primary medical treatment, people will resort to more costly emergency room care for conditions that could have been managed or even prevented.

Matters get worse when consumers call state workers for clarification, because frontline staff members are often not fully informed themselves. In the above-mentioned case of the mother fighting for her son’s coverage to be reinstated, her interaction with the IMRP hotline was unhelpful and hurtful. The representative said there was nothing more she could do and blamed the family. Stateline workers should be fully trained to provide answers; anything less only increases confusion and frustration.

The Path Forward

The state must develop plain-language notices that explain redeterminations and their importance while outlining the specific steps to keeping coverage. This would not be a new undertaking. State officials have previously brainstormed ways to create simple, more consumer friendly forms. Unfortunately, the furor around budget deficits and service cut threats has drowned out the push for clear communication standards. Even worse, continuing to deemphasize this issue will leave many rightful Medicaid recipients suddenly without coverage. Communication protocols and state staff should support individuals in maintaining their vital connection to healthcare, not create hurdles that effectively jeopardize emotional and physical health. State officials must restart the discussions on clear notices and broaden the conversation to include improved training for frontline staff. These reforms will go a long way towards supporting the IMRP’s original objective of eliminating wasteful spending while also keeping those who still deserve coverage connected to care.

Reducing Obesity: Not Simple But Doable

Photo via k lachshand
Eating these is one way to reduce obesity.

James R. Knickman President & CEO at the New York StateHealth Foundation  asked the million dollar question in his Huffington Post piece, “What's Workingto Reduce Obesity?” In his post Mr. Knickman reveals that researchers from Drexel University studied a range of experiments aimed at reducing obesity, assessing how effective those strategies were. Researchers concluded that measures such as improving sidewalks and banning trans fats had strong impact but other approaches such as restaurants posting nutrition information had very little, to no impact.

So what does work to reduce obesity?

Mr. Knickman believes reducing obesity comes down to the following points:

- Better and more research will provide a better sense of the impact of various strategies reducing obesity in communities

- Different populations require different strategies so research can determine which approaches are most effective for high risk populations

- Seek out the economic and social benefits of interventions

- Success happens when communities and neighborhoods make it easy and affordable to be physically active and eat healthy foods, rather than one method such as banning trans fats

- All these healthy components add up to create “a neighborhood value, a point of pride” and becomes a part of the culture.

Mr. Knickman asks, “What is the best bang for your buck?” Here at the Bronx Health REACH Coalition we have launched the Towards A Healthier Bronx initiative using policy, systems and environmental improvements that increase access to healthy food, healthy beverages and opportunities for physical activity for over 75% of 675,215 residents residing in 12 high need South Bronx zip codes. Many public health campaigns rely heavily on clinical evidence, but fail to research the motivating factors relevant to that audience. To avoid this our campaign emphasizes actionable health behaviors.

Led by the Institute for Family Health, Bronx Health REACH was formed in 1999 to eliminate racial and ethnic disparities in health outcomes in diabetes and heart disease in African American and Latino communities in the southwest Bronx. Since then the Bronx Health REACH coalition has grown to include over 70 community-based organizations, 47 faith-based organizations, and health care providers. Bronx Health REACH serves as a national model of community empowerment demonstrating ways to build healthier communities by promoting healthy life-style behaviors.

The plan behind Towards A Healthier Bronx is:

- Increasing the number of bodegas and restaurants involved in incentive programs offering and promoting affordable healthy foods

- Increasing the number of farm stands making healthy food more affordable and available to the community

- Increasing the number of public and charter elementary schools emphasizing nutrition education and supporting related school policies

Partnering with bodega, deli and restaurant owners by providing them with training and education makes these initiatives not only a healthy benefit for their customers, but an economic benefit for the business owner. Encouraging chefs to attend monthly trainings on healthy food preparation results in offering patrons 2 to 3 healthier menu options. As New York City neighborhood demographics change, the restaurants and bodegas can now more easily adapt to the healthy choices their new customers are seeking resulting in those restaurant and bodega owners seeing more customers come into their stores and restaurants and gaining more revenue.

Mr. Knickman also states, “So if menu labeling isn't working for the target population--as the Drexel research and other studies suggest--we need to find and test other ways to make the healthy choice the easy choice.” Euny C. Lee, Evaluator and Policy Analyst at Bronx Health REACH agrees with Mr. Knickman citing a New York University study, “Calorie Labeling Has Barely Any Effecton Teenagers' or Parents' Food Purchases” which revealed that posting calories for food items at fast food restaurants had no impact on what consumer purchased.

Euny has moderated several focus groups with our faith-based coalition members to determine which types of messages encourage healthy behavior such as healthy eating and physical activity. Findings reveal educating the community about daily calorie intake to be important as most were not aware that you should consume no more than 2000 calories a day to maintain a healthy lifestyle.

Messaging matters as well. Signs and posters promoting a health benefit rather than a scare tactic elicit more positive behavior changes. Interventions have to be customized to a specific demographic/ethnic group so that it is culturally and linguistically understandable and appropriate. Other results include social support such as having a friend or family member who you are accountable to for your actions to reach the desired health goals.

Focus group members felt this ad was not accurate saying the soda bottle should be bigger and would be more effective if other ailments such as diabetes and heart disease that causes stroke were listed.

Focus group members felt the above ad was actually a real advertisement selling juice boxes and a better message would have been the child drinking from a water bottle.

But the question still remains. “What is doable in the fight to reduce obesity?” Bronx Health REACH can point to a few projects. A city wide campaign was created to serve only low-fat and fat-free milk rather than whole milk at New York City public schools. Bronx Health REACH educated policy makers, Coalition members and residents from the community about obesity and the benefits of reduced fat milk. This led to the New York City Public school system adopting the policy and impacting over 1.1 million children in 1,579 schools as well as a model for public schools in 15 other states.

I don't know if the day will ever arrive where the only thing one needs to do is take a miracle pill that sheds those excess pounds without any physical effort while drinking a large vanilla milkshake every day. What I do know is these healthy initiatives together will begin slowing the overweight/obesity epidemic we now face.

Harvest Home Brings Local, Farm-Fresh Produce to Soundview

 Photo by Brian Nobili

                                                               

From left to right: NY State Assemblyman Marcos A. Crespo, Harvest Home CEO Marita Owens, and NYC Council member Annabel Palma.

Soundview residents no longer have to travel outside the community for farm-fresh produce as the debut of The Soundview Farmers Market officially opened with a ribbon cutting ceremony on Saturday, June 20. New York State Assemblyman Marcos A. Crespo and New York City Council member Annabel Palma along with many from the Soundview community in attendance. This new market, located at Morrison Avenue between Harrod Place and Westchester Avenue in the Bronx, will serve more than 60,000 residents, including approximately 10,000 SNAP (Supplemental Nutrition Assistance Program/food stamp) recipients. The market will offer farm fresh fruits and vegetables from Alstede farms, a New Jersey grower.

To encourage residents to shop at the Soundview Farmers Market, Harvest Home has partnered with the Institute of Family Health through its Bronx Health REACH program to issue Fruit and Vegetable Rx to its patients at the Stevenson Health Center. Located at Morrison Avenue between Westchester Avenue and Harrod Place, the Market is open every Saturday through November 21, from 8 a.m. to 4 p.m. rain or shine. Bring your SNAP/EBT, WIC Farmer's Market and Senior Farmer Market coupons along with Health Bucks. News12 covered the event.

Having a farmers market in this area has been a long held dream of Assemblyman Marcos A. Crespo (D- Bronx, 85th AD). And, he, in conjunction with other New York State and New York City Elected Officials from the Bronx heartily welcome Harvest Home Farmers market to the Soundview community. Assemblyman Crespo noted that, “Healthy eating habits promote overall healthy lifestyles, which is why I am excited about welcoming Harvest Home Farmers Market to Soundview.” He pointed out that “Bringing in an array of healthy and organic produce to our community, in an affordable way, enhances healthier choices for both adults and children.”

Council Member Annabel Palma (D-Bronx, 18th Council District), a big supporter of the market stated, “I am excited to have a new farmers market in the Soundview section of my district; now my community will have better access to healthy food. I firmly believe that, when given the opportunities, New Yorkers want to eat healthy – they simply need to be provided the option.”

Neil S. Calman, MD, President and CEO of The Institute for Family Health stated, “I am thrilled that there is a farmers market opening in Soundview. We, at the Institute for Family Health, are deeply invested in improving the health and well-being of the residents of the Bronx and bringing fresh fruits and vegetables is a major breakthrough.”

Saturday's events included cooking demonstrations and a Bronx based disc jockey playing music. The Soundview Farmers Market can be reached by taking the 6 train to the Morrison Ave-Soundview station or the Bx4, Bx4a, Bx27 buses. Harvest Home Farmers Market will operate every Saturday rain or shine from 8 a.m. to 4 p.m. through November 21st, 2015. WIC, FMNP Coupons, Senior FMNP Coupons, Health Bucks, SNAP (EBT) and Debit/Credit Cards  will all be accepted.

Medicaid: The Long-Term Costs of Short-Term Savings

The Rauner Administration’s decision to cut $1.5 billion in Medicaid spending to balance the state budget is like the proverbial cutting off the nose to spite the face. Central to the Rauner “plan” is to tighten eligibility for people with disabilities and older adults to access long-term care services and supports (LTSS). The Administration is proposing to increase the minimum eligible level of something called the “Determination of Need” score. 

The DON eligibility process determines how many hours of assistance an older adult or person with a disability can get in order to stay in their own home.While the Administration views this as an appropriate cost-cutting measure, in reality such a move will ultimately reduce needed community-based services for people with significant disabilities, and will spread those costs to other parts of the healthcare delivery system.
Where the costs go

What happens to those costs? They get passed on to hospitals and urgent care providers, taxpayers (in the form of other social programs), and family members who are either under-employed or unemployed in order to help a loved one.Persons who are aging or living with a disability require access to long-term care to live independently, and do not have other options to find support for their medical needs. Reducing access to home and community-based services means individuals who are at risk of living in more costly nursing facilities become desperate to find any help with activities of daily living, through friends or family members who may be able to assist with financial or personal healthcare needs.This is easier said than done, however, as family members or friends who can volunteer to assist are often being forced to choose between their own employment and assisting their family member or a loved one. 

Creating a further burden is Rauner’s proposed elimination of funding for developmental disabilities respite care, a program that provides assistance for people who care for persons with disabilities,Medicaid is not only the payer of last resort, but the program of last resort, for persons with significant medical needs – paying for as much as 49% of the country’s long-term care services.
How to save the state money

Keeping people out of emergency rooms and nursing homes ultimately saves the state money. Progress Center for Independent Living released data showing that home services remove pressure from Medicaid spending on nursing homes, saving the state more than $17,500 per person, per year in the Home Services Program for people with disabilities.The cost savings for seniors in the Community Care Program are even greater, at more than $24,150 per person, per year. Consider the fact that the Home Services Program serves 30,000 people with disabilities, and the Community Care Program serves more than 80,000 people year round (based on the FY 2014 Public Accounting Report for both HSP and CCP from the Illinois Office of the Comptroller), and you have staggering numbers for cost savings. According to the Service Employees International Union, more than a third of people with disabilities now in the Home Service Program – some 10,000 people – will lose access to care in their homes, thereby creating a dependence on hospitals and institutions to address their long-term care needs. 

The Community Care Program will be losing more than 38,700 seniors.Debate surrounding the state budget should be aimed at taking concrete strategic actions, rather than cutting low-cost and money-saving programs. Governor Rauner appears bent on forging ahead despite opposition from the Illinois house and senate.The facts are clear. The cuts to the Medicaid budget are not cost-effective, and they isolate vulnerable populations. The notion that diminishing social safety nets is a good way to control state budget deficit is at best misguided, and we need to move on from this policy.

Connecting Bronx Communities to Local Farmers Markets

August 2nd through 8th marked the 16thannual USDA Farmers Market Week. Farmers Market Week is an official celebration of farmers markets across the country, connecting consumers to local fresh, seasonal, and healthy produce. In the New York tri-state area, August and September is peak harvest time. Regional bounty includes beets, broccoli, fresh herbs, tomatoes, peaches, plums and much more.

This month, with the bounty of farm produce available at local farmers markets Bronx Health REACH will launch a new campaign to promote Bronx-based farmers markets. This campaign, which is part of a city-wide collaboration of the Partnership for a Healthier NYC, seeks to increase access to farmers markets.

The campaign’s intent is to connect Bronx communities to local farmers markets. These markets are an important source for healthy eating, and improved health in general. The local farmers markets serve as hubs to supply and support increased consumption of fresh fruits and vegetables.

There are 29 farmers markets in the Bronx. To learn more, check out the Bronx Farmers’ Markets map. Next year we anticipate that that number will grow to 30, through collaborative efforts led by Harvest Home, Bronx Health REACH and the Melrose Community.

The campaign to promote farmers markets will focus on raising the awareness that farmers markets are accessible to all. As part of the campaign development process, community coalitions from the Bronx reviewed materials to determine their effectiveness in communicating that message of the accessibility of farmers markets.

In offering feedback, residents expressed that farmers markets accessibility pertains to their location as well as offering good value and prices for high quality produce. In New York, farmers’ markets accept a variety of payments including: WIC FMNP coupons, EBT, SNAP, Health Bucks, cash, debit and credit cards.

So, where is your nearest Farmer’s Market? To find out:

• Check the maponline
• Text “sogood” to 877877
• OR, call 311.

Healthy Water Campaign Begins in May

A photoshoot on Thursday, March 3 captured New York public school students from PS 294 and others engaging in various activities while enjoying a drink of fresh water.

The photoshoot is part of the Partnership for a Healthier NYC of which Bronx Health REACH is the Bronx borough lead development of a city-wide campaign to increase water consumption in New York City.

Residents in the South Bronx have some of the highest rates of diet related diseases including overweight and obesity, diabetes and heart disease compared to residents in the rest of New York City.

When people don’t drink enough water, they are more likely to drink soda and other sugar-sweetened beverages, which have been linked to weight gain and obesity. The campaign is scheduled to run from May to September 2016 and includes advertising on bus shelters and distribution of flyers and other promotional material by street teams at various Bronx summer events such as Boogie on the Boulevard.

Dr. Eliseo J. Pérez-Stable, the Director of the National Institute on Minority Health and Health Disparities (NIMD) at the NIH at the April Grand Rounds

Photo via NIH website.

This post is written by Emily Oppenheimer, Program Coordinator for the Partnership for a Healthier Bronx.

On Friday, April 8th, Dr. Eliseo J. Pérez-Stable, the Director of the National Institute on Minority Health and Health Disparities (NIMD) at the National Institutes of Health (NIH) presented on Health Equity. His presentation, “Reducing Disparities in Health Outcomes: The NIMHD Agenda on Equity,” was the April Grand Rounds feature of the Department of Family Medicine and Community Health at the Icahn School of Medicine at Mount Sinai. Dr. Perez- Stable was invited by Neil Calman, MD, President and CEO of The Institute for Family Health and Chair of the Department of Family Medicine at Icahn School of Medicine.
Dr. Pérez-Stable shared his optimistic, yet pragmatic views on shifting internal medicine approaches to reduce health disparities. His presentation examined the cultural, environmental, and biological factors and emphasized five ways to reduce health disparity in healthcare settings: (1) expand access, (2) public health consensus, (3) coordinated care, (4) patient-centered care and (5) performance measurement. Primary care works, and access to care makes a difference. He argued that comprehensive systems changes can target health issues and shift disparity.

An important point made by Dr. Pérez-Stable with particular resonance to Bronx Health REACH, given that 90% of the Bronx population is Black and Hispanic, was his statement that even though 40% of the U.S. population qualifies as racial/ethnic minorities, health equity is simply social justice and common sense.

Looking ahead, Dr. Pérez-Stable explained that NIMHD will be looking to collaborate more with the Agency for Healthcare and Quality (AHRQ), diversifying the biomedical workforce, enhancing cultural competence in care, examining structural racism, and focusing research on mental health and epigenetics. Bronx Health REACH is excited to learn that the National Institutes of Health has invigorated efforts and refined its focus on reducing health disparities.

To learn more, visit the National Institute on Minority Health and Health Disparities(NIMD) website.

Halloween Marks a Scary Time for Health Care in Illinois

If things don’t change soon, health care could be in for major setbacks in Illinois. The State budget battle is approaching its fifth month and counting.  So far, Medicaid payments continue per court order, but other services are beginning to run out of money:

State payments to 911 call centers throughout the Illinois have been suspended, putting emergency services in jeopardy.
Illinois has stopped paying medical and dental claims for 150,000 state employees. The long-term cost of delayed care for a group of this size could be far greater than the cost of paying for care and preventative care today.
The state’s Psychiatric Leadership Capacity Grant, which was $27 million in the State’s FY2015 budget, is no longer being funded, affecting most of the 140 community health centers in Illinois and thousands of people who rely on them for psychiatric care.

The longer the State budget impasse continues, the more services will be cut. These include services that indirectly have an impact on Illinois health care, such as after-school programs to keep kids out of trouble and supplemental nutrition programs, especially for the older adults.

It’s Not Too Late to Raise Your Voice!

Contact your State legislators to let them know how concerned you are about the future of health care in Illinois. Tell them that Illinois seniors and children are especially vulnerable. We can’t let cuts affect them.Many program cuts will result in greater costs to the State in the not-so-long run. For example:

• Home care services and home delivered meals to seniors citizens cost a fraction of the $75,000 annual cost of nursing home care. Cuts to these programs will mean more seniors ending up in nursing homes, paid for by Medicaid.
• Cut backs to after-school programs and Department of Children and Family Services support for older children will mean more kids and young adults intersecting with the justice system. Even short-term incarceration can pay for a full year of after-school activities for a child.
• Cut backs to mental health services will only cause an increase in city and country jail populations where the State will not only have to provide mental health services, but food, clothing and shelter.

And remind them that, as the State’s infrastructure crumbles and the State’s bond ratings tumble, it will only get more and more expensive to catch up.

Phillip Lanier
Health Policy Intern
Health & Disability Advocates

Stark Health Disparities Between Bedford Stuyvesant and Bay Ridge/Dyker Heights

Photo via Flickr by Eli Duke

The New York City Department of Health and Mental Hygiene continues to address health disparities across New York City. Below is an article from Raven Rakia comparing the Bedford Stuyvesant section of Brooklyn to the Bay Ridge/Dyker Heights neighborhood and the stark health disparities between the two areas.

To read the full Community Health Profile for Bed Stuy click here

To read the full Community Health Profile for Bay Ridge click here

In New York City’s black neighborhoods, poverty, housing issues, and asthma go together

By Raven Rakia on 16 Oct 2015

It’s a tale of two cities. New data from the New York City Department of Health shows the health of New Yorkers can vary drastically by neighborhood and is linked to race, housing issues, and poverty.

Earlier this week, the Department of Health published community public-health profiles that take an in-depth look at each neighborhood in Brooklyn (other boroughs will be coming over the next two months). The profiles detail the poverty rate, access to health care, life expectancy, strokes, asthma, mental illness, and cause of death for each neighborhood’s population. They reveal the stark reality of how health in New York varies along race and income lines.

Living in Brooklyn’s predominantly black neighborhoods comes with an increased rate of asthma hospitalizations. In all but one of Brooklyn’s predominantly black neighborhoods, the number of asthma hospitalizations was higher than the borough and city average for both children and adults. The whiter the neighborhood got, the fewer asthma hospitalizations there were.

The difference is stark: In Bed-Stuy, a neighborhood that is 64 percent black, there were 531 avoidable adult asthma hospitalizations per 100,000 people and 54 child asthma hospitalizations per 10,000 people. In the Bay Ridge and Dyker Heights neighborhood, which is 60 percent white, there were 94 avoidable adult asthma hospitalizations per 100,000 people and nine child asthma hospitalizations per 10,000 people.

The four neighborhoods in Brooklyn with the highest avoidable adult asthma hospitalization rates are all over 83 percent black and Latino, and they also have some of the highest poverty rates in the borough. While showing the connections between race, poverty, and health on a microscopic level, the data also offers a glimpse into some of the reasons why the differences may be so high. In Brooklyn, most of the levels of particulate matter (as a form of air pollution) range from 8 to 9.5 micrograms per cubic meter. When it comes to housing quality, in six neighborhoods, 70 percent or more rented homes have at least one maintenance defect. All six of those neighborhoods are predominantly black and Latino, and four out of the six neighborhoods have high rates of asthma hospitalizations. Poor housing quality could mean the presence of mold or asbestos, which are associated with respiratory illnesses.

The most important thing about all of this data is that it shows a complete picture of how the neighborhood you live in can affect how healthy you are. As NYC’s Health Commissioner Mary Bassett told CBS New York, “The health of a neighborhood doesn’t just rely on the decisions an individual makes, but on the resources that are available to them in that neighborhood.”

New Yorkers, if you want to be healthy, it’s going to be much easier if you’re white and can afford to live in a richer neighborhood. For everyone else: good luck.

Institute for Family Health’s Maxine Golub Honored by ECHO Free Clinic

Maxine Golub is second from the left, Bronx Health REACH's Charmaine Ruddock is second from the right along with other Institute for Family Health employees.

On Thursday, February 11, 2016, Maxine Golub, the Institute for Family Health’s SVP for Planning and Development was honored by the ECHO Free Clinic, for her years of service and support with the Walton Family Health Center. Bronx Health REACH Director, Charmaine Ruddock attended the event and stated, "It was an amazing speech to those new doctors in various stages of their residency. Maxine spoke to them of their work in the Free Clinic in the Bronx in the context of the challenges working in a borough ranked 62 out of the 62 counties in New York State per the Robert Wood Johnson Foundation county health rankings report, and in a country struggling with racism and socio-economic factors as health determinants. But she told them that even in this context, there are many reasons to be hopeful, and told them why. And then, she challenged them. It was one of the best speeches I have heard in a very long time."

Below is Maxine's speech.

Good evening. Welcome, and thank you to all of you for being here. Many of you have been far more instrumental to the success of the ECHO Free Clinic than I have been, so I’d like to offer a special welcome to Neil Calman, Amarilys Cortijo, and Sarah Nosal from the Institute, and Hal Strelnick and Ira Sussman from Einstein, as well as other members of the department of family medicine. I also want to take a moment to thank the folks at the Robin Hood Foundation, who have supported this work since 2009, and to my colleagues and friends at the Institute who came tonight to show their support.

I am truly humbled to have been invited to be your honoree and keynote speaker this evening.  And I am deeply appreciative of your recognition of my work to support the ECHO Free Clinic, and to promote health and health care in the Bronx.

As Marika said, I was among the early supporters of ECHO, working alongside Drs. Calman, Cortijo, Nosal, Strelnick, Little, and many others to make this project a reality. Most of my work has been behind the scenes – administrative stuff like communications and fundraising.  In my opinion, the real credit for this work goes to the student leaders who had the vision to start the clinic, and who have, over the years, insisted on its importance to both the patients and the students.

The Institute has supported the Free Clinic for two important reasons. The first is the recognition that even though our health centers provide free care to all, many uninsured patients don’t come because they’re afraid of getting a bill. This is particularly unsettling for those who are undocumented.

But an equally important reason we do this is because of the students. It’s so important to us, and to our mission to serve the underserved, that each of you has this opportunity to learn what it means to be indigent and have limited access to care.  To meet, face to face, with patients who have not been to the doctor in years, or who have not taken much-needed medication because they couldn’t afford it. We hope that this experience will make each of you a better doctor, wherever you go, whatever you do.

The Institute for Family Health has worked in the Bronx since the early 1980’s.  We have built and operated several health centers, created a residency-training program, now operated by Bronx –Lebanon, and led Bronx Health REACH, a community based participatory project designed to eliminate racial and ethnic health disparities, since 1999, led by Charmaine Ruddock, who is here this evening.  And we’re not alone… Montefiore, Morris Heights, Bronx-Lebanon, St. Barnabas – all of have worked to expand access to primary care and related services.

And yet, where are we now?  According to the Robert Wood Johnson Foundation, the Bronx is  #62 out of 62 New York State counties. For those of you not familiar, the RWJ system is based on a tally of 35 criteria rolled up into 5 categories. Sadly, the Bronx ranks 62nd on health outcome, 62nd on social determinants, 61st on clinical care, 52nd on health behavior, and 33rd on physical environment.

So in spite of all the work that all of us have done for the past 35 years, all the new practices we have opened, the thousands of patients we care for, the hundreds of medical students and residents we have trained, we are still at the bottom of the state-wide barrel.

It’s depressing, isn’t it?

And if you want, you can also be depressed about what’s going on nationally. Politicians on the right promoting bigotry and hatred. Kids in Michigan getting lead poisoned from municipal water supplies. Countless unnecessary deaths at the hands of the police.

It is depressing. But I am not depressed, and I hope you won’t be either.  Because more than any time in my work for the past 35 years, I see major changes happening all around us…

First, there is the Affordable Care Act.  More people than ever before have health insurance in this country. I grant you there’s a long way to go, but it is a huge step in the right direction.   Nationally, nearly 18 million people have gotten insurance, with 2.1 million in NYS, and over one million here in NYC.

And with the ACA came the Teaching Health Center Program -- creating a new funding stream to train 500 primary care providers to work in high need communities. Sure, it has its problems, but it is indeed another huge step in toward recognizing the importance of community-based primary care.

Second, there is wide spread recognition that social determinants of health – education, housing, income, nutrition, opportunities for exercise, safety, stress - make a greater difference in health outcomes than anything we do as individual providers. If you need a primer on this, I refer you to the work of Sir Michael Marmot, the president of the World Medical Association.

This recognition is so widespread that the national center for Medicaid and Medicare has recently issued a request for proposals designed to foster collaboration between health care providers and community service organization to address social determinants. The Institute has recently piloted a survey about social determinants in one of our Bronx sites, and found that 20 percent of those asked report at least one significant problem related to food security, safety, finances or housing.

Third, people are talking about race and racism in every walk of life – and the fact that race impacts health outcome is no longer a debatable question. The impact of race and racism is being discussed in campuses across the country. The NYC Health Department and the City University of New York have new departments focused on equity.  It’s in the news, in our political campaigns, and in best selling books.  This week, the entire NY Times education section is devoted to race. Our presidential candidates have met with Black Lives Matter, and acknowledged the racism in the poisoned water of Flint, Michigan. We have a long way to go to eliminate the impact of racism in our country, but these are critical milestones in bringing this issue to light.

Fourth, groups are acknowledging the need to work together to address health and health related concerns comprehensively. Locally, Bronx Health REACH, the Institute’s CDC project to address racial disparities in health, is working with bodegas, churches, schools, hospitals, health centers, health departments, elected officials and more to address health disparities. Together with folks from the Borough President’s office, Montefiore, and the NYC DOH, we have started a campaign called #NOT 62: The Campaign for a Healthy Bronx. And in spite of spending the past five years at the bottom of the list, RWJ recognized the power of the campaign and gave the Bronx one of eight “Culture of Health” awards nationally for this effort.

And finally, there are all of you. I have watched for the past 15 years as the students, with support from their very dedicated faculty, have built this clinic from nothing… from an idea someone had, to getting support from the college, to finding the Institute to be your clinical sponsor, to opening up, to seeing roughly 1,000 patients who make approximately 1,400 visits per year.  

I have heard stories of patients who have not seen a doctor in years, often leaving chronic illnesses untreated. You have diagnosed patients with out-of-control diabetes, PTSD and other mental health problems, even cancer. You have provided physical exams to young people eager to find work.  And in many of these instances, you were true heroes, battling the system to make sure that the patient got the care that he or she needed.  Sometimes you even brought them there yourselves.  And while I hope for a day when everyone has access to health care, and we can retire the free clinics entirely, you deserve tremendous appreciation for the work that you do. You have changed lives.

You, like your predecessors, are smart, hard-working, deeply committed students.  I have great faith in your abilities, and deep confidence in you -- as the next generation of leaders in health care, in public health, and in civic life.

So if you’ll permit me, I’d like to end with a few reminders – for all us, really, since we all need them, but especially for those of you who will be graduating this spring.

These are the things that keep me from being depressed at the enormity of the challenges we face in our work.  I hope they’ll work for you too.

1) Remember the ECHO Free Clinic. It’s a great example of what is right. For those of you leaving school, please don’t tuck it away as something you did in medical school that has no relevance to your “real” life. No matter where you choose to practice, there will always be folks who need a little more help, folks whose life experience has made it difficult for them to get basic care, folks who are afraid, folks who can’t pay. Be there for them – just as you are now.

2) Appreciate your colleagues, reach out across disciplines, and across institutions.  Talk to nurses, social workers, community organizers, faith-based leaders, community members, even administrators! Healthcare is complicated, and growing more so. And addressing the social determinants of health will be even harder. We must work together to address the big challenges – to solve clinical problems, social problems, and financial problems. We may each see things a little differently, but we need each other.

It seems ironic today in light of what’s going on in Flint, but my very first job in health care was at Montefiore’s lead poisoning prevention program. It was there that I realized that the incredibly dedicated doctors I worked with could treat children, but could not prevent the problem. To do that, we needed housing organizers, tenants associations, lawyers, public health professionals, scientists and politicians.  In 1981, led by a committed city council member, NYC passed one of the toughest lead laws in the country, requiring landlords to eliminate lead hazards before a child got poisoned. In 1984, a group sued the City to strengthen its enforcement. But as we all well know, this problem hasn’t gone away…

3) Which leads me to my last and most important point -- Stay in it for the long haul. Change is a long-term proposition. Don’t give up – the world needs you. Hold on to the determination that has brought you here, and keep finding ways to make things better. None of us can do it all, but each of us can do something.

And for those of you who are physicians: you have earned authority and respect. That’s powerful. I hope you will use that power to be a force for change and a voice for the underserved.

It has been my great pleasure to watch the unfolding and blossoming of the ECHO Free Clinic, and the look-alike clinics it has nurtured in NYC and across the country.

To be honest, in our first meetings 15 years ago, it never occurred to me that it would become such a fantastic program, caring for thousands of patients, and training hundreds of doctors. Or that students al