REPORT TO THE BOARD OF DIRECTORS – September 2017

The effort in Congress to pass the Graham-Cassidy bill, another Republican vehicle to repeal and replace the Affordable Care Act (ACA) appears to have failed. As of today we are just a few days before the September 30th end of the federal fiscal year, and its deadline for Republicans to take advantage of congressional budget reconciliation rules permitting enactment of legislation germane to the 2017 budget to be passed by a simple (rather than a 2/3ds) majority.

Graham-Cassidy calls for shifting the manner in which the federal government pays its share of Medicaid to a block grant, and gives states the option to include requests in block grant applications for waivers of the ACA’s market rules on essential health benefits, the prohibition against medical underwriting, and the required medical loss ratio for plans and enrollees. Analysis of the bill’s impact projects funding losses to New York State as high as $45 billion by 2026.

The ground will continue to shift on federal health care policy, and Congressional efforts to disrupt the ACA, by cutting off cost sharing reductions to health insurers, and other means, will persist. In response, NYC Health + Hospitals’ is working aggressively with the Mayor’s Office, Hospital Associations and legislative allies such as Congressman Eliot Engel, to delay devastating cuts to Disproportionate Share Hospital (DSH) funding currently mandated under federal law. DSH is our primary source of federal funding.

As you know, the period of time for which I committed to serve NYC Health + Hospitals Mayor de Blasio as interim President and CEO is drawing to a close. I am very pleased that Mayor de Blasio has nominated an exceptionally skilled, experienced physician leader to run our essential public health care system. Dr. Mitchell Katz, a Brooklyn native, is currently the Director of the Los Angeles County Health Agency, which combines the Departments of Health Services, Public Health, and Mental Health into a single entity providing integrated care and programming within Los Angeles. The Agency has a budget of $7 billion, 28,000 employees, and a large number of community partners. For the past five years, Dr. Katz served as the Director of the Los Angeles County Department of Health Services (DHS), the second largest public safety net system in the United States. Dr. Katz’ nomination to serve as the next President of NYC Health + Hospitals is being taken up today by the Board of Directors.

Last month I was delighted to join our partners at Comunilife, a leading not for profit affordable housing developer, on the campus of NYC Health + Hospitals/Woodhull for the groundbreaking of a six-story community residence with 89 units of supportive and affordable housing each with their own kitchenette and bathroom. Fifty-four of these studio apartments will be set aside for patients of NYC Health + Hospitals/Woodhull who have behavioral health issues, or are eligible for medical discharge but do not have permanent housing to which to be released. The remaining 35 units will be available to individuals whose income is at or below 60 percent of the area median income.

This facility is going to make a big difference in the lives of future residents with special needs, and for those who would otherwise be severely rent burdened. It helps our health system transform and modernize our delivery model by providing care for those who will live in the new units with more care in the most appropriate setting. It is also a welcome new engine for commerce in the community. NYC Health + Hospitals is proud to continue to support Mayor de Blasio’s plan to build and preserve 200,000 units of housing in New York City.

In keeping with our commitment to community-based ambulatory care, we recently held a ribbon-cutting ceremony to announce the opening of our renovated NYC Health + Hospitals/Gotham Health center in Jackson Heights, Queens. Funded with $1.8 million through Mayor de Blasio’s Caring Neighborhoods initiative, the upgrade converts a facility that previously offered only pediatrics, to one that now provides pediatrics plus a wider range of services, including women’s health, behavioral health, adult primary care, and family medicine. The center will also serve the needs of the surrounding community by employing a full-time nutritionist and a bilingual social worker to support behavioral health services.

The revitalized health center features 13 upgraded exam rooms, new medical equipment and furniture, and an uplifting décor designed to create a welcoming environment for an anticipated 10,000 patients annually.

Increasingly, NYC Health + Hospitals’ leadership in pediatric behavioral health is being recognized beyond the public health and medical communities. Earlier this month the New York Times featured our expansion of mental health programs for children and adolescents. Preventative, diagnostic treatment, and training programs include Healthy Steps, 100 Schools and Project Teach address a range of pediatric behavioral health issues such as early childhood development in children who may have experienced toxic stress, better training of pediatric and adolescent providers on identifying and treating behavioral health conditions in primary care settings, and providing enhanced support in schools for students who have emotional, behavioral, or substance-use challenges. Each of these initiatives reflects the strength of our commitment to providing enhanced access to behavioral health services for children and adolescents.

U.S. News & World Report (USNWR) gave NYC Health + Hospitals an important vote of confidence this month by recognizing seven of our facilities as 2017-18 Best Hospitals for the treatment of heart failure. Three of the seven facilities also earned 2017-18 Best Hospitals recognition for the treatment of Chronic Obstructive Pulmonary Disease (COPD) care. The annual Best Hospitals ranking, now in its 28th year, is part of U.S. News & World Report’s patient portal, designed to help patients make informed decisions about where to receive care for life-threatening conditions or for common elective procedures. For the 2017-18 rankings, U.S. News & World Report evaluated more than 4,500 medical centers nationwide in 25 specialties, procedures, and conditions. In the Heart Failure and COPD categories, hospitals were evaluated on a number of different criteria involving patients 65 or older, and rated high performing, average, or below average. Congratulations and thank you to each of the named facilities for the hard work that the prestigious USNWR designation represents.

US News and World Report “High performing” public hospitals by borough:

Bronx

NYC Health + Hospitals/Jacobi: Heart Failure
NYC Health + Hospitals/Lincoln: COPD & Heart Failure

Brooklyn

NYC Health + Hospitals/Coney Island: COPD & Heart Failure
NYC Health + Hospitals/Kings County: Heart Failure
NYC Health + Hospitals/Woodhull: Heart Failure

Queens

NYC Health + Hospitals/Queens: Heart Failure

Manhattan

NYC Health + Hospitals/Metropolitan: COPD & Heart Failure

Last week, NYC Health + Hospitals/Harlem sponsored a conference titled Improving the Health of the Elderly Black Population, a Multidisciplinary Approach. A main theme was recognizing that this population, despite experiencing significant improvement in life expectancy, continues to be the least engaged and suffer from the worst health outcomes. Recommendations were generated for improving health outcomes within the elderly black population with the expectation that these will redound to the benefit of the wider elderly population in New York City.

The conference was a collaboration between Harlem’s Department of Medicine interns and residents who trained between 1975 and 1985 under the leadership of Dr. Gerald Thomson, and current medical staff under the leadership Chief Medical Officer, Maurice Wright MD. Attending were 200 medical professionals from NYC Health + Hospitals acute care hospitals, ambulatory, community-based centers, Long Term Care centers, Home Care, Metro Plus and alumni. Especially appreciated was the keynote address delivered by NYC Department of Health and Mental Hygiene Commissioner Mary Travis Bassett, MD, MPH. Dr. Mauvareen Beverley AVP, PA CO finance, organized the conference and gave a presentation on Patient Engagement and Cultural Competence and on the inclusion of the patient voice in working to improve health outcomes of the elderly black population.

I am glad to report that three of our facilities, NYC Health + Hospitals/Coney Island, NYC Health + Hospitals/ Elmhurst and NYC Health + Hospitals/ North Central Bronx have been recognized for their commitment to best practices and education on infant safe sleep. This is a vitally serious health concern: In New York City, sleep-related injuries remain one of the leading causes of death among infants.

Cribs for Kids ̶ a leading national advocacy organization dedicated to preventing infant sleep-related deaths due to accidental suffocation ̶ has awarded Coney Island and Elmhurst with “Gold” status, and NCB with “Bronze” status under its National Safe Sleep Hospital Certification Program. The facilities are recognized for their commitment to following guidelines recommended by the American Academy of Pediatrics and for providing training for parents and staff. Community outreach at the hospital includes pediatric health fairs, educational baby showers, Lamaze classes, and partnerships with local organizations to provide newborn supplies and car seats to patients. Few hospitals in New York City are recognized at any level by the program, and six are within our system, including NYC Health + Hospitals/Harlem, NYC Health + Hospitals/Metropolitan, and NYC Health + Hospitals/Woodhull, each of which carry “Bronze” status./p>

Last week we announced the appointment of William A. Brown as chief executive officer at NYC Health + Hospitals/Coney Island. With 38 years of health care leadership in the Midwest and East, Bill comes to the new role most recently from Louisville, Kentucky-based Baptist Health, a health system with eight acute-care hospitals, as well as urgent care and retail-based clinics, home health care, outpatient diagnostic and surgery centers, and a health maintenance organization. His extensive experience in the health care arena includes stints as Chief Executive Officer of VHS West Suburban Medical Center in Oak Park, Illinois, and VHS Westlake Hospital in Melrose Park, Illinois.

Mr. Brown was selected for this important role because of his success in filling many of the needs we have in Brooklyn. We’re pleased that he is looking forward to building on so much of the positive work already underway at the only full-service hospital for the 900,000 residents of southern Brooklyn, and we look forward to working with him.

NYC Health + Hospitals/Kings County’s award-winning Stroke Center has added a cutting-edge, minimally invasive surgical technique to treat acute ischemic stroke, which occurs when a blood vessel carrying blood to the brain is blocked by a blood clot. I’m pleased to report to the board that the first patient to undergo the procedure has been successfully treated.

Mechanical thrombectomy involves the insertion of a catheter through the patient’s groin and threading it into the artery where the blood clot is located. A device called a “stent retriever” is then inserted to trap the clot and pull it out through the catheter. The treatment has demonstrated a greatly improved success rate in the most severe cases of ischemic stroke over the use of blood-thinning medicine alone.

NYC Health + Hospitals/Elmhurst has added two new shuttle vans to transport patients and staff to and from NYC Health + Hospitals/Queens. New York State Senator Toby Ann Stavisky sponsored a $100,000 grant for capital improvements through the Dormitory Authority of the State of New York for the vans, which took their inaugural runs earlier this summer. The new vans make 18 scheduled trips throughout the day between the two hospitals, allowing patients (who receive care at both hospitals) and staff (who work at both locations) to more easily and efficiently move between the two sites, and they allow us to provide patients with improved access to medical care. We are deeply appreciative of Senator Stravinsky’s work on behalf of Elmhurst and the public hospital system.

A key initiative to align the care we provide with the services offered by our community partners, OneCity Health has launched a population health and care management program designed to reduce avoidable hospitalizations among New York City children who suffer from asthma.

The home-based environmental management program assigns community health workers to visit homes to identify asthma triggers, reinforce strategies to help patients and their families maintain control over asthma, and supply free pillow cases, special cleaning supplies, and professional pest control services as needed. An initial 500 home assessments have been completed, with plans to expand the program to hundreds more children and families this year.

Through this initiative, we are doing a better job of connecting primary care physicians with community health workers and home remediation services, helping professionals across these organizations work together to care for patients with asthma. This is exactly the sort of transformational work that will strengthen our care continuum, increase access to health care services, and meet patients where they are in our future state.

Vera Institute of Justice (Vera) and NYC Health + Hospitals’ Division of Correctional Health Services (CHS) has announced findings from a 2015-2016 pilot program and study titled, The Enhanced Pre-Arraignment Screening Unit (EPASU): Improving Health Services and Diversion Opportunities in Manhattan Central Booking. EPASU is an innovative strategy outlined by Mayor de Blasio’s Task Force on Behavioral Health and the Criminal Justice System Action Plan, to increase diversion opportunities for people with substance abuse and mental health disorders, and reduce over-incarceration. It requires that prior to being arraigned, a person charged with a crime in New York City must go through a medical screening at one of four central booking facilities within the City to determine a defendant’s health status and provide care if needed. This is a critical juncture in the adjudication process and opportune for prevention, intervention, and diversion.

Vera and CHS conducted a process evaluation of the pilot from May 2015 through October 2016. As of November 2016, the EPASU offered its services around the clock in Manhattan’s Central Booking. The EPASU pilot was operational eight hours a day, five days a week. Since moving to coverage 24 hours a day, seven days a week, CHS has conducted over 35,000 screenings, referring approximately 25 percent for a more in-depth health encounter, likely avoiding an unnecessary hospital run. Results of the pilot demonstrate increased capacity to deliver medical care to people moving through the arrest-to-arraignment process, coordinate health services across correctional and community settings, and bolster diversion efforts for people with behavioral health needs.

NYC Health + Hospitals is partnering with the City to help counter Federal policies that would exclude LGBTQ Americans from fuller participation in American life. Recently, First Lady Chirlane McCray launched the NYC Unity Project, the City’s first-ever, multi-agency strategy to deliver unique services to LGBTQ youth. It unites 16 city agencies to offer new and enhanced programs and supports, including training and certification for more than 500 Health + Hospitals physicians, as well as a public awareness campaign centered on LGBTQ youth and their families. NYC Health + Hospitals will focus initially on three elements of the wider strategy:

• Partnering with The Fenway Institute/The National LGBT Health Education Center to launching intensive training for our Health + physicians in culturally competent LGBTQ health services. We anticipate 500 of our physicians becoming certified by the summer of 2018, sending a powerful signal to LGBTQ youth in need of care.
• Training 50 healthcare providers to provide clinical care – including transition care – to gender expansive youth throughout the city, and establishing emerging adult clinical programs that specialize in affirming health services for LGBTQ youth.
• Transforming health records to more accurately capture information about patients’ gender identity and sexual orientation, including pronouns and other information that can affect quality of care.

As discussed in previous versions of my report to the Board, Mayor de Blasio has sponsored “City Hall in Your Borough” programs throughout the spring and summer. I’d like to highlight several of the ways in which NYC Health + Hospitals participated by partnering with the Mayor and City agencies to improve the health of patients and communities during this week’s “City Hall in Manhattan”. Activities included:

• Announcement of capital funding from Borough President Gale Brewer’s office to be used to improve patient care and experience at three Manhattan hospitals.
• City Hall Resource Fair at the Malcolm X and Dr. Betty Shabazz Memorial and Educational Center, 3940 Broadway. The health system will be represented by MetroPlus, various community outreach and local public affairs staff.
• Announcement that NYC Health + Hospitals/Metropolitan has been designated as a Diabetes Center of Excellence by the American Association of Diabetes Educators in recognition of the hospitals expertise in diabetes patient care and education.
• City Hall participation at NYC Health + Hospitals/ Bellevue’s regularly scheduled Fresh Food Box program at which patients, employees, and other members of the community obtain locally grown produce at a reasonable price, combined with healthy recipes to prepare the produce.
• Reach Out and Read program where patients in the pediatric waiting room enjoy story-time reading as part of a weekly program.
• GirlTrek walk for health at NYC Health + Hospitals/Harlem with CEO Ebone Carrington and Commissioner Mary Bassett of the Department of Health and Mental Hygiene —involving a lunchtime walk for the Harlem community and hospital staff.

OneCity Health continues to help NYC Health + Hospitals and community partners build a foundation to integrate primary care and behavioral health.

• Ten pilot sites planning for co-location attended instructional webinars on the Co-Location of Primary Care and Behavioral Health Services; topics included implementation, operational measures, quality improvement, billing and screening tools.
• Through the 100 Schools Project, Mental Health Coaches are training staff to identify the early signs of mental illness and substance abuse, and to promote classroom wellness, at 43 New York City schools. The next 58 schools have been identified for implementation. The project was featured in the recent article New York Times article mentioned above titled City Hospital System Is Expanding Children’s Mental Health Programs.

Through asthma education, intervention, and linkage to primary care teams, OneCity Health partners continue to improve pediatric health.

• Since January 2017, NYC Health + Hospitals and OneCity Health community partners have yielded a 62% conversion rate (up from 20% historically) between enrollment in a primary care site and a successful home assessment.
• Over 30 partners attended OneCity Health’s latest asthma webinar, “Partnership in Care”, which provided further education on utilizing a written Asthma Action Plan.

To begin to impact patients’ social determinants of health, OneCity Health continued with trainings for its social service provider partners.

• OneCity Health has selected NowPow as its vendor for a Closed Loop Referral System, which will enable health care providers to refer patients to community-based organizations to meet their social support needs.
• An immigration attorney from LegalHealth trained 18 staff from NYC Health + Hospitals and other OneCity Health partners to help understand and make client referrals to legal and immigrant health-related services.
• OneCity Health social service partners are beginning to complete assessments which will help OneCity Health direct technical assistance resources and ensure partners’ ability to improve patient outcomes within a value-based contracting environment beyond the DSRIP program.