Policy Project
The Step Two Policy Project is a policy think tank that focuses on issues involving health, behavioral health, and human services in New York. We work to accelerate the adoption of good ideas.
Focus Areas
Data Transparency and the Democratization of Analysis
In New York, healthcare delivery system data and the useful information that can be derived from it frequently remains siloed and confined within each of the governmental agencies that collect it. This hinders the ability of healthcare providers to provide patient-centered, integrated services, particularly for individuals with complex needs. This lack of an evolved health data and information ecosystem also impairs efforts by policymakers to develop policies that enhance access to comprehensive services, to evaluate the impacts of State policies, and to adequately plan for the future. New York does not have to imagine what a robust infrastructure of health data, information, and policy analysis would look like. It just has to look to the infrastructure that exists in states that have created comprehensive state data organizations, like the Massachusetts Center for Health Information and Analysis.
Healthcare Affordability
The affordability of healthcare in New York is a complicated topic. Given the vast differences in the cost of healthcare depending on income and age, the threshold question of healthcare affordability is, “affordable for whom?” The affordability of healthcare in New York needs to be addressed in terms of the burden on three distinct groups – individuals, taxpayers, and employers. Within the category of individuals, there are another three distinct groups – individuals receiving publicly funded healthcare, individuals purchasing individual health insurance policies, and individuals with employer-sponsored coverage. In addressing the question of healthcare affordability for these distinct groups and categories, one of the challenges is the way data is presented, which typically is based on averages that can easily obscure the actual experience of those who fall on the wrong side of the median. The crisis of affordability may well be beyond the capacity of government at any level to solve, much less the capacity of any individual state. But it is a challenge that must be managed even if it cannot be solved.
Financial Sustainability of Safety Net and Community Hospitals
The financial performance of safety net and community hospitals has deteriorated significantly since 2019, the year before the COVID-19 pandemic began. Changes in technology and business models have enabled many more procedures to be performed outside of the hospital. This shift in site of service is being reinforced by policies that condition reimbursement on the service being delivered in a less expensive outpatient setting.
At the same time, hospital expenses have been rising inexorably. The workforce shortage among clinical and support staff has led to a surge in temporary staffing agency costs. Nursing homes have reduced admissions due to their own workforce shortages, which has increased the number of patients who cannot be discharged from the hospital even though they no longer require an acute level of care. The structural financial challenge is that the fixed costs of operating an acute care hospital represent a large percentage of the total cost, and total expenses do not adjust commensurately with declining patient volume relative to the conditions described.
Access to Dental and Oral Care
There are many barriers to accessing dental and oral care in New York, including lack of comprehensive private dental insurance coverage, low reimbursement for dental services in public insurance programs, uneven geographic distribution of dental care providers, limited access to fluoridation, and a lack of integration between dental care and physical health care. This is a multifaceted problem that will not be fixed overnight. Incremental progress in this area can yield significant improvement in health outcomes.
The Healthcare Workforce
Shortages in the healthcare workforce existed before COVID-19, but the pandemic created a breaking point from which the healthcare system is still struggling to recover. The current state of the healthcare workforce greatly hampers efforts to ensure access to high quality, cost effective, and equitable healthcare delivery system. Allowing more flexibility in the scope of practice would help address healthcare workforce shortages. Adjustments to scope of practice, training, and exploring innovative models for recruitment and retention can impact this fundamental component of healthcare delivery.
Sustainability and Access in Behavioral Health
New York has made important strides in expanding access to behavioral health services, including investments in crisis response, youth mental health, and telehealth. However, challenges remain in ensuring a fully integrated and sustainable system that meets the needs of individuals with serious mental illness and substance use disorders. Strengthening the behavioral health workforce, developing data resources, and fostering better coordination between mental health, substance use treatment, primary care, and social services providers can enhance access and improve outcomes. By leveraging data-driven strategies and innovative care models, New York can build a more responsive and equitable behavioral health system that supports stability and recovery, reduces unnecessary acute care utilization, and improves overall well-being.