REPORT TO THE BOARD OF DIRECTORS – September 2019

City

On Wednesday, September 18, Matilde Roman, Chief Diversity and Inclusion Officer, and Dr. Machelle Allen, Senior Vice President and Chief Medical Officer of NYC Health + Hospitals testified before the City Council’s Committee on Hospitals on Health + Hospitals regarding the delivery of culturally competent and equitable health care services to its 1 million patients. Important Health + Hospitals initiatives that were highlighted included our language access program, LGBTQ affirming services, access to care for people with disabilities, resources and trainings for employees, improving maternal and infant health, implicit bias training, among others.

On Tuesday, September 3, Chris Keeley, Senior Director for Legal Affairs and Labor Relations, answered questions on behalf of Health + Hospitals at the City Council’s Committee on Immigration hearing on the final public charge rule. The rule was published on August 14 and is scheduled to take effect on October 15 if litigation does not delay or prevent it from taking effect. Mr. Keeley shared with Committee members that I had sent a message to all Health + Hospitals employees about the impact of the rule, including an emphasis that the final rule is narrower than the proposed rule. He noted that staff, including financial counselors, social workers, and other front line staff are being trained so that they may appropriately answer patients’ questions and refer concerned patients to LegalHealth on-site at our facilities or through their legal services hotline.

State

On September 17, the State Department of Health released a notice of intent to the Centers for Medicare and Medicaid Service (CMS) for a 4-year Delivery System Reform Incentive Payment (DSRIP) program 1115 waiver extension/renewal. The current DSRIP waiver expires on March 31, 2020 and the program’s primary goal is to restructure the delivery system by reducing avoidable hospital use by 25%. The State is requesting an additional $8 Billion in federal funding over the next four years. OneCity Health is the largest Performing Provider System in the DSRIP program. Accordingly, OneCity Health and Health + Hospitals will submit comments to the draft application, which are due November 4, 2019, and continued financial support for the goals of DSRIP is a key priority for Health + Hospitals. As the State and CMS negotiate the broader waiver renewal, OneCity Health and Health + Hospitals are continuing to work to achieve the goals of the current waiver and hope to have the opportunity to earn funds not already allocated in the first five performance years of the waiver.

On August 9, 2019, Dr. Charles Barron and Rebecca-Linn Walton from the Office of Behavioral Health participated in the State Senate’s Task Force on Opioids, Addiction and Overdose Prevention to discuss the programs that we have implemented system-wide to address substance use and opioid use disorders.

Federal

On September 20, the US House of Representatives passed a continuing resolution to fund the government and delay Federal Medicaid Disproportionate Share Hospital (DSH) payment cuts from October 1 to November 21. The resolution, which received the bipartisan support of more than 300 members of Congress, is expected to be passed by the Senate and signed by the President this week. Negotiations with Senate Republicans continue over a more permanent delay or repeal of the cuts. Such a longer-term delay would likely be part of a larger scale budget deal, which could be enacted later this year or early next year. Given the strong bipartisan support for preventing the cuts in the House and the successful delay of the cuts in 2018, Health + Hospitals is confident that the cuts will not take effect this year or next.

In New York City, healthcare is a fundamental right, not a privilege. And NYC Health + Hospitals is playing a vital part in making that right a reality. On August 1, we launched NYC Care, a key component of Mayor Blasio’s commitment to guarantee health care for all New Yorkers, by offering quality and affordable health care for hundreds of thousands of New Yorkers who are not eligible for insurance or who cannot afford it. With the launch of NYC Care in the Bronx, eligible New Yorkers in that borough were able to begin their enrollment process by calling 646-NYC-CARE and receiving a personalized NYC Care membership card in the mail. We marked the launch with a “Day of Action” with dozens of staff, partners from community-based organizations and volunteers distributing education materials about the program at subway hubs and busy street corners all across the borough.

NYC Care gives New Yorkers in that borough access to a dedicated primary care provider, preventive care and routine screenings, access to specialty care services, customer services support 24/7, and access to affordable medications day or night. The customized membership card details the specific discounted costs for primary care, specialty visits, and prescription drugs for each member based on household size and income. All services are provided by NYC Health + Hospitals and all information about patient care and treatment is kept private and confidential in accordance with the law.

Two weeks after the launch, we were able to announce that membership in NYC Care had reached 2,000 New Yorkers from every zip code of the Bronx. In addition, 100 percent of patients enrolled in NYC Care were offered a first appointment within two weeks with a primary care provider who coordinates all treatment and services needed, and there were nearly 600 low-cost prescriptions filled during the new extended pharmacy hours. To prepare for the program roll-out, the seven NYC Health + Hospitals patient care facilities in the Bronx added new staff and evening and weekend hours to accommodate members. There are now more than 70 primary care providers in the Bronx seeing members. The program is on track to meet the Bronx enrollment goal of 10,000 patients in the first six months.

In recognition of National Recovery Month, I had the pleasure to help honor 12 employees for their dedication and commitment to our patients with substance use disorders. We presented the awards for excellence to doctors, nurses, social workers and addiction counselors who were nominated by their peers, supervisors, and leadership for their excellence in delivering addiction treatment services, their long-time service to our public health care system and their tireless work to help New Yorkers overcome their addiction. The 12 honorees are just a few of the many doctors, nurses, social workers, addiction counselors and support staff that help treat the 90,000 patients who rely our services for substance abuse treatment and support. The 2019 Substance Use Treatment Excellence Awards honorees are:

• Mary Aikuele, RN, Nurse at NYC Health + Hospitals/Woodhull (31 years of service)
• Jantra Coll, Administrator at NYC Health + Hospitals/Jacobi (3 years of service)
• Sal Florio, Substance Use Disorder, Director at NYC Health + Hospitals/Coney Island (13 years of service)
• Donna Crummell, Associate Director, Office of Behavioral Health at NYC Health + Hospitals (9 years of service)
• Sylvia A. Ford-Williams, Senior Addiction Counselor at NYC Health + Hospitals/Gotham Health, Cumberland (17 years of service)
• Netty Hamilton Rivera, Senior Addiction Counselor at NYC Health + Hospitals/Queens (32 years of service)
• Meghan Hedges, Social Worker at NYC Health + Hospitals/Bellevue (12 years of service)
• Ilir Isufi, Peer Counselor at NYC Health + Hospitals/Harlem (1.5 years of service)
• Sandra Knight-Lewis, Senior Addiction Counselor at NYC Health + Hospitals/Metropolitan (32 years of service)
• Angela Torres, Senior Addiction Counselor at NYC Health + Hospitals/Lincoln (24 years of service)
• Gloria Tovar, RN, Nurse at NYC Health + Hospitals/Elmhurst (31 years of service)
• Susan Whitley, MD, Physician at NYC Health + Hospitals/Kings County (9 years of service)

Between January 2018 and June 2019, NYC Health + Hospitals increased the number of patients with high blood pressure under control by 3,971 more patients. During this timeframe, patients ages 18 to 75 being treated for hypertension who got their blood pressure under control improved from 72.6 percent to 76.4 percent. It is estimated that this will result in over 100 additional prevented deaths, strokes, and heart attacks. Today more than 73,000 patients receiving care for high blood pressure within NYC Health + Hospitals have their blood pressure under control. Nationally, 54 percent of people with high blood pressure have their condition under control, according to the CDC. Taking care of chronic diseases, such as hypertension, saves lives and limbs, and keeps hearts and minds healthy. We are grateful to our excellent nurses for supporting patients in managing their blood pressure.

To mark the anniversary of 9/11, NYC Health + Hospitals WTC Environmental Health Center announced the center now serves about 10,944 patients — an increase from 9,700 members in July 2018. The NYC Health + Hospitals WTC Environmental Health Center program provides services at no out-of-pocket costs to residents, students, workers, or passersby eligible for care under the Zadroga 9/11 Health and Compensation Act. In the last year, the WTC Environmental Health Center expanded capacity by hiring 16 additional providers at the clinics and modernizing the electronic health records system at the three sites. A wide range of NYC Health + Hospitals clinical providers, such as physicians, therapists, psychiatrists, and social workers who specialize in many of the common health conditions related to 9/11, serve the WTC Environmental Health Center members. It has been 18 years since the terror attacks, and New Yorkers continue to feel the effects of that horrific day. Our hope is that those whose health was affected by 9/11 seek the care they deserve through the WTC Environmental Health Center and continue to monitor their health.

NYC Health + Hospitals launched Point of Reentry and Transition (PORT) practices, an initiative of Correctional Health Services (CHS) with the Office of Ambulatory Care, NYC Health + Hospitals/Bellevue and NYC Health + Hospitals/Kings County. The PORT practices increase access to and improve continuity of care for patients recently released from custody in City jails. NYC Health + Hospitals/Bellevue and NYC Health + Hospitals/Kings County are the sites of the new primary care practices, providing critical linkages to community primary care. PORT practices are staffed by CHS primary care providers who usually work in the jails, shoulder-to-shoulder with primary care providers who work in the two community hospitals. These practices are supported by CHS Community Health Workers who work inside the two hospitals, serving as bridges to help ensure successful and sustained access to community health care. General assistance with reentry and transition can also be obtained through the CHS PORTline at (646) 614-1000. The PORT practices represent an unprecedented collaboration between the high quality primary care resources in our community based and jail based facilities. This is a unique partnership that I believe will yield a tremendous benefit to our patients and can serve as a model to other municipalities.

NYC Health + Hospitals’ Office of Behavioral Health, in partnership with OneCity Health, announced the launch of Pathway Home, an innovative care transition program created by Coordinated Behavioral Care (CBC), to help individuals with mental health needs transition from short-term health services to ongoing community-based care. The Pathway Home program will serve patients 18 and older transitioning from psychiatric inpatient units who have had four or more mental health inpatient visits in the past 12 months. Pathway Home teams will actively participate in aftercare planning and perform a transition needs assessment, accompany patients home and arranging for any immediate needs, such as food and filling prescriptions, accompanying them to primary care visits, and meeting with them regularly for six to nine months post-discharge. In addition to reducing avoidable readmissions, Pathway Home aims to strengthen community-based care and improve connections to outpatient services post-discharge, shortening length of stay and increasing participation in treatment.

Twenty-three NYC Health + Hospitals patient care locations across all five boroughs have received the designation “Leader in LGBTQ Healthcare Equality” from the Human Rights Campaign Foundation for 2019. This is the fourth consecutive year NYC Health + Hospitals has received this designation for the health system’s commitment to health care equity and leadership in meeting the health care needs of LGBTQ New Yorkers. The new NYC Health + Hospitals/Gotham Health, Vanderbilt health center on Staten Island received the designation for the first time, raising the number of patient care locations recognized to 23. The health system is at the forefront of ensuring equitable access to high quality care for LGBTQ patients, offers a variety of services through its four Pride Health Centers, and offers gender-affirming surgery. Our commitment is to ensure all New Yorkers have access to inclusive, culturally responsive, high-quality health care. We are proud to receive this recognition and continue to break down barriers to health care that LGBTQ communities still face.

U.S. News & World Report issued its annual report of high performing hospitals, recognizing seven NYC Health + Hospitals facilities in various specialties. The recognition was published as part of the national magazine’s “Best Hospital” issue for 2019-20. The annual rankings are designed to assist patients and their doctors in making informed decisions about where to receive care. For the 2019-20 rankings and ratings, U.S. News evaluated more than 4,500 medical centers nationwide in 25 specialties, procedures and conditions. In the 16 specialty areas, 165 hospitals were ranked in at least one specialty. In rankings by state and metro area, U.S. News recognized hospitals as high performing across multiple areas of care. We are honored to have our hospitals recognized by U.S. News & World Report because it is a testament to our doctors, nurses, and entire staff who strive every day to make their patients the healthiest they can be. The recognition went to these hospitals:

• NYC Health + Hospitals/Bellevue, for heart failure
• NYC Health + Hospitals/Coney Island, for heart failure
• NYC Health + Hospitals/Elmhurst, for chronic obstructive pulmonary disease, heart failure, and orthopedics
• NYC Health + Hospitals/Harlem, for heart failure
• NYC Health + Hospitals/Jacobi, for heart failure
• NYC Health + Hospitals/Kings County, for heart failure
• NYC Health + Hospitals/Lincoln, for heart failure

MetroPlus Health Plan announced new partnerships with the Fire Department of the City of New York (FDNY), NYC Housing Authority (NYCHA) and the New York City Taxi and Limousine Commission (TLC) to provide New Yorkers who interact with these three critical agencies information about the City’s public option health plan and encourage them to enroll in affordable health insurance. The three large City government agencies interact with more than 700,000 New Yorkers annually. The collaboration between MetroPlus, the health insurance plan of NYC Health + Hospitals, and these City agencies supports the City’s commitment to guarantee health care for all New Yorkers and Executive Order 40 signed by Mayor Bill de Blasio in January requiring city agencies to help enroll people in health insurance anywhere New Yorkers are directly served. These are great collaborations that help us increase access to affordable, quality health insurance to many more New Yorkers. These three new collaborations will help us reach more than 170,000 taxi drivers, 400,000 New Yorkers who live in public housing and the tens of thousands of New Yorkers who interact with the FDNY every year.

NYC Health + Hospitals/Elmhurst hosted a groundbreaking ceremony for construction of its new ambulatory surgery center. The $5.5 Million capital expansion project, which is being funded by the New York City Council, will feature 5,000 square feet of additional space, and includes a new operating room, four procedure rooms, 18 pre-and post-procedure beds, and comfortable waiting areas. Healthcare providers from a wide range of surgical specialties, including urology, gastroenterology, general surgery, pulmonology, ophthalmology, and gynecology, will practice in the new center, allowing NYC Health + Hospitals/Elmhurst to increase the volume of its same-day surgeries by around 45 percent, with a projected revenue of $6.8 million. Construction will be completed by the spring of 2021.

As part of our transformation strategy to improve and expand primary care, NYC Health + Hospitals/Bellevue announced outcomes of a primary care pilot that significantly reduced patient wait-times for appointments in its Adult Primary Care Clinic and improved continuity of care, ensuring that a patient is likely to see the same primary care physician (PCP) at each visit. The average time a new patient has to wait for an appointment is now 14 days, down from 52 days, and the wait-time for a revisit is now less than week. At the same time, the continuity rate between patients and their PCPs improved from 69.9 percent to 87.1 percent. NYC Health + Hospitals/Bellevue’s Adult Primary Care Clinic provides care to approximately 30,000 patients.

The hospital team was able to accomplish such improvements by working directly with our Call Center operation, developing scripts that emphasized continuity between patients and PCPs, and transitioning to EPIC, an electronic medical record system, which allows patients to request appointments through its MyChart patient portal. Other NYC Health + Hospital ambulatory care practices have begun to adopt this new system. It is also worth noting that these changes create the infrastructure needed to support the additional patients who will seek care through the public health system as NYC Care launches.

NYC Health + Hospitals/Bellevue announced that the New York State Department of Health has formally designated the hospital with provisional status as a Level II Pediatric Trauma Center. With the new designation, the hospital’s pediatric emergency room has begun treating trauma patients under age 15, ensuring that New Yorkers of all ages get the most advanced and timely trauma care possible. Prior to this provisional status, pediatric trauma patients were transferred to a nearby hospital for care. NYC Health + Hospitals/Bellevue is the only Level I Adult Trauma Center and Level II Pediatric Trauma Center south of 68th Street. Level II Pediatric Trauma Center designation is significant because, once stabilized, pediatric trauma patients no longer need to be transferred to another hospital. Pediatric trauma patients are now able to receive specialized treatment and take advantage of our expertise and exceptional services.

NYC Health + Hospitals/Coney Island leadership, New York City Council Brooklyn Delegation Co-Chair Mark Treyger and New York City Council Hospitals Committee Chair Carlina Rivera unveiled plans to improve access to care, experience and comfort for patients with new, upgraded ultrasound technology purchased with $400,000 capital funds secured by Council Member Treyger. The Council allocation will fund three new ultrasound machines, a portable ultrasound machine for labor and delivery, and urodynamics testing equipment for urogynecology. The upgrades made possible through the City Council support build on the public health system’s focus to increase access to high-quality care for all New Yorkers. This equipment will enhance our obstetrics and gynecology services, and marks a significant investment in women’s health. We are grateful to the Council for their support and commitment to the New Yorkers we serve.

Gregory Calliste, CEO of NYC Health + Hospitals/Woodhull, has been named one of Brooklyn’s “Power 100” by City & State New York for his work in improving patient care and overall experience, community engagement, and securing funds for a Comprehensive Psychiatric Emergency Program and Emergency Department expansions. Mr. Calliste has also fostered community partnerships that provide local residents wraparound services through their engagement with health care providers and case managers. City & State New York‘s “Power 100” lists recognize the most powerful people in the City, including elected officials, business owners, and advocates. This is a well-deserved recognition for Gregory Calliste. Under his leadership, NYC Health + Hospitals/Woodhull continues to be a vital part of the North Brooklyn community, ensuring that patients live the healthiest lives they can.

The Board of MetroPlus Health Plan announced the appointment of Sanjiv S. Shah, M.D. as the health plan’s new Chief Medical Officer (CMO). As the health plan owned by NYC Health + Hospitals with more than half a million members in the five boroughs, MetroPlus is a vital part of New York City’s initiative to guarantee health care to all New Yorkers. Dr. Shah assumed his new position on August 12. Dr. Shah has more than 20 years of experience as a physician leader, managed care executive, and infectious disease specialist. He joins MetroPlus from the Mount Sinai Health System where he served as Medical Director. He also served as Chief Medical Officer at Fidelis Care and Deputy Chief Medical Officer and Associate Medical Director of HIV Services at MetroPlus.

As I reported earlier this month, I have asked Maureen McClusky, our Senior Vice President of Post-Acute Care, to serve as Acting CEO of NYC Health + Hospitals/Coney Island following the departure of our esteemed colleague Bill Brown. Maureen will continue her current responsibilities, which she so capably leads, while also heading the search committee to identify a new hospital CEO. I am grateful to Maureen for accepting these additional duties and feel confident that we will be able to attract great talent to continue the transformation and rebuilding of the new hospital campus.