REPORT TO THE BOARD OF DIRECTORS – December 2018

City Update

NYC Health + Hospitals and the NYC Department of Health jointly submitted a letter on December 6 to NYC Council Member Mark Levine, Chair of the Committee on Health, in support of the New York State Health Act, which would establish a single-payer health system in New York State. Expanding access to health insurance coverage and implementing a single payer system would support Health + Hospitals’ mission to provide high quality health care services to all New Yorkers regardless of their ability to pay. We also participated in City Council hearings where we highlighted the NYC Health + Hospitals World Trade Center Environmental Health Program for survivors with physical and mental health conditions related to the 9/11 terrorist attacks; as well as our services for patients impacted by female genital mutilation/cutting.

State Update

The State Department of Health has yet to release the report of its findings of the Temporary Workgroup on indigent care funding which was due on December 1. However, NYC Health + Hospitals and the Community Coalition continue to advocate for our proposal which would direct indigent care funding to NYC Health + Hospitals and other safety net hospitals and at-risk hospitals across the state. This will be one of our priorities in the upcoming State legislative session which begins on January 9, 2019. As the new session begins, we look forward to continuing our working relationships with both Senator Gustavo Rivera and Assembly Member Richard Gottfried who will be the Chairs of the Health Committee in their respective houses.

Federal Update

• I was very proud to join members of our staff, immigration advocates, elected officials, and labor partners earlier this month to call on all New Yorkers to speak out and reject the proposed changes to the federal “public charge” rule and remind New Yorkers to seek care without fear. If adopted, these changes could prove to be a far-reaching and highly damaging immigration policy shift, penalizing immigrants for utilizing certain public benefits for which they are eligible—essentially forcing them to choose between proper medical treatment and pursuing a green card or visa renewal. NYC Health + Hospitals serves more than one million New Yorkers annually—40 percent of whom are born outside the United States – and we are likely to bear a disproportionate burden if the changes to public charge were to take effect. The proposed rule would pose significant risks, partially due to fear, and could harm 350,000 of our patients. Our analysis suggests that as many as 62,000 patients could abandon Medicaid and other insurance, more than one million patient visits could be skipped, and much-needed prescriptions to prevent or treat contagious diseases like the flu and tuberculosis could go unfilled. Just as disturbing, are the predicted declining health outcomes that could result including increased complications in pregnancy, more premature births, and maternal deaths. In addition to fueling the current environment of fear among immigrants and the potentially negative health impact to patients, our estimates show that our public health system could absorb a financial loss of up to $362 million in the first year.

  During the rally, we heard stories from our front-line insurance enrollment counselors and WIC benefits managers about patients who are already declining to enroll in Medicaid, dropping out of our MetroPlus health plan, and refusing essential WIC program benefits– even though that program which offers nutrition assistance to women and children is not part of the targeted public benefits under the public charge rules. We believe the current impact pales in comparison to the much larger anticipated effects if the rule is to be implemented. We submitted our formal comments along with the City Of New York and its many service agencies, and more than 200,000 others from around the country who sent in their comments against this proposal. We also sent a letter to the New York Congressional Delegation urging their continue advocacy against this proposal and distributed educational materials about the public charge in 14 languages. We expect to hear from the federal government sometime in March.

  Thanks to Henry Garrido, Executive Director of DC37, for agreeing to author a joint Op-ed with me that was published in the Daily News to bring attention to this issue and underscore how it simply runs counter to the great progress we have made at NYC Health + Hospitals.

• On December 14 a federal judge issued a ruling in the Texas v Azar case, the latest legal challenge to the Affordable Care Act. The ruling, though not unanticipated, was sweeping in its breadth. It found the law’s individual mandate to be unconstitutional and inseverable for the remainder of the statute, rendering the entire law invalid. The Trump Administration quickly stated that the ruling had no effect on the current ACA open enrollment period or on the myriad other ongoing programs and policies originally included in the ACA. The ruling is certain to be appealed to the 5th circuit court of appeals and will prompt fierce advocacy from Democrats in Congress and stakeholders across the nation. Liberal and conservative legal scholars have questioned the soundness of the ruling and expect it to be overturned on appeal. However, given recent changes to the composition of the US Supreme Court, the case will warrant close attention and strong public opposition. This is simply a cruel and misguided ruling. Dismantling health benefits to millions will result in deaths and suffering. And I hope the appeals court will make a better decision. On a positive note – this week we also learned that New York’s open enrollment figures continue to defy national trends and exceed the state’s performance last year. More than 1 million people have enrolled for the first time or renewed coverage through December 14 on the NY State of Health marketplace set up under the Affordable Care Act. Unlike the federal exchange, which closed December 15, New York residents have until January 31 to choose a plan.

• On November 29, 2018, the New York Academy of Medicine hosted the public comment day for New York’s 1115 waiver program. OneCity Health PPS partners submitted written comments about the value of the partner network, the services provided by OneCity Health, and the investments they have made through the funding earned from the DSRIP program.
• OneCity Health was highlighted as the top PPS in the State for improving performance on avoidable admission of pediatric patients with asthma.
• OneCity Health was selected to present at the New York State Department of Health DSRIP Learning Symposium next February 2019 to share some best practices in a number of areas of success:
• Demonstrating impact: Improving Follow-up after Psychiatric Hospitalization and Implementation of Opioid Addiction Intervention Services in 11 Public Emergency Departments, in partnership with the NYS Health + Hospitals Office of Behavioral Health
• Building effective partnerships: Addressing Barriers to Learning: How Schools and Community Partners are Supporting NYC Youth
• Spreading and scaling best practices: Scaling New Care Models: Standardizing and Implementing ExpressCare across a Large Health System
• Sustaining Impact post-DSRIP: Creating Sustainability in CBOs in a Value-Based Payment Environment

Mayor Bill de Blasio last week announced the appointment of five members to the NYC Health + Hospitals Board of Directors who will begin their service effective January 1, 2019. The new members are: José A. Pagán, Sally B. Hernandez-Pinero, Anita Kawatra, Feniosky Peña-Mora, and Freda J. Wang The new board members bring expertise from both the private and public sectors, including health policy and delivery, community development, engineering, health communications, and municipal finance and infrastructure. We look forward to the addition of the newly appointed board members, who will bring their own fresh perspectives and enthusiasm to the oversight of our essential public health system.

On behalf of the entire NYC Health + Hospitals family, I want to share our deep gratitude to the board members who will be completing their service to the board at the end of this month. Emily Youssouf, Mark Page and Bernie Rosen have each given so generously of their time and expertise over many years in support of our health system’s mission. I also want to thank Gordon Campbell for so ably serving as Action Board Chair and for continuing on as board member. We’ve been fortunate to have this dedicated group of New Yorkers serving in this important volunteer leadership role.

Mayor Bill de Blasio this moth announced the launch of the nation’s first City-led nurse residency program in 24 participating local hospitals – including all of our 11 acute care facilities at NYC Health + Hospitals. During the first year of the program, called the Citywide Nurse Residency program, 500 newly-hired nurses will be provided with specialized training and mentorship to promote job retention. Estimates show that losing one nurse can cost up to $100,000 and retention of newly-graduated nurses is a challenge. While residencies are a recognized best practice for retaining nurses, New York City’s public and safety net hospitals have not had the capacity and resources to launch these programs. We are excited to offer our nurses this opportunity to thrive in our hospitals and help us deliver quality health care to so many New Yorkers.

New guidelines developed by NYC Health + Hospitals clinicians are helping providers to make difficult, life-sustaining treatment decisions for patients who have no next of kin, no advance care directives and lack the ability to make informed medical decisions. This is a real challenge that poses moral and ethical dilemmas and undue stress for clinical care teams in nursing homes and long-term care facilities all across the country. But our skilled providers and ethics experts have developed a new decision tool – an “Algorithm for the Unbefriended” — that was applied to care for residents at NYC Health + Hospitals/Coler and has already proven successful in improving end of life care for these patients. The tool guides an ethical, compassionate and careful framework for all providers, one that minimizes ambiguity and the potential for arbitrary decisions for this most vulnerable population of New Yorkers.

Most significant among the outcomes was that unnecessary or unwanted treatments were largely avoided for many of these residents who were elderly, frail, debilitated and in advance stages of dementia. The tool helped the team endorsed a reduction in patient transfers for acute care, thereby sparing them from medically inappropriate, burdensome treatments that would have been of little benefit. The ethics-focused group also determined that enhanced oral feedings were the more compassionate alternative to the traditional tube feeding that is often followed in these cases. The patient care outcomes lauded and reported in the fall 2018 issue of the New York State Bar Association Health Law Journal.

The American Heart Association and American Medical Association named NYC Health + Hospitals/Elmhurst a leader in the national effort to get people’s blood pressure under control and reduce the number of Americans who have heart attacks and strokes each year. The hospital received the organization’s “Target: BP™” recognition award presented to physician practices around the country that share a common goal to reduce the number of adult patients with uncontrolled blood pressure and improve health outcomes associated with heart disease. I know the clinical teams have worked closely with our patients to help them make lifestyle adjustments that include a focus on exercise and healthy eating. Their efforts are having a real impact and empowering patients to make choices that will lead to good outcomes.

NYC Health + Hospitals/Kings County has enhanced its surgical capabilities with the acquisition of the highly advanced da Vinci Robotic Surgical System, which they showcased to the community at the hospital’s inaugural Robot Day. The “robot” is operated by a trained surgeon who is in control at all times. It has four interactive arms, a high-definition 3D vision system, and an ergonomically designed console that allows surgeons to perform minimally invasive and complex surgical procedures with precision and dexterity. In addition to being less invasive than traditional surgery, robotic surgery allows surgeons to see patients’ tissue and organs magnified up to 10 times. Patients are expected to experience minimal incision scarring, shorter hospital stays, reduced pain and discomfort, less need for medication to manage pain, and faster recovery times. The robotic system will be used to perform a variety of minimally invasive surgeries for complex diseases and conditions in gynecology, urology, and thoracic, general, and colorectal surgery.

NYC Health + Hospitals/Bellevue announced today that its pilot program to help patients transition to a plant-based diet and healthy lifestyle will launch on January 16, 2019. The program has already attracted 260 participants, more than double what was expected, with more enrollees every day. The Plant-Based Lifestyle Medicine Program includes a whole-foods, plant-based diet to improve, and in some cases reverse, chronic conditions such as heart disease, diabetes, obesity, high cholesterol, and high blood pressure. The program is designed to serve as an intensive resource for adult patients with chronic disease who wish to reduce their cardio metabolic risk through healthful lifestyle changes, including following a diet that emphasizes legumes, whole grains, fruits, vegetables, nuts, and seeds, and reduces animal products, fried foods, refined grains, and added sugars. The program has hired new staff, including a health coach and a dietitian. The pilot program is a result of Brooklyn Borough President Eric L. Adams’ advocacy around plant-based nutrition.

If you ride the subways, you may have seen new MetroPlus Health Plan advertising that says MetroPlus members are seeing stars. That’s because MetroPlus this month was ranked New York City’s highest-rated health plan for exceptional clinical services, high consumer satisfaction, commitment to community and the great rewards available to MetroPlus members. Our health plan earned an overall rating of 5 stars, the highest possible score in the New York State Department of Health 2018 Consumer’s Guide to Medicaid and Child Health Plus Managed Care Plans in New York City. The health plan’s overall rating included 5 stars in the clinical areas of Cardiovascular Care, Diabetes Care, Child and Adolescent Care, Women’s Preventive Care, and Adult Care. This top ranking really reflects well on our entire public health system. It not only recognizes our health plan for superior member services but also for its excellent provider network which includes all of the NYC Health + Hospitals acute care hospitals, our ambulatory care services and community based health centers, and our skilled nursing facilities. Congratulations to the MetroPlus team and to the committed clinicians in our health system.

MetroPlus’ new 5-star rating was partly earned thanks to the health plans model community outreach efforts and commitment to overall wellness among its members. One example of these efforts was demonstrated earlier this month at a holiday reunion of members who participated in the health plan’s Camp MetroPlus, a five-week program launched last summer to reduce isolation among seniors through a series of special events to promote health, wellness, and social activities. MetroPlus Medicare members and staff were joined by representatives from the New York City Police and Fire Departments and Brooklyn Borough President Eric L. Adams who shared lessons from his own experiences in embracing a healthier lifestyle.

MetroPlus staff was joined by local Bronx leaders and community residents this week to celebrate the grand opening of its new flagship community office in the Longwood section of the Bronx with toy distribution, healthy treats, and free dental screenings for children. The MetroPlus Community Office is located at 953 Southern Boulevard, at East 163rd Street in the Bronx. MetroPlus has significantly expanded its presence in local communities this year. The health plan has opened two new offices in Manhattan and one in Staten Island, in addition to the multiple locations already in Brooklyn, Queens, and the Bronx. MetroPlus can also be found at kiosks or offices within all NYC Health + Hospitals facilities, as well as at community partner locations.