New York City Council Hearing: Changes in the Delivery of Health Care Services: Moving Towards a Community-Based Outpatient Model

Matthew Siegler, Senior Vice President, Managed Care, Patient Growth
and Interim Lead for Government & Community Relations
NYC HEALTH + HOSPITALS
Wednesday, October 3, 2018

Good afternoon Chairperson Rivera and members of the Committee on Hospital Systems. I am Matthew Siegler, Senior Vice President for Managed Care, Patient Growth, and interim leader for Government & Community Relations at NYC Health + Hospitals (“Health + Hospitals”). Thank you for the opportunity to testify before you at this oversight hearing on “Changes in the Delivery of Health Care Services: Moving Towards a Community Based Outpatient Model.” Our President and CEO Dr. Katz apologizes that he can’t be here today. Every Wednesday he sees patients at NYC Health + Hospitals/Gotham Health, Gouverneur. As a practicing primary care physician, Dr. Katz is committed to the patients and does his best to never miss a clinic day. Gouverneur is a beautiful facility just a mile up the road from here, a block from the East Broadway station. If you’ve never visited, or you need a primary care doctor, I encourage you to stop by.

This hearing addresses a timely and important topic for Health + Hospitals and the broader health care industry. Through advances in medical practice and technology, as well as a better understanding of how to deliver care most efficiently and effectively, more patient care is shifting from the inpatient hospital setting to outpatient or virtual care settings. This shift is a welcome change for both patients and clinicians. The more safe and convenient we can make it for patients to get their care and the sooner we can get patients home if they need to come to the hospital, the better.

In 2016, the City correctly identified capitalizing on this shift as key to Health + Hospitals future. The “One New York: Health Care for our Neighborhood” report presented a comprehensive plan to transform Health + Hospitals into a high-performing, competitive, and sustainable community-based system. As noted in the report, between 2012 and 2014 Health + Hospitals experienced declines in hospital stays, losing nearly 5% or 10,000 of its hospitals stays, which was similar to the decline in overall hospital stays in New York City hospitals during the same time period. While these downward trends have begun to level off over the past year, the shift away from inpatient-based health care delivery to outpatient care is continuing. Given this trend, we needed to transform our public hospital system to better serve our patients and communities by enhancing access to ambulatory care services; addressing social determinants of health; and restructuring our clinical services to provide 21st century health for all New Yorkers.

One major challenge with the transition to outpatient care is aligning the financial incentives so that safety net providers continue to have the resources to deliver care that can only be provided on an inpatient basis. More broadly, the historical financial model in American health care was for doctors and hospitals to bill on a fee-for-service basis. That essentially means that the more care delivered and the more expensive the care, the better the provider did financially. Thankfully, we are taking important steps in New York State and around the country towards paying for the value of the care delivered – not just the quantity. New York State’s Delivery System Reform Incentive Payment (DSRIP) program is one reflection of this shift. The program aims to reduce avoidable hospitalizations for Medicaid patients by 25% by 2020, and restructure the health care delivery system so that patients can receive comprehensive preventive care in community settings, and avoid long hospital stays that often lead to unnecessary complications. While the new funding and the new incentives for improving quality are important, the shift required in staffing and the culture of health care delivery systems is vast. Many hospitals continue to compete for patients and base their business models on offering expensive tests, consultations with specialists, and elective procedures that may not deliver true value to the patient or the taxpayers.

However, NYC Health + Hospitals is committed to value-based payment and delivering efficient, high value care. And we are well positioned to capitalize on the industry’s shift in this direction. Our physicians are largely salaried – meaning they have no incentive to deliver unnecessary care – and much of our business comes through risk-based contracts – meaning we share in the savings if we deliver efficient, high-quality care.

Despite these structural advantages, capitalizing on this shift to value-based care and community-based outpatient care does require significant changes for our system. As Dr. Katz has shared with the committee in the past, his goal is to accelerate the transformation of the system in order to ensure its long-term stability and quality by focusing on three top priorities: invigorating and expanding primary care; improving access to much-needed specialty care; and achieving fiscal solvency.

In recent months, thanks to the generous support of the Mayor, the City Council, and other elected officials, we have opened a new community health center on Staten Island, renovated and re-opened another community health center in lower Manhattan, and continued our efforts to use technology to expand access to needed specialty care. In July, we opened Health + Hospitals’ first full service ambulatory center on Staten Island. NYC Health + Hospitals/Gotham Health, Vanderbilt will expand access to primary care for children and adults, mental health counseling and referrals, and opioid treatment. In August, we celebrated the modernization and re-opening of the NYC Health + Hospitals/Gotham Health, Roberto Clemente Center, which has provided care to Manhattan’s Lower East Side community for more than 30 years. The health center provides expanded access to essential primary care and behavioral health services. We’ve also continued to expand use of our e-consult system, which allows primary care doctors to get specialists opinions on their patients’ virtually. Now, instead of waiting weeks or longer for a specialist’s appointment, a primary care doctor can get a specialist’s consultation within hours or a few days through e-consult. We’ve more than doubled the number of e-consults occurring across the system, and we are thrilled to use this technology to expand specialty access.

Going forward, we are launching a series of strategic initiatives designed to transform the health system’s vast ambulatory care operation, improve access to in-demand primary and specialty care, and reverse the recent trend of declining outpatient visits. We have just released a five-point strategy that will be adopted across the public health system’s more than 70 community-based health centers, including 11 hospital-based outpatient operations, which together provide more than five million outpatient visits to children and adults every year. The plan will 1) fix continuity of care and build fidelity by more consistently connecting patients to their assigned primary care clinician; 2) reduce no-show rates and use technology to help patients come to their appointments; 3) expand eConsult, which will make it easier for primary care providers and specialists to communicate about and co-manage patients when appropriate. This will result in a reduction in long patient wait times for specialty care; 4) improve clinic management by empowering physicians and nurses to practice at the top of their licenses. They would now be liberated them from tasks and responsibilities that others can do, so that they can focus on their specialties and focus on the patients that only they can treat; and 5) increase revenue by improving billing and coding to ensure insurance payment for services provided.

From these key steps to improve ambulatory care, to our new partnerships with city agencies and community groups to address the social determinants of health, Health + Hospitals is committed to delivering high-quality care where and when our patients need it. We know that there will always be a need for inpatient hospitals and the critical role our facilities play in their communities cannot be overstated. But moving towards a community-based care model will deliver better care at lower cost, and we are committed to partnering with our staff, our providers, and this committee to succeed in this changing marketplace.

Again, I appreciate the opportunity to testify here today and I look forward to your questions