REPORT TO THE BOARD OF DIRECTORS – July 2021

COVID Cases – Positive COVID-19 cases have increased throughout New York in the past week as vaccinations slow. The highly transmissible Delta variant has been the most dominant COVID-19 strain in New York City — and virtually every important infection metric in the city is moving in the wrong direction. At NYC Health + Hospitals, the steady declines in COVID-19 hospitalizations and ICU admissions that we saw over the last few months have also begun to turn. Fortunately, our patient load is relatively small, but we have seen a slow increase – with hospitalizations in the 50s and about 15 ICU cases system wide. The hospitalizations we are seeing are overwhelmingly among the unvaccinated. We continue to promote vaccinations and testing as our best tools to fight the epidemic. And all our health care facilities continue to require face masks for all staff, patients and visitors.

Vaccine or Test Requirement for all City Workers – I am so proud of the role NYC Health + Hospitals has played during the COVID-19 pandemic. Our dedicated staff came together as a system to serve, help, and save New Yorkers. Now it is time for us to take additional steps to keep our patients and each other safe.

As the mayor announced last week, starting Monday, August 2, we will ask all our staff to protect their patients and each other by taking one of two steps: Get a COVID-19 vaccine if they are not already vaccinated or go for weekly COVID-19 testing to be certain that they do not transmit this virus. The City went a step further this week and announced that starting this fall, all City workers who have not received a COVID-19 vaccine must also test weekly for the virus.

Although we all wear masks at NYC Health + Hospitals facilities, we know that the Delta variant is incredibly contagious. And we know that vaccines work in preventing people from getting sick with this strain. We also know some of our patients are at risk for COVID-19 because of underlying illness; some of those illnesses such as immunosuppression may prevent them from mounting an adequate response to the vaccine.

That’s why we must do everything possible to protect our patients and each other. We are working collaboratively with all our staff, facility leadership and labor partners to make it easy to be vaccinated or tested weekly. We will continue to offer walk-in vaccination and testing across our health system sites, and we will make testing available for all shifts.

We’ve come a long way from once being the ‘epicenter of the epicenter’ of COVID-19, but this pandemic is not over yet. We have a moral responsibility to take every precaution possible to ensure we keep ourselves, our colleagues and loved ones safe. Our City’s new testing requirement for City workers provides more piece of mind until more people get their safe and effective COVID-19 vaccine.

NYC Test & Trace Corps – Our NYC Test & Trace Corps team has continued to provide a strong layer of protection for NYC. We are currently reaching more than 90% of all new cases. We have also served nearly 21,500 total guests in our Take Care hotel program. To date, NYC Health + Hospitals has completed more than 3.5 million COVID-19 diagnostic tests at all of our sites, including our hospitals, Gotham Health centers and Test & Trace locations.

It’s hard to believe it’s been two years since we launched NYC Care – our health care access program for New Yorkers who cannot afford or are not eligible for health insurance. We marked the milestone moment this week by teaming up with our partner community-based organizations (CBOs) for a ‘Week of Action’ and City-wide membership drive. We launched the Week of Action with our partners in BronxWorks as part of the City Hall in Your Borough series of community events.

We have been able to enroll more than 80,000 New Yorkers to NYC Care – many of them have accessed health care for the first time. And now we are stepping up enrollment efforts all across the five boroughs to help get us to 100,000 members. By connecting people in a permanent way to quality health care, we have begun seeing improvements in chronic diseases among this group of patients, and so much more. This important milestone would not have been possible without the work of our trusted CBOs who are helping us reach New Yorkers who need us most.

In addition to this membership drive, NYC Care recently released video testimonials featuring four immigrant New Yorkers who shared their personal tales of struggles without health insurance and how the public health system’s NYC Care program got them back on track to live their healthiest life. Click here to view the videos. To enroll in NYC Care, New Yorkers can call 1-646-NYC-CARE or visit nyccare.nyc for more information.

In a year that saw unprecedented challenges within the entire health care community, our health plan MetroPlus Health, was ranked number one among all 15 New York State Medicaid plans in overall quality, according to the New York State Department of Health’s 2020 Quality Incentive results. Key factors contributing to the top ranking, where MetroPlus Health scored above 90% of State benchmarks, included care related to diabetes, hypertension, substance abuse disorders and mental illness.

While our health plan has consistently scored high in quality, having achieved the #1 spot during a global pandemic speaks volumes about our dedicated team and their focus on our members. Just like our front-line clinical staff sacrificed their own needs to put patients first, our MetroPlus staff prioritized member needs, directed them to COVID-19 testing and vaccine, and provided other supports to help with day-to-day essentials. Even through this difficult time, more New Yorkers chose MetroPlus – we grew membership by 15% to more than 620,000 members.

Federal – The House Appropriations Committee recently approved the FY-22 Labor, Health and Human Services, Education and Related Agencies (LHHS) funding bill. The bill includes the five NYC Health + Hospitals Community Project Requests, otherwise known as earmarks, that were selected by the NYC House delegation. There is still a long and competitive road ahead, as these proposals need to make it into the Senate bill, and then through negotiations between the House and the Senate. We reiterate our thanks to both of our Senators and so many of our Representatives for supporting and shepherding these initiatives. As the Biden Administration and Congress consider infrastructure funding, NYC Health +Hospitals and our industry partners continue to reinforce the importance of including funding for hospitals and health care facilities in any funding package, whether the developing initial infrastructure agreement or subsequent vehicles. The COVID-19 pandemic has brought into stark relief how much we need infrastructure support both to continue battling COVID-19 and for the unknown future.

City – We are grateful to our City representatives for the support they provided through capital awards for FY-22. The Borough Presidents collectively awarded us $16M, the City Council awarded us $13M, and the Mayor’s Office supported us with $5M. Our individual facilities and our health system will benefit from this support for critical capital investments. Many thanks.

Community – On July 23, 2021, NYC Health + Hospitals hosted the 17th Annual Marjorie Mathews event to honor our Community Advisory Boards and Auxiliaries who devote so much of their time and talent to support our facilities. The event was primarily conducted over WebEx, though we were lucky enough to welcome our special award winners and their guests at NYC Health + Hospitals/Queens in a COVID-safe way. The event recognized Dr. Anthony D. Andrews, Chairperson of the Council of Community Advisory Board, with a lifetime achievement award for his dedication and service to NYC Health + Hospitals over the last 20 years. Also honored were the Co-Chairs of the Central Council of Auxiliaries, Ms. Judith Berdy and Nicole Shearman, two CAB members, Gloria Thomas (Kings County CAB) and Theresa Scavo (Coney Island CAB), for their exemplary work on behalf of NYC Health + Hospitals during these extraordinary times. We are grateful to the Board members who joined us remotely, several of our facility CEOs and leaders who joined us, and Council Members Selvena Brooks-Powers and Adrienne Adams for attending and supporting us.

FEMA Reimbursement – New Yorkers are tough and resilient by nature and we will eventually contain the COVID-19 virus—but at a personal cost and expense. To date, NYC Health + Hospitals has incurred approximately $2 billion in expenses fighting the pandemic and will likely have to spend more if the Delta Variant is not addressed. As a safety-net health care delivery system we cannot absorb this level of expenses — Federal assistance is needed. Over 18 months ago NYC Health + Hospitals was one of the first hospital systems in the country to seek assistance from FEMA and to date only $266 million has been received.

On June 11th I sent a letter to FEMA Administrator Criswell seeking immediate attention to our outstanding request. In the letter we ask for FEMA to approve $1.19 billion in outstanding documented expenses—which we believe fully meet the regulatory requirements for a FEMA claim and the intent of Congress who appropriated these funds for this purpose. We are very optimistic that FEMA will respond expeditiously to our request. We sent a follow up on Friday the 23rd, reiterating our needs and the urgency of our request.

I would also like to thank Senator Schumer Representative Ritchie Torres and the rest of the New City Congressional delegation who sent to FEMA a letter advocating on the behalf of the NYC Health + Hospitals’ request and recently held a press conference to broadcast this issue at NYC Health + Hospitals/Lincoln on Friday, July 23rd. We are very grateful for the support of our delegation because without it we would not be able to continue with our mission of providing health care to low incomes New Yorkers and immigrants. We are also very thankful for our partners in City government at the Mayor’s Office of Federal Legislative Affairs and the Office of Management and Budget, who are side by side with our Offices of External Affairs and Finance in this advocacy.

Budget – The system had an FY-21 closing cash balance of $737M (33 days cash-on-hand). This is right in line with the System’s target from the Executive 2022 Financial Plan. We had a net budget variance of -$10.9M, through May FY-21. The variance excludes T2 revenue and includes about $630M in COVID costs that we have not received Federal relief for yet. Our direct Patient Care Receipts came in $459M higher than YTD May FY-20 continuing the pace of positive performance that we experienced during FY-20, where direct patient care revenue came in $500M over the prior year. Our patient care volume is returning to pre-COVID levels in Q3 of FY-21 but is still below Q3 FY-20. Revenue base is strong and resilient primarily driven by Medicare rate increases and the stability of VBP/sub-cap contracts.

Overall, our Strategic Financial Initiatives remain on track with our post-COVID strategies, generating $604M with a line of sight of $662M. Strong areas of performance include:

• Value Based Payment Initiatives (e.g., HARP conversions & panel management)
• Managed Care Contract Negotiations
• Revenue Cycle Improvement

We have made staffing investments consistent with our overall system needs with additional RN and targeted nursing support positions to help support COVID surge needs and stabilize ongoing services.

Given the time sensitivity, I have recently approved two contracts that would otherwise have been brought to the Board.

The first is a contract amendment with Rapid Reliable Testing NY, LLC (RRT) for emergency COVID mobile units for testing and vaccination, for a nine-month period, with funding from the City’s Office of Management and Budget (OMB). RRT is the only laboratory in contract with NYC Health + Hospitals, which also operates a fleet of ambulances, and the only ambulance company in contract with us with laboratory capacity. RRT is uniquely qualified to administer overdose care, COVID vaccinations, and rapid, on-site COVID testing as well as to scale up capacity as needed. The contract amendment has a not-to-exceed value of $9M.

The second exception is a contract amendment with Optum Insight, Inc. to expand their emergency call center work to include calls to the public to encourage vaccination. The original agreement was limited to telephone work to identify the contacts of people who tested COVID positive, and to encourage them to get tested and isolate. This was a re-purposing of $18.5M of allocated contract funding, and involves no new costs. This work is also funded through OMB.

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