Tuesday, January 14, 2025
1/14/2025
The New York State Department of Health (DOH) will implement and evaluate evidence-based (EB) strategies to prevent and control diabetes and cardiovascular disease across the state and in high-burden populations. DOH will lead a coordinated approach to 1) improve the care and management of adults with diabetes and improving access to, participation in, and coverage for the National Diabetes Prevention Program (NDPP) for adults with prediabetes, particularly in underserved areas, and 2) tracking and monitoring clinical measures shown to improve healthcare quality and identifying (ID) adult patients with hypertension (HTN), implementing team-based care for adult patients with high blood pressure (HBP) and high cholesterol (HC), and linking community resources and clinical services that support systematic referrals, self-management (SM), and lifestyle (LS) change for patients with HBP and HC. Outcomes: DOH will make measurable improvements in the following Category A outcomes: increased access to and coverage for ADA-recognized/AADE-accredited diabetes self-management education and support (DSMES) programs for people with diabetes, increased use of pharmacist patient care processes that promote medication management for people with diabetes, increased access to and coverage for the NDPP for people with prediabetes, increased community clinical links (CCLs) that facilitate referrals and provide support to enroll and retain participants in the NDPP, increased participation in ADA-recognized/AADE-accredited DSMES programs by people with diabetes, increased enrollment and retention in CDC-recognized organizations delivering the NDPP, decrease the proportion of adults with diabetes in poor control (A1c >9), and increase the number of people with prediabetes participating in a CDC-recognized LS change program who have achieved 5-7% weight loss; in Category B: increased reporting, monitoring, and tracking of clinical data for improved ID, management, a nd treatment of patients with HBP and HC, increased use of and adherence to EB guidelines and policies related to team-based care for patients with HBP and HC, increased CCLs that support systematic referrals, SM, and LS change for patients with HBP and HC, increased medication adherence among patients with HBP and HC, increased engagement in SM among patients with HBP and HC, increased participation in EB LS interventions among patients with HBP and HC, and increased control among adults with known HBP and HC. Approach: DOH will (1) allocate funding, resources and level of effort equally between Category A and B Strategies; (2) implement practice facilitation (PF) in Federally Qualified Health Centers (FQHCs) to improve ID of patients with diabetes, referral to DSMES, and engagement of pharmacists in medication management; 3) implement statewide and focused activities to increase awareness of, access to and participation in DSMES among target populations with diabetes; 3) implement PF in FQHCs to improve ID of patients with prediabetes, HTN and HC, referral to CDC-recognized LS change programs, and engagement of community health workers in NDPP participant enrollment and retention; 4) work with key payers and partners, including Medicaid and the NYS YMCA Alliance, to enhance availability of NDPP as a covered benefit for NYS Medicaid members and state employees; 5) implement statewide and focused activities to increase awareness of and participation in CDC-recognized LS change programs among target populations with prediabetes; 6) facilitate team-based care to manage patients with HTN and HC, and refer to community resources and clinical supports; 7) implement statewide and focused activities to improve ID, management and referral to and participation in community and clinical support services among target populations with HTN and HC; 8) maintain and expand NYS’ highly sophisticated chronic disease surveillance and performance measurement system for monitoring, and evaluating activities.
HHS’ Tracking Accountability in Government Grants System (TAGGS) website provides access to detailed descriptions of grants, loans, aggregated direct payments and other types of financial assistance awarded by the HHS Operating Divisions (OPDIVs) and the Office of the Secretary Staff Divisions (STAFFDIVs).