REPORT TO THE BOARD OF DIRECTORS – January 2018

Good Afternoon

I am so happy to be back home in New York City, and honored to be President and CEO of NYC Health + Hospitals. I want to thank the Board and the Mayor for their support.

As this is my first report to the Board, I want to use the opportunity to lay out the challenges before us and how I see us succeeding.

NYC Health + Hospitals is an amazing organization with an outstanding mission: Care of one million New Yorkers, 400,000 of whom are uninsured. It’s a system with a proud history: the first public hospital in America (NYC Health + Hospitals /Bellevue), the first open heart surgery performed in New York State (NYC Health + Hospitals/Kings County) and the first long-term care beds in the United States for people living with AIDS (NYC Health + Hospitals/Coler).

We have trauma departments that literally breathe life back into persons who are pulseless. And as is apparent from just my second week, NYC Health + Hospitals is full of committed, mission driven people who want us to succeed.

But to succeed we must modernize our operations. We need to focus our efforts in the ambulatory care area. There will always be a need for great trauma centers and hospitals, but health care has moved to a world where both patients and payers expect that most care is provided outside of the hospital.

We need to connect every patient in our system who has a chronic disease to a primary care provider. A large body of evidence demonstrates that longitudinal care – provides higher quality care at lower costs. Every clinician can tell you why. When you know patients over time, you know their preferences; you know how they respond to illness; you understand their social situation. And longitudinal relationships facilitate the healing role of therapeutic relationships. And you don’t have to be a doctor to make a difference. One of the most therapeutic relationships I ever saw develop was between a middle-aged woman receptionist in a San Francisco AIDS clinic and a frightened young man.

Over the next several years we will expand primary care teams, including case managers and community workers to improve access, quality, and patient satisfaction. We will use the tools of population management to ensure we are reaching all who need us.

We must improve specialty care by shortening wait times. We will do this through a greatly expanded electronic consultation system. Electronic consults enable primary care doctors to consult with specialists about the needs of their patients. They result in decreased wait times and more efficient specialty visits. NYC Health + Hospitals has already developed the capability to do electronic consults, but it must expand from a few clinics and a few specialties to the way we do specialty care system-wide. We also need a central Call Center for scheduling our patients and directing them to the appropriate facility.

When we expand our primary care capacity and have a robust electronic consultation system in place we will be able to successfully increase enrollment from insured persons, which will improve our revenues. Metroplus is a valuable asset for us, but for it to realize its potential, we must have sufficient outpatient capacity.For our inpatient services, we must ask what are the services that we need to grow and what are the services that we need to change. For example, NYC Health + Hospitals has many acute detox beds but no longer-term substance treatment facilities. The result is patients have many hospitalizations without being given the best treatment for long term sobriety. Similarly, we have most of the acute mental health inpatient beds in New York City, but we lack longer-term residential treatment programs. Substance addiction and mental illness are chronic diseases best treated with long term care plans.

Correctional Health is an integral part of NYC Health + Hospitals. Incarcerated persons are among the most vulnerable for serious health problems. When they are released from jail they are in our clinics, on the train next to us, in the apartment next door. We need to care for them when they are incarcerated and assure a tight connection to our primary care systems.

We need to open urgent care centers at our hospitals so that patients with more minor illnesses do not need to go to the emergency room. This will save money, and provide a better-quality service.

Our financial situation is precarious. We will always need help from the City of New York to support the care of the uninsured. But that amount must be predictable and defendable as an appropriate subsidy for care provided. The amount of subsidy that the City was required to put into NYC Health + Hospitals has grown over the last couple of years, primarily due to loss of federal supplemental payments. But these payments are not likely to return to prior levels. Even if the federal administration were more supportive of public health care, funding has moved to payment for delivering value, not for keeping people in the hospital. We too must move to demonstrate the value of our care.

There are no easy answers to our financial situation. I agree that we cannot simply “cut” our way out of the budget gap. However, we must provide services in more effective ways. People will need to do different jobs in different places for us to be able to deliver the right service at the right time in the right place by the right person.

I commit to our NYC Health + Hospitals facilities and long term care teams that the health system’s Central Office exists to serve you, not the other way around. As a practicing clinician, I know that the action occurs on the hospital floor, in the clinic, in the rehabilitation unit, and in the home. The Central Office will make it easier for you to deliver the high-quality care that uplifts our patients and ourselves. Every episode of care in NYC Health + Hospitals should represent the care we would want for our parents and our children.

To achieve our vision, we will work collaboratively with front line workers, with organized labor, with our community partners, and all those who want to see public hospitals succeed. Collaboration is not telling people what you want to do and asking their approval. Collaboration means we each bear the responsibility of helping NYC Health + Hospitals out of its financial troubles. We have the same goals. Now we must realize them.

I am a 100% in. I will do whatever it takes. I know there is a large community of people, both inside and outside of NYC Health + Hospitals, who are prepared to do the same to assure the success of our nation’s first and largest public hospital system.

Current Congressional authorization for the funding of the federal government expires this Friday January 19th. Congress is poised to pass a continuing resolution (CR) to avoid a government shutdown and authorize the funding of federal government operations. The new CR may include provisions to;

• Extend the Children’s Health Insurance Program (CHIP) which expired over 100 days ago. National media reporting indicates that several states, New York among them, are close to running out of funding for CHIP.
• Continue funding for the nation’s community health enter program (FQHCS)
• Delay implementation of reductions to Medicaid Supplemental Disproportionate Share Hospital funds called for under existing federal statute.

Governor Cuomo released the New York State FY2018-19 executive budget proposal on Tuesday. The budget is roughly $168 billion, with a $4.4 billion budget deficit. The Executive Budget limits spending growth to 2% which will help mitigate the gap. The Governor’s budget extends the current DSH distribution formula for one year. If the Federal Government does not delay the cuts to DSH payments and the current State distribution formula is maintained, NYC Health + Hospitals will lose $329M this federal fiscal year. Currently we are working aggressively with the Mayor’s Office, Hospital Associations and legislative allies to delay devastating cuts to Disproportionate Share Hospital (DSH) funding currently mandated under federal law. DSH is our primary source of federal funding.

• The Governor’s budget proposal assumes continuation of the Essential Health Plan under which MetroPlus has approximately 72,000 members.
• The Governor’s budget proposal also assumes an extension of the Children’s Health Insurance Program (CHIP), and allows for modification of the state’s program by the State Budget Director if necessary to preserve services in face of federal reduction, or a failure to reauthorize.

The budget does not include the potential of a $2 billion cut in Federal funding for health care. However, to address the potential federal risk association with DSH, Essential Plan and CHIP, the Executive budget:

• Establishes a Health Care shortfall fund of $1 billion to preserve services in face of shortfalls in federal reimbursement for health care programs administered by the State or ensuring the continued availability and expansion of funding to improve health care delivery.
• Extends Medicaid “Superpowers” on the part of the Governor, through State fiscal year 2020.

The budget proposal also includes $40 Million in safety net funding, however, the distribution methodology of these funds is not outlined in the language and is instead left to the discretion of the State Department of Health.

NYC Health + Hospitals staff is reviewing the State budget documents for full impact and will work with our colleagues in City Hall and our union and community partners to advocate for NYC Health + Hospitals on all relevant State budget issues.

New York City Council Member Corey Johnson, previous chair of the Council’s Committee on Health, has been chosen as the Council Speaker for the next four years. The Council has also reorganized the manner in which it will conduct oversight for health care in New York City, by establishing a new Committee on Hospital Systems, to be chaired by Council Member Carlina Rivera, along with the existing Committee on Health, chaired by Council Member Mark Levine, and Committee on Mental Health, Disabilities, and Addiction, chaired by Council Member Diana Ayala.

NYC Health + Hospitals looks forward to working with each Council Member on their new assignments.

OneCity Health distributed Phase III Comprehensive Schedules B contracts to OneCity our partners in December, 2017 which outline obligations until the end of DSRIP in March, 2020. For the initial budget period, which runs from January 1, 2018 until December 31, 2018, the OneCity Health Executive Committee approved $162M for the partner share of funds, including $89.5M for the Comprehensive Schedules B contracts and $5M for a partner Innovation Fund.

Between January and July 2017, Action Teams from NYC Health + Hospitals/Bellevue and NYC Health + Hospitals/Lincoln participated in the New York State DSRIP Medicaid Accelerated eXchange (MAX) Series, which focused on improving care for High Utilizer patients, with a goal of reducing inpatient admissions by ten percent over a six month period. New York State announced results in December, 2017.

• The Action Team from NYC Health + Hospitals/Lincoln established four linkage pathways for high utilizers – Patient-Centered Medical Home (PCMH) program, Health Home, a transition manager or care management. Greater than 51 percent of patients were connected to services post-discharge and received warm hand-offs to key services.
• The Action Team from NYC Health + Hospitals/Bellevue coordinated with the NYC Health + Hospitals Health Home and Home Care teams to follow patients in the community, leading to a 17 percent decrease in their readmission rate.

In January, OneCity Health launched a pair of initiatives aimed at enhancing primary care across NYC Health + Hospitals and the OneCity Health Performing Provider System (PPS).

• Monthly web-based Primary Care & Population Health Grand Rounds and cover topics ranging from practical strategies to effectively treat obesity to offering buprenorphine treatment to patients. Participants are eligible for CME and CNE credits.
• January through March, OneCity Health and the MJHS Institute for Palliative Care are hosting palliative care case conference covering topics from initiating a goals-of-care discussion to management of patients with chronic pain. Participants are eligible for CME credit.

Earlier this month Mayor de Blasio announced the expansion of 60 new skilled nursing facility beds at NYC Health + Hospital/ Gouverneur to increase short-term rehabilitation and long-term services for clinically complex cases at our post-acute care facility. The new beds will occupy two new units to be constructed at Gouverneur’s Madison Street campus. The units, being built in previously unused space at the facility, are expected to be fully operational by April. To accommodate the new capacity, Gouverneur has begun hiring the approximately 75 health care professionals, including nurses, doctors, therapists, social workers, and dieticians needed to run the units. The 295-bed facility is one of the country’s top post-acute care centers. The skilled nursing beds are part of a larger project announced by the Mayor that also includes affordable homes for approximately 100 seniors.

I am glad to have the opportunity at my first board meeting to bring to your attention this expansion of best-in-class nursing care and rehabilitation services at NYC Health + Hospitals. The project will provide much-needed continuity of care to many more residents of the Lower East Side, as well as other patients served by the 11 hospitals in our public health care system.

NYC Health + Hospitals/Elmhurst and Queens Library have announced a new series of free educational events to increase health care literacy for Queens’ residents. The series features discussions at Queens Library branches throughout the borough led by NYC Health + Hospitals/Elmhurst providers who are experts on a range of topics. The events are open to the public and will focus on emergency preparedness, adolescent health, hypertension, CPR training, depression, and other topics. The ongoing collaboration is part of the library’s Community Health Service program. For a list of event dates, please visit our website.

NYC Health + Hospitals welcomed the health system’s first baby of 2018 on January 1 at 12:23 a.m. at NYC Health + Hospitals/Lincoln, in the Bronx. The baby boy, Brysen Duarte Rivera weighed 3 lbs. 7 oz. Baby Brysen was soon followed by our health system’s first baby in Brooklyn, Baby boy Joshua Miguel Brito, who was born at 12:25 a.m. at NYC Health + Hospitals/Woodhull, weighing in at 6 lbs. 14 oz. Congratulations to both families. I thank all the labor and delivery teams across our system who work that midnight shift and helped deliver the newest New Yorkers. And I encourage you all to visit our website to see adorable pictures of both babies.