NYU Langone has launched an initiative to screen Emergency Department patients for prediabetes and diabetes. Patients who meet the screening criteria are given a blood test, and any patient who has elevated A1C levels is urged to seek follow-up primary care. This is a critical point for newly diagnosed patients, and NYU Langone is exploring ways to streamline patient education in order to improve patient compliance. The team was tasked with developing a comprehensive educational toolkit for care providers to use in conjunction with existing resources. The team conducted a literature review on best practices for diabetes education and performed a gap analysis using stakeholder interviews, evaluating current diabetes screening initiatives and identifying gaps in current workflow processes. Based on its findings, the team proposed budget-neutral enhancements for the client, including recommendations for improved workflow processes and an educational toolkit to guide future patient care.

Established in 2014, RIP Medical Debt has eradicated over $5.6 billion in medical debt to date, providing financial and mental relief for over three million people. Despite significant legislative changes like the Affordable Care Act, the national medical debt crisis persists, often destroying the financial stability of America’s most vulnerable communities: the sick, the elderly, and the poor. RIP Medical Debt engaged a Capstone team to provide a comprehensive overview of the medical debt crisis, including extensive research to determine the scope of the crisis, how medical debt is created, why it persists, and who is most impacted. The team conducted a landscape analysis, interviewed key stakeholders, and surveyed existing efforts to decrease medical debt. The final report includes the team’s analysis of the current state of medical debt as well as specific recommendations to guide RIP Medical Debt’s emerging public policy agenda.

How should healthcare systems in the US navigate physician shortage? The COVID-19 pandemic drew attention to this shortage, but other long-term challenges, such as an aging baby-boomer population and climate change, may further stress physician supply. These shortages are occurring at uneven rates across the US, especially in relation to geographic region and practice. A team studied relevant peer-reviewed literature and industry and government reports from the past ten years, and explored a variety of operational and technological solutions that healthcare systems can leverage to manage local physician shortages. However, in this uncertain and evolving environment, organizational strategies alone cannot remediate the national shortage. The team recommends a push for federal and state policy changes to enhance clinical worker pipelines, incentivize the equitable geographic distribution of clinical workers, and increase access to telehealth solutions.

The Department of Orthopedic Surgery at NYU Langone Medical Center ranks among the top five orthopedic facilities in the nation, providing tens of thousands of patients with world class care in orthopedics, rheumatology, and rehabilitation. A team was tasked with recommending a feedback system within EPIC (an electronic health record system) on the accuracy of patient diagnosis in the Emergency Department. The goal was to find mechanisms for providing real time feedback to the Emergency Department that would otherwise require orthopedic consultation and an alternative course of treatment. The team conducted a comprehensive literature review, analyzed patient-level data, and compiled insights from key stakeholders, including Orthopedic and Emergency Department physicians and Quality Team leadership. The team’s final report offers practical recommendations for interdepartmental collaboration and physician education, and outlines data specifications for an EPIC feedback system aimed at reducing discrepancies in diagnoses.

Founded in 1983, SPM Marketing & Communications (SPM) is a healthcare brand consultancy and integrated marketing communications firm that has partnered with more than 300 organizations in 40 states to help establish meaningful brand strategies and deliver results across the healthcare sector. SPM engaged a team to identify leading practices in addressing race- and gender-based health inequities that have been exacerbated by COVID-19, and to translate these findings into corporate values and actions. To evaluate best practices, the industry landscape, and SPM’s positioning, the team conducted an extensive literature review and interviewed 12 internal and external stakeholders. Based on its findings, the team highlighted consistent themes for addressing race- and gender-based health inequities, and created actionable short- and long-term recommendations for best practices.

Innovative Resources for Independence (IRI) is a nonprofit organization that operates 36 locations throughout New York City. Its mission is to support people with intellectual and developmental disabilities (IDD) and comorbid behavioral disorders to live, work, and participate in their community and maintain healthier lives. IRI engaged a team to help determine whether Medicaid Managed Care and Value Based Payment are the best payment systems for the IDD population. The team collected and analyzed aggregate clinical data on weight and physical, mental, and behavioral issues for individuals within the IRI system, and conducted extensive research into the impact of the Medicaid Managed Care and Value Based Payment methodologies on the IDD population in terms of cost, quality, client satisfaction, and perception. The team completed an executive report and presented its findings and recommendations for future nutrition and exercise management practices to IRI’s leadership team.

The Institute for Community Living (ICL) is a New York-based nonprofit human services organization that provides integrated trauma-oriented, recovery-oriented, and person-centered care. In its continual effort to improve patient health, ICL identified an opportunity to propose a Value-Based Proposition (VBP) to one of its Managed Care Organizations. ICL tasked a team with developing a VBP proposal with a cost saving incentive and a strategy for improving patient lives by addressing social determinants of health. The team conducted an extensive literature review and performed a data analysis using ICL data, New York State Office of Mental Health data, and patient demographic information. The team developed a VBP proposal focused on delivering community-based integrated care to a target patient population in order to reduce unnecessary hospitalizations and ER visits, ultimately saving the Managed Care Organization nearly $4 million.

The Milbank Memorial Fund (MMF) is an endowed foundation that works to improve population health by connecting leaders and decision makers with the best available evidence and experience. MMF’s Emerging Leaders Program (ELP), launched five years ago, seeks to cultivate leaders who can address the challenges and opportunities in today’s complex health policy environment by developing practical, hands-on leadership skills in future public service officials. In anticipation of a future redesign with a more virtual program model, MMF solicited a team to conduct ELP’s first formal program evaluation. The team designed and conducted interviews and surveys with past ELP participants and mentors, and analyzed the results using both qualitative and quantitative methods to identify key themes. With this evaluation, the team generated specific recommendations for improving program monitoring and data collection and implementing mechanisms to improve ELP’s mentorship, networking, curriculum, activities, and program format.

NYU Virtual Urgent Care is a 24/7 video chat service that allows patients to connect with a NYU Langone Health care provider from the privacy of their home. NYU Langone Health tasked a team with spearheading the launch of a Virtual Urgent Care program for PrEP (Pre-Exposure Prophylaxis), a preventative HIV drug regimen that is nearly 100 percent effective when taken daily. The team conducted a literature review on best practices and created a workflow for PrEP initiation via telehealth, which includes a PrEP initiation protocol and an “express lane'' of orders and documentation in the electronic health record for provider use. The team generated an educational presentation on the protocol, and assisted the client with outreach and marketing to the LGBTQ+ community and other groups at risk for HIV infection. Throughout the project, the team partnered closely with the NYU Langone Health corporate marketing team, the community-based Family Health Centers program, and the IT and Emergency Departments.

The Partnership to End Addiction provides services to families impacted by substance use and addiction through its helpline, educational resources, and toolkit of training sessions. With the help of a Capstone team, the organization sought to deliver fee-based substance use programs for parents and caregivers through schools. The team conducted a needs assessment to identify potential barriers to successful implementation and a competitor analysis of the landscape of existing substance use and prevention programs. The team worked with the client to develop strategies for financial sustainability through mixed revenue sources, program implementation, toolkit marketing, and increased accessibility. The team also provided a framework to measure program success and effectiveness.

Vibrant Emotional Health (Vibrant) operates NYC Well, a service that provides 24/7 mental and emotional wellbeing support services to individuals and families via call, text, and chat. Vibrant is contracted by the NYC Department of Mental Health and Hygiene through its ThriveNYC initiative to increase the accessibility of behavioral health services for New Yorkers. Vibrant commissioned the team to identify more effective metrics for measuring the impact of each support session. The team completed a literature review and market analysis, and reviewed the client’s current data criteria. The team then recommended metrics for Vibrant to use to inform and improve rapport building, so that the organization can more effectively communicate its work to stakeholders, track variation in rapport based on call volume or intensity, and train counselors to build rapport.

FAIR Health is a nonprofit organization committed to bringing transparency to healthcare costs and insurance. The organization engaged a team to uncover the most important risk factors for adverse outcomes to COVID-19 (such as hospitalization and mortality). Leveraging material from the organization’s collection of 32 billion health insurance claims—the largest collection of private health data in the country—the team ran statistical analyses on claim data to identify significant risk factors associated with patient demographics and clinical characteristics. The team used this analysis, along with findings from a literature review, to compile a report that includes key findings, recommendations for at-risk populations, and a dissemination plan for various policy and clinical stakeholders to use.