New York City Council Oversight Hearing: Health Access in New York City and The Roll Out of NYC Care

Mitchell Katz, M.D., President and Chief Executive Officer
NYC HEALTH + HOSPITALS
Thursday, October 31, 2019

Good Morning Speaker Johnson, Chairperson Levine, Chairperson Rivera, and members of the Committee on Health and the Committee on Hospitals. I am Dr. Mitchell Katz, President and CEO of NYC Health + Hospitals (Health + Hospitals), and I am joined by Marielle Kress, the Executive Director of NYC Care. Thank you for the opportunity to update you on the implementation of NYC Care – a key component of the City’s commitment of guaranteed health care for all, which would not be possible without the efforts from the last two years to make systemic changes in the public hospital system by modernizing our operation, and stabilizing our finances.

Before providing an update on the successes of NYC Care since its launch in the Bronx on August 1, I’d like to begin my testimony by saying no one should go without the health care they need in New York City. Health care is a human right, and in this City we’re going to make that a reality. According to the Census, it is estimated that almost 600,000 of New York City residents remain uninsured and half of them are ineligible for health insurance, and as such lack the access needed to maintain and improve their health. This is why I strongly support a single payer health system at the federal or state level, or in the meantime expanding eligibility for the Essential Plan at the state level, which would provide coverage to more uninsured New Yorkers. As the chief executive of Health + Hospitals – the largest public health care system in the nation that serves over one million patients each year, of which 375,000 are uninsured – and a primary care doctor, I believe implementing a single payer system would support our mission to provide high quality health care services to all New Yorkers regardless of their immigration status or ability to pay.

While the single payer debate continues, New York City will do its part and provide access to health care for the hundreds of thousands of people who need it. In January, I was proud to join the Mayor in his announcement of the launch of the largest, most comprehensive initiative in the nation to guarantee health care for every New Yorker. No one should live in fear of getting sick, and not having a trusted health care provider they can turn to because they are poor, or they are an immigrant. There are two components of NYC’s Guaranteed Care commitment. The first component is to enroll everyone who is eligible for insurance because it’s always better to have coverage. A great option is the City’s public health insurance option – Health + Hospital’s health plan MetroPlus, which is the plan of choice for over half a million New Yorkers and has a five- star rating based on the State’s 2018 Consumer’s Guide to Medicaid and Child Health Plus Managed Care Plans in New York City. The second is to enroll those who do not qualify for or cannot afford health insurance into NYC Care, which will be available across the five boroughs by the end of 2020.

NYC Care builds on two prior initiatives I previously spearheaded – Healthy San Francisco and My Health LA. The difference here is NYC Care provides more expansive services to all New Yorkers who cannot afford coverage or are ineligible. While it is not insurance, NYC Care provides access to comprehensive primary care and specialty services at Health + Hospitals facilities, including at our Gotham Health Federally-Qualified Health Center (FQHC) network – the largest FQHC in NYC and the country – on a sliding fee scale based on the patient’s income and household size. There are no membership fees or monthly fees. Distinctly, NYC Care provides members with a guaranteed first appointment with their regular primary care provider within two weeks of enrollment. NYC Care has a 24/7 member services hotline to assist patients in navigating our system, as well as 24/7 access to affordable prescription drugs, including extended pharmacy hours in the evenings and on Saturday or Sunday. NYC Care issues a membership card that lists the member’s primary care provider name and fees.

On August 1, Health + Hospitals launched NYC Care in the Bronx. In the first three months alone, we have enrolled 7,500 New Yorkers who hail from every zip code in the Bronx and are well on track to reach the Bronx enrollment goal of 10,000 patients in the first six months. In January, we will launch the program in Brooklyn and Staten Island, and NYC Care will be in every borough by the end of 2020.

I am very pleased to share with you that in the Bronx, in the first two months, 100 percent of NYC Care members continue to be offered a first appointment within two weeks with a primary care provider, and in the first two months of the program, there were over 3,000 low-cost prescriptions filled during the new extended pharmacy hours – life-saving prescriptions that patients did not have timely access to before the program launched. To prepare for the program launch, the seven Health + Hospitals facilities in the Bronx hired new providers, and added new clinics with evening and weekend hours to accommodate patients. There are now more than 70 primary care providers in the Bronx who coordinate the care of NYC Care members, including referrals for specialty care, diagnostic testing, and management of chronic diseases.

Stakeholder Engagement Strategy: The launch of NYC Care is a huge accomplishment, and a lot of the success is due to Health + Hospitals’ collaborative spirit and strategy to engage stakeholders and partners. We collaborated with the Mayor’s Office of Immigrant Affairs and the Mayor’s Fund to Advance New York City to engage key constituencies and thought leaders to reach potentially eligible New Yorkers. The health system has contracted with five community based organizations in the Bronx to hire 15 full-time staff members – BronxWorks, Emerald Isle Immigration Center, Northwest Bronx Community and Clergy Coalition, Mekong NYC, and Sauti Yetu Center for African Women. The staff at these organizations speak 10 different languages, and they identify, recruit, and refer uninsured New Yorkers in the Bronx for insurance screening and enrollment in NYC Care in a culturally appropriate and sensitive manner. In preparation for the launch of NYC Care in Brooklyn and Staten Island in January, we have already announced an RFP opportunity for community based organizations for NYC Care outreach in those boroughs. Responses to the Brooklyn and Staten Island RFP must be submitted by Friday, November 8. Health + Hospitals is also leveraging GetCoveredNYC’s existing outreach to uninsured New Yorkers in the Bronx to refer eligible people to NYC Care for enrollment. We are also working with MetroPlus – its network of locations provide another access point for potentially eligible NYC Care members. New Yorkers who apply for insurance and are found ineligible or are unable to afford any options are directed to NYC Care.

Public Awareness Campaign: We launched a multilingual and multiplatform public awareness campaign to promote NYC Care launch in the Bronx. The campaign includes paid advertisement and special partnerships in 20 ethnic and community outlets. The ads in all campaign platforms were issued in Spanish in addition to English to target high percentage of Spanish speaking New Yorkers in the Bronx potentially eligible for NYC Care. All the campaign ads and collateral are available in 14 languages on our website and are being distributed to ethnic communities borough wide by our internal and external stakeholders. As the program rolls out in other boroughs by the end of 2020, we plan to replicate this and additional approaches to ensure we continue to work with ethnic and community media to reach key communities in every borough.

Collaboration with non – Health + Hospitals FQHCs: Health + Hospitals has been meeting and working very closely with non-Health + Hospitals FQHCs. We met with other FQHCs themselves – CEOs and senior leaders from FQHCs across the Bronx to ensure the patients of non-Health + Hospitals FQHCs are redirected back to their primary care providers if they call the NYC Care contact center, but may enroll in NYC Care for specialty services. The non-Health + Hospitals FQHCs developed a call center process and scripting for Health + Hospitals to ensure that their patients were redirected back to them. We have since met with them again to ensure the process is working. Additionally, primary care providers external to the Health + Hospitals system are listed as ‘community provider’ on NYC Care members’ cards. We have modernized our external referrals process so that external providers can refer their patients to specialty care services at Health + Hospitals through EPIC Care Link, which is web visible and available to any outside provider.

While more work needs to be done, I am proud of the progress we’ve made thus far in rolling out NYC Care. Thank you for the opportunity to testify before you today and I look forward to taking your questions.