Chapter 8

Healthcare System Reform: Fostering Cross-Sector Collaboration

For over a decade, state and city officials and public health advocates had struggled to determine how best to address the crisis of safety net hospitals in Brooklyn. In 2016, the State commissioned Northwell Health, the State's largest healthcare provider, to make recommendations for restructuring Interfaith, Brookdale and Kingsbrook Hospitals under DSRIP.


What readers will learn:

  1. Why DSRIP chose integration of  clinical and community-based services as its strategy to reduce healthcare costs

  2. The key elements of  Maimonides’ successful approach to integrating clinical and community-based care

  3. How DSRIP funding was intended to support Interfaith

Northwell recommended that the State consolidate  and streamline services  across the hospitals to improve access to care and improve Medicaid reimbursement rates.58

Brooklyn’s Maimonides Medical Center: A Leader in Coordinated Care

Maimonides Medical Center, located approximately 5 miles southwest of Interfaith, was perfectly positioned to take full advantage of the DSRIP program.   Maimonides sought for years to curb the lack of coordination of services that resulted in unnecessary suffering for patients, high rates of readmission and exorbitant avoidable costs.59  Its population health division had developed expertise in coordinated care for Brooklyn’s most vulnerable patients by linking healthcare providers with community-based care management agencies. Maimonides’ Brooklyn Health Home, not an actual place, but a designated team of caregivers for patients—a care manager, primary care physician and therapist/psychiatrist supported patients’ medical needs, as well as the many interrelated aspects of caring for chronic illness.60

Maimonides onsite care managers made sure patients could connect with a range of providers after they left the hospital or doctor’s office. Whether ensuring that patients taking temperature-sensitive medication had access to a refrigerator and reliable power source, or stationing primary care physicians at psychiatric centers, the team coordinated care in ways that measurably reduced emergency department visits and improved clinical outcomes.61 Its data and information system enabled sharing of patient health information in service of coordinating care and improving patient outcomes.62

Despite the obvious effectiveness of these approaches, for decades, care in Maimonides’ Central Brooklyn service area had gone largely uncoordinated.  Some providers located within blocks of each other had never been in the same room together.63 Such lack of coordination led not only to unnecessary suffering for patients, but also resulted in unnecessary readmissions and exorbitant avoidable costs.64

Maimonides PPS: Community Care of Brooklyn

Founded in 2014, the Maimonides PPS was called Community Care of Brooklyn (“CCB”). CCB received nearly $500 million65 from DSRIP to support collaboration and coordination among more than 800 local organizations.66  It developed advanced analytic capability and financial management systems “to fully realize . . .[a] vision of a really integrated model of care, working hand in hand with social service organizations and community-based organizations”—and giving opportunities for people to actually be healthy outside the walls of the hospital and clinics.67

"To fully realize our vision of a really integrated model of care, working hand in hand with social service organizations and community-based organizations—who we always knew played an important role in building healthy communities"

-Shari Suchoff, VP Policy and Strategy, Maimonides Dept. of Population Health

Soon after it was formed, the State’s DSRIP team68 proposed integrating Interfaith into CCB.  DSRIP would provide a critical source of funds to keep Interfaith open and strengthen  coordination  between Interfaith, Maimonides and other local hospitals.

Chapter 8 Questions

  1. Why did New York State want to consolidate  the three safety net hospitals in Central Brooklyn?

  2. What was the problem that Maimonides’ coordinated approach sought to address?

  3. What is the Maimonides Brooklyn Health Home and how did it support patients?

  4. How did Community Care of Brooklyn strengthen coordination of care in its service area?

  5. Name three ways in which  DSRIP funding would help Interfaith.

1. An Epidemic of Hospital Closures
2. Crisis at Interfaith
3. Time to Mobilize: Forming the Coalition to Save Interfaith
4. Protest and Resolution
5. Medicaid Reform
6. Research-Based Action
7. Participatory Action Research as a Tool for Change
8. Healthcare System Reform: Cross-Sector Collaboration
9. Reinventing Interfaith
10. Focus on Health Equity
11. Creating Healthier Communities: Leveraging Community Assets
12. Community Planning for Healthier Communities
13. Making Health a Shared Value: Building Civic Infrastructure
14. Building a Culture of Health: Outcomes
15. Planning for the Future
16. Sustaining Transformation in the Face of Challenge
About the Report