The New York State Department of Health and Social Justice Summary

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Write a one page summarizing the case study attached 

Afterseveralyearsoffundinghospital-basedbreastcancerscreeningprograms,in1992theNewYork State Departmentof Health determined itwas notreaching people itneeded to reach- theuninsuredandunderinsured,andwomeninminoritypopulations.

Thestateappealedtothelocalhealthdepartmentstoserveasconvenersintheircommunities.Inturn,thestatewouldprovidefundingtonetworksofcommunityagenciesandhealthcareproviderstopromotecancerscreenings,knockondoorstopersuadetheunpersuaded,andl

As it happened, Monroe County, New York already had much of this community apparatus inplace.Comingoffasuccessfulfour-yearinfluenzavaccinationproject,theMonroeCountyHealthDepartmenthadawebofcontactsinthepracticeandacademiccommunities,andithadonstaffanexperiencedprojectdirector,BonnieLewis,whohadorchestratedaclinicalpreventioncampaignthroughdoctors’offices.Theirfirsttaskof“persuadingtheunpersuaded”actuallyinvolvedbringingthe two competing canceradvocacy groups,the American CancerSociety and CancerAction,together in the coalition. “It was the first time they sat willingly at the same table,” marveled oneparticipant.

Underthe direction ofthe deputy health department director, Nancy M.Bennett, M.D.,M.S.,thePartnershipincludedtheMonroeCountyMedicalSociety(whichinitiallyservedasthefiscalagentfor the project’s funding), several University of Rochester medical school departments involved indataanalysisandevaluationactivities,theAmericanCancerSocietyandCancerAction,thefaithcommunity,anumberofcommunity-basedorganizations,andaservice-deliverycomponentthatinvolvedradiologistsandseveralhospital-basedwomen’scenters.ThePartnershipdevelopedaseriesofcommitteesto overseecomponentsofthework—suchasevaluation,publicity,professionaleducation,andphysicianrecruitment—andtocoordinatethe41Partnershipagenciesandover110providerstoperformthescreeningsandprovidenecessarytreatment.

AttheheartofthePartnershipistheofficerunbyLewis.“Ourstrategy,”saidLewis,“isthatwedon’t take credit for things. We’re the workhorse that drives the operation.” Her staff of threeoperates on a $469,000 annual budget, of which 40 percent is spent on clinical services, 10percentondataanalysisandevaluation,andhalfonoutreach,advertising,andcoalitionstaffing.Theofficeoverseesbudgetmanagement,datacollection,schedulingandcasemanagementof2,500clients,reportwriting,andthecoordinationofatleasteightmonthlycommitteemeetings.

ThePartnershipisfundedbythestatehealthdepartment,theRochesterPrimaryCareNetwork(anot-for-profit foundation established by a local managed care organization), and a Johnson &JohnsonCommunityHealthAward.ThePartnershipusesmediaandcommunityeventstopublicizethebreastandcervicalcancerscreeningsandpromotesthescreeningsaspathwaysforwomeninto primary care. The Partnership office will determine a woman’s eligibility for the program overthephone,with no documentation required,and schedule an appointmentwith amedicalpractitionerofherchoice.“Ifshedoesn’thaveaproviderwefindheroneandpayforherinitialexam,”saidLewis.Almosthalfofthewomenhavesometypeofinsurance,althoughtheymayhave ahigh deductible orno coverage formammograms.In the case of Medicare patients,whoarecoveredforbi-annualbreastexams,thePartnershippaysfortheexaminthe“off”year.

Through the medical society’s and the Partnership’s ties to the practice community, they haverecruitedeveryradiologistintheareatoparticipate.Asfortreatment,accordingtoLewis,“thesurgeonsareacceptingourrateof$290foranincisionalbiopsywheretheywouldnormallyget

$800.Theycometothetablebecausetheyknowthattheirinputisvalued.Theburdenofuncompensatedcareislightenedwhensharedbymanyproviders.Andpeerpressuredoeshelp.”ThePartnershipextendsitselfbeyonditsconventionalboundsaswell.Whenalocalgynecologisthadapatientwhoneededfollow-upcounseling,andwhohadalreadybrokennineappointments,thephysiciancalledthePartnershipofficesforhelp.AlthoughthepatientwasnotaPartnershipclient, Lewis immediately dispatched the patient educator to the woman’s home. The educatorexploredwhatwasbotheringherandeventuallypersuadedthereluctantpatienttovisitherdoctor.

Likewise, the Partnershipprovides a numberofsupportservices, such as childcare andtransportation,toassistwomeninovercomingbarrierstomakingandkeepingtheirappointments.

ThePartnership’sbureaucraticflexibilityandbroadcommunityreachhaspaidoff.SincethePartnership’scommunity-widecampaignbegan,mammographyratesforwomenages50to74inMonroeCountyhaveincreasedfrom43percentto62percent,withthegreatestimprovementinthoseneighborhoodswithparticularlylowratesatbaseline.Asaresult,breastcancerincreasinglyis being diagnosed at earlier stages. Of the 2,500 clients served by the Partnership thus far, 10womenhavebeenidentifiedwithcancer,and9haveacceptedtreatment.

Dr.Bennettsummarized:

“Theroleofthehealthdepartmentasconvenerofthecoalitionhasbeencritical.Althoughwe’resometimesoverlookedasaplayer,weareperceivedasbeingneutral.We’renotincompetitionwiththeprovidersinthecommunitybecausethehealthdepartmentdoesnotprovideprimarycareexcepttochildreninfostercare.Thesedays,there’sarealriskofsplinteringcareinthecommunity,andthepotentialforalotofcompetition.Weneedtostepinto the role of holding the systemtogether—bysharing data,and by helping people tocollaborate.”