named programs · 4 · from sources
What they call their work
Care Management
Provides high-touch support including case management, transition care, and psychosocial services addressing social determinants of health such as food, housing, and transportation for vulnerable populations.
Health Equity Impact Assessments (HEIA)
Supports healthcare organizations in completing state-mandated HEIAs through data analysis, community engagement, and actionable recommendations to mitigate equity risks.
Independent Practice Association (IPA)
Provider network offering data-driven insights, regulatory expertise, and care coordination support to improve outcomes for underserved populations in New York.
QUIC Dashboard
Real-time data tool developed with Adirondacks ACO that integrates behavioral and physical health metrics to identify care gaps and support integrated care delivery.
activities · 8 groups
What they do
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Medicaid Health Home Care Coordination 4 activities
- Comprehensive care management for Medicaid membersProvides comprehensive care management for Medicaid members with complex health conditions by connecting them to primary and specialty care, mental health and addiction support, housing and food resources, family and caregiver support, and education and employment programs.
- Identification and enrollment of individuals for care managementIdentifies individuals in need of care management using clinical and claims data, provider referrals, and predictive analytics, and provides ongoing care team support to enrolled clients to manage chronic conditions and address clinical and social needs.
- Integrated care, case, and disease management servicesProvides integrated care management, case management, and disease management services to support individuals across varying levels of medical and social needs.
- Intensive case management for individuals with complex needsDelivers intensive, individualized case management for individuals with complex medical, behavioral, and social needs, including support during care transitions.
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Health Information Exchange Support 2 activities
- Quality Utilization and Integrated Care (QUIC) dashboard developmentDeveloped the QUIC dashboard in partnership with Adirondacks ACO to provide real-time data on primary care gaps for behavioral health providers, supporting integrated care and improved patient outcomes.
- Utilization management process improvement for Amida CareProvided expertise to Amida Care to streamline utilization management processes, resulting in improved timeliness and quality of reviews and strengthened regulatory compliance.
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Healthcare Provider Directories and Clinical Support Services 1 activity
- Capacity building through healthcare professional network representationRepresents a network of nearly 12,000 healthcare professionals across New York State to support system-wide capacity and collaboration.
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Healthcare Compliance and Ethics Programs 1 activity
- Compliance and regulatory support for care deliveryUpholds applicable laws, regulations, and ethical standards in delivering care and supporting provider partnerships through routine compliance training, internal reviews, external audits, and anonymous reporting channels for employees, providers, and the public.
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Mental Health Research and Services Funding 1 activity
- Funding programs to expand access in underserved communitiesFunds programs aimed at expanding access to care and strengthening stability in underserved communities.
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Community Health Equity Initiatives 1 activity
- Health Equity Impact Assessments (HEIAs) supportSupports healthcare organizations in completing Health Equity Impact Assessments (HEIAs) for Certificate of Need applications in New York State through quantitative analysis, community engagement, and development of actionable recommendations to address equity risks; one of the first organizations to conduct HEIAs under state regulations.
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Supportive and Emergency Housing Services 1 activity
- Person-centered care coordination for vulnerable populationsProvides person-centered care coordination for individuals facing housing insecurity, behavioral health challenges, or other complex life situations.
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Uncategorized 1 activity
- Personalized SMS engagement for HPV vaccination adherenceImplements a personalized SMS platform to improve HPV vaccination adherence among young, at-risk populations, resulting in increased compliance rates.
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financials · form 990 · fy2024
revenue
Total revenue$21.82M
Contributions & grants$00%
Program service revenue$18.84M86%
Investment income$2.90M13%
Other revenue$81K
expenses
Total expenses$23.08M
Program expenses—
Admin / overhead—
Fundraising—
Salaries & benefits$17.03M
Grants paid out$0
Largest expense lineCompensation
balance sheet
Total assets$117.51M
Cash$6.35M
Investments$51.81M
Liabilities$7.55M
Net assets$109.96M
Liquid reserves30.2 mo
5 years on record · 2020–2024 · YoY revenue +6.3%
leadership · form 990 part vii · fy2024
Who runs it
paid leadership · 21
| Name | Title | Hours/wk | Compensation |
|---|---|---|---|
| MICHAEL MESSIER | CFO/EVP | 40 | $404K |
| KIM HESS | COO | 40 | $393K |
| DENNIS GRAZIANO | President & CEO | 40 | $298K |
| GEORGE HUGHES | SR VP OF FISCAL OPS & VEND | 1 | $285K |
| JANINE BARRY | SVP HR & MARKETING | 1 | $267K |
| TODD GLANTON | MGR BUSINESS APP | 1 | $258K |
| LESLIE TREZISE | DIR CASE DISEASE | 1 | $256K |
| CHRISTOPHER LOMBARD | DIR OF FINANCE | 1 | $227K |
| JILL PARKER | MANAGER OF HR | 1 | $181K |
| George Matthews | Chief Medical officer | 40 | $175K |
| Donna Crane | Manager of Case Management Services | 1 | $173K |
| Jon Bidwell | Manager IT/Business Suppor | 1 | $169K |
| HOWARD BRILL | SR VP OF QUALITY & POP HEA | 1 | $145K |
| KEVIN PICKHARDT | Chairman | 1 | $10K |
| RIJAD KARABEGOVIC | Treasurer | 1 | $8K |
| MARDY SANDLER LMSW | VICE CHAIRWOMAN | 1 | $6K |
| ARTHUR D PELLITTIERI MD | Director | 1 | $5K |
| EDITH GRANNUM | Secretary | 1 | $5K |
| ELIZABETH NAUMBURG MD | Director | 1 | $5K |
| LARRY DENK MD | Director | 1 | $5K |
| SUSAN H MCDANIEL PHD | Director | 1 | $5K |
board members · 2
- GABY RAZZOUK MD — DIRECTOR
- STEPHANIE FRETZ MD — Director
relationships · 12
Who they work with
- Adirondacks ACO Partner — Collaborated to develop the Quality Utilization and Integrated Care (QUIC) dashboard for integrated behavioral and physical health care.
- Amida Care Partner — Partnered to streamline utilization management processes, improving timeliness, quality, and regulatory compliance.
- Compliance Office Government — Entity responsible for overseeing compliance program and receiving compliance inquiries.
- Elm & Oak Health Network — Monroe Plan for Medical Care is now operating as Elm & Oak Health
- Elm & Oak Health Network — Monroe Plan for Medical Care is now operating as Elm & Oak Health.
- Elm & Oak Health Partner — Collaborates on partner solutions in care management
- Elm & Oak Health Partner — Collaborates with Elm & Oak Health to deliver community-based care coordination services.
- GoMo Health Partner — Collaborated to implement a personalized SMS engagement platform to improve HPV vaccination adherence.
- Monroe Plan For Medical Care Inc Government — Administers Health Home services under a New York State initiative for Medicaid members with complex needs.
- Monroe Plan For Medical Care Inc Partner — Elm & Oak Health partners with Monroe Plan For Medical Care Inc to deliver care management services.
- Monroe Plan For Medical Care Inc Partner — Elm & Oak partners with Monroe Plan For Medical Care Inc to support health equity initiatives.
- New York State Government — Collaborates with state agencies to deliver healthcare solutions.
strategies · 5
How they approach the work
Named approaches extracted from this org’s sources. Where others share an approach, follow it to see the full set of orgs running it.
- Client Empowerment Through Coaching and Educationmethodology: education_and_empowermentBy coaching clients to independently navigate care systems over time, we produce sustained engagement and self-sufficiency because teaching skills and building confidence enables long-term health management beyond direct service provision.
- Community-Integrated, Locally Responsive Partnershipsmethodology: community_integrated_careBy forming locally informed partnerships and delivering care in community settings, we increase access and effectiveness because services are grounded in local realities and trusted contexts.
- Data-Informed, Compassionate Care Deliverymethodology: data_and_compassion_driven_careBy combining data-driven insights with high-touch human support, we improve healthcare outcomes because analytics identify needs and gaps while personal engagement builds trust and ensures adherence.
- Integrated Care Model Addressing Social Determinants of Healthmethodology: whole_person_careBy integrating clinical care with support for social determinants such as food, housing, and transportation, we improve health outcomes for vulnerable populations because holistic interventions address root causes of poor health and reduce barriers to care adherence.
- Provider Support Through Coordination and Data Toolsmethodology: provider_support_networkBy equipping healthcare providers with care coordination, data insights, and regulatory guidance, we improve population health outcomes because frontline clinicians are better enabled to deliver effective, compliant, and patient-centered care.