Reducing Surgical Cancellations in the Department of Orthopedic Surgery
The Department of Orthopedic Surgery (DOS) at Montefiore Medical Center provides comprehensive care for all orthopedic and musculoskeletal conditions. The DOS consists of ten subspecialties and five surgical facilities, treating more than 130,000 patients across the New York City Metropolitan area in 2014. The DOS engaged a Capstone team to assess causes of surgical cancellations—a critical impediment to their care delivery model—and quantify the financial and resource implications of these cancellations, with the goal of developing a remediation plan. To achieve that objective, the team conducted stakeholder interviews, process walkthroughs, and a thorough analysis of financial and cancellation data. Based on the team’s findings and industry best practices identified in a literature review, the team outlined a series of process enhancements and a pilot intervention to target and mitigate preventable cancellations.
A Financial Model for High-Touch Community-Based Palliative Care
A nonprofit organization dedicated to serving the needs of New Yorkers facing life-limiting illnesses, Metropolitan Jewish Health System (MJHS) Hospice and Palliative Care created a community-based palliative care program eight years ago. MJHS’s most challenging and important home care program is called the High-Touch Model, which offers home visits by members of an interdisciplinary team (physician or nurse practitioner, social worker, and chaplain, if needed), telephonic outreach by a nurse specialist in palliative care, and 24/7 access to on-call services. MJHS’s corporate commitment to in-home palliative care can only be sustained, however, if management develops clinical models that offer a clear value proposition to payers in the healthcare system. Through environmental scans, literature reviews, and an analysis of clinical and financial data, a Capstone team developed a financial model that can be flexed based on clinical acuity, patient census, and staffing type and levels, as well as a white paper outlining the model.
New York Dialysis Provider Coalition
DaVita is one of the major dialysis care providers in the United States and has the largest dialysis chain organization in New York. In addition to providing dialysis care, DaVita takes an active role in educating patients and lobbying for policy reforms to improve dialysis healthcare. In New York, DaVita provides dialysis care to over 6,000 patients across 53 clinics and 12 hospital partners. Providers in the dialysis market encounter many challenges, including inadequate reimbursements, non-emergency patient transportation, and emergency Medicaid care. DaVita seeks to ascertain the potential benefits of a coalition of dialysis providers, specifically in terms of improving patient care and mitigating the challenges faced by providers. The Capstone team performed a cost/benefit analysis based on literature reviews, an environmental scan, and market surveys on the benefits of forming the coalition that involves other chain organizations and independent providers. The team presented recommendations to DaVita on the benefits of forming/joining a coalition and the cost/risk this would entail. They also weighed the cost/benefit of a coalition against the alternative of standing alone as a chain organization.
Evaluation of Howie the Harp Peer Specialist Training Program
Community Access is a nonprofit organization committed to helping individuals with mental health issues make the transition from shelters and institutions to independent living. The organization’s Howie the Harp Peer Specialist Training Program (HTH) helps individuals with serious mental illness and histories of homelessness and incarceration train to become peer specialists. As peer specialists, individuals use their experiences to assist others going through recovery. Given the changing healthcare landscape in New York, peer specialist training programs are in high demand. Community Access engaged a Capstone team to evaluate the HTH program. Specifically, the team created survey tools to measure the program’s effectiveness and its impact on HTH graduates and employers. The team also conducted a comparative analysis of similar peer programs around the country. Using the data collected through surveys, the comparative analysis, and a literature review, the Capstone team produced a detailed evaluation report and provided future recommendations for the program.
Identifying a Strategic Direction in an Alternative Payment Model Future
With state and federal dollars, healthcare providers are increasingly incentivized to address the socioeconomic factors leading to poor health through partnerships with community-based social service organizations (CBOs). Yet access to such financial incentives has been limited for CBOs. CAMBA, a Brooklyn-based CBO, delivers services that providers and managed care organizations (MCOs) are required to offer in emerging value-based reimbursement models that pay for services not traditionally considered healthcare. Yet CAMBA, like most CBOs, has struggled to establish reimbursement agreements with providers and MCOs. CAMBA engaged a Capstone team to develop a plan to establish such reimbursement agreements. The team also advised CAMBA on which of its 160+ programs are the best candidates for the value-based payment model. The team reviewed existing literature and evaluated the New York market through a series of qualitative interviews with experts in the field. The team made recommendations about which of CAMBA’s existing services are the best candidates for provider or MCO partnerships and how these programs can best position themselves for such partnerships.
Urban Solutions to Reducing Carbon Emissions through Solid Waste Disposal
The Station Alliance is a nonprofit, privately funded organization established to improve the environment of New York City’s subway stations. The Station Alliance requested a Capstone team to identify ways to upgrade the condition of the stations and develop strategies to provide long-term funding for those changes through a variety of sources: local partnerships, retail operations, sponsorships, donations, and improved technology. The team conducted research on current practices in subway stations nationally and internationally, as well as projections based on new, innovative ideas. The Capstone team developed a plan that provides recommendations for generating new services and amenities in stations, as well as funds to improve station conditions system-wide.
Accessory Dwelling Units: Exploring Options for Affordable Housing in New York City
The New York City Department of Housing Preservation and Development (HPD) is the largest municipal housing preservation and development agency in the nation. HPD promotes quality housing and thriving neighborhoods through preservation and development programs for affordable housing. HPD engaged a Capstone team to conduct an in-depth review of New York City’s interrelated regulatory, policy, and financial issues associated with accessory dwelling units (ADUs). ADUs are residential units that are often found in basements, attics, or garages in one- to four-family homes. ADUs can be a source of affordable housing and provide homeowners with rental income. The Capstone team was charged with reviewing best practices in ADU development nationally and internationally; identifying building typologies that are suitable for ADU development in New York City; investigating the potential for incentivizing New York City homeowners to develop and legalize ADUs in their properties; calculating the potential cost of ADU development; and identifying policy and regulatory implications of ADUs.
Evaluating the New York State Brownfield Opportunity Areas Program
Brownfield sites occur where soil contaminants exceed the New York State Department of Environmental Conservation cleanup objectives. Clusters of Brownfields present a challenge to redevelopment, particularly in lower income communities where extrinsic market factors further suppress real estate values. The New York State Department of State Brownfield Opportunity Areas (BOA) program provides financial and technical assistance to municipalities and community-based organizations to complete revitalization planning studies and implementation strategies. New Partners for Community Revitalization, a nonprofit organization dedicated to renewing low and moderate income neighborhoods through the redevelopment of Brownfield sites, engaged a Capstone team to conduct an assessment of BOA program performance. To assess the efficacy of the BOA program, the team used geospatial analysis to evaluate the program’s impact on land values. Additionally, the team tracked program funding flows, surveyed stakeholders, and developed case studies to highlight the strengths and challenges of this community-based planning program.
Mobilizing Transit-Avoided Carbon
Four out of every five New York City rush-hour commuters travel using public transportation, making the New York State Metropolitan Transportation Authority (MTA) perhaps the single largest source of greenhouse gas avoidance in the nation. MTA’s Sustainability Initiatives office engaged a Capstone team to analyze the monetization of transit-avoided carbon and potential participation in a carbon market, an exchange of carbon credits designed to reduce carbon dioxide emissions. Recognition of this positive externality could contribute toward better maintained facilities and fleets, expansion of services, and additional funding for sustainable projects. The Capstone team investigated existing carbon trading models and green financing schemes, and conducted interviews with stakeholders. In its final report, the team provided recommendations on feasibility and potential routes, incorporating feedback from participants in industry, academia, and the public sector. The team also developed a presentation on MTA’s supply of transit-avoided carbon and its value in future sustainability initiatives.