Two Adelphi Alumni On a Mission to Reform Medicaid

by Kurt Gottschalk

Although they attended Adelphi University a decade apart, College of Nursing and Public Health Dean Patrick Coonan ’78, Ed.D., and William Toby Jr., M.S.W. ’63, speak like they’re old friends. It was, in fact, their collegial ribbing that led to their working together on a panel overseeing an $8 billion dollar overhaul of the New York State Medicaid program. Despite a rapport that would seem to go back decades, the two only met in 2012 at the inaugural meeting of the advisory board for the Center for Health Innovation (CHI), an agency that serves as a regional resource and academic partner to Long Island communities seeking to promote physical well-being. At the time, Dr. Coonan was CHI’s acting director.

Toby, who had a long career working in Medicaid services, was appointed to the state’s Medicaid Delivery System Reform Incentive Payment (DSRIP) Project Approval and Oversight Panel in January, 2015. Always having kept close ties with his alma mater, he was quick to send out an email announcing the appointment—and Dr. Coonan was just as quick to respond.

“I sent him back a note that said, ‘Wow, Bill, this is great, but where’s the nurse on the committee?'” Dr. Coonan recalled. “Ten minutes later came his response asking me for my resume. And three days later, I was on the panel.”

DSRIP and the component panel are part of New York Governor Andrew Cuomo’s efforts to make the state’s Medicaid program more cost efficient while delivering better care. Toby was a natural fit. He has worked as a private healthcare consultant since retiring in 1996 from the U.S. Health Care Financing Administration (HCFA), where he oversaw the national and New York State programs. The Cuomo initiative, Toby said, will have a bigger impact on the state’s Medicaid program than anything has in the last 40 years. He brings a focus on community involvement and minority concerns.

“If you are poor and live in central Brooklyn and you get sick, there is no doctor,” he said. “You go to the hospital.”

But hospitals are geared toward providing targeted care for specific problems, and often aren’t equipped to address problems that require long-term care, added Dr. Coonan, who has served as dean of the nursing school since 2004. His presence on the panel is to ensure that the changing roles of nurses is addressed as the program looks to build healthcare provider partnerships and decrease unnecessary hospital visits.

DSRIP aims to provide incentives and create what Dr. Coonan called collaborating competitors and a network of providers who aren’t vying for the same patient dollars. In the process, nurses will likely be called upon to provide new and different duties.

“One of the issues is, ‘What is the role of nurses going forward?'” he said. “How are we going to educate the workforce going forward?”

The Project Approval and Oversight Panel is charged with getting those providers to work together, and Toby in particular is there to make sure community needs are being met while alliances are being made.

“Most of the providers don’t have any input from local communities, minority communities,” Toby said. “We have a cultural competency work group to make sure there is input from the minority communities.”

By implementing new practices and greater responsiveness to community needs, Toby said the panel will be able to isolate and reduce spurious spending as well.

Dr. Coonan was vocal from the first meeting he attended, making him a natural for the panel, Toby observed. The panel meets twice a year and has weekly conference calls.

“Pat and I, two Adelphi grads, are responsible for assuring the integrity of $8 billion. This is amazing,” Toby said.