Building A Culture of Health in Central Brooklyn

From Protest to Health Systems Transformation

The American healthcare system stands on the precipice between reform and collapse

While its problems  predated the current pandemic, they have been made much worse in the months since the novel coronavirus outbreak began. Many of the issues being encountered nationally today, such as lack of access to resources and care, overwhelmed hospitals, and unemployment can be found in the microcosm of Brooklyn, New York.

In 2012, the New York State Governor announced plans to close Interfaith Medical Center

It would have been the fifth Brooklyn safety net hospital to close in the last decade. Instead, the announcement sparked a community-wide movement, led by the Coalition to Save Interfaith, that not only kept Interfaith open, but catalyzed the formation of a new health system in Central Brooklyn.

This marked a disruptive moment in Brooklyn’s healthcare sector

Defined by shifting economic models, racing to contain costs, and a failure of political will--union and community leaders knew business-as-usual tactics would not save the day. Building a Culture of Health in Central Brooklyn: From Protest to Health Systems Transformation case study is the story of the Coalition—why it formed, and what it accomplished.

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1. An Epidemic of Hospital Closures

Sets the context of repeated safety net hospital closures in NYC and spotlights the economic and social realities that drive shocking health disparities, avoidable sickness and premature death in Central Brooklyn’s black communities.  

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2. Crisis at Interfaith

Describes the specific conditions that threatened to close Interfaith: a combination of egregious mismanagement, inadequate Medicaid reimbursement rates, and long-running government neglect.

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3. Time to Mobilize: Forming the Coalition to Save Interfaith

Details the formation of the Coalition to Save Interfaith that mobilized the many stakeholders drawn together by the Interfaith crisis and launched concerted community action to keep the hospital open.

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4. Protest and Resolution

Lays out the campaign of widespread community protest and negotiation that led to a decision to keep Interfaith open.

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5. Medicaid Reform

Dives deeper into the context in which the fight to transform Interfaith took place: a major overhaul of federal and state healthcare delivery and insurance systems and the creation of the Delivery System Reform Incentive Payment (DSRIP) program, a state-based effort to encourage innovation in local health systems.

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6. Research-Based Action

Outlines Coalition’s partnership with MIT to provide research- based proposals for change.  Through the partnership, the Interfaith crisis became an opportunity to propose an innovative approach to transforming the local healthcare system.

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7. Participatory Action Research as a Tool for Change

Highlights participatory action research (“PAR”) efforts to help residents take ownership of community health status. PAR centers on the lived experience and intelligence of those most affected by the problems it seeks to address, based on the premise that they will have the most insight into addressing problems and finding solutions.

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8. Healthcare System Reform: Cross-Sector Collaboration

Highlights the role of Community Care of Brooklyn (“CCB”) at Maimonides Medical Center in Central Brooklyn’s unfolding healthcare systems reform. Maimonides longstanding expertise in care coordination and community engagement set the stage for the ambitious effort to address social determinants of health.

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9. Reinventing Interfaith

Describes how a bankruptcy ruling and DSRIP funding put Interfaith back on its feet. The Coalition members fight for a voice in selecting a new Interfaith CEO paid off in the appointment of LaRay Brown. Brown, the first African-American woman president of a private hospital in New York State, brought a clear vision for Interfaith to support community health, well-being, and wealth generation in its service area.

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10. Focus on Health Equity

Details the partnership that developed between CCB and the Coalition, and their shared decision to  address racial disparities as the only way to effectively address SDOH.

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11. Creating Healthier Communities: Leveraging Community Assets

Explains how the collaboration between CCB and the Coalition moved beyond transforming healthcare delivery and set its sights on building a comprehensive approach to address the drivers of poor health together by changing the ways that communities and healthcare institutions relate to each other economically, politically and culturally.

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12. Community Planning for Healthier Communities

Details CCB and the Coalition efforts to develop specific interventions that activate hospitals to localize procurement, and seed community- based wealth-generating enterprises, thus creating new community jobs and revenue streams that can also improve community health.

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13. Making Health a Shared Value: Building Civic Infrastructure

Outlines the forms of “civic infrastructure” created by CCB and the Coalition, detailing how that infrastructure helped build the community’s voice and participation in authentic and sustainable community transformation. It also explains how CB and Coalition efforts began building a culture of health by establishing health as a shared value across multiple sectors.

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14. Building a Culture of Health: Outcomes

Describes the range of outcomes resulting from the CCB and the Coalition’s collaboration: from preventing Interfaith’s closure, to reducing avoidable hospitalization rates, to establishing an alternative vision and framework for community health and wealth, and more.

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15. Planning for the Future

Casts an eye to the future. It describes how the Coalition and CCB plan to build on the strengths of the ecosystem they have cultivated over the last five years to continue advancing a framework for health and wealth.

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16. Sustaining Transformation in the Face of Challenge

Outlines the daunting  challenges faced by leaders in Central Brooklyn in their ongoing efforts to sustain healthcare system transformation.

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About the Report

Details the research methods used.                                                                                              

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Epilogue: Pandemic

Describes the impact of the COVID-19 pandemic on the already-overburdened healthcare system in Central Brooklyn. Impacts include the decision to not implement key elements of the Interfaith system redesign that would have reduced the number of hospital beds.

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