REPORT TO THE BOARD OF DIRECTORS – July 2017

As mentioned in previous reports to the Board of Directors, Congressional Republicans continue to entertain proposals designed to repeal the Affordable Care Act, as well as the expansion of Medicaid authorized under the ACA’s provisions. Democratic members of Congress remain committed to preserving the 2011 act, though many propose amending it to allow state health insurance marketplaces to function more effectively.

Despite having voted numerous times before the 2016 elections for repeal, during the current (115th) session of Congress the consensus necessary to enact health care legislation has eluded Republicans. A bill passed by the House in June was disregarded by the Senate in favor of a bill drafted under the auspices of Majority Leader McConnell. On Tuesday this bill cleared a procedural vote needed to send it to the senate floor for debate. If a bill passes the Senate it will move on to a conference committee made up of members of both the House and the Senate, who will need to reconcile differences between the legislation passed by the separate houses. Although Congressional Republicans have not yet been able to convert their rearguard health care philosophy into viable legislation, it is likely that Congressional and administration assaults against progressive national health care policy will continue for the foreseeable future.

Also as reported earlier, the president’s budget proposal contains staggering cuts to Medicaid, reducing the program by $610 billion over 10 years. The Medicaid funding cuts would grow over time, from a nearly 10% reduction in 2019 to nearly 50% cuts by 2027. It would convert Medicaid into a block grant program, leaving it more vulnerable to shifting priorities at the state level in future years. It would also implement significant cuts to the Supplemental Nutrition Assistance (SNAP/food stamps) program, the Children’s Health Insurance Program (CHIP), Social Security Disability Insurance (SSDI), and other safety net spending at the federal level.

Although when it comes to the federal budget the president proposes, the Congress disposes–meaning it has the final say on federal spending. Given the vagaries of the appropriations and the budget reconciliation processes, the outlook for passage of the president’s draconian budget proposal is very uncertain.

Last week I was pleased to announce that after negotiations with the union representing many physicians employed by NYC Health + Hospitals and our affiliates, the Doctors Council SEIU approved our offer to raise the minimum salaries for physicians in primary care, psychiatry, and emergency services, and a retention payment for many of these physicians currently serving in our system. The new compensation will be offered to all eligible physicians practicing in our system in those three service areas, including those who work under the affiliation agreements and are not represented by Doctor’s Council. I am confident that this agreement will help ensure our ability to recruit and retain the best and brightest, mission-driven physicians we need to make a difference in these critical areas and meet the needs of the communities we serve.

The tough choices we have been making and the financial savings we have been working so hard to secure — by spending less and working more efficiently — are not just driven by the need to close our large budget gap. They allow us to redirect our resources where they are needed most and make critical investments like this one, which directly affect the front line of care. Our agreement with the Doctors Council shows that even in the midst of very difficult financial challenges, we are finding ways to invest in the system’s future and strengthen our ability to improve the health of more New Yorkers.

This month NYC Health + Hospitals took an important step in the modernization of our business practices — a key tenet in support of our ongoing drive to provide clinical excellence, while also offering more modern and convenient experience that meets the 21st century needs of our patients. In launching Enterprise Resource Planning (ERP) we are moving rapidly towards replacing paper and manual processes, eliminating reliance on obsolete technology, and driving improvements in operational performance. By 2020 we intend to have a fully implemented new ERP system at our 11 hospitals, five long-term care facilities, and more than 70 community-based health centers.

The new system will standardize inventory management, payroll, time keeping, budget, and other business functions across the health system’s vast network of acute care hospitals, nursing facilities, and ambulatory care sites. NYC Health + Hospitals expects to save $65 million over the next five years by maximizing operational efficiencies and avoiding the costs associated with running the four separate legacy systems that will be retired, which currently support more than a dozen business functions. The health system also expects to achieve additional savings worth tens of millions annually after FY 2021 and well into the future.

As part of “City Hall in your Borough” weeks held this spring and summer, NYC Health + Hospitals recently highlighted our partnership with the Mayor and City agencies to improve the health of patients and communities across the borough of Queens.

Activities included:

• The release of data showing how NYC Health + Hospitals’ new Electronical Medical Record system at NYC Health + Hospitals/Queens and NYC Health + Hospitals/Elmhurst has had a positive impact on quality and the patient experience. Through the use of MyChart, more than 14,000 patients are already managing their health online and are able to view test results, request medication refills and communicate directly with providers. The new EMR has also helped establish a more efficient and predictable flow for clinic appointments, particularly since it helps reduce in-person demand for medication refills. Following EMR implementation, the time between patient arrival and completed visit was reduced to an average of 80 minutes from 104 minutes, with very little weekly variation.
• An event to feature NYC Health + Hospitals/Elmhurst’s Women Infant and Children (WIC) clinic that provides information to mothers of young children about the importance of a nutritious diet, and the hospital’s farmers market where “health bucks” provided at the WIC clinic may be used to obtain fruits and vegetables. This event was in collaboration with the NYC Department of Health and Mental Hygiene (DOHMH). In attendance were Board members Deputy Mayor Palacio and Commissioner Bassett.
• Hosting of a “Town Hall” at NYC Health + Hospitals/Elmhurst sponsored by the Mayor’s Office of Immigrant Affairs and the NYC Department of Consumer Affairs to help educate immigrant small business owners about legal protections and rights available to them.
• Hosting an event at NYC Health + Hospitals/Queens, held by DOHMH, the City’s Administration for Children’s Services (ACS) and Borough President Melinda Katz to announce an initiative involving the investment of 1,000 portable “Pack & Plays” to be donated to moms and infants in need.
• The distribution of free anti opioid overdose Naloxone kits at NYC Health + Hospitals/Queens.

The American Hospital Association has named NYC Health + Hospitals/Elmhurst and NYC Health + Hospitals/Harlem among the nation’s “Most Wired” hospitals for successfully incorporating technology into health care delivery and helping patients become more actively involved in their own health through the use of technology. The designation is the result of surveys to more than 2,000 hospitals to examine how health care organizations are leveraging information technology to improve performance for value-based health care in the areas of infrastructure, business, and administrative management; quality and safety; and clinical integration.

NYC Health + Hospitals/Elmhurst was among the first of our hospitals to implement our new, best-in-class, advanced electronic medical record system, which is helping physicians provide safe, high-quality, efficient care and allowing patients to easily access their medical records online. NYC Health + Hospitals/Harlem is also a system leader in the implementation of new technology, having adopted Computerized Physician Order Entry (CPOE) which increases clinical capabilities and decision-making, and enhances patient experience and safety. Congratulations to CEOs Eboné M. Carrington and Israel Rocha Jr. and as well as to the IT staffs of each hospital and EITS central office staff for its support of these initiatives.

Earlier this month NYC Health + Hospitals/Woodhull became the first hospital in Brooklyn to be named “Baby-Friendly” by the World Health Organization and the United Nations Children’s Fund (UNICEF). The coveted designation recognizes hospitals taking the lead in encouraging and promoting breastfeeding and mother-baby bonding, and exceeding patient care standards in a rigorous on-site evaluation. Woodhull is the seventh hospital within our system to earn Baby Friendly designation. The news was announced at an event celebrating the one-year anniversary of its redesigned Mother-Baby unit.

Labor and Delivery and maternal and infant health, are clinical service areas in which NYC Health + Hospitals continues to excel, and can expect to successfully compete in the future. We congratulate CEO Gregory Calliste and the entire staff at Woodhull on this achievement.

NYC health + Hospitals/Kings County celebrated a milestone this month when a record 164 patients graduated from its Diabetes Self-Management Education Program. With the education and support of a team of doctors, nurses, diabetes educators, and nutritionists, patients learn how to control blood pressure, reduce A1C blood glucose levels, and improve eating habits. Pre-diabetic patients learn important skills in preventing diabetes. The program is offered in English, Spanish and Haitian Creole in a series of six classes. The graduation ceremony was attended by Brooklyn Borough President Eric L. Adams, as well as hospital staff who were celebrating the 16th year of the program and this year’s largest ever graduating class. Congratulations to all participants.

Late last month the NYC Health + Hospitals Board of Directors approved the appointment of Kim Mendez, EdD, ANP, RN, as senior vice president and chief nurse executive. Dr. Mendez has served as the health system’s interim chief nurse executive since January and was selected for her new role following a nationwide search. As chief nurse executive, she will lead initiatives to support patient-centered care and ensure patient satisfaction.

Dr. Mendez has been a hospital executive for more than 10 years and most recently served as NYC Health + Hospitals/Bellevue’s deputy executive director and chief nursing officer. During her time at NYC Health + Hospitals/Bellevue, she helped develop population health strategies and coordinated efforts to promote organizational excellence. Congratulations to Dr. Mendez.

I’m also pleased to call your attention to the appointment Fay Rim, MD, FAAPMR, as senior assistant vice president for palliative care. In this newly created position, Dr. Rim will guide the development of an integrated system of palliative care and hospice services spanning the care continuum, including primary care, specialty care, inpatient care, emergency department, and long-term care, as well as care delivered in the community. She assumes her new role on July 31.

Congratulations and welcome to Dr. Rim.

I’m glad to share with you the fact that MetroPlus has announced the opening of new community offices in three Bronx locations, representing the first time the health plan has established community offices in the borough. While MetroPlus already counts many Bronx residents among its members, bringing health care directly to where New Yorkers live and work is a core part of our mission. Opening up these three community-based offices provides MetroPlus with a great opportunity to further serve the Bronx.

The three sites are conveniently located at street level in the Bronx, with easy subway and bus service access:

Morrisania – 227A 167th Street, 10456
Bathgate – 720 East Tremont Avenue, 10457, and
Morris Heights – 1733 University Avenue, 10453

OneCity Health is continuing with efforts to enhance access to primary care for patients, and the range of services available to them.

• All 32 NYC Health + Hospitals primary care clinics that applied for PCMH status have now successfully achieved 2014 Level 3 certification, which is the highest level of recognition conferred by the National Committee for Quality Assurance (NCQA).

  In July, OneCity Health hosted the latest Patient-Centered Medical Home (PCMH) Learning Collaborative, providing strategies to improve communication and coordination between providers, and implement systems to better share information. This learning session was a part of OneCity Health’s efforts to assist 54 sites in the OneCity Health network toward achieving PCMH recognition, which drives transformation in patient care and improves coordination throughout our developing integrated delivery system.

• Sixteen NYC Health + Hospital facilities and six community partners are currently generating referrals from the primary care setting to OneCity Health partners with Community Health Workers. Since January 2017 OneCity Health partners have referred over 860 patients to Community Health Workers (CHWs), who have completed 529 home assessments.

  Care management programs continue to expand across the OneCity Health network.

• Transition Management Teams (TMTs) continue to provide 30 days of supportive care management for patients at high risk of readmission across eight medicine and three behavioral health inpatient units, located across eight NYC Health + Hospitals facilities.
• The Health Home At-Risk program continues at 11 NYC Health + Hospitals facilities and two community partner primary care practices. In this program, primary care practitioners make referrals to care coordinators provided by OneCity Health’s Health Home lead agencies.

  OneCity Health continues to work with community-based organization (CBO) partners to prepare them for value-based payments and improving health outcomes. Throughout July, OneCity Health hosted a series of listening sessions in order to hear from CBO partners about their knowledge and understanding of the changing health care landscape. In addition, OneCity Health selected Community Service Society of New York as a technical assistance partner for CBO capacity building. Support will include providing social service partners with a variety of organizational and educational assistance.

  Finally, in late June, NEJM Catalyst published an article by Jeremy P. Ziring, AB, Kathleen S. Tatem, MPH, Remle Newton-Dame, MPH, Jesse Singer, DO, MPH, and Dave Chokshi, MD, all of OneCity Health. Titled “Coverage Expansion and Delivery System Reform in the Safety Net: Two Sides of the Same Coin,” the authors describe how maintaining—and optimally, growing—the insured population is crucial both to take care of those who are still uninsured, and for the system’s transformation efforts. For example, they discuss how expanding access to high-quality primary care, with integrated behavioral health services, is a linchpin of delivery system improvement.