REPORT TO THE BOARD OF DIRECTORS – May 2019

On May 1, Dr. Patsy Yang joined the NYC Department of Corrections at the City Council’s Committee on Criminal Justice Services’ oversight hearing on the experience of transgender and gender non-conforming individuals in New York City jails. Dr. Yang emphasized that Correctional Health Services treats all patients according to their individual clinical needs, including any needs associated with gender identity.

On May 9, I testified before the City Council Finance and Hospitals Committees on NYC Health + Hospital’s executive budget and discussed our health system’s progress on its revenue generating and expense reducing initiatives as well as strategic investments the system has made in nurse staffing. Council members were supportive of Health + Hospitals’ direction and offered assistance in advocating at the federal level to delay DSH cuts.

On May 28, I testified at a joint hearing of the Assembly and Senate Health Committees on the NY Health Act to expressed support for the legislation, which would create a single payer system in NY State. While acknowledging the complexity of such a significant change to the health care system, I argued argued that the administrative simplification and improvements in patient care would be very beneficial for patients.

The NY State 2019 legislative session is set to end on June 19th. No proposals posing a significant fiscal threat to Health + Hospitals are likely to pass but we are monitoring potential new mandates related to discharging planning and domestic violence.

On May 17, I participated in a briefing for Congressional Staff on the Disproportionate Share Hospital Program. The briefing was sponsored by America’s Essential Hospitals, the national trade association for public and safety net health systems. The briefing was well attended and I made clear the potentially devastating impact DSH cuts could have on NYC Health + Hospitals and our patients. With over 300 members of the House of Representatives publicly opposing the DSH cuts, including Speaker Pelosi, the cuts are not expected to take effect. However, aggressive advocacy will be required to advance legislation to delay the cuts, likely in a larger appropriations legislation this fall.

Mayor de Blasio announced that we are on track to guarantee health care for every single New Yorker and unveiled the NYC Care card, the key to quality and affordable health care for hundreds of thousands of New Yorkers who cannot afford or are ineligible for insurance. For NYC Care, NYC Health + Hospitals is investing in new primary care doctors in the Bronx, launching a new customer service system, and preparing for our new members and patients at our clinics and hospitals. When NYC Care launches in the Bronx on August 1, people who live in the borough will be able to use their NYC Care Card to get their own doctor, get preventative screenings and tests, and connect to a 24/7 service to problem-solve and help make appointments.
An estimated 300,000 New Yorkers are currently ineligible for health insurance, including people who can’t afford insurance and undocumented immigrants, and will be able to enroll in NYC Care. The $100 million program – one of two major components of the City’s Guaranteed Care commitment, which also includes directing more uninsured New Yorkers to enroll in Metro Plus – will be available in the five boroughs by the end of 2020. The Mayor announced a series of milestones toward implementing Guaranteed Care in NYC:

• New NYC Care Card, which will provide each member with a dedicated doctor, access to a 24/7 customer service line to make appointments, and clear copays that are affordable to each individual member.
• New NYC Health + Hospitals doctors hired in the Bronx to serve approximately 10,000 patients expected to enroll in NYC Care in the first six months.
• New Executive Director for NYC Care, Marielle Kress, who was instrumental in the Affordable Care Act’s (ACA) successful expansion of Medicaid in states across the country.
• Access to 24/7 pharmacy services in the Bronx, launching on August 1, that will provide NYC Care members with easy access to affordable medication.
• GetGoveredNYC, the City’s health insurance outreach and enrollment initiative, has enrolled more than 19,000 New Yorkers into coverage in 2019, a 19 percent increase from the same time period last year.

• Eligibility Determination: NYC Care will be open to anyone who has lived in New York City for six months or longer and does not have an affordable insurance option or who is ineligible for insurance.
• New 24/7 customer assistance operation: Starting August 1, NYC Care members will have access to a 24/7 customer assistance line where they ask questions about NYC Care and speak to an on-call clinician for all of their needs, including prescription refills. Members will also be able to schedule appointments at convenient times and will have assistance to help navigate members through the NYC Health + Hospitals system.
• Expanded pharmacy hours: NYC Care patients will have 24/7 access to medications in the Bronx starting Aug. 1. This includes expanded hours at all NYC Health + Hospital pharmacy locations in (NYC Health + Hospitals/Jacobi, NYC Health + Hospitals/Lincoln, and NYC Health + Hospitals/North Central Bronx). Until now, uninsured patients have been limited to NYC Health + Hospital pharmacy access during business hours, which makes it challenging for patients to get their medications if they are at work.
• Outreach with Community-based Organizations: To reach eligible New Yorkers, NYC Health + Hospitals is partnering with the Mayor’s Office of Immigrant Affairs and the Mayor’s Fund to Advance New York City. The health system will invest $450,000 to partner with community-based organizations in the Bronx to reach New Yorkers eligible to participate in NYC Care. This money will fund up to 15 full-time outreach workers, or the part time equivalent, who will conduct direct, grass-roots outreach to targeted population in a culturally appropriate and sensitive manner and make appointments with NYC Care enrollment staff.

One of the Guaranteed Health Care milestones announce by the Mayor included the appointment of Marielle Kress as Executive Director of NYC Care. A native New Yorker, Kress brings more than a decade of experience in policy management, operations and advocacy related to complex health care programs. Previously, she played a critical role in the successful expansion and modernization of the Medicaid program under the Obama Administration. Most recently served as Director of Federal Advocacy at the American Academy of Pediatrics (AAP) in Washington, D.C., where she led successful campaigns to protect Medicaid and extend the Children’s Health Insurance Program (CHIP) for an additional 10 years, among other access and financing issues intended to advance equitable provision of health care to all children and families. As the Executive Director, Kress will be responsible for the strategic rollout, operations and implementation of NYC Care. She started in this role on May 6.

Guaranteed Health Care for all New Yorkers will not be possible without our strong public option health plan, MetroPlus. To help take the plan into a new era of growth and service, the Board of MetroPlus Health Plan announced the appointment of Talya Schwartz, MD, as the health plan’s President and CEO. MetroPlus is the low-cost, five-star quality health insurance plan of choice for more than 500,000 New Yorkers. As the health plan owned by NYC Health + Hospitals, MetroPlus is a vital component of Mayor de Blasio’s Guaranteed Health Care plan to ensure health care for all New Yorkers. Dr. Schwartz, currently the Chief Medical Officer of MetroPlus, assumed her new position on May 10th. Since 2016, Dr. Schwartz has served as Chief Medical Officer at MetroPlus, leading the Medical Management division including quality, case management, utilization management, pharmacy, network relations, provider contracting, credentialing, health analytics and various lines of business. Under her leadership MetroPlus ranked among the top plans in the State for quality.

s the City’s public option health plan and a vital part of the City’s Guaranteed Health Care initiative, MetroPlus this month launched its latest public awareness campaign, “Health Care is Your Right. Not a Privilege” which will be seen through the end of June on subway cars, bus shelters near NYC/Health + Hospitals locations, ethnic and community-based print media, and featured at other venues across New York City, including Brooklyn Cyclones games. The ads will be available in eight languages, including English, Spanish, Chinese, Bengali, Haitian Creole, Polish and Russian.

MetroPlus Health Plan reported a 45 percent jump in membership in MetroPlus Gold, the special insurance option exclusively for New York City employees and eligible dependents, between January 2018 and January 2019. More than 16,200 City employees and government retirees chose MetroPlus as their preferred health plan by the end of 2018, compared to 11,320 at the end of 2017. The MetroPlus Gold option, which offers $0 premium, $0 copays, $0 deductibles, has tripled membership to 16,325 as of March 2019. By choosing MetroPlus, New York City police officers, social service workers, university professors and thousands of other government employees are not only making a choice for quality care for themselves and their families, they are also supporting our public health system’s mission to care for all without exception and our ability to succeed and be able to serve many more generations of New Yorkers.

NYC Health + Hospitals/North Central Bronx opened a new, larger Midwifery Unit co-located on the same floor as the Women’s Health Services Unit to improve patient experience and expand access to the hospital’s unique midwifery maternal services. The new, relocated unit will reduce the amount of walking pregnant patients need to do to access prenatal services and will allow physicians, nurses, midwives and other clinicians to move seamlessly between services to care for patients in a larger, more modern space. The $50,000 Midwifery Unit expansion doubles the unit’s clinical space – from 2,300 square-feet to 4,800 square-feet. The renovation reflects an investment by NYC Health + Hospitals to expand access to high quality, culturally responsive care for pregnant women in the North Central Bronx community. With this renovation, we also reaffirm our commitment to the dedicated midwives who support expectant mothers through every stage of pregnancy and beyond.

The Midwifery Unit at North Central Bronx Hospital has provided vital services to the community since its opening in 1977. Since then, the hospital team has delivered more than 90,000 babies, and trained more than 280 practicing midwives and many midwifery, nurse practitioners, physician assistants, and SUNY Downstate, Columbia, NYU and Frontier Midwifery School students. I’m pleased to report that the reopening of this new and improved unit has received the support and endorsement of many community partners, including the Bronx Borough President and the Executive Director of Northwest Bronx Community & Clergy Coalition, who had her second child at the hospital and recommends it highly to friends and family.

NYC Health + Hospitals this month announced the expansion of patient access to on-site legal services for immigration issues, building on its longtime partnership with LegalHealth to address patients’ legal matters and concerns. The new immigration-focused legal services will expanded to NYC Health + Hospitals/Kings, two major NYC Health + Hospitals/Gotham Health community-based centers in Brooklyn and the Bronx (/Morrisania and /Cumberland), and offer expanded hours of service in NYC Health + Hospitals/Bellevue in Manhattan. The expansion of this program, funded by $300,000 in FY19 by the New York City Council, represents a vital patient service offered by the public health system. The new immigration-focused legal services will offer Health + Hospitals’ patients legal support to address matters related to residency, citizenship, visas, asylum and concerns related to the pending federal “public charge” proposal. These services are now available at a total of seven patient care sites, which also include: NYC Health + Hospitals/Elmhurst, NYC Health + Hospitals/Gouverneur, and NYC Health + Hospitals/Lincoln.

I was pleased to join dozens of NYC Health + Hospitals nurses during National Nurses Week to unveil our system’s first official nurse recruitment campaign, NURSES4NYC, to recruit the next generation of dedicated and committed men and women who will care for our patients. This recruitment effort will help Health + Hospitals fill nurse positions and expand access to community-based primary care across the five boroughs. The NURSES4NYC campaign focuses on four high need specialty areas where nurses are needed the most: Emergency Room/Trauma; Ambulatory Care; Home Care; and Correctional Health Services/Behavioral Health. As you know, we recently hired more than 340 new nurses. Our transformation as a health system demands that we invest in nurses and doctors to meet the future needs of our primary care focus. Nurses4NYC is a vibrant campaign that will attract those drawn to our mission of caring for one and all.

The open application period for the 2020-2021 NYC Health + Hospitals Clinical Leadership Fellowship, a one-year opportunity designed for post-residency graduates interested in administrative roles within the nation’s largest public hospital system, is now open. Fellows are placed with one of the health system’s central office operations teams to acquire hands-on, practical work experience to develop and lead a substantial quality improvement or population health-oriented project. Projects may include topics such as improving cycle time in clinic, emergency room, or operating room or improving performance in recommended primary care screening tests. The Clinical Leadership Fellowship teaches the skills necessary to advance hospital system quality improvement, population health, and strategic leadership initiatives. This program is geared toward mission-driven individuals eager to help serve the more than one million New Yorkers who come through our doors annually. This program serves as an extension of existing NYC Health + Hospitals initiatives aimed at recruiting more physicians and strengthening the quality of care available to patients across the five boroughs. More information and the application is available on our public website.

NYC Health + Hospitals/Elmhurst has renovated and enhanced its ophthalmology clinic to better serve patients being treated for general and specialty eye services. The clinic now offers modern, state-of-the-art technology designed to offer patients a wider range of services related to their eye care needs. The redesigned clinic offers patients an enhanced experience through individual exam rooms and an improved registration process. Patients with conditions, including cataracts, glaucoma, and vision disorders related to diabetes will be treated in the redesigned space. Many people come to the clinic with conditions that can be easily treated if caught early. We know that saving a person’s sight is a vital part of keeping them healthy in the long-term, and we want to be proactive in ensuring that we can accurately diagnose eye diseases as early as possible to prevent blindness and other complications that dramatically affect a person’s quality of life.

In order to prepare for viral outbreaks occurring in other parts of the world, New York City and State partnered with first responders in New Jersey to conduct an emergency exercise earlier this month to transport a person pretending to be an Ebola patient from a NJ hospital to NYC Health + Hospitals/Bellevue. This exercise – the first of its kind between New York City and New Jersey – tested the health care system’s ability to safely move a patient to a clinical setting where Ebola can be most effectively treated. The exercise assessed the ability of participants to coordinate patient transportation, safely use biocontainment devices and personal protective equipment while caring for the patient, and appropriately decontaminate and dispose of equipment after transportation. More than 70 clinicians, first responders and emergency management experts participated. Funding for this exercise was provided through the U.S. Assistant Secretary for Preparedness and Response (ASPR) Hospital Preparedness Program Ebola Preparedness and Response Activities cooperative agreement. Given the current outbreak of Ebola in the Democratic Republic of the Congo, which is the second largest Ebola outbreak in history with over 1,100 confirmed cases and 700 deaths, it is critical that the healthcare system is prepared to handle an actual case of Ebola or other infectious disease threat. Despite this critical need for readiness, federal funding for Ebola preparedness is set to expire in 2020, placing the future of these emergency response capabilities in jeopardy.

The NYC Health + Hospitals/Lincoln Department of Obstetrics/Gynecology and Division of Neonatology achieved Perinatal Care Certification by The Joint Commission. The Joint Commission accredits and certifies nearly 21,000 health care organizations and programs in the United States, and its accreditation standards ensure a hospital’s commitment to meeting certain performance standards. NYC Health + Hospitals/Lincoln is the first in the public hospital system and first in the south Bronx to receive this honor. The certification recognizes the hospital’s rigorous commitment to maternal and infant health and their work to deliver high quality, coordinated and patient-centered care for newborns, mothers and families.

Joseph A. Marcellino, MPH, CHE, was selected from among 250,000 New York City workers to receive the prestigious Sloan Public Service Award, also known as the Nobel Prize of City Government. Marcellino, who serves as the hospital’s Associate Director, Emergency Management, is one of six recipients of this esteemed award for extraordinary work and commitment to the public. During Hurricane Irene and Superstorm Sandy, he organized and coordinated the successful evacuation, closure and reopening of the hospital. Marcellino is a nationally recognized expert in both public health emergency management and agency preparedness and response. We are fortunate to have such a dedicated professional leading emergency preparedness and response for the staff and community we serve on Coney Island. Because of his expertise during such disasters, precious lives were saved.

Dr. Caralee Caplan-Shaw, Medical Director of the Tuberculosis Program and Director of the NYC Health + Hospitals/Bellevue Chest Service, was awarded the United Hospital Fund Tribute to Excellence Award for leading a team of physicians, nurses, and administrative staff in a project to improve patient access to the chest clinic at the hospital. Dr. Caplan-Shaw and her team used several strategies including the implementation of a new electronic consult service (e-Consult) to reduce patients’ wait times for appointments and, once they are at their doctor’s appointments, to move them more efficiently through the visit. The wait for an appointment at the chest clinic went from 49 days to 3 days, and the cycle time, or the total amount of time a patient spends at an appointment, went from 92 minutes to 62 minutes. Providing and expanding critical services supports the health system’s patient population and contributes to Mayor Bill de Blasio’s plan to guarantee health care for all New Yorkers. This was truly a model approach to improving patients’ access to essential services, and we applaud Dr. Caplan-Shaw for her leadership and persistence, and congratulate her for earning this important recognition.

This month we also recognized 23 physicians from across our health system at our annual “Doctors’ Day” celebration. The impressive, mission-driven group of physicians from our hospitals, community health centers, and post-acute care facilities were honored for their dedication to our patients and leadership contributions to our health system. The group represented a range of specialties and years of service, and truly represented our multi-ethnic and multi-cultural workforce, which showcases our strength in providing culturally competent care to all, without exception. Every day the physicians at NYC Health + Hospitals ensure that New Yorkers – their patients – are living their healthiest lives, and the 23 physicians we recognized, who were nominated by their peers, represent the heart of our health system.

I was honored by the Heritage Provider Network (HPN), one of the nation’s leading physician-led managed care organizations, and Crain’s New York Business, with a Heritage Healthcare Innovation Award this month. I received the Organization Leadership award and got credit for transforming access to and quality of affordable healthcare in the New York metropolitan area. But the credit for this recognition truly goes to the employees of NYC Health + Hospitals who for the last couple of years have been building the foundation for our health system’s success. I accepted the award on behalf of our entire workforce and their efforts to fundamentally change how healthcare is delivered, champion new ways of thinking and doing, and for uniting diverse constituencies to work together to care for more than one million New Yorkers every year.