REPORT TO THE BOARD OF DIRECTORS – March 2017

The U.S. House of Representatives is scheduled to vote today on the American Health Care Act (AHCA), legislation introduced by the Republican leadership to repeal and replace the Affordable Care Act (ACA). Medicaid expansion states like New York would experience significant negative impact under this proposal, which reduces the enhanced Medicaid rate from 90 percent to 50 percent, and reduces funding for the Basic Health Plan. Disproportionate Share reductions for expansion states for FF 2018 and 2019 will mean an estimated negative impact to New York State of $1 billion. The bill eliminates the tax penalty on the individual and employer mandate.

Congressional “Coverage Caucus” members oppose AHCA for its draconian reductions in Medicaid spending ($800 billion over ten years) and projections that it will make comprehensive health insurance coverage unaffordable for lower income and older individuals, while “Freedom Caucus” members are highly critical of AHCA for not going far enough to roll back the ACA. Our analysis, based on State estimates, indicates that repeal would risk the coverage of upwards of 200,000 NYC Health + Hospitals patients. According to the Congressional Budget Office, under the House Republican leadership’s proposal, 14 million would lose coverage in 2018 with 24 million people losing coverage by 2026.

While our health system has been working diligently to overcome financial challenges and is on track to achieve targeted goals and savings this fiscal year, the federal government is threatening our stability. There’s no question that repealing the Affordable Care Act will compound our financial challenges and unacceptably jeopardize our ability to provide quality health care for the people who need it most. We are coordinating advocacy efforts against ACA repeal with members of the New York Congressional delegation, the Mayor’s Office, our union partners, and state and federal hospital associations including America’s Essential Hospitals, the American Hospital Association, Greater New York Hospital Association and Hospital Association of New York State.

Response to changing Federal health care policy

The Governor’s budget proposal (released in January) doesn’t include language to address the financial impact resulting from ACA repeal, but it does empower the Governor to redirect an unspecified amount of Medicaid funding in the event of federal policy changes. Last week the State Senate and Assembly passed individual budget resolutions rejecting special powers for the Governor to redirect Medicaid funds.

Safety Net and Capital Funding

In a veto message last year the Governor suggested that the budget process, rather than legislation, is more appropriate for increasing safety net reimbursement for systems treating a high proportion of Medicaid patients and the uninsured. However, his FY 2018 budget recommendation is silent on the issue. The Assembly’s budget resolution supports increased safety net funding (by $25 million in FY 2018, growing to $100 million in FY 2019), the Senate’s budget resolution does not. The Governor’s budget proposal includes $500 million for health system capital funding, $50 million of which is set aside for Montefiore Health System. The Senate’s budget resolution calls for $800 million in capital funding, while the Assembly’s resolution calls for $700 million.

Other Provisions:

The Governor’s budget proposes curtailing funds for nursing home bedholds, when a patient has moved temporarily for medical treatment to an acute care facility. Neither the Senate nor the Assembly are supportive of change to current law governing bedholds. The budget resolutions of both houses reject the Governor’s proposals to cut emergency department funding, and to retroactively penalize hospitals for unnecessary emergency room visits. NYC Health + Hospitals worked with legislative allies, advocates and labor partners to push back against these proposals.
As with the pending federal legislation mentioned above, NYC Health + Hospitals is actively coordinating with allies in Albany to effectuate legislation and administrative policy that is more favorable to our health system.

The “Blue Ribbon” Commission on Health Care for our Neighborhoods has released three issue briefs addressing the imperative that NYC Health + Hospitals transform in order to continue carrying out our mission while also achieving long term sustainability. The briefs are titled (1) Reenvisioning Clinical Infrastructure, (2) Building Clinical Partnerships and (3) Sustaining the Safety Net. These findings will help guide our development of consensus about meeting current fiscal challenges, transforming into a high-performing health system and reimagining how we will deliver high-quality health care, with limited resources. The issue briefs will be posted on www.nychealthandhospitals.org.

Last week the Joint Commission completed its triennial survey of NYC Health + Hospitals/Bellevue, and has accredited the hospital for the next three years. Over the course of 4 days Bellevue underwent an extremely thorough and rigorous survey process by a team of 8 surveyors, while simultaneously dealing with the effects of a blizzard that shut down much of the city. Consistent with the Joint Commission’s focus this year, the surveyors conducted countless tracers on inpatient units and ambulatory care clinics, and reviewed many processes, including infection control, radiology, medication management, performance improvement, contracts and the facility structure and environment. Surveyors recommended certain Bellevue best practices for submission to the Joint Commission database library, including the Rehab Discharge Planning and the Clinical Alarm process that is included in patient assessment.

Congratulations to William Hicks, CEO, Nate Link, MD, Chief Medical Officer, Michael Rawlings, COO, Kim Mendez, RN, CNO, Marcia Peters, Sr. Associate Executive Director, Clinical Management, and the staff of NYC Health + Hospitals/Bellevue, on a successful survey. Grateful thanks to Board Member Barbara Lowe, RN, for representing the Board and participating in the Leadership Session of the survey.

At a time that women’s rights to health care are being threatened, our health system has come forward to remind New York women of every age that we’re there for them. Women are the majority of caregivers in this country and the health care decision makers for their families. They take the lead role in choosing a family doctor, selecting a health plan, scheduling check-ups and making sure their loved ones are safe and healthy. Earlier this month we launched a digital marketing campaign that has driven increased traffic to our women’s health webpage, helping us make more New Yorkers aware of the comprehensive range of affordable women’s health services that we offer.

One of the campaign’s main features involved asking key stakeholders and social media influencers to share our message with their followers on Facebook and Twitter. Special thanks to our Board members Deputy Mayor Palacio, Commissioner Bassett, and Commissioner Banks for their support. The campaign continues throughout the month and we encourage everyone to participate. Please take a look at this brief slideshow highlighting some of the people who supported the effort.

In response to an epidemic of opioid overdose which claimed more than 1,000 lives in New York City last year, the City has launched HealingNYC, a comprehensive effort to reduce opioid overdose deaths by 35 percent over the next 5 years. The City will invest $38 million annually in order to:

• Transform NYC Health + Hospitals’ substance use care models to become a system of excellence in addressing harmful opioid use.
• Create new mental health clinics in high-need schools that account for a disproportionate share of suspensions and mental health issues, which can be precursors for substance misuse.
• Distribute 100,000 naloxone kits to health care providers, first responders and shelter providers so they have access to the tools they need to save lives.
• Make new investments in the Office of the Chief Medical Examiner and the NYPD to increase testing and information sharing necessary to better understanding the local drug environment, and by creating new Overdose Response Squads that target dealers, modeled on existing NYPD efforts in Staten Island.

As a result of NYC Health + Hospitals/Jacobi’s three-week on-site collaboration with IDNYC, 630 Bronx residents now possess a new IDNYC card–a government-issued identification card that is available to all City residents age 14 and older, without regard to Immigration status. An initiative of the de Blasio administration, IDNYC is the largest municipal identification card program in the nation. It enables residents to access City services, grants admission to City buildings, and can be presented as proof of identification for interacting with the police. IDNYC is also an accepted form of identification for opening a banking account at select financial institutions.

Last month NYC Health + Hospitals successfully implemented Epic, a state of the art Electronic Medical Record system at NYC Health + Hospitals/Coney Island. Epic has also been fully adopted at NYC Health + Hospitals/Queens, NYC Health + Hospitals/Elmhurst, the health system’s home care operations, and 20 community-based health centers in Queens in April 2016. Ultimately, it will unify 40,000 users across the public health care delivery system in more than 70 patient care sites. The new EMR seamlessly connects Coney Island, a 371 bed hospital in Southern Brooklyn with emergency room, and robust primary and specialty outpatient services into a unified electronic information system that helps physicians to provide safe, high-quality, efficient care and allows patients to easily access their medical records via a secure patient portal. More than 2,000 health care providers at Coney Island have been trained to use the new technology.

NYC Health + Hospitals/Coler has received a “five-stars” from the federal Centers for Medicare and Medicaid Services (CMS) —its highest rating, reflecting “much above average quality.” The new rating makes Coler the fourth of our system’s skilled nursing facilities to earn CMS’s highest ranking, and further cements our public health system’s reputation for offering post-acute care that is among the best in the city, and the country.

In the component measures that combine to provide the overall score, Coler maintained its perfect five-star rating in the coveted “Quality” category, which scores information on 11 different physical and clinical measures for nursing home residents, including information about nursing homes’ use of antipsychotic medications in both long-stay and short-stay residents. Congratulations to CEO Robert Hughes, and the entire Coler team.

NYC Health + Hospitals, in partnership with the Mayor’s Office of Immigrant Affairs, New York Immigration Coalition, and New York Legal Assistance Group is hosting four public “Immigrant Health Care Rights” panel discussions in March. These events are designed to reassure immigrant communities that it is safe to seek care, and let them know of our unwavering commitment to provide services to all New Yorkers, regardless of immigration status. The forums will help offer information and resources, and address a variety of important health care topics affecting immigrants, such as health care rights, access to care, and privacy concerns regarding immigration status.

In community engagement forums held in December, 2016 to inform the design and goals of health system transformation, participants provided feedback about ways NYC Health + Hospitals can improve services across the city, and raised areas of concern related to their health care. Questions about paying medical bills, the availability of health insurance for immigrant populations, Emergency Medicaid, financial support via New York State’s Financial Assistance Law, and access to primary and specialty care, were frequently raised and led to the development of more focused forums on immigrant health care rights being held this month.

A greater focus on care management is one of the strategies laid out in “One New York,” the report issued in April 2016 outlining New York City’s plan to transform NYC Health + Hospitals. Important to care management is improving our patients’ blood pressure control, which reduces their risk for stroke, heart attack, kidney damage, vision loss, erectile dysfunction, and memory loss.

Earlier this month we announced that over 72,000 patients receiving care for high blood pressure within our system now have their blood pressure under control, an increase of 2,200 patients over the course of just one year. The percentage of NYC Health + Hospitals’ patients (ages 18 to 75) being treated for hypertension whose blood pressure was under control (i.e., 140/90 or lower) between January 2016 and January 2017, improved from 62.5 percent to 65.8 percent. Nationally, 54 percent of people with high blood pressure have their condition under control, according to the Centers for Disease Control and Prevention.

Also this month, NYC Health + Hospitals launched a campaign to raise awareness of colorectal cancer, which is the second-leading cause of cancer deaths in New York City, killing approximately 1,400 New Yorkers each year, despite the fact that 90 percent of colorectal cancers are curable when caught early. The campaign is designed to let the public, staff, and especially New Yorkers aged 50-75, know about the importance of colon (or colorectal) cancer screenings. And about the fact that NYC Health + Hospitals makes screening a routine—and affordable– part of preventive health care.

OneCity Health is excited about the initiation and expansion of a number of programs and transformation efforts as the third year of DSRIP begins on April 1.

To support partners implementing care management programs, including Health Home At-Risk (primary care setting), Care Transitions (inpatient setting) and ED Care Triage (Emergency Department), OneCity Health continues to train care management staff on critical skills needed to properly care for high-needs patients, including documenting care plans and motivational interviewing. To date, we’ve trained over 77 individuals from NYC Health + Hospitals/Home Care, BoomHealth!, Harlem United, Village Care, Arch Care, Bridging Access to Care, Federation of Organizations, Selfhelp and Community Healthcare Network. We are also continuing to expand our efforts in these care management initiatives.

One City has begun piloting a Health Home At-Risk initiative in six NYC Health + Hospital/ Gotham sites and four community partner primary care practices (Community Healthcare Network, SUNY Downstate Medical Center, Center for Comprehensive Health Practice and Brightpoint Health). Through this intervention, primary care practitioners can make referrals to care coordinators provided by OneCity Health’s Health Home lead agencies, which are NYC Health + Hospitals, Community Healthcare Network and Community Care Management Partners. Six additional NYC Health + Hospital facilities (Belvis, Bellevue, Cumberland, East New York, Governeur and Morrisania) will soon begin to generate referrals as well.

Transition Management Teams (TMTs) continue to provide 30 days of supportive care management for patients at high risk of readmission at NYC Health + Hospitals/Bellevue and NYC Health + Hospitals/Kings County. To date, 850 patients have been referred to the program and 463 patients have completed all 30 days. Three of our community partners – VillageCare, ArchCare, and New York City Department for the Aging– are expected to provide an additional eight TMTs across medicine and behavioral health inpatient units in NYC Health + Hospital facilities in May.

As part of OneCity Health’s clinical asthma program, community health workers (CHWs) from our community partners have completed over 100 home assessments. Seven NYC Health + Hospital facilities and two of our community partners (Urban Health Plan and Gentle Touch Medical) are generating referrals to our partners with CHWs. The CHWs – from VillageCare, CABS Home Attendants Service, St. Mary’s Healthcare System for Children, Asian Community Care Management, Make the Road New York, a.i.r NYC and NYC Health + Hospitals – complete an asthma assessment, reinforce recommendations from the clinical team, and conduct home visits to evaluate the environment for asthma “triggers.”

Thirty eight of our community partners continue to conduct outreach to, and engage with, uninsured New Yorkers through Project 11. To date, they have connected approximately 2,500 people to primary care and approximately 3,200 individuals to insurance.