REPORT TO THE BOARD OF DIRECTORS – January 2019

City Update

Mayor de Blasio this month announced two major efforts to guarantee health care for all New Yorkers, and NYC Health + Hospitals, along with MetroPlus, the City’s public health insurance option, will be at the heart of those plans.

• The first initiative, announced at NYC Health + Hospitals/Lincoln, will serve the 600,000 New Yorkers without insurance by strengthening MetroPlus and guaranteeing anyone ineligible for insurance – including undocumented New Yorkers – direct access to NYC Health + Hospitals physicians, pharmacies and mental health and substance abuse services through a new program called NYC Care. All services will be affordable on a sliding scale. The programs will include customer-friendly call lines to help New Yorkers – regardless of their insurance – make appointments with general practitioners, cardiologists, pediatricians, gynecologists and a full spectrum of health care services. NYC Care will be the biggest and most comprehensive health coverage program in the country. Building on the great work of our doctors, nurses and staff, and working collaboratively with community partners, NYC Health + Hospitals will help give all New Yorkers the quality care they deserve. NYC Care will launch in summer 2019 and will roll out geographically, starting in the Bronx. It will be fully available to all New Yorkers across the five boroughs in 2021. The City will invest at least $100 million annually at full scale. Additionally, MetroPlus will announce a series of enhancements throughout the year.
• The second announced this week at NYC Health + Hospitals/Kings County, is an Executive Order signed by the Mayor requiring City agencies to provide New Yorkers with information on health insurance options and encourage them to enroll in a plan. This order expands on the work GetCoveredNYC is already doing to help New Yorkers enroll in health insurance before the Open Enrollment deadline of January 31 for the plan on the State health exchange, as well as year-round enrollment in MetroPlus. The City will train agency front line staff, provide agencies with relevant information, and develop a framework to ensure all New Yorkers who interact with the City get information to help them access affordable health insurance. The executive order means increased outreach to enroll people in insurance at parks, schools, public housing, police precincts and government offices—anywhere City agencies connect with New Yorkers directly.

On January 16, I testified before the City Council’s Committee on Hospitals at the hearing entitled Charity Care Funding in New York City Hospitals to share key elements of the Community Coalition proposal to rework the State’s Indigent Care Pool funding, which covers the unreimbursed costs of providing medical care to the uninsured and Medicaid populations. The proposal is budget neutral to the state and would benefit NYC Health + Hospitals and many other under-resourced hospitals around the state. With $700 million in Medicaid disproportionate share hospital (DSH) cuts looming on the horizon in FY 2020, NYC Health + Hospitals advocated that New York State should move to increase Medicaid rates and direct more DSH funding to hospitals that provide a true disproportionate share of care to low-income and uninsured patients. The Council was supportive of the Community Coalition proposal and hopes to partner with us and other stakeholders to advocate for the State to pass legislation to adopt the proposal.

State Update

Governor Cuomo’s FY 2020 budget proposal was released on January 15. We continue to review the details of the budget proposal for impacts on NYC Health + Hospitals. The budget proposes to hold state spending growth to two percent, with spending under the Medicaid Global Cap totaling $19.4 billion in FY 2020, an increase of $568 million, consistent with the statutory index of three percent. A few key issues we have identified in our initial review of the budget include:

• The proposed budget does not address the Indigent Care Pool (ICP) collar. As a member of the state workgroup on indigent care, Health + Hospitals believes that funding for indigent care should go to hospitals that provide a disproportionate share of care to the uninsured and those on Medicaid around the state. The Community Coalition proposal, supported by labor representatives, community advocates, NYC Health + Hospitals and other stakeholders, remains a common sense solution to this issue. Continuing to work with our partners in Albany, we remain hopeful that a budget-neutral reworking of Indigent Care Pool funding, consistent with our proposal, can still make it into the enacted budget.
• The proposed budget also does not specifically address federal DSH cuts. We are hopeful that Congress will delay these cuts as they have in the past, but it could result in a loss of DSH – up to $870 million to our facilities. If these cuts happen, then state law must be changed to protect Health + Hospitals.
• The proposed budget codifies the ACA, bans Preexisting Condition Limitations, and ensures that all insurance policies sold in New York cover the essential benefits. In addition, the budget establishes a commission on universal access to health care.
• The proposed budget continues a $50 million appropriation for safety net hospitals, which is important to NYC Health + Hospitals.
• Additional areas of concern include the lack of new funding for hospital capital improvements and a proposed administrative cut to nursing facilities. We are continuing to evaluate these proposals for their impact on NYC Health + Hospitals.

We will work with our Legislative partners over the next few months to ensure that the enacted budget is fair to Health + Hospitals.

Federal Update

The Federal government remains shut down following the expiration of a continuing resolution on December 22. The shutdown has not disrupted core NYC Health + Hospitals federal revenue streams such as Medicare and Medicaid reimbursement, and there has been no disruption to our operations as of yet. But, naturally, we are concerned about the broader public health impacts of an extended shutdown as well as the economic impact of the shutdown on federal workers and our broader community. Our system remains open to all federal workers, and we are willing to take any financial hardship caused by the shutdown into consideration in the patient financial responsibility associated with our services.

• OneCity Health launched a series of trainings to support community-based organizations in capacity development that is critical for value-based partnerships with health care entities. Trainings include: developing an understanding of the external trends influencing cross-sector partnership development; applying design thinking to develop service models and effective partnerships; building a business case for partnership, including a Return on Investment calculator and partner profile template; and communicating value to health care entities.
• Completed workforce training for 225 front-line staff as part of the Care Restructuring Enhancement Pilot to better serve the needs of managed long-term care populations with the goal of closing gaps in services and providing better care for individuals.

I was pleased to be joined by Brooklyn Borough President Eric Adams, and our nutrition and food services staff from NYC Health + Hospitals/Coney Island, to launch our new Meatless Monday campaign earlier this month. Every Monday across all our 11 hospitals, patients will be able to select from a broad range of new, healthy meal options for breakfast, lunch, and dinner. Our staff have developed tasty, plant-based recipes like spaghetti with garden bolognese sauce or three chili, which we got to taste at the kickoff event. We know the health benefits of plant-based diets and its potential to even reverse chronic disease, and we want to empower our patients to live their healthiest lives by introducing them to these healthier foods that they may choose once they’re discharged. The campaign will also feature education and counseling, focused on both the inpatient stay and nutrition after discharge. The first Meatless Monday this month was a great success. More than 1,500 patients at the 11 hospitals opted for one of the meatless chef’s choice selections, and we expect many more will opt for the tasty and healthier meatless options

Earlier this month we announced the completion of the lease agreement that was approved by the board last October. The new lease with GFP Real Estate and Northwind Group for 526,552 square feet of office space at 50 Water Street will help us reduce rental costs by more than $200 million and bring together into one unified campus hundreds of central office and health plan staff who are now spread out across six different locations: 125 Worth Street, 160 Water Street, 199 Water Street, and 33 Maiden Lane, in Manhattan; 1 MetroTech, in Brooklyn; and The Factory/Long Island City, in Queens. We plan to occupy 14 floors of the 29-story building at 50 Water Street and gradually consolidate into the new campus at 50 and 55 Water Street over the next five years to take advantage of affordable rents, new infrastructure, efficient layouts, and economies to reduce our overall administrative office footprint by 20 percent. By eliminating the inefficiencies of having staff in multiple sites, we will reduce travel time and expenses, strengthen the work environment, and build a stronger operation to provide better support to our frontline staff throughout the five boroughs. And the more we save in rent, the more doctors, nurses, social workers, and pharmacists we can make available to our patients, which is our priority.

I was pleased to join Mayor de Blasio at the end of December to announce that the City will be making a $52 million capital investment for infrastructure projects at NYC Health + Hospitals/Metropolitan. The projects will be conducted over time, with some scheduled for completion as soon as the spring, while others will require work through late 2021. While $52 million is obviously a significant investment, it’s clear that it is needed as part of our long-term commitment to the hospital. We want our staff to be able to focus on meeting our patients’ care needs and keeping them healthy, not worrying about roofs and power systems. Flanked by large banners that said “Met is Here to Stay,” the Mayor recognized that Metropolitan has been a mainstay in the East Harlem community for decades, and this investment will help the hospital get the upgrades needed to continue serving the community for generations to come.

NYC Health + Hospitals/Elmhurst Department of Neurosurgery was recognized for the second year in a row with the Healthgrades’ Cranial Neurosurgery Excellence Award. The award recognizes exceptional, specialized care for the array of neurosurgical services provided at the hospital, including the acute treatment of head and spine trauma and neurological emergencies, cerebrovascular disorders, brain tumors, and degenerative spine disease. This is really a testament to the focus on patient-centered care by so many providers — doctors, nurses, physical therapists, social workers and case managers — who together offer this life-saving care to all, without exception. Congratulations to the team at Elmhurst.

Wearing protective jumpsuits and headgear, NYC Health + Hospitals/Kings County staff conducted an emergency response simulation and training event inside a Mobile Satellite Emergency Department trailer last week. The trailer is a 7-bed Emergency Room on wheels that was stationed outside the hospital and used to simulate an alternate care site where patients would be treated in the event of a pandemic outbreak in New York City. The simulation was a great team effort among the staff at the hospital, our Special Pathogens Program team, our emergency operations group and our Simulation Center. The mobile ED, which also includes a large tent where patients can be triaged, has been deployed to other hospitals and locations locally and regionally to support public access to general and emergency care. In a mass emergency event, such as an Ebola or influenza outbreak, the mobile unit would be used to support and ensure readiness for an unexpected influx of patients presenting with emergency needs.

NYC Health + Hospitals/Correctional Health Services announced that it has distributed more than 13,000 naloxone kits to people visiting New York City’s jails since the launch of HealingNYC. The program was first launched as a pilot program at the Central Visitor Center at Rikers Island in 2014. In 2018, as part of HealingNYC, the program expanded to visitor centers at Manhattan Detention Center, Vernon C. Bain Complex in the Bronx, and Brooklyn Detention Center. Naloxone is a safe medication that can reverse the effects of an opioid overdose. Correctional Health Services distributes naloxone at jail visitor centers 16 times a week. Each naloxone kit distributed by this program contains two doses. National research has consistently shown the heightened risk of overdose for people who are newly released from incarceration. Putting naloxone in the hands of their family and friends is an important strategy to save lives.