REPORT TO THE BOARD OF DIRECTORS – NOVEMBER 2017

NYC Health + Hospitals recently announced that our accountable care organization (ACO) under the national Medicare flagship program, has achieved shared savings for the fourth consecutive year—the only program in the state to achieve such shared savings success. The ACO was eligible for the savings in part because of its outstanding quality performance, saving the Medicare program $3.59 million for 2016 and returning $1.58 million in shared savings to the public health system. Through enhanced care coordination, the health system was able to prevent unnecessary emergency department visits, avoidable hospitalizations, and other high-cost care for the more than 10,000 Medicare fee-for-service patients who are followed through the program.

As a result of our consistent success in the Medicare Shared Savings Program, NYC Health + Hospitals is expanding its value-based payment focus beyond Medicare. It has submitted an application to the New York State Department of Health to become a State All Payer ACO, which would change the payment structure for coordinated care for Medicaid fee-for-service patients and privately insured patients as well. Achieving shared savings for a single year is not easy and is itself a cause for celebration. Savings over four consecutive years, however, is remarkable, given that we are measured against benchmarks of our own past performance. Our success in recent years has made these benchmarks increasingly challenging, and yet, through the focused work of countless members of our hard-working team, especially our front-line providers, we have met our goal yet again.

The reality of tougher benchmarks, however, has meant that shared savings earned in FY 2017 are considerably reduced from previous years’ totals. As a gesture of solidarity with NYC Health + Hospitals physicians, whose work is at the core of our ACO’s continued record of achievement, we have made the decision this year to forego retention of our portion of shared savings in order to further incentivize our providers.

Earlier this month we issued an important announcement detailing system-wide primary and specialty care expansion in underserved communities. Collectively, seven new or enhanced sites, reflecting $40 million in City investment, will serve 48,000 New Yorkers, or some 42,000 more patients than before the expansion.

This partnership with Mayor de Blasio demonstrates our commitment to providing equal access to health care. These seven sites will better connect tens of thousands of New Yorkers to primary and specialty care, promoting wellness and care management, as well as smoother transitions to other care when needed—goals that are important to the long-term transformation of our health system.

The announcement was made at a ribbon-cutting ceremony celebrating an upgraded community health center in Bushwick, Brooklyn, one of five NYC Health + Hospitals/Gotham Health centers that have been refurbished with more than $10 million in funding from New York City’s Caring Neighborhoods Initiative. The five sites are in Brooklyn (in Bushwick, Crown Heights, and Brownsville), the Bronx (Tremont), and Queens (Jackson Heights). In addition, two completely new sites are scheduled to open this winter in Brooklyn (Bedford) and Staten Island (Clifton).

I am pleased to report to the Board that 32 of our hospital and community-based primary care clinics have received the highest-level Patient-Centered Medical Home (PCMH) recognition for meeting rigorous national standards and establishing a model to deliver patient-centered, coordinated, and convenient health care services to New Yorkers. The National Committee for Quality Assurance’s PCMH designation is granted to primary care practices that have implemented a delivery model of care that ensures access, communication, and shared responsibility among a cross section of providers, including doctors, nurses, and social workers, who must work together to improve patient health outcomes.

The National Committee for Quality Assurance’s PCMH 2014 Level 3 recognition reflects greater emphasis on identifying high-need patients for care management, integrating behavioral health screenings and treatment into primary care practice, and engaging patients in their own care. The 2014 Level 3 designation is expected to yield NYC Health + Hospitals approximately $60 million in state reimbursements over fiscal years 2018 and 2019. Making high-quality primary care more accessible for our patients is a linchpin of our health system transformation efforts. Meeting these tough national standards for primary care services underscores the commitment to excellence from our clinicians, administrators, and staff and our ability to seize the opportunity to maximize payment incentives to ensure financial sustainability.

NYC Health + Hospitals PCMH Level 3 primary care practices, by borough:

Bronx
NYC Health + Hospitals/Jacobi
NYC Health + Hospitals/Lincoln
NYC Health + Hospitals/North Central Bronx
NYC Health + Hospitals/Gotham Health, Belvis
NYC Health + Hospitals/Gotham Health, Morrisania
NYC Health + Hospitals/Gotham Health centers in Williamsbridge and Tremont

Brooklyn
NYC Health + Hospitals/Coney Island
NYC Health + Hospitals/Kings County
NYC Health + Hospitals/Woodhull
NYC Health + Hospitals/Gotham Health, Cumberland
NYC Health + Hospitals/Gotham Health, East New York
NYC Health + Hospitals/Gotham Health centers in Brownsville, Bushwick, Fort Greene, Greenpoint, and Williamsburg

Manhattan
NYC Health + Hospitals/Bellevue
NYC Health + Hospitals/Harlem
NYC Health + Hospitals/Metropolitan
NYC Health + Hospitals/Gotham Health, Gouverneur
NYC Health + Hospitals/Gotham Health, Sydenham
NYC Health + Hospitals/Gotham Health, Roberto Clemente
NYC Health + Hospitals/Gotham Health centers in Inwood and Harlem

Queens
NYC Health + Hospitals/Elmhurst
NYC Health + Hospitals/Queens
NYC Health + Hospitals/Gotham Health centers in Jamaica, South Jamaica, and Springfield Gardens

Earlier this month, NYC Health + Hospitals/Kings County proudly launched a new multidisciplinary outpatient Heart Health Center designed to provide heart failure patients with comprehensive services to improve heart health and maintenance in a community-based setting. Staffed by a full-service heart health team, including cardiac specialists, psychologists, psychiatrists, nurse practitioners, nutritionists, pharmacists, and social workers, the new center will help alleviate health challenges that are common to heart failure patients. Patients can walk in, meet with a doctor, be tested—same-day echocardiograms are available—and receive the doctor’s treatment recommendations based on the test results—all under one roof in one visit.

The Heart Health Center will make the patient experience simpler and more streamlined by serving as a medical home base after heart failure patients leave the hospital, facilitating better treatment compliance, more consistency in follow-up visits, and the provision of comprehensive care that keeps patients healthy and out of the hospital and emergency rooms.

Earlier this month NYC Health + Hospitals/Bellevue announced that it is one of only two hospitals recognized for excellence in six or more categories of heart and stroke care by the American Heart Association/American Stroke Association. This recognition earns NYC Health + Hospitals/Bellevue a prestigious position on U.S. News and World Report’s list of America’s Best Hospitals for outstanding care of heart and stroke patients, and was awarded for Bellevue’s implementation of the AHA/ASA Get With The Guidelines program, which establish metrics for high standards for care and patient outcomes.

Congratulations to Bellevue’s Cardiology and Stroke teams, including doctors, nurses, and quality improvement professionals, for truly outstanding work that puts our health care system at the forefront of cardiac care nationally by employing a true multidisciplinary team approach, and providing the fullest range of services. For more details on other NYC Health + Hospitals facilities named to U.S. News & World Report’s Best Hospitals List, visit our website. For details on the Get with The Guidelines program click here.

NYC Health + Hospitals/McKinney, our 320-bed post-acute care and rehabilitation center in East Flatbush, Brooklyn, has received five stars—the highest rating possible—from the federal Centers for Medicare and Medicaid Services for achieving exceptional quality standards. The new rating places NYC Health + Hospitals/McKinney among the top providers of post-acute care in the country. All five skilled nursing facilities in the NYC Health + Hospitals system have received top ranking from the Centers for Medicare and Medicaid Services.

The facility earned the five-star rating for achieving above average performance on 16 different physical and clinical measures for nursing home residents, including for reducing the use of antipsychotic medications among both long-stay and short-stay residents. NYC Health + Hospitals/McKinney also outperformed state and national averages for the percentage of short-stay residents who improved in their ability to move around on their own; the facility has achieved an 83.1 percent success rate, compared to 68.8 percent for New York State and 66.7 percent for the nation.

Israel Rocha, Jr. has been appointed interim CEO for OneCity Health. Mr. Rocha will lead the continued implementation of the transformation agenda set forth by the New York State Delivery System Reform Incentive Payment (DSRIP) program, and provide overall programmatic, operational and strategic leadership for OneCity Health. He will report to the President, and will continue to serve in his role as CEO of NYC Health + Hospitals/Elmhurst.

OneCity Health held meetings with the CEO from each NYC Health + Hospital facility to discuss allocation of resources, workforce development and other initiatives to help NYC Health + Hospitals meet remaining DSRIP goals and earn potential revenue over the final two-and-a-half years of the program. These conversations will continue to ensure OneCity Health and NYC Health + Hospitals are integrated and aligned to meet DSRIP and future transformation goals.

OneCity Health continues with initiatives to further the development of an integrated delivery system focused on improving health outcomes.

• OneCity Health began to formally educate partners about value-based payments (VBP) with the launch of its initial training, “Value Based Payment: The Basics”. Future trainings will cover contracting models, risk-sharing and data analytics to improve outcomes, among other topics, to begin to drive VBP arrangements in the OneCity Health PPS. By April 2020, New York State expects 80-90 percent of Performing Provider Systems’ payments to providers to be VBP arrangements.
• In addition, OneCity Health and its partner, Community Service Society of New York (CSS), are providing technical assistance to build community based organization (CBO) partners’ capacity for value-based contracting. In the initial phase, participating partners are completing organizational self-assessments so OneCity Health and CSS have a foundation on each partner and can tailor individual assistance.
• OneCity Health begin a phased rollout of a web-based social services directory and referral software, NowPow, to OneCity Health partners. NowPow is a web-based technology platform that enables providers to identify community resources, make referrals for patients and clients, and track patient engagement, continuing OneCity Health’s evolution to an integrated delivery system inclusive of social services.

In other OneCity Health news the Journal of the American Medical Association’s JAMA Forum published “Latent Natural Resources for Health” by Dr. Dave Chokshi, Chief Population Health Officer, OneCity Health and Christopher C. Jennings, founder and president, Jennings Policy Strategies, which lucidly discusses how three latent natural resources – people, policy and data – are ready to be tapped to promote health and reduce medical spending.