cutaneous diversion (CCD) and orthotopic neobladder (ON) subgroups.• A linear cost model was created to simulate treatment with OC vs RC. Procedural costs were derived from the Medicare Resource Based Relative Value Scale. Materials costs were obtained from the respective suppliers. The indirect costs of complications were considered.• Sensitivity analyses were performed.

The Washington Heights-Inwood section of Manhattan is a predominantly poor Hispanic community with disproportionately high rates of chronic disease, including asthma, diabetes, and congestive heart failure. In October 2010, NewYork-Presbyterian Hospital, in association with the Columbia University Medical Center, launched an integrated network of patient-centered medical homes that were linked to other providers and community-based resources and formed a "medical village." Three years later, a study of 5,852 patients who had some combination of diabetes, asthma, and congestive heart failure found that emergency department visits and hospitalizations had been reduced by 29.7 percent and 28.5 percent, respectively, compared to the year before implementation of the network. Thirty-day readmissions and average length-of-stay declined by 36.7 percent and 4.9 percent, respectively. Patient satisfaction scores improved across all measures. Financially, NewYork-Presbyterian experienced a short-term return on investment of 11 percent. Some of the gain was a result of increased reimbursements from New York State. Nonetheless, these findings demonstrate that academic medical centers can improve outcomes for poor communities by building regional care models centering on medical homes that incorporate patient-centered processes and are linked through information systems and service collaborations to hospitals, specialty practices, and community-based providers and organizations.

Communities of poor, low-income immigrants with limited English proficiency and disproportionate health burdens pose unique challenges to health providers and policy makers. NewYork-Presbyterian Hospital developed the Regional Health Collaborative, a population-based health care model to improve the health of the residents of Washington Heights-Inwood. This area is a predominantly Hispanic community in New York City with high rates of asthma, diabetes, heart disease, and depression. NewYork-Presbyterian created an integrated network of patient-centered medical homes to form a "medical village" linked to other providers and community-based resources. The initiative set out to document the priority health needs of the community, target highprevalence conditions, improve cultural competence among providers, and introduce integrated information systems across care sites. The first six months of the program demonstrated a significant 9.2 percent decline in emergency department visits for ambulatory care-sensitive conditions and a 5.8 percent decrease in hospitalizations that was not statistically significant. This initiative offers a model for other urban academic medical centers to better serve populations facing social and cultural barriers to care.A population-based model of health and health care encompasses the ability to assess the health needs of a specific population; implement and evaluate interventions to improve that population's health; and provide care for individual patients in the context of the population's culture, health status, and health needs.1 NewYork-Presbyterian Hospital, in association with the Columbia University Medical Center, has developed a population-based, collaborative model of regional health planning and care coordination designed to measurably improve health and reduce disparities.This model, called the NewYork-Presbyterian Regional Health Collaborative, aligns services to meet the documented health needs of the local community by incorporating cultural competency, using information systems such as electronic health records and disease registries, and coordinating care across the continuum. The collaborative encompasses the entire neighborhood of Washington Heights-Inwood, in upper Manhattan, to help improve the health of the community by reducing health disparities at both the individual and population levels. The goal is to uniformly enhance and align the health care systems throughout the neighborhood to improve overall access and quality for the entire population.In 2008-recognizing that the residents in its community were experiencing gaps in care and unmet needs in the context of escalating health costs-NewYork-Presbyterian initiated a major review of the health care delivery model. The goal was to create a system of care modeled on the concept of population-based health. The hospital wanted the system to meet identified needs of the community; improve access to care; and coordinate care for each patient, wherever he or she received care.The hospital reviewed the ser...