About

John Billings is a Professor of Health Policy and Public Service at NYU Wagner. He is the principal investigator on numerous projects aimed at assessing the performance of the safety net for vulnerable populations and understanding barriers to optimal health for these groups. His work has involved analyzing patterns of hospital admission and emergency room visits to evaluate access barriers to outpatient care and to assess the performance of ambulatory care delivery systems. Additionally, he has examined the characteristics of high-cost Medicaid patients to help design interventions that improve care and outcomes for these individuals. His research extends internationally, including work in the United Kingdom where he developed an algorithm for the National Health Service to identify patients at risk of future hospital admissions and to design interventions for high-risk patients. Professor Billings is also a founding member of the Foundation for Informed Decision Making, which aims to provide patients with clearer mechanisms for understanding and making informed decisions about available treatments.

Research topics

• Internal medicine
• Emergency medicine
• Medicine
• Gerontology
• Family medicine
• Pediatrics
• Surgery

Selected publications

• Association between hospital ownership type and ST-segment elevation myocardial infarction outcomes: Insights from the National Readmission Database, 2016-2022

  American Heart Journal · 2026-04-23

  article
  PublisherDOI

• Evaluating Implementation and Outcomes of an Early Childhood Community Health Worker Program in a Safety-Net Hospital System

  2025-09-01

  articleOpen accessSenior author

  <h3>Context</h3> New York City Health + Hospitals (NYC H+H), a large urban safety-net hospital system, launched an Early Childhood Community Health Worker (EC CHW) program in 2021 to facilitate referrals to Early Intervention (EI) and address other social needs impacting families of pediatric patients. <h3>Objective</h3> Evaluate the EC CHW program implementation and outcomes using mixed methods. <h3>Study Design and Analysis</h3> Qualitative data included interviews with program staff at 5 facilities, program leadership, and caregivers of pediatric patients. Interview transcripts were analyzed using rapid qualitative methods. Quantitative primary data collection and analysis included a pre/post survey (baseline, 3 months) with caregivers of pediatric patients. Secondary quantitative data included NYS Medicaid claims to analyze program effects on children. Matching methods based on child and maternal characteristics identified a comparison group of pediatric patients who received care at similar NYC safety-net providers (n=18,158) that was compared to families in the program (n=7,516). <h3>Setting or Dataset</h3> NYC H+H pediatric primary care facilities. <h3>Population Studied</h3> EC CHW program staff and leadership; pediatric patients and their caregivers. <h3>Intervention/Instrument</h3> An EC CHW program. <h3>Outcome Measures</h3> Pre/post caregiver surveys assessed self-reported health, parenting self-efficacy, engagement with child’s healthcare, social needs, and clinic/program satisfaction. Analysis of mother-child dyads assessed impact of the program on use of EI evaluation and services one year after enrollment. <h3>Results</h3> Qualitative interviews identified key facilitators and barriers to effective program implementation. We found significant increases in caregiver engagement with their child’s healthcare as well as parenting self-efficacy, and high satisfaction with pediatric clinics and the program. Medicaid claims analyses showed that children in the program were 15.7 percentage points (pp) more likely to have an EI evaluation and 9.7 pp more likely to receive EI services than children in the comparison group. <h3>Conclusions</h3> The EC CHW program was successfully implemented across NYC H+H pediatric primary care facilities, was well received by families, and resulted in families receiving EI evaluation and services at a higher rate compared to pediatric patients seen at similar NYC safety-net providers. Our findings can inform the development, implementation, and sustainability of similar programs.

  PublisherOA PDFDOI

• Short-Term Medicaid Utilization Associated With an Advanced Primary Care Model

  PEDIATRICS · 2025-11-20

  articleSenior author

  OBJECTIVE: Early childhood advanced primary care models are promising ways of addressing child and family needs, but there is limited evidence to support short-term sustainability within current Medicaid payment structures. We evaluate claims-based outcomes associated with 3-2-1 IMPACT (IMPACT), an early childhood advanced primary care model, compared with the standard of care. METHODS: Using New York State Medicaid claims, we identified and matched children aged 1 to 35 months receiving care at 3 IMPACT sites and 3 comparison sites within a large public hospital system. Regression models were used to analyze use, expenditure, enrollment, and quality outcomes between groups. RESULTS: There were 6045 children at the treatment sites and 4832 matched children from the comparison sites. IMPACT was associated with a significant increase in 6 or more well-child visits and a decrease in emergency department visit rates. There was also a significant increase in 6 more well-child visits specifically for Black and Hispanic children seeking care at IMPACT sites compared with comparison sites. There were no significant differences in expenditures, other use types, or Medicaid enrollment across groups. CONCLUSION: An early childhood advanced primary care model that incorporates multiple evidence-based programs can show short-term, positive effects on preventative and acute care use and quality within Medicaid. These results highlight short-term strategies for sustainability while awaiting the long-term, cross-sector benefits expected from models like IMPACT. Future studies addressing additive model component effects and longer-term outcomes across mother-child dyadic and social-emotional outcomes are warranted.

  PublisherDOI

• Effectiveness of Hospital Addiction Consult Services for Increasing Post-Discharge Medication for Opioid Use Disorder (MOUD) Treatment Initiation and engagement: Findings from a Pragmatic Trial in 6 New York City Public Hospitals

  Drug and Alcohol Dependence · 2025-02-01

  article
  PublisherDOI

• Addiction Consult Services, Mortality, and Acute Care Utilization in Inpatients With Opioid Use Disorder

  JAMA Network Open · 2025-08-06 · 3 citations

  articleOpen access

  Importance: With acute care utilization and mortality rates increasing among people with opioid use disorder, hospital addiction consult services can provide an important touchpoint for care, potentially leading to improved outcomes. Objective: To study the effectiveness of interprofessional hospital addiction consultation services on postdischarge acute care utilization and mortality. Design, Setting, and Participants: In this pragmatic stepped-wedge cluster randomized implementation and effectiveness (hybrid type 1) clinical trial, 6 New York City public hospitals were randomized to an intervention start date, and outcomes were compared during treatment as usual (TAU) and intervention conditions. Participants included adults with hospitalizations identified in Medicaid claims data between October 2017 and January 2021. Eligible patients had an admission or discharge diagnosis of opioid use disorder or opioid poisoning or adverse effects, were hospitalized at least 1 night in a medical or surgical inpatient unit, and were not receiving medication for opioid use disorder before hospitalization. Intervention: Hospitals implemented the Consult for Addiction Treatment and Care in Hospitals (CATCH) program, an interprofessional inpatient addiction consult service providing specialty care for substance use disorders, with teams consisting of a medical clinician, social worker or addiction counselor, and peer counselor. Main Outcomes and Measures: Acute care utilization (hospitalizations and emergency department [ED] visits) and mortality rates (all-cause deaths, overdose deaths, and opioid-involved overdose deaths) 1 year after hospital discharge. Data for the eligible patients were analyzed July 2023 to September 2024. Results: In total, 1355 eligible admissions were identified (968 [71.4%] men; mean [SD] age, 46.6 [12.4] years). A majority of patients (835 [61.5%]) had at least 1 subsequent hospitalization or ED visit. There were 113 deaths, including 34 overdose deaths (30.1%), of which 28 (82.4%) involved opioids. ED admissions were lower in the intervention period compared with TAU (incidence rate ratio, 0.79 [95% CI, 0.72-0.88]; P < .001). There were no statistically significant differences between CATCH and TAU periods in numbers of hospitalizations (incidence rate ratio, 0.99 [95% CI, 0.87-1.13]) or mortality (eg, hazard ratio for all-cause death, 1.14 [95% CI, 0.98-1.92]). Conclusions and Relevance: In this prespecified secondary analysis of a cluster randomized clinical trial, postdischarge ED visits decreased with the CATCH program, highlighting the potential of hospital-based addiction consult services to address needs of patients with opioid use. Nonetheless, high rates of acute care utilization and mortality persisted, underscoring the need for comprehensive care strategies that extend beyond the hospital walls, and addressing the complex health and social needs of individuals with opioid use. Trial Registration: ClinicalTrials.gov Identifier: NCT03611335.

  PublisherOA PDFDOI

• Addiction Consultation Services for Opioid Use Disorder Treatment Initiation and Engagement

  JAMA Internal Medicine · 2024-07-29 · 49 citations

  letterOpen access

  Importance: Medications for opioid use disorder (MOUD) are highly effective, but only 22% of individuals in the US with opioid use disorder receive them. Hospitalization potentially provides an opportunity to initiate MOUD and link patients to ongoing treatment. Objective: To study the effectiveness of interprofessional hospital addiction consultation services in increasing MOUD treatment initiation and engagement. Design, Setting, and Participants: This pragmatic stepped-wedge cluster randomized implementation and effectiveness (hybrid type 1) trial was conducted in 6 public hospitals in New York, New York, and included 2315 adults with hospitalizations identified in Medicaid claims data between October 2017 and January 2021. Data analysis was conducted in December 2023. Hospitals were randomized to an intervention start date, and outcomes were compared during treatment as usual (TAU) and intervention conditions. Bayesian analysis accounted for the clustering of patients within hospitals and open cohort nature of the study. The addiction consultation service intervention was compared with TAU using posterior probabilities of model parameters from hierarchical logistic regression models that were adjusted for age, sex, and study period. Eligible participants had an admission or discharge diagnosis of opioid use disorder or opioid poisoning/adverse effects, were hospitalized at least 1 night in a medical/surgical inpatient unit, and were not receiving MOUD before hospitalization. Interventions: Hospitals implemented an addiction consultation service that provided inpatient specialty care for substance use disorders. Consultation teams comprised a medical clinician, social worker or addiction counselor, and peer counselor. Main Outcomes and Measures: The dual primary outcomes were (1) MOUD treatment initiation during the first 14 days after hospital discharge and (2) MOUD engagement for the 30 days following initiation. Results: Of 2315 adults, 628 (27.1%) were female, and the mean (SD) age was 47.0 (12.4) years. Initiation of MOUD was 11.0% in the Consult for Addiction Treatment and Care in Hospitals (CATCH) program vs 6.7% in TAU, engagement was 7.4% vs 5.3%, respectively, and continuation for 6 months was 3.2% vs 2.4%. Patients hospitalized during CATCH had 7.96 times higher odds of initiating MOUD (log-odds ratio, 2.07; 95% credible interval, 0.51-4.00) and 6.90 times higher odds of MOUD engagement (log-odds ratio, 1.93; 95% credible interval, 0.09-4.18). Conclusions: This randomized clinical trial found that interprofessional addiction consultation services significantly increased postdischarge MOUD initiation and engagement among patients with opioid use disorder. However, the observed rates of MOUD initiation and engagement were still low; further efforts are still needed to improve hospital-based and community-based services for MOUD treatment. Trial Registration: ClinicalTrials.gov Identifier: NCT03611335.

  PublisherOA PDFDOI

• Impact of Social Determinants of Health on Predictive Models for Outcomes After Congenital Heart Surgery

  Journal of the American College of Cardiology · 2024-06-01 · 12 citations

  articleOpen access
  PublisherOA PDFDOI

• Comparison of Care Provided to Underserved Patients With Diabetes by a Telementoring Model of Care to Care Provided by a Specialty Clinic: Endo ECHO Versus an Academic Specialty Clinic

  The Science of Diabetes Self-Management and Care · 2023-04-27 · 1 citations

  article

  PURPOSE: The purpose of the study was to examine differences among adult patients with diabetes who receive care through a telementoring model versus care at an academic specialty clinic on guideline-recommended diabetes care and self-management behaviors. METHODS: Endocrinology-focused Extension for Community Healthcare Outcomes (ECHO Endo) patients completed surveys assessing demographics, access to care, health care quality, and self-management behaviors at enrollment and 1 year after program enrollment. Diabetes Comprehensive Care Center (DCCC) patients completed surveys at comparable time points. RESULTS: At baseline, ECHO patients were less likely than DCCC patients to identify English as their primary language, have postsecondary education, and private insurance. One year postenrollment, ECHO patients visited their usual source of diabetic care more frequently. There were no differences in A1C testing or feet checking by health care professionals, but ECHO patients were less likely to report eye exams and smoking status assessment. ECHO and DCCC patients did not differ in consumption of high-fat foods and soda, physical activity, or home feet checks. ECHO patients were less likely to space carbohydrates evenly and test glucose levels and more likely to have smoked cigarettes. CONCLUSIONS: Endo ECHO is a suitable alternative to specialty care for patients in underserved communities with restricted access to specialty care. Results support the value of the Project ECHO telementoring model in addressing barriers to high-quality care for underserved communities.

  PublisherDOI

• Diabetes Management through Telementoring of Primary Care Providers and Community Health Workers: Changes in Patient-Reported Outcomes

  Research Square · 2023-03-27

  preprintOpen access

  Abstract Background Endocrine ECHO (Extension for Community Healthcare Outcomes) is a scalable model of healthcare education that extends enhanced training through ongoing telementoring of community primary care providers (PCPs) by a team of specialists. The purpose of this study was to assess whether patients of providers engaged in the Endocrine ECHO program (Endo ECHO) exhibited improvements in lifestyle, and self-management behaviors. Methods A sample of 533 adult Endo ECHO patients diagnosed with type 1 or complex type 2 diabetes (insulin dependent and/or with an HbA1c of 9% or higher) took a comprehensive survey during Endo ECHO study enrollment (pre-test) and again after at least one year past their first exposure to the intervention (post-test). We assessed pre/post changes in patient-reported outcomes on well-being, lifestyle, and self-management behaviors using McNemar’s tests for paired data. Results A broad array of patients’ self-reported well-being, lifestyle, and self-management behaviors improved over the course of their engagement in the Endo ECHO program. Despite relatively low average health literacy and numeracy, patients’ confidence and self-efficacy to manage their disease also improved significantly from pre-test to post-test. Discussion Endo ECHO may be an effective means of enhancing primary care for individuals with type 1 and complex type 2 diabetes and improving patient capacity to perform the extensive array of lifestyle and self-care behaviors necessary to effectively manage their diabetes outside of the clinical setting. Conclusions The ECHO model of care has been shown to improve provider and satisfaction, quality of care, and in some cases clinical outcomes across various program areas. This study indicates that endocrinology-focused ECHO programs may also lead to behavior changes among patients in between visits to their provider. Further research should examine the impact of the ECHO model on patient behavior.

  PublisherOA PDFDOI

• Long-Term Health Care Utilization After Cardiac Surgery in Children Covered Under Medicaid

  Journal of the American College of Cardiology · 2023-04-01 · 8 citations

  article
  PublisherDOI

Frequent coauthors

• Nicole Lurie

  Coalition for Epidemic Preparedness Innovations

  36 shared

• Miriam Komaromy

  Boston Medical Center

  36 shared

• Kevin Grumbach

  University of California, San Francisco

  36 shared

• Andrew B. Bindman

  S.P.E.C.I.E.S.

  36 shared

• Dennis Osmond

  36 shared

• Karen Vranizan

  University of California, San Francisco

  36 shared

• Kacie Dragan

  Harvard University

  30 shared

• Margaret M. Paul

  New York University

  30 shared