REPORT TO THE BOARD OF DIRECTORS – January 2017

The United States District Court has agreed to end oversight of NYC Health + Hospitals/Kings County’s behavioral health program by the U.S. Department of Justice (DOJ). The court action marks a successful transformation of the hospital’s behavioral health services to a high-quality, patient-centered psychiatric program that is dramatically improving the experience of the 11,000 New Yorkers it serves every year. In its letter to the court requesting to end the case, DOJ reported that the hospital’s performance has exceeded expectations, and is now a model for the caring for individuals with serious mental illness. Some of the reforms include:

• Dramatic transformation of the physical environment with a $153 million, 300,000-square-foot behavioral health center;
• New reform-minded leadership that has built staff expertise and accountability and is committed to a patient-centered, customized treatment planning process;
• Greatly improved psychiatric emergency room experience, with reduced overcrowding and wait times;
• Establishment of trained, qualified, full-time Peer Counselor staff who have been mental health patients themselves and now serve as patient navigators, mentors, and patient advocates;
• Improved safety and security for patients and staff with new ways to better identify and curtail risk of violent behavior, including replacement of hospital police with behavioral health associates, resulting in reduced reliance on uniformed hospital police to manage patients in crisis; and
• Strengthened complementary medical care for patients with behavioral health issues.

NYC Health + Hospitals recently announced a pilot program designed to improve the quality of life of long-term hospital patients who are difficult to discharge into post-acute care settings. Through the “Better Way to Live” program, patients transition out of the hospital and into post-acute settings better suited to provide the care they need.

The pilot brings together a joint team of hospital and post-acute care providers to develop a new transition path, targeted interventions, and services for Alternate Level of Care (ALC) patients who are no longer acutely ill but cannot live on their own and prove difficult to discharge into the next appropriate level of care due to their medical, mental health, and social challenges. Better Way to Live has already successfully transitioned more than 60 ALC patients—some who were hospitalized for months and even a year—into long-term care beds in the public health system’s top-ranked post-acute nursing facilities. Once expanded system-wide, the program is expected to save the health system more than $3.5 million annually.

NYC Immigrant Affairs Commissioner Nisha Agarwal and I recently issued a reassuring message to New Yorkers who may not be accessing health care services for fear of having their immigration status disclosed. Our “open letter” to immigrant New Yorkers was written in 14 languages, and distributed to patients, staff, community and immigrant advocacy organizations, and ethnic community papers. We assured the community that NYC Health + Hospitals remains committed to its mission to serve all New Yorkers, without exception, and regardless of immigration status. The joint letter underscores NYC Health + Hospitals’ commitment to protecting patients’ right to privacy, to keeping immigrant status completely confidential, and makes clear that the primary concern of NYC Health + Hospitals is our patient’s health, not their immigration status.

NYC Health + Hospital this month launched upgraded websites for its health system and 21 patient care centers, including its 11 hospitals, five top-ranked post-acute care/nursing facilities, and six large community-based health centers. NYCHealthandHospitals.org is designed to improve the visitor experience from any device and make it easier for New Yorkers to access physicians in their communities. The new websites feature a standard look and navigation that reflects the health system’s branding, as well as better functionality that offers several ways to search for health care information, providers, and locations. To protect against hardware-related outages and improve overall performance, the new websites are cloud-based. The integrated design is more patient-focused and provides a common online experience for visitors—whether they are trying to find a doctor in their community, learn more about our hospital-based Centers of Excellence, or find out what’s new in New York City’s essential public health care system.

Mayor Bill de Blasio, Department of Health Commissioner Dr. Mary T. Bassett, Community Service Society President/CEO David R. Jones, Public Health Solutions President/CEO Lisa David and I recently attended an event at NYC Health + Hospital/Gouverneur to launch a campaign focused on enrolling more New Yorkers in health insurance. GetCoveredNYC is an ambitious partnership between the Mayor’s Office, our health system and other city agencies to provide more access to primary and preventive care at NYC Health + Hospitals facilities by enrolling 50,000 New Yorkers who are eligible for health insurance but are not taking advantage of existing enrollment options. Outreach teams are proactively engaging uninsured New Yorkers who have visited one of our patient care sites. The campaign will include at-home outreach as well as office hours at community partner or elected officials’ offices, providing direct access to in-person assistance from outreach specialists. Specialists will schedule individuals for an enrollment appointment and case-manage each applicant through the entire process.

While some New Yorkers rang in 2017 celebrating in Times Square or at home watching the ball drop on television, many of our staff were helping to deliver New York City’s new babies. Our health system welcomed one of the first babies on January 1 at 12:09 a.m. at NYC Health + Hospitals/Jacobi in the Bronx. The baby girl, Melanie Londono, weighed 6 lbs. 9 oz., and was born to mother Zuelen Londono and father Kristian Payares. The first baby at our system’s Brooklyn hospitals is baby girl Alayna Baloch, born to Nasma Baloch at NYC Health + Hospitals/Coney Island at 1:38 a.m., weighing 7 lbs. 4oz.

OneCity Health has launched a variety of new educational seminars and trainings to ensure that the NYC Health + Hospitals workforce and community partners implement primary care, care management and behavioral health initiatives effectively. These initiatives are important components of health system transformation to better meet today’s health care needs of the patients and communities we serve.

In December, trainings were launched for care management staff from NYC Health + Hospitals/Home Care, Village Care, Arch Care and Community Healthcare Network, focused on documenting care plans and motivational interviewing as a means for improving team communication and helping patients with prevention and chronic disease self-management. These trainings are essential for partnerships offering care management services equivalent to the New York State Health Home program. Over 30 care coordinators are anticipated to be trained by the end of January.

OneCity Health has trained over 160 NYC Health + Hospitals and community partner staff members to utilize care coordination and care management software solutions to better coordinate and integrate patient care. Initial training efforts have focused on community health workers and primary care staff implementing clinical asthma efforts, as well as on Health Home At-Risk care coordinators and Transition Management Teams providing 30 days of supportive care management for patients at high risk of readmission at NYC Health + Hospitals/Bellevue and NYC Health + Hospitals/Kings County.

To help reduce the effects of asthma on children and their families, in December OneCity Health began Physician Asthma Care Education (PACE) trainings for physicians at NYC Health + Hospitals/Woodhull, NYC Health + Hospitals/Gotham, East New York and NYC Health + Hospitals/Gotham, Cumberland, as well as SUNY Downstate Medical Center. This educational seminar improves physician awareness, ability, and the use of communication and therapeutic techniques for patients with asthma. To date, approximately 200 pediatric clinical staff have been trained. OneCity Health partner 1199SEIU Training and Employment Funds has helped facilitate trainings.

For community partners seeking to achieve Patient Centered Medical Home (PCMH) recognition, OneCity Health will soon host a second learning collaborative to introduce key concepts in population health management. Nearly 40 community partners attend our first learning collaborative in late 2016.

NYC Health + Hospitals/Cumberland, NYC Health + Hospitals/Elmhurst, NYC Health + Hospitals/Kings County, NYC Health + Hospitals/Bellevue, and NYC Health + Hospitals/Lincoln, as well as five community partner pilot sites continue their work implementing co-located services for primary care and behavioral health. OneCity Health recently presented regulatory and licensure options available to further these efforts.

Governor Andrew Cuomo has released the New York State Fiscal Year 2018 Executive Budget proposal. It does not assume losses to the state due to the potential repeal of the Affordable Care Act. Earlier this month however, the Governor released a report estimating the state budget impact from repeal at $3.7 billion. Counties across the state would lose over $595 Million in direct spending. 2.7 million New Yorkers face loss of health insurance, 1.6 million of them in New York City.

The Governor’s budget proposal includes broad authorization to reduce funding for health care programs if federal receipts come in below expectations, or if federal Medicaid matching rates or eligibility requirements change.

The budget proposal extends the Medicaid Global Cap through 2019 and allows for its adjustment in the event of changes at the federal level. It reauthorizes the Health Care Reform Act (HCRA) for three years, but without change to the Medicaid inpatient hospital reimbursement methodology or collection of HCRA surcharges and assessments.

A full analysis is being conducted, but of concern to NYC Health + Hospitals is the Governor’s proposed elimination of reimbursement to long term care facilities for bed hold days, while preserving the requirement that these facilities hold beds while residents are offsite receiving in-patient care. Also of concern are a proposed administrative action to reduce payments to hospitals for avoidable Emergency Department readmissions without consideration of factors outside the health system’s control, and new requirements for cost sharing by enrollees of Essential Plan with incomes above 138% of the federal poverty level.