REPORT TO THE BOARD OF DIRECTORS – July 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.

NYC Health + Hospitals Harlem is among four NYC Medical Centers selected to be part of National Institute of Health (NIH) research aimed at preventing and treating disease based on individual differences. The Precision Medicine Initiative (PMI) is a $46 million dollar, five-year, study to extend personalized medicine to a variety of human diseases. We are delighted that Harlem has been included in this “participant-powered” research that holds out the promise of transforming our delivery of equitable care to the city’s most vulnerable populations. Our collaboration with Columbia University Medical Center (CUMC), Weill Cornell Medicine and New York-Presbyterian underscores the critical role that we play in medical education and cutting edge research to benefit the communities we serve.

The aim of the prestigious study is to engage a million people in a significant research effort to improve the nation’s ability to prevent and treat disease based on individual differences in lifestyle, environment, and genetics. Harlem and its partners will ensure that participants in the research represent the geographic, ethnic, racial and socioeconomic diversity of the country. On a local level, the goal is to enroll 150,000 culturally diverse volunteers/participants by 2021.

According to the NIH, the PMI Cohort Program is one of the most ambitious research projects in history and will set the foundation for new ways of engaging people in research. PMI volunteers will be asked to contribute a wide range of health, environment and lifestyle information. They will also be invited to answer questions about their health history and status, share their genomic and other biological information through simple blood and urine tests and grant access to their clinical data from electronic health records. In addition, mobile health devices and apps will provide lifestyle data and environmental exposures in real time. All of this will be accomplished with essential privacy and security safeguards. As partners in the research, participants will have ongoing input into study design and implementation, as well as access to a wide range of their individual and aggregated study results.

Last week NYC Health + Hospitals launched an exciting new marketing campaign to promote health care services for adolescent New Yorkers.

Emphasizing sexual and reproductive health, the campaign features a new youth health services website at nycyouthhealth.org and extensive social media with provocative and fun emojis on Facebook, Instagram and other platforms expected to reach the social news feeds of up to 2.4 million NYC adolescents in the next three months.

The goal of the new campaign is to clearly let young people know that our NYC Health + Hospitals YouthHealth centers are here to help regardless of their ability to pay, their immigration status, gender identity or sexual orientation.

The campaign is garnering terrific interest from the media and its target audience of young people. The New York Times, the New York Post, Teen Vogue and Becker’s have all run feature stories, and the new website has received almost 10,000 unique page views since the launch last week.

Whether it’s birth control, pregnancy testing, emergency contraception or depression screening, the public health system has affordable services in local community health centers, where we speak our young patient’s language, understand their culture and will always respect their privacy in a confidential and non-judgmental environment.

In 2015 alone NYC Health + Hospitals saw 152,000 adolescent patients. NYC Health + Hospitals community health centers are also uniquely situated in neighborhoods that experience disparities in care, where adolescent pregnancy rates and STD rates are higher, and where access to care is difficult.

In addition to the social media campaign and the new website, the YouthHealth campaign includes posters, brochures, wallet-size cards with the website address, and ad panels that will be posted in City hospitals. Community-based organizations near NYC Health + Hospitals health centers are partnering with the system to distribute the materials. Google search ads will also direct people searching for services to the website.

This month we began posting bold, colorful, outdoor banners promoting NYC Health + Hospital services.

By the end of the summer, 840 banners will be installed in the vicinity of our hospitals, long term care facilities and neighborhood health centers for a total of 66 sites. They utilize great photography, and our new brand graphics to tell the story of our different facilities. The banners represent the first time ever that our system has presented a unified, outward-facing, identity to the city we serve. Metroplus is also featured on the banners as our sponsor.

Let’s take a moment to watch a quick video that offers a sneak preview of what will be going on city wide over the next month:

Earlier this month the New York City Council approved plans to build supportive, affordable housing on an underutilized parcel on the campus of NYC Health + Hospitals/Woodhull in Central Brooklyn. The project demonstrates our commitment to address housing instability, a major social determinant of health, by creating safe, supportive and accessible housing for low-income individuals and patients managing mental illness. It’s also a good example of our Vision 2020 transformation in action: We are simultaneously improving our delivery of care while also strengthening the financial viability of the public hospital system.

The proposed six-story structure will be built on a leased hospital parcel by Comunilife, a non-profit, community based organization that will develop the building and provide on-site social services helping to keep residents closely connected to the hospital’s comprehensive health services.

This type of supportive housing has been proven to improve the health of sick individuals, prevent some health conditions before they develop, and reduce costly health services. The New York City Council granted the last needed approval for NYC Health + Hospitals to lease 13,000 square feet of property to Comunilife. The project already received necessary state approvals and had the early endorsement of local Council Member Robert Cornegy.

The building will be located on the corner of Park and Throop in Bedford-Stuyvesant, and will feature 89 studio apartments for low income residents who earn less than 60 percent of the area’s median income, or less than $36,300; 54 of the units will be designated for income-eligible residents living with mental illness. Construction is expected to begin in late 2016 and be completed in 2018. Building features will include:

On site social services
Laundry room
Community room
Computer room
Bike storage
Landscaping
24 hour doorman security

Last month we announced the appointment of Israel Rocha, Jr. as Chief Executive Officer of NYC Health + Hospitals/ Elmhurst in Queens. Mr. Rocha’s expertise in hospital operations, legislative affairs, and federal and state funding programs will aid the NYC Health + Hospitals Vision 2020 transformation goals toward financial stability and growth.

His experience working with the Centers for Medicare and Medicaid Services (CMS) and the Delivery System Reform Incentive Payment Projects (DSRIP) as well as his knowledge of the workings of the federal government make him an important addition to our team as we confront policy shifts in Washington and work toward building more support for our essential public health care system.

Mr. Rocha was the Chief Executive Officer of Doctors Hospital at Renaissance (DHR) in Edinburg, Texas, a 513-bed facility which is comparable to Elmhurst’s size with 545 beds. While at DHR he led key initiatives that helped the hospital transition from a general acute care hospital into a comprehensive medical and teaching center. Prior to becoming CEO, Rocha served as the Government, Public and Corporate Affairs Officer at DHR. A South Texas native who graduated from Columbia University, he also worked for 10 years at the U.S. House of Representatives. We are delighted to welcome Mr. Rocha to our health care system.

NYC Health + Hospitals today announced two more hospitals in the city’s public health care system have earned the prestigious “Baby-Friendly” designation for promoting the highest level of care for infants through breast feeding and promoting bonding between mother and baby. The recognition is awarded to hospitals all over the world by Baby-Friendly USA, part of an initiative of the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF).

NYC Health + Hospitals/Bellevue in Manhattan and NYC Health + Hospitals/Jacobi in the Bronx received the designation this month for providing the optimal level of care to mothers and their babies. Other hospitals in the health system that have earned this designation include NYC Health + Hospitals/Lincoln, NYC Health + Hospitals/Harlem, NYC Health + Hospitals/Queens and NYC Health + Hospitals/North Central Bronx. There are only eight hospitals in NYC that have received the designation.

To receive the designation, the hospitals were required to meet or exceed patient care standards in a rigorous on-site evaluation by the Baby-Friendly Hospital Initiative, including:

• A comprehensive education program that offers mothers the information, confidence and skills needed to successfully initiate and continue breastfeeding their babies.
• Immediate skin-to-skin contact for mother and baby after birth. Intensive education of both patients and hospital staff about the important benefits and management of breastfeeding.
• Allowing newborns to stay with their mothers 24-hours-a-day during postpartum care.
• Providing connections for breastfeeding support groups in the area.
• Train all health care staff in the skills necessary to implement this policy.

In 2015, 2,400 babies were born at Jacobi Hospital – 97% of the babies receive mother’s milk. Jacobi has been a leader in maternal and pediatric care for many years. The hospital offers a Level 3 Neonatal Intensive Care Unit and is the Regional Perinatal Center for the area, meaning medical staff are highly trained and equipped to handle the most complicated maternity problems.

NYC Health + Hospitals/Coney Island recently marked the opening of its new critical care room in the hospital’s emergency department designed specifically to treat patients with the most serious, life-threatening injuries and illness. The new 450 square-foot area can be used to treat and evaluate up to two critically ill patients simultaneously and will help alleviate the busy community hospital’s emergency room. NYC Health + Hospitals/Coney Island Chief Executive Officer Anthony Rajkumar was joined by emergency department staff, Councilman Chaim Deutsch, Councilman Mark Treyger, Assemblywoman Pamela Harris, Assemblywoman Helene Weinstein, Assemblyman William Colton, District Leader Nancy Tong, and representatives from community organizations during a ribbon cutting ceremony to unveil the new space.

The new, fully equipped space is constructed with two patient bays, both including state-of-the-art medical equipment and technology necessary for staff to care for the most complex traumas. The area is large enough to accommodate many hospital team members such as respiratory, radiology, medical critical care, cardiology, surgery and others who may need to respond and assist the emergency department team. The cost of construction and equipment for the new critical care room is approximately $100,000.

• June 30, 2016 was the end of the first quarter of DSRIP Year Two and was a reporting deadline to the New York State Department of Health (NYS DOH) for our clinical projects which were underway across the entire OneCity Health network.
  We successfully surpassed our commitments for the Integration of Palliative Care into the Patient Centered Medical Home (PCMH) and Project 11.
  For the Integration of Palliative Care into the Patient Centered Medical Home (PCMH), 16 NYC Health + Hospitals neighborhood health centers and acute care facilities are providing simple advanced care planning to their adult patients.
  For Project 11, our NYC Health + Hospitals facilities and over 30 community partner teams have met all DSRIP commitments. We continue building workflows so that our non-Medicaid billing community based organizations can more easily link New Yorkers to primary care and care management providers.
• We continue progress with clinical project implementation across the entire OneCity Health network. A few highlights:
  • At Bellevue and Kings, transitions management teams are providing 30 days of supportive care management for patients at high risk of readmission. We expect to add two more NYC Health + Hospitals pilots over the next six weeks, and have identified five community based organizations who will work with our inpatient teams to provide the same service.
  • The OneCity Health team recently issued a Request for Proposal for consultant support in the integration of primary care and behavioral health services. This model of care includes the physical co-location of both services and will help NYC Health + Hospitals advance its good work beyond the collaborative care model currently in place.
• To support the building of a strong primary care network, the OneCity Health team is supporting PCMH certification for its community primary care partners. Our vendors are conducting outreach to partners for baseline assessment. Our NYC Health + Hospitals facilities will achieve certification via in-house efforts, as was successfully done in past.

Ambulatory Care:

At the two adult primary care clinics undergoing improvement: Kings County and Morrisania, the patient cycle time has been steadily decreasing for at least the past three months. At Kings County from 110 minutes in February to 76 minutes in June (31% decrease). At Morrisania from 74 minutes in February to 55 minutes in June (26% decrease). Morrisania now has the lowest patient cycle time of all adult clinics.

Emergency Services:

In the six facilities where Breakthrough is deployed (Bellevue, Jacobi, Kings, Metropolitan, Queens and Woodhull), the average length of stay for ESI 4&5s (subacute patients) has decreased since we started the improvements. Examples are: Kings County decreased from 183 minutes in March to 160 minutes in June, Bellevue from 137 minutes in March to 118 minutes in June, Woodhull from 156 minutes in March to 137 minutes in June.

Behavioral health:

At Kings County the total revenues for Adult, Child Adolescent and PHP services has increased by 15.4% since Breakthrough started a number of strategic improvements. One of the major improvements is the reduction of bed days per patients over 15 days per admission. This has resulted in $357,896 in cost savings. When combined with other revenue producing initiatives, there has been a total of $739,385 in new revenue and cost savings. In addition, The TNAA (third next available appointment) rate has been reduced from 37 days in January to 7 days in June (81% decrease).

• The Fund for NYC Health + Hospitals and the Department for the Aging are collaborating to launch a new community-based Music & Memory program in Bushwick. The program will bring personalized music playlists to seniors at the Woodhull-affiliated Diana H. Jones Innovative Senior Center who have dementia, and is the first of its kind in New York City. The senior center identified seniors for the program based on their dementia screening results and staff will monitor the impact of the program. Woodhull will provide speakers and special guests from its music therapy and pastoral care departments to augment the programming. This is NYC Health + Hospitals’ 10th Music & Memory site, with programs now active in all 5 long term care facilities and 4 hospital rehabilitation departments.
• On July 23, four adolescent health experts from NYC Health + Hospitals led the health panel at the Soledad O’Brien and Brad Raymond Starfish Foundation’s annual PowHERful Summit. This is the third consecutive year that The Fund has collaborated with the Foundation on this event, which brings together 250 young women from disadvantaged backgrounds for a day of educational, professional, and personal development.
• Since 2014, the Fund’s partnership with the Starfish Foundation has evolved beyond the PowHERful Summits. This summer, 2 Starfish Scholars are interning for NYC Health + Hospitals, and more young women are expected to intern with us going forward. This fall, The Fund and NYC Health + Hospitals / Workforce Development will also launch a mentorship program for Starfish Scholars.

Some institutions have an indelible footprint in certain fields:

Think of the University of Chicago for economics, the Kaiser Family Foundation for health care policy, or the Urban Institute for crime prevention. They have the intellectual heft and influence necessary to lead the way in their fields. When it comes to medical education and research, NYC Health + Hospitals is one of these institutions. We are a major player in the medical education firmament, here in New York City, nationally, and across the globe.

Through our partnerships with NYU, SUNY, Sinai, Touro, Einstein and others we are recognized for both the quantity and the quality of our contributions to the training of physicians, nationwide.

The statistics speak to our magnitude, especially when many underserved areas across the nation suffer from a physician shortage: This year alone, NYC Health + Hospitals has over 2000 medical students rotating in and out of our system. Nearly half of them enter via our innovative CityDocs Program, where Health + Hospitals selects students based on merit and need, for scholarships to St. Georges University Medical School. In return these students commit to practicing in the public hospital system after graduation.

Last year we trained 2500 residents, roughly 15% of all residents in New York State and 20% of the residents here in the city, in nearly 300 separate programs. We offer Anesthesiology, Urology and almost every conceivable specialty in-between, with nearly 1100 residents focusing on Internal Medicine, Family Medicine, or Pediatrics. Over the past decade, well over 20,000 residents have received their training in our system. In fact, we train more residents annually than all the teaching systems in most other states (38 states including D.C. and Puerto Rico).

Our trainees come from backgrounds involving all four corners of the earth, and all five boroughs of our city—they represent every culture, language, ethnicity and sexual orientation—and mirror the incredible diversity of our patient base. At least 24% are foreign born, nearly 39% are Asian, 10% are Latino and over 8% are or African or Caribbean American.

But it’s not just quantity that underscores Health + Hospitals’ commitment to training the doctors of tomorrow, it’s also quality. And that commitment is supported by a robust Research Administration which supports study of cutting edge medical interventions and devices, and new clinical and drug therapies.

We offer an unparalleled learning experience where doctors-in-training are exposed to patients from all over the world, who have very pronounced versions of illnesses or conditions. Many haven’t received treatment before coming through our doors.

By assisting attending physicians, by being the doctors who often spend the most time with the patients I’ve just described, our residents are a powerful tool for delivering high quality care. They help us attract the highest caliber faculty for whom teaching and mentoring make our system a more attractive and stimulating place to practice.

One more point: The importance of our medical education lay not just in the number of physicians we train, or in the benefit they bring to our patients and our organization: It also lies in the tremendous opportunity we offer to people of excellence and drive, some from the most downtrodden areas of New York City and abroad. We provide them with a chance to exercise their talents in an incredibly meaningful way, which should make each of our hearts swell with pride.

The number of talented faculty members and medical education directors from around our system would never fit in our board room. But they are with us today in spirit. Let’s offer a round of applause for the work that they do.

Last month I was delighted to give commencement remarks at residency graduations around our system, and to reflect on the fact that the medical education we offer is not just about creating doctors, it’s about transforming good people into great physicians.

Because training in the public system helps a young physician focus on what doctoring truly means. It’s not simply an assortment of skills and knowledge. Any system can teach that. But at NYC Health + Hospitals, we are different… Because in addition to the sort of categorical training a physician could learn in any teaching system, here we teach compassion. We teach empathy. We teach community involvement. We expose our trainees to the fullest experience of human struggle. And a great many of them come to us already well versed in those struggles.

Our Person of the Month, Dr. Luis Chavez recently graduated from the Internal Medicine residency program at Queens. He and his wife Francy Valencia not only suffered economic hardship, they experienced the searing pain of caring for a gravely ill child. And still, they endured. Dr. Chavez got himself to where he is today, in spite of all odds against him and his loved ones.

So, his story is a special one—so special that we are going to deviate from our normal practice and invite him to tell us directly about his career, his family, and about what NYC Health + Hospitals meant to his success. Dr. Chavez, welcome…