REPORT TO THE BOARD OF DIRECTORS – February 2019

As you know, Mayor de Blasio last month announced exciting plans to guarantee health care for all New Yorkers in all five boroughs, and NYC Health + Hospitals, along with MetroPlus, the City’s public health insurance option, will be at the heart of those plans. Our goal is to 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 primary care doctors and specialists, pharmacies and mental health and substance abuse services through a new program called NYC Care.

Having led two similar efforts in California, I can tell you that NYC Care will be different in a number of ways. The sheer size and scale of what we will do in New York City reflects a true commitment to universality. NYC Care will have more expansive services –including outpatient mental health treatment, a wider variety of addiction treatment, psychotherapy, extended pharmacy hours and access, nurse first visits, and social determinants screening and connection to services. And it will be fully funded by City government, and neither limited nor reliant on an employer tax or subsidies from the state.

There’s been a lot of work happening behind the scenes and we are on track to launch NYC Care this summer in the Bronx. As we mentioned last month, all services will be affordable on a sliding scale based on income, and eligibility will be limited to NYC residents. We are identifying existing patient care sites where screening and enrollment will take place, and are ramping up the call center operation to offer 24/7 membership support, appointment scheduling and the navigation that most of us are accustomed to getting from our health insurance customer service reps. We’re also developing a staffing plan based on the two year roll out citywide, to ensure we are ready to expand the primary care teams we will need to meet the increased demand for our services. And we are working on all the marketing materials we need to engage the community and welcome our members – including the new NYC Care membership card, welcome packet and materials in multiple languages.

City

• On February 25, I testified before the City Council Committee on Hospitals at a hearing entitled “Oversight: Access to Specialty Care at NYC Health + Hospitals” where I discussed Health + Hospitals unique role in providing outpatient specialty care for the uninsured as well as progress in improving wait times and customer experience. The system’s progress in implementing eConsult and the importance of the EPIC electronic health record system in improving scheduling were key topics of discussion.
• Following the Mayor’s Executive Order to require city agencies to boost their efforts to enroll all New Yorkers into health coverage, MetroPlus has been actively partnering with the Mayor’s office and a number of city agencies. MetroPlus and the Mayor’s Public Engagement Unit expect to announce the early success in forming these partnerships in the coming weeks.
• On February 7, the Mayor released his preliminary budget for Fiscal Year 2020. The plan includes the additional $25m in funding for Health + Hospitals associated with the new NYC Guaranteed Care initiative.

State

• On February 12, eighty-three Health + Hospitals Community Advisory Board members, Auxiliary members and staff traveled to Albany and connected with nearly 50 Assembly members, Senate members and/or their representatives to advocate for Health + Hospitals’ legislative priorities. Due to an incoming winter storm, several meetings were canceled and travel was difficult, but these community members’ advocacy was well informed and powerful.
• In an attempt to close a budget gap associated with declining state revenues, the Governor released 30-day amendments to the state budget, which includes health care cuts totaling over $1 billion statewide. Most notably, the budget reverses a previously announced increase in Medicaid reimbursement rates and makes changes to the state’s distribution of the Indigent Care Pool (ICP) funds. Health + Hospitals and a variety of health care stakeholders around the state are strongly opposing the cuts to Medicaid rates. While the Governors ICP proposal would eliminate some of the unfairness of distributing these funds to well-resourced hospitals, Health + Hospitals continues to advocate for the community coalition proposal to adjust the ICP as a more fair and efficient way to support care for the uninsured and Medicaid populations in the state.

Federal

• On February 22, the Department of Health and Human Services released a final rule related to the Title X family planning program. The so-called “gag rule” makes any entity that provides or refers patients for abortion services from receiving Title X funding. Health + Hospitals believes the full range of family planning and women’s health services is critically important and strongly opposes the rule. Health + Hospitals is evaluating the financial impact of the rule and will not reduce the essential women’s health services we provide to our patients.

• The One City Health Central Services Organization (CSO) Board and OneCity Health PPS Executive Committee, comprised of community partners and providers, passed a resolution supporting OneCity Health and NYC Health + Hospitals to take the steps necessary to explore and negotiate an extension of the Delivery System Reform Incentive Payment (DSRIP) Program with the New York State Department of Health. The extension would enable the PPS to maximally achieve the purposes of the program and support future sustainability.
• OneCity Health presented at the 2019 New York State Department of Health DSRIP Learning Symposium in Saratoga Springs, New York. OneCity Health hosted a discussion on the impact of the PPS for CMS, NYSDOH, health plan, and provider audiences, and presented the following workshops: Creating Sustainability in Community-Based Organizations in a Value-Based Payment Environment ; Scaling New Care Models: Standardizing and Implementing ExpressCare across a Large Health System ; Addressing Barriers to Learning: How Schools and Community Partners are Supporting NYC Youth; Implementation of Opioid Addiction Intervention Services in 11 Public Emergency Departments; and Improving Follow-Up after Psych Hospitalization.

The Rehabilitation Medicine and Infectious Disease clinics at NYC Health + Hospitals/Lincoln this month became the 100th and 101st specialty clinics in the city to adopt our new eConsult system that facilitates enhanced communication between primary care providers and specialists and creates quicker, easier access to outpatient specialty services. Depending on the diagnosis, the guidance from specialists can empower the primary care provider to treat the patient in the primary care setting, avoiding the visit to the specialist completely, which frees up valuable appointment times for patients who really need to see the specialist.

Our expanding eConsult system lets primary care doctors like me send an electronic referral directly to a specialty clinic. I can include all the necessary clinical information, any scans or other images, and any information a specialist needs to provide an initial consult. My eConsult will then be promptly reviewed by a clinical expert. If the specialist thinks I can handle the patient in primary care, they will share their guidance back with me, giving me suggestions such as a change of medicine. If the specialist believes the patient needs to be seen by a specialist, the patient will be contacted with an appointment. Today, eConsult is live in over 100 clinics across 10 facilities, including adult medical and surgical subspecialties, behavioral health, and pediatric subspecialties. Nearly 8,000 referrals per month are managed by eConsult clinics, which is up from 2,300 per month in 29 clinics in January 2018. And our average review and response time is under three days. For a set of 14 specialty clinics using eConsult for over a year, we saw a 23% reduction in overall wait time for new patient visits.

Northwell Health and NYC Health + Hospitals celebrated the opening of a $47.7 million shared, centralized laboratory in Little Neck, Queens. The new Clinical Laboratory of New York – the largest nonprofit, hospital-operated lab in the nation – will enhance quality and patient services, while reducing costs for both health systems and their hospitals. The pooled expertise from our two health systems, combined with staff having the latest technology at hand, will benefit all our patients. The high volume of testing combined with greater efficiency from the overhead costs of operating just one large facility will save significant money for both our health systems. Such an endeavor is possible only with a partner like Northwell that shares a vision for and commitment to the highest quality of care. Northwell made the upfront investment to build the Little Neck facility, which will provide enhanced service levels to physicians and patients in the community, while also bringing additional jobs to the city. The joint project is expected to save NYC Health + Hospitals more than $20 million annually.

Yesterday, I joined New York City First Lady Chirlane McCray and philanthropist Laurie M. Tisch to announce a $1.5 million grant we are receiving though the Laurie M. Tisch Illumination Fund’s Arts in Health initiative and the Mayor’s Fund to Advance New York City to launch our system’s Arts in Medicine program. The generous grant will support innovative arts initiatives to help health care professionals reduce stress and support their emotional health. The Arts in Medicine program will introduce new initiatives such as:

• “HHArt of Medicine, an art-observation initiative that guides clinicians through intensive art viewing designed to enhance focus, improve communication, and encourage active listening, which in turn improves their ability to serve patients;
• SoulCollage®, workshops that facilitate self-discovery through collage composition to help staff express and share their experiences and emotions; and
• Communal Murals, collaborative projects of hospital artists in residence, staff, and community members to create stunning works of art inside and outside facilities.

The Arts in Medicine program will also support broader adoption of patient-targeted initiatives that have worked at a single site. Engaging in the arts makes for happier patients and less stressed staff, and we want our care community to benefit from a substantive and accessible Arts in Medicine program. We are enormously grateful to Laurie Tisch and the Illumination Fund for their generosity and for having the appreciation and foresight to encourage the arts as a tool for fostering wellness and making it a priority for our patients and staff.

Jay Russel, MHA, LNHA, was appointed chief executive officer at NYC Health + Hospitals/Sea View, our five-star, top-ranked skilled nursing facility on Staten Island that provides high-quality long-term care and short-term rehabilitation services. Mr. Russel served as a licensed nursing home administrator for the Cassena Care Group, an owner and operator of 15 skilled nursing facilities throughout the five boroughs, Nassau and Suffolk counties, and Connecticut. Mr. Russel holds a bachelor’s degree in human biology from SUNY and a master’s degree in healthcare administration from Hofstra University. We welcome Jay to NYC Health + Hospitals family.

NYC Health + Hospitals/Jacobi marked the expansion of the newly renamed Health and Empowerment Center, a multi-service clinic that will expand access to comprehensive, state-of-the-art HIV treatment, education, and prevention services for adults and adolescents in the Bronx. NYC Health + Hospitals is investing $1.1 million to expand staff and create a one-stop service model to offer on-site nutrition counseling, mental health services, and more. The center will be able to serve an additional 100 patients annually, offer same-day appointments, and give the city’s public option health plan, MetroPlus, an opportunity to enroll more patients in its specially designed plan for patients with HIV. Having provided care and support to so many people living with HIV and AIDS throughout my clinical career, I’m especially proud of everyone who helped re-imagine this one-stop service model. Projects like this help us better serve the community, grow our health system, and achieve greater fiscal stability.

NYC Health + Hospitals/Lincoln this month reached a milestone in its work to address the opioid epidemic in the South Bronx. The hospital has distributed 1,084 naloxone kits to members of the community since February 2018 and trained some 859 individuals on how to identify an overdose and how to administer naloxone. It’s great to see how our naloxone distribution has gained traction in the community. Every kit that’s out there has the potential to save another life.

NYC Health + Hospitals/North Central Bronx launched a new program to inspire children from diverse backgrounds to pursue careers in health care. The mentoring program will offer elementary and middle school students an opportunity to learn about human anatomy, physiology, pathology, and biomedical careers in a fun and interactive format. A partnership with the national non-profit Mentoring in Medicine, the Youth Academy will launch its first series next month, with an age-appropriate curriculum that will cover health science topics through hands-on activities.

Fewer patients at NYC Health + Hospitals/Jacobi now have post-surgery blood clots thanks to protocols undertaken by clinicians to identify and reduce the threat of deep vein blood clots, or venous thromboembolism. In the first year following the protocols’ implementation, the number of cases of deep vein blood clots following surgery declined by half, and in the second year by an additional 15 percent. The team improved post-surgical safety by identifying patients at highest risk and introducing special monitoring and new preventive measures into their care. In addition to the life-saving interventions, the hospital also noted an improvement in patient satisfaction. The early results from this work were published in the December issue of the peer-reviewed Journal of Patient Experience.

NYC Health + Hospitals/Lincoln completed the installation of state-of-the-art antimicrobial cooling towers that support the heating, ventilation, and air conditioning system. The new towers include antimicrobial features that prevent or impede the potential growth of bacteria, including Legionella, which can cause a type of pneumonia commonly known as Legionnaires’ disease. The modern towers are also expected to reduce energy consumption by about 40 percent, and are resistant to corrosion from salt air, industrial gasses, and chemicals required for use in treating the recirculating water and cleaning the towers.

NYC Health + Hospitals/Elmhurst opened a newly renovated Behavioral Health unit designed to meet the special needs of geriatric and frail patients. Located on the hospital’s 11th floor, the new unit can serve up to 11 inpatients, providing a warm and welcoming atmosphere in a setting designed for individualized care and enhanced safety for a particularly vulnerable population. The new unit features a number of design elements to address the physical challenges of a geriatric or otherwise frail population, including skid-free flooring to decrease the risk of falls, handrails in the lounge/day area, chairs that help lift patients to a standing position, and more. The new unit will help us provide care for our elderly and frail patients as they undergo treatment for mental and physical health issues in a safe, modern, and supportive environment.

Claudia Aristy, director of Children of Bellevue’s Reach Out and Read Program at NYC Health + Hospitals/Bellevue, was awarded the prestigious Joan H. Tisch Community Health Prize for her work that encourages children to read and parents to read to their children from the time they are infants. Through Reach Out and Read, children and their families receive not only books but health information, as well as improving literacy. As a young mother, Ms. Aristy used Bellevue’s Pediatric Clinic and has a keen understanding of the many challenges the parents face. We thank Ms. Aristy for her service and commitment to patients and their family.

Eleven NYC Health + Hospitals clinicians have been selected as Fellows for The Clinical Quality Fellowship Program (CQFP) by the United Hospital Fund and Greater New York Hospital Association. The 11 physicians and nurses were selected for their commitment to advance quality and safety programs across NYC Health + Hospitals. The CQFP is a 15-month intensive training program designed to expand the number of medical professionals with the skills needed to lead quality improvement and patient safety efforts in their hospitals and other health care settings. They will participate in learning retreats and webinars, benefit from mentoring by expert faculty, and develop a “capstone” project to plan and implement a major quality improvement project at their patient care locations. Congratulations to the new Fellows:

Marie Estelle Lejarde MBA, BSN, CWOCN, NYC Health + Hospitals/Bellevue
Zachary Rosner MD, NYC Health + Hospitals/Correctional Health Services
Anjali Hulbanni MD, NYC Health + Hospitals/Harlem
John E. Arbo MD, NYC Health + Hospitals/Jacobi
Marguerite Anne Tirelli MSN, BSN, RN-C, IBCLC, NYC Health + Hospitals/Jacobi
Josephine Johnson RN, MSN, MPH, NYC Health + Hospitals/Lincoln
Usha Venugopal MD, NYC Health + Hospitals/Lincoln
Rajnish Jaiswal MD, NYC Health + Hospitals/Metropolitan
Daran Kaufman MD, MBA, NYC Health + Hospitals/North Central Bronx
Vimala Ramasamy MD, NYC Health + Hospitals/North Central Bronx
Valanie Lezama MS, RN, CCRN, NYC Health + Hospitals/Woodhull

I would like to extend congratulations to three senior leaders in our health system who this week graduate from the 12-month America’s Essential Hospitals Fellows program. Kenra Ford, Sr. AVP Clinical Laboratories, Chief of Staff to the System CMO; Stephen Catullo, Deputy Executive Director, NYC Health + Hospitals/McKinney; and Geralda Xavier, Chief Quality Officer, NYC Health + Hospitals/Kings County completed this intensive training, which brings essential hospitals leaders together to look at the enormous challenges they face, provide the tools necessary to meet those challenges, and become champions and advocates for excellence in health care for all. The program includes a network of more than 650 alumni, some of whom have become CEOs of essential hospitals, C-suite leaders, and national health care thought leaders.