REPORT TO THE BOARD OF DIRECTORS – May 2018

I was pleased to present to the New York City Council last week our new five- year financial plan – my vision for our future financial health. Thanks to the hard work of our staff, we will exceed revenue and savings targets this fiscal year and will close FY18 $600 million ahead of budget. We are also building on recent achievements and have a path to generate $850 million of new revenue and new savings targets that will create a balanced financial plan through FY 2022 and further stabilize the system for the most vulnerable New Yorkers.

This financial plan represents our intention to double down on a number of successful strategies and take the transformation of our health system to another level in order to ensure long term stability and quality. Our doctors, nurses, social workers, pharmacists and other professionals are committed to transformation and I am committed to working with all our staff, our community stakeholders and the members of this Board to make the “System” as good as the people working in it.

The new balanced financial plan relies less on staff reductions than prior plans. Instead, the plan continues administrative savings through targeted attrition, managerial reductions, and cutting consultant costs, and makes strategic investments to grow revenue through our existing patient population. As I’ve said before, my plan is to help our hospitals, health centers and long-term care facilities to flourish.

Our financial plan reflects new revenue and savings strategies to:

• Improve billing, contracting, coding, and documenting and capture $630 million in revenue by FY 2022.
• Invest in Patient and Revenue Growth by keeping more MetroPlus business inside Health + Hospitals, expanding well-reimbursed services and opening up hospital pharmacies to patients with insurance to generate $135 million in new revenue by 2022.
• Enroll the Uninsured in affordable health plans through the City’s Get Covered initiative and MetroPlus’ ongoing enrollment that is expected to generate an estimated $80 million in revenue by FY 2022 – $40 million above the projections in the prior plan.
• Reduce administrative expenses by building on $250 million personnel savings already achieved, with targeted personnel savings, supply chain enhancements, and consultant reductions.

OneCity Health has partnered with the Local Initiatives Support Corporation (LISC) NYC, which received a grant from the New York State Health Foundation to improve housing stability and quality, and therefore health outcomes. In partnership with LISC, OneCity Health will connect health care and housing through effective partnerships and referrals between the Performing Provider System (PPS) and community based organizations.

Through the Value-Based Purchasing Quality Improvement Program (VBP QIP), OneCity Health has assisted NYC Health + Hospitals in earning $120M in revenue for performance over the course of Delivery System Reform Incentive Payment (DSRIP) Year 3 (April 2017 – March 2018). The primary objectives of the VBP QIP program are to assist hospitals in the move towards value-based payments, and improve quality of care and financial sustainability.

OneCity Health has launched two new initiatives to improve the cardiovascular health of patients and communities:

• Registry Report – available to all partners and developed in the electronic health record using criteria such as diagnosis, medications or other information to identify patients from high risk groups for a cardiovascular event and may benefit from updated treatments of Statin Therapy.
• Heart Failure Collaborative Initiative – in collaboration with NYC Health + Hospitals and designed to help hospitals provide the highest quality of care to patients with congestive heart failure (CHF) by implementing a standard clinical management model that will reduce the risk of readmission.

OneCity Health launched a DSRIP Dashboard, which includes facility-level performance on key DSRIP process and outcome metrics. This new, web-based and interactive tool allows each NYC Health + Hospitals facility to view their DSRIP performance and see trends in performance over time. The DSRIP Dashboard was developed in collaboration with the Office of Population Health.

As of April 15, 2018, 163 of OneCity’s primary care partner sites earned the National Committee for Quality Assurance’s highest Patient-Centered Medical Home (PCMH) 2014 Level 3 recognition with OneCity Health’s assistance.

As you know, primary care is at the center of my vision for the future of our essential health system. As a primary care physician, I’ve always had a passion for both primary care and public health systems, and we are looking for like-minded doctors who are excited about transforming the nation’s largest public health system by positioning primary care at its very core. To help us find the right candidates, last week we lunched DOCS4NYC, the health system’s first official physician recruitment campaign in recent history to help fill dozens of new and open primary care physician positions and expand access to community-based primary care across the five boroughs. This targeted investment in primary care physicians is a vital part of our financial sustainability strategy to help reverse the decline in patient visits by increasing capacity and access in underserved neighborhoods. DOCS4NYC has a new website, docs4nyc.org. We hope you help us spread the word to find primary care providers who want to take advantage of the professional growth and leadership opportunities we offer, the loan forgiveness programs available to help ease the burden of student debt, and believe in our mission to offer high-quality care equally to all New Yorkers without exception.

For too long, NYC Health + Hospitals has been leaving money on the table and subsidizing private insurance companies by letting denials slide. Our clinicians provide high-quality care and advance our mission every day. It’s our responsibility to stand up for them and challenge wrongful denials, as all health systems should. That’s why this month we entered into arbitration to recover $11.5 million in wrongfully denied bills submitted to United Healthcare from patients who received services in hospitals across our health system. This represents our new, aggressive approach to ensure we get back every dollar earned for services provided. Negotiating fair rates and terms with private insurance companies and collecting accurate payment for services rendered are critical elements of our new approach. We are being represented by the NYC Law Department in this matter and we look forward to a favorable result. We are reviewing all of our managed care contracts and denials, and may pursue arbitration against others to appropriately collect revenues we are due.

Also in support of our financial health, this month we launched the NYC Health + Hospitals Coder Academy, a free training program for employees to improve coding accuracy and help ensure reimbursement for services provided. The Coder Academy is a collaboration with the CUNY School of Professional Studies and will offer up to 21 CUNY academic credits starting in August. Since joining NYC Health + Hospitals, I have been frank about our need to increase revenue. This work is critical to ensuring that our nurses, doctors, social workers, and other professionals can continue to provide life-saving care each day. I strongly believe that investing in medical coding training will not only be financially beneficial but will help us better track patient procedures and ultimately lead to more cost-effective medical services for our patients. OneCity Health, the NYC Health + Hospitals-sponsored Performing Provider System (PPS) under the New York State Delivery System Reform Incentive Payment (DSRIP) program, is providing funding for the Coder Academy, in addition to operational and project management support. Courses will be offered to NYC Heath + Hospitals and PPS partners.

Thousands of Empire Blue Cross Blue Shield HealthPlus consumers will now have access to the high quality, affordable health services offered by NYC Health + Hospitals thanks to our new Medicaid managed care contract. HealthPlus Medicaid consumers enrolled in managed care, Essential Plan, and Child Health Plus insurance plans will now have access to the wide range of services for children, adolescents, and adults offered by our health system. We also renewed the contract with HealthPlus’s affiliate, Empire BlueCross BlueShield (Empire), that enables Empire’s commercial and Medicare Advantage consumers to continue having access to NYC Health + Hospitals’ providers. The agreements are designed to expand treatment options while improving consumer safety, health care quality, and efficiency. These agreements reflect growing recognition that our public health system must be included as an in-network participant of a world-class insurance network. It also represents our focused efforts to secure fair rates and terms with our private health insurance partners.

Early this month, NYC Health + Hospitals/Lincoln underwent their triennial Joint Commission 4-day unannounced survey. I would like to congratulate CEO Milton Nunez, his leadership team and the entire staff at NYC Health + Hospitals/Lincoln on a successful survey. Their commitment and dedication was evident by the many accolades received from the surveyors – “Super Care Coordination, Chasing the Zero, Passion of Ownership, Antibiotic Stewardship Program, which is ahead of its time”, – on the high quality care provided to the patients and the community. The hospital was applauded as being a High Reliability Organization, focusing on providing safe quality care for the “whole patient”. The hospital also received recognition for its care coordination, strong team work and communication among staff. Several hospital practices were recommended by the TJC survey team to be submitted to The Joint Commission’s Leading Practice Library, including the organization’s C-section Protocol, Hemodialysis Care Plan and consumption of Clinical Nutritionists.

Thanks also to Board Member Helen Arteaga Landaverde, who participated in the Leadership Session on behalf of the H+H Board of Directors.

NYC Health + Hospitals/Kings County has become one of the first orthopedic teams in New York City to offer an innovative method of hand surgery that allows patients to be awake during the outpatient procedure that lasts approximately 45 minutes from check-in to check-out . Known as WALANT (Wide Awake Local Anesthesia No Tourniquet), the surgical technique is recognized for improving patient outcomes and experience since the procedure does not require hospitalization, general anesthesia, pre-operative testing or post-operative recovery time. Instead, patients receive a local anesthetic to the surgical site and pain medications that are commonly used in simple dental procedures. Patients who can benefit from this innovative technique include individuals with carpal tunnel release, or those who require follow-up surgeries after amputation, tendon repairs and transfers, reconstructive repair of wounds, and the removal of dead tissue. Congratulations to Dr. Steven Koehler and the orthopedic team at Kings for advancing this exciting new technique, which was featured prominently on a WNBC-TV health segment.

NYC Health + Hospitals/Metropolitan is the first hospital in Manhattan to be designated a Gold Safe Sleep Champion by Cribs for Kids®, a national safe sleep hospital certification program. The Gold certification recognizes the hospitals good work to keep babies as safe as possible in their sleep environments and eliminate as many sleep-related injuries and deaths as possible. To earn the Safe Sleep champion recognition the team at Metropolitan had to demonstrate a commitment to preventing sleep-related injuries and deaths through evidence-based practice, parent education, staff training, and community outreach. Congratulations to the team at Metropolitan.

A new collaboration between NYC Health + Hospitals/Elmhurst and the 82nd Street Partnership is helping local restaurants in Elmhurst and Jackson Heights to adopt a “Get Fit” menu to help neighborhood diners make healthy choices when eating out without having to give up the global cuisine and comfort foods they love. Certified dieticians from the hospital’s Food and Nutrition Department will review menus of participating restaurants to identify healthy food options and offer suggestions for ways chefs can modify menu items to reduce fat, calories, sugar, and sodium. Those modified dishes will be identified as dietician-approved items with a “Get Fit Menu” sticker that will be displayed on restaurant windows and menus. The program is free for local restaurants and is expected to bring positive exposure to the area’s diverse food scene.

NYC Health + Hospitals/Coler received an $84,000 grant from the Fan Fox and Leslie R. Samuels Foundation to pursue Comfort Matters® accreditation and to expand and enhance palliative care practices for people living with dementia throughout the skilled nursing facility. More than half of the residents at the 815-bed facility have a dementia diagnosis, including 155 living in one of three memory care units. The new grant will allow the team at Coler to build on its comfort approach to caring for people with dementia which has already demonstrated success with reduced utilization of anti-psychotic medications, increased participation in the Music & Memory Program, fewer physical altercations, fewer falls, and fewer transfers to the hospital emergency department.

Few people can say they survived being hit by a train, especially after sustaining severe traumatic injury. But thanks to the Trauma Center team at NYC Health + Hospitals/Jacobi, 36-year-old White Plains resident can. Last September, Phillip Buffone was waiting for his train at the Yonkers Metro North station when he became dizzy, fell to the tracks, and was hit by an oncoming train. When EMS brought him to Jacobi, his injuries were so severe that his body appeared to have been nearly severed in half. Life-threatening lacerations extended laterally from his spine around to his front, exposing his intestines. He also had significant damage to his colon and small bowel, and sustained multiple rib fractures, leg fractures, and nerve damage to one arm. But our amazing trauma team there put him back together and today our patient is walking with ease and has had a full recovery. This amazing patient story was featured in the New York Daily News and made the cover of one of the local Bronx newspapers. Congratulations to Drs. Srinivas Reddy, John Bliton and Zachary Sharfman, and the entire surgical team and surgical ICU.

As part of a series about New York’s opioid crisis, NY1 featured frontline emergency room staff at NYC Health + Hospitals/Coney Island and NYC Health + Hospitals/Bellevue. Four of our doctors and a nursing director provided insight about caring for affected patients and efforts by the health system to connect patients in the emergency department to addiction treatment. As you know, our health system is a vital partner in the city’s efforts to address this epidemic and we’ve have been the launching pad to many of the best practice responses to the epidemic. Let’s watch the NY1 news piece that aired last week.