REPORT TO THE BOARD OF DIRECTORS – OCTOBER 2017

With the Trump administration’s decision to eliminate Cost Sharing Reductions (CSR), the fate of this key Affordable Care Act mechanism for maintaining affordability of insurance plans purchased on state exchanges is now up to Congress. Currently, neither the Alexander-Murray compromise bill (which would extend CSR for two years in exchange for greater flexibility on the part of states to discontinue some Affordable Care Act mandates) nor other legislative “fixes” to the ACA appear to have sufficient traction for Congressional passage. Elimination of CSRs are projected to cause loss of Essential Plan coverage for a substantial number of Metro Plus members.

Today I am pleased to formally inform the board that our dispute with New York State over the withholding of $380 million in Disproportional Share Hospital (DSH) dollars has been resolved.

The State will process the Federal and City matching funds to reimburse our health care system for most of these funds in three separate payments over the next few months and the rest will be paid during our fiscal year.

With the mutually agreeable resolution between the State and NYC Health + Hospitals, we are now able to resume filling vacancies at a rate of 50 percent of the number of staff members who separate from our health care system each month. Even with this resolution, NYC Health + Hospitals continues to provide care for our Medicaid and uninsured patients that will not be reimbursed.

These are uncertain times for the health care industry. And that uncertainty, especially in terms of policy at the federal level, is likely to persist for some time. Now, however, the State, the City, and NYC Health + Hospitals will turn our collective attention to fight the battle against DSH reductions in Washington—together.

I want you to know how appreciative I am for the solidarity and support we have received from employees, labor partners, community allies, and elected officials in standing up for what is right when it comes to funding our essential health care system. Your commitment speaks to the enormity of our mission and to our obligation to fight harder than ever for every precious dollar needed to continue achieving it.

I am pleased to bring to the Board’s attention the fact that for the fourth year in a row NYC Health + Hospitals’ Accountable Care Organization (ACO) has achieved impressive results in lowering the cost of providing care for Medicare patients, while achieving a quality score in the 90th percentile nationally. Our ACO—the only Medicare Shared Savings program in the country led by a public hospital system—saved $3.6 million in 2016 and earned nearly $1.6 million in shared savings, according to results released recently by CMS. Ours is the only ACO program in New York State to earn shared savings for four years in a row. We achieved this despite the fact that requirements implemented by CMS this year made it harder to achieve shared savings.

Open Enrollment season is nearly upon us, and I’d like to use this opportunity to call the Board’s attention to a wide range of activity occurring at the State, City and organizational levels to better connect New Yorkers with health insurance coverage. Our work stands in opposition to concerted efforts by the Trump administration and Congressional Republicans to roll back successes achieved over the past seven years in covering more Americans. One clear example of the divergent Federal path is the slashing by half ̶ to just six weeks ̶ of the open enrolment period for the Federal Health Insurance marketplace. This contrasts with New York State’s 2018 open enrollment period, which will be three months long, from December 1 2017 through January 31, 2018. Each of us at NYC Health + Hospitals can take a measure of pride in the work we are doing as in partnership with the City to expand access to care.

• We are developing and rolling out new workflows to streamline referrals to financial counseling in order to ensure that uninsured patients are screened for eligibility and enrolled in insurance at every opportunity.
• We are leveraging the availability and expertise of MetroPlus insurance representatives on site at our facilities including in outpatient clinic areas, in order to enroll more of our patients, and members of the communities we serve.
• And we are partnering with the City’s GetCovered campaign to conduct outreach to uninsured patients, including targeted outreach to inpatient short stayers.

We will continue to fight for access to care because doing so represents both a strategic priority, and a core principle of our mission to provide care for any New Yorker in need.

Once a year, our annual Nursing Excellence Awards offer an opportunity to celebrate the unwavering dedication that NYC Health + Hospitals nurses demonstrate to our patients, thousands of times each day, in every corner of our essential health care system. Over 8,000 nurses work at NYC Health + Hospitals, advancing values of accountability, collaboration, respect for the patient’s unique voice and viewpoint, altruism and compassion. No one champions or embodies these values more than the Nursing Excellence nominees and winners we celebrate. The Awardees in six different categories were announced at a truly inspiring ceremony this week at NYC Health + Hospitals/Jacobi. Those recognized were:

Esmie Taylor RN, MSN, GNP-BC, from NYC Health + Hospitals/North Central Bronx
for excellence in Management

Dorothy Mcintosh-Waddy, RN, CRRN, from NYC Health + Hospitals/Sea View
for excellence in Inpateint Clinical Nursing

Sabina Wood, RN, MSN, from NYC Health + Hospitals/Woodhull
for excellence in Education and Mentorship

Rosa Borges BSN, RN, of NYC Health + Hospitals/Metropolitan,
for excellence in Home, Community, or Ambulatory Nursing

John Huaylinos, RN-INC, CCM, of NYC Health + Hospitals/Coney Island,
for excellence in Volunteerism and Service

Arturo E. Ceniza, BSN, RN, from NYC Health + Hospitals/Queens,
for excellence in Advancing and Leading the Profession

Congratulations to each of them, and to their nursing colleagues for the skill, professionalism, caring and compassion they provide for our patients every day.

Earlier this month we announced the addition of new, 3D breast imaging equipment at NYC Health + Hospitals/Bellevue. Staff and patients gathered for a ribbon-cutting ceremony at Bellevue’s Rita J. Kaplan Breast Imaging Center for the unveiling of two new Hologic 3D Selenia Dimensions mammography units, one of which features an Affirm 3D stereotactic biopsy device. This state-of-the-art equipment will produce enhanced imagery resulting in increased early detection of breast cancer, and greater treatment options for patients.

The new equipment allows the medical team to perform minimally invasive biopsies on a wide range of patients. Additionally, a 3D Prone Breast Biopsy system has also been added, which will increase comfort for patients by allowing them to lie flat while undergoing the procedure. The new 3D mammography equipment is expected to serve more than 10,000 patients a year, allowing radiologists to view multiple imaging “slices”, with more accurate visualization of fine details, and improved biopsy specificity. These enhancements will reduce the number of patients who are unnecessarily called back for additional pictures, relieving patients of a degree of unnecessary anxiety, increasing our efficiency, and helping us deliver the best possible care for our patients.

NYC Health + Hospitals/Elmhurst honored first responders from local NYPD precincts, FDNY companies, and EMS stations at the hospital’s first Annual Red, White, and Blue Tribute on September 27– a recognition and awards ceremony for their outstanding commitment to protecting the community and assisting the hospital in its mission to provide high-quality health care to the residents of Queens.

NYC Health + Hospitals/Elmhurst leadership and staff were joined by several local elected officials, including New York State Assembly Members Brian Barnwell and David Weprin, and New York State Senator José Peralta. Elmhurst CEO Israel Rocha explained that the event offered a formal opportunity to show the appreciation that we feel for our first responder partners every day, stating, “we are continuously inspired by these extraordinary men and women and their unwavering dedication to our community”. First responders who received awards were:

• Chief Edward Baggott, FDNY Queens Borough Commander
• Police Officer Daniel Carter, NYPD, Transit District 20
• Joseph Fox, Chief of Transit, NYPD EMT
• Eric Feng #2246, FDNY EMS Station 46
• EMT Alex Gonzales #2353, FDNY EMS Station 46
• Assistant Chief Juanita Holmes, NYPD Borough Commander, Queens North
• Kubrat Hristoff, Director, Hospital Police 6th Division, NYC Health + Hospitals/Elmhurst
• Police Officer Thomas Imperatore, NYPD, 110th Precinct
• Special Officer Iana Isaacs, Hospital Police, NYC Health + Hospitals/Elmhurst
• Special Officer Christopher Labella, Hospital Police, NYC Health + Hospitals/Elmhurst
• Battalion Chief Frank Leeb, FDNY, Battalion 46
• EMT Gerald Lenox III #3922, FDNY EMS Station 46
• Christine M. Mazzola, Division Commander, FDNY
• Paramedic Jose Mendoza #4241, FDNY EMS Station 46
• EMS Division 4 Captain Denis Mullaney, Commanding Officer, NYPD, Transit District 20
• EMT Michael Rojas #1925, FDNY EMS Station 46
• Captain Thomas Schulz, Commanding Officer, FDNY EMS Station 46
• Captain Michael Sitler, FDNY/Eng 287
• Special Officer Anthony Stephens, Hospital Police, NYC Health + Hospitals/Elmhurst
• Police Officer Althea Thomas, NYPD, Transit District 20
• Detective Brian Timmons, NYPD, 110th Precinct
• Nicola Ventre, Deputy Inspector, NYPD, 110th Precinct
• Special Officer Jefferson Yagual, Hospital Police, NYC Health + Hospitals/Elmhurst

Last week we announced the availability of flu vaccine at locations across New York City and urged New Yorkers six months and older to get vaccinated early in the season. We are emphasizing that protection against the flu is not fully effective for up to 10 days after getting vaccinated, so delaying vaccination until flu season is declared may put individuals and those around them at risk of illness. The flu is a serious, highly contagious, and sometimes deadly disease, and the severity of each season is unpredictable, making annual vaccination the best defense against illness.

One indication that experts use in predicting the upcoming flu season is to look at the Southern Hemisphere, where winter and the flu season has just concluded. In Australia, the number of patients with flu was nearly double that of the preceding winter, making the importance of vaccination here this year even greater.

At NYC Health + Hospitals we strongly believe that knowledge about insurance empowers our patients. That’s why we have made it a practice for the past six years to sponsor free seminars NYC Health + Hospitals in partnership with the Centers for Medicare & Medicaid Services (CMS) to help community partners, faith-based partners, caregivers, and community members understand health insurance options available to them during the open enrollment periods for Medicare and New York State of Health, the State’s official online marketplace. The next open enrollment period for New York State of Health, when residents will be able to change their insurance plan or enroll in health insurance for the first time, will take place from November 1, 2017, through January 31, 2018. For people with Medicare, the annual enrollment period begins October 15, 2017, and ends December 7, 2017. During this time, people with Medicare can select a Medicare Advantage plan or prescription drug plan, or they can switch plans if they are already enrolled.

At these seminars, health insurance specialists from CMS will provide updates on Medicare (Parts A, B, C, and D) and Medicaid programs, information about health care reform initiatives, and guidance on how to select and purchase affordable insurance on New York State of Health. CMS will also provide information about what to expect as new Medicare cards are issued in 2018, including information about protecting patients from fraud and abuse. The seminars are open to the public and will be held at NYC Health + Hospitals/Kings County (Brooklyn), NYC Health + Hospitals/Lincoln (Bronx), and NYC Health + Hospitals/Bellevue (Manhattan). Caregivers, patients, community providers, NYC Health + Hospitals staff nearing age 65, and individuals who work with seniors, are all encouraged to attend to receive information about:

• The benefits of Medicare and how to apply
• The parts of Medicare – Part A: hospital insurance; Part B: medical insurance (outpatient visits, lab work, preventive services); Part C: health plans; and Part D: prescription drug coverage
• The Medicare appeals process
• The Medicare programs in place for people with limited income and resources
• Medicaid basics
• Updates on New York State of Health
• Enrollment resources for the uninsured

As discussed in previous versions of my report to the Board, Mayor de Blasio has sponsored “City Hall in Your Borough” weeks throughout 2015. Each has offered an opportunity for NYC health + Hospitals to partner with the Mayor’s office and city agencies to highlight improvements to the city’s health care landscape. At a ribbon-cutting earlier this week celebrating an upgraded community health center in Bushwick, Brooklyn, NYC Health + Hospitals announced system-wide ambulatory care access expansion in underserved communities in four boroughs. Collectively, when all the facilities achieve their expected growth, they will serve approximately 42,000 more patients than before the enhancements.

The Bushwick site is one of five NYC Health + Hospitals/Gotham Health community health centers that have been refurbished and reopened better than ever. Renovated with more than $10 million in funding from New York City’s Caring Neighborhoods Initiative, these five health centers will offer an improved patient experience and access to more patients. The five sites are in Brooklyn (in Bushwick, Crown Heights, and Brownsville), the Bronx (Tremont), and Queens (Jackson Heights).

In addition, two completely new sites, Bedford in Brooklyn and Clifton in Staten Island, are scheduled to open this winter. The creation of the Bedford health center is supported with $1.4 million in Caring Neighborhoods Initiative funding. Funding for the creation of the Staten Island health center includes $20 million from New York City’s Primary Care Expansion Initiative and $8 million from the New York City Council. While services available at the sites differ, all seven will offer behavioral health care, which community assessments consistently show is needed.

Other City Hall in Your Borough (Brooklyn) activities supported this week by NYC Health + Hospitals included:

• Hearst Foundation Grant
  NYC Health + Hospitals/Coney Island will receive a $100,000 Addiction Medicine Research Grant From the Hearst Foundation. The grant proceeds will go to Michael Stavros Radoes, MD, MPH, associate chairman and director for Quality Improvement for the Department of Emergency Medicine, and Sassan Naderi, MD who will join NYC Health + Hospitals/Coney Island’s faculty as the director for In-service Education. Drs. Radoes and Naderi are the first Hearst Scholars in Addiction Medicine at NYC Health + Hospitals/Coney Island. The two addiction medicine research scholars seek to develop a better understanding of the social and medical complications of addiction. Over the course of 2018, the researchers will focus on the approximately 17,000 emergency department visits annually by patients with substance use disorders who present at NYC Health + Hospitals/Coney Island.
• Heart Health Center ribbon cutting at NYC Health + Hospitals/Kings County
  Earlier this week NYC Health + Hospitals launched the Heart Health Center at NYC Health + Hospitals/Kings County, a community based facility bringing together a spectrum of care and services including same day echocardiograms. It will be staffed by a full service heart health team including, cardiac specialists, psychologists, psychiatrists, nurse practitioners, nutritionists, pharmacists, and social workers in anticipation of the interrelated challenges heart failure patients face.

  This center’s innovative and convenience-oriented approach departs from the standard three- to four-week series of appointments for heart failure patients. Patients can walk in, meet with a doctor, be tested, and have the same doctor make a treatment decision based on the results, all with the goal of reducing hospitalizations, readmissions, and emergency room visits while lowering costs. Equipment and renovations for the Heart Health Center were made possible by a $50,000 grant from Council Member Mathieu Eugene.

Earlier this month we announced the appointment of Sheldon McLeod as Interim Chief Executive Officer at NYC Health + Hospitals/Kings County effective November 17. Sheldon will take on this interim post as we bid farewell to Ernest Baptiste who is leaving NYC Health + Hospitals after more than five years of distinguished service to take on a new challenge as CEO of Stony Brook University Hospital. Under Ernest’s leadership, NYC Health + Hospitals/Kings County has achieved numerous milestones, including the development of a world-class model of mental health services and the successful transition of Behavioral Health Services from DOJ oversight, and the US News & World Report designation as best hospital for heart failure and COPD care. We are grateful for Ernest’s service and thank him for his commitment to our health system, our patients and staff. We wish him well in his new post. Sheldon McLeod has served as Chief Operating Office at NYC Health + Hospitals/Kings County since 2014. I thank Sheldon for taking on this new role and responsibility, and am confident that he will advance our health system’s transformation agenda and champion the staff and patients of NYC Health + Hospitals/Kings County.

NYC Health + Hospitals is at the forefront of innovative services and programming designed to better address the health care needs of younger New Yorkers. Yesterday, we sponsored a conference at Baruch University titled Adolescent Sexual and Reproductive Health: A New Direction, attended by clinicians and youth health experts from inside and outside our system. A wide range of panel discussions were held on topics such as, Long Acting Reversible Contraception (LARC), Pre-Exposure Prophylaxis (PrEP) Implementation Models for Youth, Comprehensive Health Care for Transgender and Gender Non-Conforming Youth, Adolescent Male Sexual and Reproductive Health, Minors’ Rights to Confidential Health Care in New York and Implementing Youth Health Clinic Standards. We thank the event organizers for a thoughtful and progressive program.

OneCity Health progressed with plans for the next phase of DSRIP – and beyond.

• OneCity Health plans to cement its future relationship with DSRIP partners, and better enable them to improve patient outcomes, by contracting through the remainder of performance year 2020. The OneCity Health Executive Committee approved these parameters for the next phase of contracting, which begins January 1, 2018.
• OneCity Health submitted its Gap Analyses for the Care Restructuring Enhancement Pilots (CREPs) Program to Fidelis Care, the program administrator, and the NYSDOH for both the Behavioral Health Home and Community Based Services (BH-HCBS) Pilot and the Managed Long Term Managed Long-Term Care (MLTC) Workforce Pilot on September 15. These Gap Analyses required conducting a current state evaluation of the demographics, health needs and service gaps of the targeted populations and determining areas for future training. Both were approved for payment, totaling $66.68M.
• NYC Health + Hospitals continues its longstanding partnership with the NY Legal Assistance Group (NYLAG). OneCity Health has been coordinating a number of September and October trainings for NYC Health + Hospitals and community partners to enhance their ability to screen and refer for legal needs, including trainings focused on immigration, palliative care, housing, and behavioral health. Additionally, beginning in April 2017, OneCity Health began coordinating with NYLAG to enhance the collection of data on the services. From April-August 2017, NYLAG served 378 clients covering 425 legal matters, over half of which related to immigration.

In an August report, “An Emerging Approach to Payment Reform: All-Payer Global Budgets for Large Safety-Net Hospital Systems,” the Commonwealth Fund highlighted transformation activities underway at NYC Health + Hospitals through OneCity Health and the Delivery System Reform Incentive Payment (DSRIP) program to help illustrate how global budgeting might be applied in an urban area.