REPORT TO THE BOARD OF DIRECTORS – January 2016

Good afternoon. As is customary, I will highlight just a few items from my report to the board. The full version is available to all here and will be posted on our website.

We welcome New York City’s new Deputy Mayor for Health and Human Services, Dr. Herminia Palacio.

Dr. Palacio is a person with a deeply impressive background in the universe of issues that confront safety net hospitals and public health systems.

We are delighted you are joining us, and we are looking forward to having the benefit of your continued guidance and advice.

Now that the snow has mostly melted, l must take a moment to thank our employees for the amazing effort they made to keep our essential health system up and running during last weekend’s record breaking blizzard.

Let’s take a moment now to watch a quick slide show featuring some images from the weekend.

On January 11th we shared with our employees an update on our Vision 2020 plan for growth. Our message highlighted three issues:

First, accomplishing our goals by the year 2020 is not an arbitrary timeline.
It’s a deadline, driven by real changes to the environment in which we operate. Changes like the shrinking of federal revenue streams, and the end of DSRIP incentive payments.

Second, the 16 different major initiatives we have embarked on—-everything from —
the Patient Experience Action Plan, to EPIC Implementation, to our Accountable Care Organization (ACO) —all are components of the same Vision 2020 strategy.

All are about growing our system by bringing excellence to patient experience, expanding access to our services and reforming our organization.

Third, we cannot expect success overnight. Achieving our goals will take time.
Vision 2020 is a five year plan. We should expect that it will take the full balance of those five years to see the transformation we are working towards.

Let’s watch a brief video clip from New York 1’s coverage about our message:

I’d like to take a moment to note the impending departure of an esteemed leader of our system: Tonight marks the final board meeting that Steven R. Alexander, Executive Director of NYC Health and Hospitals/Bellevue will be with us.

He is retiring at the end of this month after 27 years of exemplary and distinguished service.

Steven has dedicated his professional life to improving the public hospital system, and to safeguarding the health of our patients. He will be greatly missed.

One of the most important social obligations of public health is eliminating disparities that cause illness in so many of our patients. And we at NYC Health and Hospitals are doing our part.

Not only are we working effectively to expand access to primary care across the city, but we are also partnering with others to develop a more diverse workforce and healthcare leadership.

That’s why we are proud to participate in a mentorship program sponsored by the Association of Hispanic Heath Care Executives (AHHE) to ensure that more Latinos and other young people of color enter policy-making, patient care and leadership positions in healthcare.

Senior members of our staff have already begun taking these talented young people under our wing. We are helping them become knowledgeable about healthcare, establish lasting relationships in the field, and position themselves for success.

Several students have joined us here today. Welcome to:

• Emmanuel Ofori
• Heber Chamorro
• Mickael Demean

On January 4 we announced that MetroPlus Health insurance is now available for the first time to Staten Island residents.

Staten Island residents can enroll immediately in MetroPlus plans, including the new “Essential Plans” with premiums from $0 to $20 per month.

We are very proud to now offer Staten Islanders a health insurance option for quality care which is accessible and affordable in every neighborhood.

In December, NYC Health and Hospitals/Kings County held a ribbon cutting for its new Varian Trilogy Linear Accelerator (“Linac”). The equipment will improve radiation oncology service for cancer patients by enabling our clinical team to better diagnose conditions and evaluate a patient’s response to treatment more quickly and efficiently. With two linear accelerators now located at Kings County we can improve the patient experience, expand access to care, and reduce patient wait times.

The Linac will enable us to expand the scope of services by offering Image Guide Radiation Therapy (IGRT), Stereotactic Body Radiation Therapy (SBRT) and Stereotactic Radiosurgery (SRS). The hospital’s Radiation Oncology Department will also have the capability to treat over 200 additional patients per year.

NYC Health and Hospitals is grateful to Council Member Mathieu Eugene for securing over $2.6 million in funding from the New York City Council for the new equipment and its installation, which will expand the scope of services offered to patients and reduce wait times for treatment.

Nursing Home Quality Initiative Results for December awarded NYC Health and Hospitals/Sea View with five star ratings in staffing, influenza vaccinations for staff, percent of long stay residents (high risk) with pressure ulcers, and percent of long stay residents who have depressive symptoms, among other ranking components. The Center for Medicare Services rates Sea View as “Much above Average” in its 5 Star ranking system. Sea View has consistently maintained its 5 Star rating since 2008.

Installation of a tremendous new mural, two and a half stories tall, has been completed at NYC Health and Hospitals/Lincoln. An unveiling ceremony took place on December 18, 2015 with a distinguished group of 100 in attendance. The mural’s theme encourages patients, visitors and employees to use the stairs, rather than the elevator. Research has long indicated that exercise is a step towards prevention for many common ailments and can improve overall health.

Artist / Muralist Katie Yamasaki created the mural after meeting with Lincoln patients, staff, and community groups from the Bronx, to find out what would best motivate them to use the stairs. The mural includes healthy eating tips, street scenes, fantasy journeys and exercising options in a colorful voyage up the stairwell. A special thanks goes to The Fund for HHC and to Joe Schick, its Executive Director, for making this project possible.

NYC Health and Hospitals/ Lincoln’s Child Advocacy Clinic Director, Dr. Nina Agrawal participated in a December effort spearheaded by Doctors for America to advocate for the lifting of a Congressional ban on federal Centers for Disease Control (CDC) and National Institutes of Health (NIH) research of gun violence as a health issue.

Covering this important public health issue were CNN, the Washington Post, Newsweek, NPR, CBS and other local media. Eight physician organizations and five members of Congress joined Doctors for America on December 12, 2015 at the U.S. Capitol to deliver petitions. Allies from Doctors Council, American Medical Women’s Association, National Physicians Alliance, American College of Preventive Medicine, Committee of Interns and Residents, Physicians for the Prevention of Gun Violence, American Academy of Pediatrics and the American Medical Student Association stood together to speak out for thousands of physicians.

On January 21, Dr. Christina Jenkins presented an update on OneCity Health planning and implementation to the Public Authority Oversight Panel (PAOP), which oversees the NYS Department of Health for the DSRIP program. Information was provided on network configuration, primary care strategy, behavioral health integration, funds flow approach, and engagement and funding of Community Based Organizations (CBOs). These PAOP-identified themes will continue to be areas of focus as DSRIP implementation progresses.

We expect to begin distributing funds beginning in February and continue to keep our partners informed on timing. Our first partners to receive funds will be those CBOs participating in Project 11. There are no DOH-defined deadlines or penalties associated with timing of funds flow. We are linking partner funds flow directly to resource needs and process milestones associated with a phased project rollout.

We are continuing site-level planning and implementation for DSRIP clinical projects across the entire OneCity Health network:

For Project 11, asthma home-based self-management, and integration of palliative care into the Patient Centered Medical Home (PCMH), local implementation is well underway across pilot sites including a subset of NYC Health and Hospitals and community provider organizations.

Our strategy includes an important foundational requirement to achieve PCMH Level III status under NCQA 2014 standards, as well as achieving certain core competencies within the primary care setting, including the ability to function operationally as a high-performing care team. We have developed a contracting framework for our community partners to achieve goals and expect to execute contracts beginning in February. We are proud that our sites are currently at PCMH Level III status and their primary care planning will continue under leadership of the Division of Medical and Professional Affairs with DSRIP funding as appropriate.

Planning continues for all other clinical projects, including those related to care management and care transitions, and we expect to formally initiate those projects in February and March.

We are continuing the process of executing the Master Services Agreements (MSAs) for all partners and the payment schedules for each project in which a partner will participate. To date, roughly 80 percent of our Master Services Agreements have been executed.

Our community-based organizations within the OneCity Health partners will be the first to receive DSRIP funding for the important work they are undertaking in Project 11, which requires us to engage our uninsured patients, administer the PAM® survey as required by NYS DOH to assess their ability to self-manage their health, and to link them to insurance and primary care.

With the endorsement of NYC Health and Hospitals and OneCity Health Executive Committee, the OneCity Health Stakeholders Committee structure will be modified to provide more focus on the issue of workforce planning and training and to allow for greater inclusion of our labor partners in our efforts to transform into a more tightly integrated, health and wellness focused delivery system.

The James L. Zadroga 9/11 Health and Compensation Act was passed by Congress and signed into law on December, 18, 2015. The bill extends the Zadroga medical program, which includes NYC Health and Hospitals’ World Trade Center Environmental Health Center program, for 75 years. The bill extends the companion Victims Compensation Fund for five years. Thank you to all of those who worked so hard for passage. The World Trade Center Health Program is a priority of NYC Health and Hospitals. We are proud to continue rendering essential 9/11-related care and services for decades to come.

Governor Andrew Cuomo has released the State Executive Budget for 2016-2017. Our legislative team is currently analyzing the proposal for its impact to NYC Health and Hospitals. During the legislative session we will work with state legislators and our union partners to advocate for our vital access provider funding and to preserve our indigent care funding levels.

Mayor Bill de Blasio’s preliminary budget was released on January 21, 2016.
It includes a provision to assist NYC Health and Hospitals with ongoing financial challenges.

$337 million will be directed to our system as an offset to federal and state charity care funding reductions that we have absorbed.

We appreciate the City’s bridge assistance as we transform our essential system to achieve financial stability.

As we all know, the shortage of skilled primary care physicians grows more acute every day, as fewer medical school graduates choose a career path in family medicine.

But we are in the position to do something about this. Because we provide the training opportunities that medical schools need.

We should use this leverage to create a pipeline of doctors to work in the public hospital system. Medicine is treated differently than other professions by the federal government, because medical residency programs are supported with tax dollars.

But taxpayers should have the right to expect a return on their investment. They should receive the health care services that they need, rather than a glut of specialists that they don’t. And Medicine should honor an ethical obligation to give back to the society that supports it. Instead, we have passively stood by, while newly-minted physicians shun primary care in favor of more lucrative specialty fields.

I am proud that NYC Health and Hospitals is working hard to change this dynamic.
We have partnered with St. George’s University Medical School to create the CityDoctors scholarship program. It’s a program that I am glad to recognize today as NYC Health and Hospital’s Program of the Month.

Earlier this month we held a beautiful ceremony at NYC Health and Hospitals/Harlem Hospital to award scholarships to 17 very deserving young New Yorkers representing all five boroughs.

In return, these students have committed to serving as primary care physicians in the public system after their education and training concludes.

Our CityDoctors program is a great start. But the program should be scaled up, to include partnerships between NYC Health and Hospitals and all the medical academic institutions in New York City.

We should develop a pipeline of physicians that the City can truly depend on. Physicians who grew up in diverse communities all across this city. Physicians whose deep cultural and linguistic connections will enable us to deliver more effectively on our mission of providing comprehensive, personalized health care to all New Yorkers.

All of the CityDoctors scholarship winners announced early this month have already begun their studies at St. George’s University, and so could not be with us tonight.

But I think we can give them—and the CityDoctors program a round of applause anyway.

As we know, 2014 marked the deadliest worldwide Ebola outbreak on record.
It killed more than 11,300 people and infected more than 28,500 others.

We all remember the alarm and fear here in New York…
…fear that was calmed only after we discharged Dr. Craig Spencer from Bellevue with a clean bill of health. The crisis demonstrated something very clearly:
New Yorkers depend on us to shoulder the responsibility of managing public health emergencies like Ebola.

The City, State and Federal governments depend on us. Our competition, the other health care systems in New York depend on us. And we came through for them. We delivered. We kept the city safe.

Last week, the World Health Organization finally declared an end to the 2014 outbreak. This is extremely welcome news.

But we have not, and will not, withdraw from our intensive engagement with Ebola and other highly infectious diseases.

On the contrary, we are growing our mission. We are taking a leadership role in preparing our system, our region, and our country for the next outbreak.

Which is why today we honor our Ebola specialists as January’s Team of the Month.
These colleagues are doing great work on three different levels simultaneously:

• Within our own health care system.
• Regionally, in our capacity as one of only 9 federally designated referral treatment centers for patients with Ebola or other severe, highly infectious diseases.
• And nationally, as one of three medical research institutions to co-lead a new National Ebola Training and Education Center in partnership with Emory University and the University of Nebraska.

They have implemented a system-wide plan to recognize, evaluate, and treat patients who have contracted special pathogens.

They have secured $10 million in competitive grant funding from the U.S. Department of Health and Human Services to help ensure that the logistics, planning and training we do now, will result in an effective and prepared response in the future.

As a result of our effort, NYC Health and Hospitals is among only a handful of institutions across the nation fully trained and equipped to handle the most advanced and complex infectious disease scenarios.

So, tonight in the aftermath of the World Health Organization announcement, we offer our appreciation and congratulations for work well done to our Ebola team— represented here this evening by:

• Dr. Ross Wilson, Chief Medical Officer
• Dr. Nicholas Cagliuso, Assistant Vice President for Emergency Management
• Dr. Laura Evans, Medical Director for Critical Care at NYC Health and Hospitals/Bellevue
• Patricia Ann Tennill, RN, Assistant Director of Nursing at NYC Health and Hospitals/Bellevue