Expand and strengthen quality out-of-hospital health care for the most underserved and vulnerable populations.
- Increase in New Yorkers benefitting from primary care from a “Patient-Centered Medical Home” or comparable out-patient community-based provider
- Increase in New Yorkers benefitting from coordinated care, care management, and/or multi-disciplinary services and supports provided in an accessible community- or home-based setting, with a focus on programs targeting individuals living in poverty, with multiple chronic or behavioral health conditions, and/or who are transportation-challenged, including frail elders
- Increase in New Yorkers receiving services and supports aimed at reducing unnecessary hospital admissions, readmissions, or emergency room use, and successfully transitioning patients into out-of-hospital community-based care and care management
(Priority will be given to programs capable of being sustained with earned or public sector revenue, producing outcomes of long-term value in a short time, and/or of reducing cost to the system while maintaining or improving quality of care to the individual.)
God's Love We Deliver, Inc.
To help support the technology expansion and program evaluation capacity required for program success and systems change efforts related to Medicaid coverage of medically tailored meals
NYC Health + Hospitals
$200,000 (over two years)
To help support the development, implementation, and evaluation of a Home-Based Primary Care program targeting high-risk home- or nearly home-bound older adult patients
Supportive Housing Network of New York, Inc.
To maximize supportive housing opportunities for medically needy homeless people