REPORT TO THE BOARD OF DIRECTORS – October 2019

City

This morning, I was joined by Marielle Kress, Executive Director of NYC Care, to present testimony at a City Council hearing regarding NYC Care and to discuss the City Council’s interest in direct access. We highlighted the successes of NYC Care since the launch in August, and our planned rollout to remaining boroughs before the end of 2020.

On October 8, Rebecca Linn-Walton, Ph.D., NYC Health + Hospitals Assistant Vice President in the Office of Behavioral Health, answered questions at a City Council Committee on Immigration hearing on addressing the mental health needs of immigrants in New York City. Dr. Linn-Walton emphasized that during this adversarial climate emanating from Washington, DC, NYC Health + Hospitals remains committed in our guarantee of health care, including mental health services, for immigrant New Yorkers.

State

On October 23, I testified at a joint hearing of the State Assembly and Senate Health Committees on the New York Health Act and single-payer systems. As I have done before, I spoke in favor of a single-payer system, emphasizing that such a system would advance healthcare as a universal right and allow physicians like myself to focus more on patient needs than on administrative burdens. The hearing provided me with an opportunity to again partner with Senate Health Chair Gustavo Rivera and Assembly Health Chair Richard Gottfried, both supporters of NYC Health + Hospitals.

OneCity Health, NYC Health + Hospitals, and MetroPlus are collaborating, along with NYC DOHMH and the Mayor’s Office, to submit comments in support of the State’s draft 4-year Delivery System Reform Incentive Payment (DSRIP) program 1115 waiver extension/renewal application. We plan to submit our comments by November 4. The continued financial support for the goals of DSRIP remains a key priority for our health system.

Federal

Medicaid Disproportionate Share Hospital (DSH) cuts were again delayed as part of the President’s continuing resolution (CR) to fund the government until November 21. Initial discussions have begun on Capitol Hill regarding a subsequent CR through or perhaps beyond the end of the year. While the ongoing impeachment-related activity raises unique timing and process questions, there continues to be broad bipartisan support for ongoing and perhaps permanent delay of the Medicaid DSH cuts. We remain confident that the cuts will not take effect this year or next.

On October 23, Deborah Brown, Senior Vice President for External and Regulatory Affairs presented Representative Elliot Engel (D-NY) with the America’s Essential Hospitals Congressional Leader Award in recognition of his leadership in the fight against Medicaid DSH cuts. Congressman Engel, along with Texas Republican Rep. Pete Olson, recently led a bipartisan Dear Colleague letter and a bill to delay the cuts for at least two years. NYC Health + Hospitals is grateful for his advocacy.

NYC Care is making guaranteed care a reality in New York City and setting a nationwide model of what it means to provide low-cost, affordable health care. I’m proud to report that we are already more than half-way to our goal of 10,000 NYC Care members in the Bronx since our August launch. In just the first two months of the program, we were able to connect more than 5,000 people in the Bronx to primary care, low-cost prescriptions, and a new member experience. In addition, 100 percent of members enrolled in NYC Care who are new to our system continue to be offered a first appointment with a primary care provider within two weeks of enrollment, and we have filled nearly 3,000 low-cost prescriptions during the new extended pharmacy hours made possible through NYC Care. We are excited to bring these same benefits to Brooklyn and Staten Island early next year and have the program in place citywide by the end of 2020.

Our success is in great part due to the support of community partners that have been conducting culturally appropriate outreach to prospective NYC Care members in the Bronx. I want to thank these community-based organizations for their support: BronxWorks, Emerald Isle Immigration Center, Mekong NYC, Northwest Bronx Community and Clergy Coalition, and Sauti Yetu Center for African Women. We are now seeking Requests for Proposals from Brooklyn and Staten Island community-based organizations to help us replicate this successful outreach model when we launch in those boroughs early next year. The RFP can be found on the NYC Care website at www.nyccare.nyc. Responses are due Nov. 8.

I was pleased to report earlier this month that our public health system’s financial turnaround is on track. Patient revenue is up, expenditures down, and our investments in nurses and other initiatives are ensuring quality patient care. Fiscal year end 2019 shows an on-budget performance with a $36M net positive margin with receipts exceeding disbursements and beating the budget by more than one percent. Patient care revenue was $30M higher than FY18; and, cash on hand grew to $776M — $51M greater than the previous year and the highest in five years. Additionally, at fiscal year end, the health system was able to close 65 percent of its $1.8B structural gap through additional revenue, savings, managed care negotiations, and getting New Yorkers enrolled into insurance. Our investments included the hiring of 426 registered nurses, 229 nursing support, and hiring revenue staff to bill insurance companies for patient procedures.

Financial stability is a critical part of our transformation plan and our fiscal year end shows that we are on the right track – we are achieving our goals and exceeding our budget expectations. We could not have accomplished this significant financial turnaround without the hard work and commitment of our amazing mission-driven workforce, and the support of labor partners and city and state elected officials who are equally invested in the success of this vital public health care system.

Our budget good news generated some positive feedback from a number of stakeholders. We won praise from the New York Daily News Editorial Board who reported on our success with the headline: Prognosis positive? City hospital system improves its act. News headlines in the Wall Street Journal, Crain’s and Politico noted that the city’s public health system is “regaining financial footing” and “in the black after years of financial woes.” And fiscal watchdogs took notice – a representative of the Citizen’s Budget Commissioner said to Crain’s: “They deserve credit for making substantial progress.”

As New York’s public safety net system, our mission is to improve the health of all patients in the communities we serve, without exception. This means not only providing excellent clinical care, but also designing the health care system and providing services in such a way that addresses the whole person. Not only offering our patients access to our high-quality doctors and programs like NYC Care which unlocks those services to our patients, but also removing or helping them to overcome the everyday challenges that make it hard for them to get and stay healthy. Earlier this year, I asked OneCity Health, our DSRIP PPS to assist us in conducting our Community Health Needs Assessment. They facilitated an inclusive process leading to an assessment that was approved by the Board in June 2019.

Since June, they have been working with stakeholders including our DSRIP network of partners, city agencies and NYC Health + Hospitals leadership and front-line staff to design and identify solutions to address the communities’ priority health needs. OneCity Health, our clinicians and our partners will all play a critical role in implementing these solutions. OneCity Health will also provide ongoing evaluation leadership and support of our progress. With that, I am pleased to have Mr. Rocha and Dr. Allen present the Implementation Strategy Plan for your consideration and approval today.

Newsweek has ranked four NYC Health + Hospitals post-acute care facilities on its list of “Best Nursing Homes” – and three of our facilities ranked among the top 10 in New York State. The rankings were based on recommendations from medical experts and nursing home performance outcomes from the U.S. Centers for Medicare and Medicaid Services. The rankings are designed to assist patients and their families in making informed decisions about where to receive the best long-term care and post-acute care services. We are incredibly proud of our long-term care facilities and our staff teams who are setting an example of excellence and compassion. Newsweek’s ranking underscore the quality of care we provide to residents who rely on our top quality rehabilitation or long-term care services. Here’s how our facilities ranked as Newsweek’s Top Nursing Homes:

• NYC Health + Hospitals/Gouverneur – ranked #2 in NY
• NYC Health + Hospitals/Coler – ranked #5 in NY
• NYC Health + Hospitals/Sea View – ranked #6 in NY
• NYC Health + Hospitals/Carter – ranked #32 in NY

We rolled out the new inter-facility transport system this month, which features 26 new ambulances and will transport patients faster, make it easier for staff to order transport services, and ensures patients can be seamlessly transferred to the appropriate facility to improve patient retention. The new patient transportation system streamlines the logistics of transferring patients between hospitals and from hospital-to-home by consolidating from multiple transportation companies to one single vendor agreement with the medical transportation company Hunter Ambulance. The new system is expected to generate $21M in new insurance revenue through patient retention and complete more than 30,000 ambulance trips a year. The transition to a single transportation vendor is a win for our patients, health care providers, and facilities. Patients will notice reduced wait-times for transport to a nearby facility, and our physicians can be assured that their patients will get to a facility in a specific time window. The new system knits our facilities together like never before, creating an inter-facility network that is convenient, reliable and of the highest quality.

This month we announced an investment of $224 million over ten-years to upgrade medical imaging technology system-wide. Across the NYC Health + Hospitals system, there are 470 imaging machines, and they are used to screen, diagnose, and treat numerous disease states. With this new investment, we will be able to update 230 medical imaging machines over the next four years. That will include MRI, CT, nuclear cameras, X-ray machines, catheterization labs, PET/PETCT machines, and fluoroscopy units. The new equipment, supplied under contract with GE Healthcare, will support our public health system’s goal of standardizing care and providing patients modernized, state-of-the-art technology that will produce faster and better image quality, and lead to quicker diagnoses and treatment for patients.

The NYC Health + Hospitals Accountable Care Organization (ACO) – a group of doctors and other providers who coordinate care for patients under the Medicare Shared Savings Program (MSSP) – earned nearly $3 million from the federal government for reducing costs and meeting high standards of quality care for patients. The health system’s ACO is the only MSSP ACO based in New York State to earn shared savings for six consecutive years and one of only 18 ACOs around the country to have earned that distinction. The federal MSSP was created to change the payment structure for the Medicare fee-for-service beneficiary population. It holds participants accountable for the cost and quality of care delivered to a defined patient population over time. There are over 500 ACOs in the MSSP serving over 10.5 million beneficiaries across the country. We have consistently demonstrated that our ACO can provide better care for patients while lowering the growth of health care costs. We achieved these goals through the hard work of our physicians, nurses, and all the frontline staff who care for our patients.

We will be hosting a series of free health insurance workshops in collaboration with the Centers for Medicare & Medicaid Services (CMS) to prepare New Yorkers for the upcoming open-enrollment periods. The workshops will help community partners, faith-based organizations, caregivers, and community members understand health insurance options available to them as they prepare for the open-enrollment periods for Medicare and New York State of Health, the State’s official online marketplace. This is the seventh consecutive year NYC Health + Hospitals and CMS are partnering to bring free workshops to communities across New York City. You can only make the right decisions on health insurance for you and your family if you have all the information. There are many factors that one should consider before selecting health insurance, from family needs to individual health needs, so I encourage New Yorkers to take advantage of this free information. For those looking to apply for health insurance, our staff can help you get connected with information, and for those not eligible for coverage or unable to afford it, we can help you get enrolled in NYC Care or NYC Health + Hospitals’ Options. Visit our website to learn more about the health insurance workshop dates and locations.

Our health plan, MetroPlus, this month launched a redesigned and more member-friendly website that features mobile-first design and new architecture that allows users to readily find what they most want to do, see or search on the site. The new website builds on recent technology upgrades to support MetroPlus’ members, providers, and the City’s push to guarantee access to affordable, quality health care for eligible members. Visitors to our new site will discover that it’s now much easier to find a doctor, pay a premium, check their eligibility for health insurance, and just get in touch with our top ranked health plan. The website features access to the many support services offered to MetroPlus members, which includes coordination of care for members with complex issues, connection to available social services, large selection of member rewards, and a robust new Health Library with helpful healthy living tips. There is also an easy-to-use way for people to find MetroPlus locations in their neighborhoods, where they can receive a full gamut of health insurance services.

This month we celebrated the opening of a new comprehensive Pride Health Center dedicated to lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) adolescent and emerging adult patients. The new health center at NYC Health + Hospitals/Gotham Health, Judson will focus on providing comprehensive, effective, and affirming patient-centered and culturally sensitive health services to adolescent LGBTQ communities. NYC Health + Hospitals/Gotham Health, Judson is home to the Bridge Program, which helps continuity of care between adolescents and adults ages 13 to 35. The new Pride Health Center is the public health system’s fifth, building on a commitment to LGBTQ New Yorkers that has earned the system national recognition by the Human Rights Campaign Foundation as “Leaders in LGBTQ Healthcare Equality.” Judson is also a part of First Lady Chirlane McCray’s NYC Unity Project, the City’s first-ever, multi-agency strategy to deliver unique services to LGBTQ youth. It is an important milestone for NYC Health + Hospitals to announce a new health center that targets a population that is often overlooked and underserved. We’re proud of the innovative programs we’re developing to engage adolescent LGBTQ patients, further illustrating our commitment to engage all New Yorkers and provide access to inclusive, culturally responsive, high-quality health care.

NYC Health + Hospitals/Correctional Health Services opened its fifth annual art exhibit, “Where I’m From.” The exhibit ran at the School of Visual Arts Gallery until last week. It featured the powerful narratives of incarcerated individuals, displaying the work of the Creative Arts Therapy Program participants – the oldest and largest jail based arts therapy program in the nation. This year’s exhibit included approximately 40 collaborative pieces, ranging from visual art to music and poetry, developed during the course of the past year with instruction from creative art therapists. Creative arts therapy, a therapeutic intervention that has proved effective in correctional settings, uses art, music, movement, poetry, or drama with the goal of supporting patients’ mental health and coping skills through the encouragement of self-expression. The program’s creative art therapists are part of the Correctional Health Services clinical mental health team, and coordinate with other staff on mental health care and treatment planning.

As part of our annual Nursing Excellence Awards celebration, NYC Health + Hospitals this month honored 16 nurse professionals from across the public health care system. The honorees were selected by a panel of nurse leaders to highlight the diverse clinical service areas and serve as great representatives of the more than 8,000 nurses who are the backbone of our health system. They not only reflect the diversity of our city but also reflect the mission, vision and ICARE values of integrity, compassion, accountability, respect and excellence. The 2019 Nursing Excellence Award honorees are:

Doris Amalu, BSN, RN, NYC Health + Hospitals/Harlem
Kimberly Campbell-Taylor, RN, BSN, MSN, NYC Health + Hospitals/Simulation Center
Erwin B. Ceniza, RN, NYC Health + Hospitals/Jacobi
Jude Coye, RN, NYC Health + Hospitals/Metropolitan
Soosy Joseph, RN, BSN, NYC Health + Hospitals/North Central Bronx
Francine Keogh, RN, BC, NYC Health + Hospitals/Community Care, Associated Director of Nursing
Maureen Daly Maroney, MS, MSN, RN-BC, CCRN, NYC Health + Hospitals/Coney Island
Nabiha Minhas, RN-BC, BSN, NYC Health + Hospitals/Kings County
Lorna Mullings, RN, MSN/MPH, WCC, NYC Health + Hospitals/Woodhull
Marilou Omoyon-Perham, BSN, MSN, RN, MNP-BC, NYC Health + Hospitals/Elmhurst
Shila Pandya, BSN, RN, NYC Health + Hospitals/Bellevue
Queenie Joy Papa, BSN, RN, MN, NYC Health + Hospitals/Lincoln
Jasmine Pascual, RN, NYC Health + Hospitals/Gotham Health, Gouverneur
Trichelle Phillips, RN, BSN, NYC Health + Hospitals/Queens
Nenita Premian, RN, BSN, NYC Health + Hospitals/Sea View
Abiola Salami, RN, BSN, FNP, NYC Health + Hospitals/Correctional Health Services

Nicole Jordan-Martin, MPA, has been appointed Executive Director of NYC Health + Hospitals/Community Care, the public health system’s program to deliver services to patients at home and in the community – and a major part of our broad approach to improve population health. She will be responsible for overall strategic priorities, including patient growth, clinical integration, care management, quality improvement, and financial sustainability. Ms. Jordan-Martin served as a Senior Assistant Vice President, Executive Director for Implementation and the Brooklyn Hub Executive Director at OneCity Health, NYS’s largest Performing Provider System (PPS). She also previously worked with NYC Health + Hospitals’ sponsored partnerships of organizations and healthcare professionals, collaborating to meet community needs by transforming healthcare delivery. Nicole Jordan-Martin is the right leader for this exciting transformation, as we expand and strengthen services, particularly for our most vulnerable patients.

Deborah Brown has been appointed NYC Health + Hospitals Senior Vice President for External and Regulatory Affairs. Brown will guide the System’s external partnerships and manage complex regulatory and policy matters, defining and executing strategies to advance NYC Health + Hospitals’ local, state, and federal priorities. She will lead our Government and Community relations teams. Deborah Brown has nearly two decades of experience representing, advocating for, and leading hospital systems. She joins the public health system from her position as the Chief Strategy and Innovation Officer for Health in the NYC Mayor’s Office. She also served in a senior staff position in the Montefiore Health System, where she led policy, regulatory, and advocacy initiatives to advance the system’s expansion of value-based care. Her extensive knowledge of health policy and health systems will be an incredible asset to NYC Health + Hospitals. From her service at the Mayor’s Office to her years representing New York’s hospitals and long-term care facilities, Ms. Brown stands as a true leader in the field.

Collaborative Drug Therapy Management (CDTM) Pharmacists are clinical pharmacists we have hired to partner with primary care providers under a Collaborative Practice Agreement to optimize the management of specified disease states, such as diabetes. In order for the pharmacists to practice, they need to be credentialed as CDTM pharmacists at NYC Health + Hospitals/Gouverneur. This process requires adding the role of CDTM pharmacist to the definition of Allied Health Professionals in the Gouverneur Ambulatory Care Bylaws. The credentialed staff have already voted to add the CDTM pharmacists to their bylaws. The NYC Health + Hospitals Board bylaws (Article IX) delegates this authority to the President. Therefore, at the recommendation of the medical staff, and in my official capacity as President, I am approving this bylaw change on behalf of the Board.