Washington continues to roil the nation’s health care landscape with reports of a revived attempt to repeal and replace the Affordable Care Act (ACA). Congressional Republicans who voted 62 times to repeal and replace the ACA during the Obama Presidency, are now seemingly unable to agree on a path forward for American health care. A proposal floated late last week designed to win support from moderate and more conservative House members would amend Speaker Ryan’s American Health Care Act by allowing states flexibility to apply for limited waivers to opt out of some of the ACA’s core requirements. One waiver would allow insurers to charge higher premiums for people with pre-existing conditions as long as the state also offered high-risk pool coverage. No timetable or set date for a vote has been announced. In aggressively opposing the American Health Care Act we continue to work closely with the Mayor’s office, health care associations, our labor partners and New York’s congressional delegation, including Representative Dan Donovan who has reiterated his opposition to the latest proposal for ACA repeal.

The final version of the FY2018 state budget empowers the Governor to prepare a plan reducing Medicaid spending equally and proportionally across all programs affected, in the event that federal budget, statutory or regulatory changes reduce federal participation in Medicaid by $850 million or more.

The budget also provides $20 million in new funding for the operations of enhanced safety net hospital systems like NYC Health + Hospitals, serving a high share of Medicaid and uninsured individuals. We expect the distribution methodology to be favorable, and anticipate receiving approximately 40-46%, of the funding. The legislature was instrumental in pushing for this funding in the enacted budget. It represents an important first step in recognizing the challenges facing safety net hospitals.

Last week we held the first of our yearly, state-mandated meetings in each borough to give patients and community members the chance to convey comments and concerns about our operations directly to members of our Board of Directors. The meeting for the Bronx was held at NYC Health + Hospitals/Jacobi, with Robert F. Nolan and Josephine Bolus, RN,MS, APRN-BC representing the Board. Approximately 60 people were in attendance and 19 speakers, many of them from labor organizations, community boards and community advisory boards, addressed the Board.

MetroPlusHealth is opening new community locations in Brooklyn, Queens, and Staten Island. The three sites will serve as resource centers for New Yorkers to get answers to health insurance program questions and receive assistance to enroll in plans such as Child Health Plus, Medicaid, Qualified Health Plans and the Essential Plan. In Queens, the Flushing Skyview Mall will feature a MetroPlusHealth kiosk to help people find out if they are eligible for no-cost or low-cost health insurance. A second kiosk will offer similar options at the Staten Island Mall, the borough’s first MetroPlusHealth location. And in Brooklyn, a new MetroPlusHealth community office has just opened in Sunset Park.

Health care specialists who speak English, Chinese, Spanish, and a number of other languages are available at most MetroPlusHealth community locations. There are now over 20 such sites throughout the five boroughs.

I am pleased to report to you that as a result of our partnership with St. George’s University in Grenada, twelve students will receive CityDoctors scholarships worth $1.5 million to attend St. George’s School of Medicine. This innovative program helps bring more primary care physicians into the workforce and into communities across the city, where they are urgently needed. Earlier this month Council Member Jumaane D. Williams and the New York City Council honored the CityDoctors program with a proclamation, recognizing its work to address the looming shortage of primary care physicians in New York City.

The program provides students who have strong ties to the New York City area with a great opportunity to continue their education, and to find job security following graduation. In return for their scholarships, students commit to practicing primary care medicine in New York City’s public health care system after graduation. The five-year collaboration between St. George’s University and NYC Health + Hospitals has helped 81 students from New York City and its surrounding area attend medical school on scholarships totaling $7.9 million. The 2017 class of CityDoctors scholarship recipients are a diverse group of women and men, representing Queens, Brooklyn, the Bronx, and Manhattan, as well as Florida and Pennsylvania. Recipients hold undergraduate and graduate degrees from a range of prestigious institutions, including New York University, Columbia University, New York Institute of Technology, University of Texas, Hunter College, and the University of Rochester.

Earlier this month NYC Health + Hospitals led a citywide full-scale special pathogens exercise to assess New York City’s readiness to care for patients with contagious and potentially lethal illnesses. The multiagency drill underscored our system’s leadership role in emergency preparedness and in safeguarding the health of New Yorkers in the event of a public health crisis.

We partnered with the New York City Department of Health and Mental Hygiene, the Fire Department of New York, the Office of Chief Medical Examiner, New York City Office of Emergency Management, and New York State Department of Health for the daylong interactive training. The exercise mimicked a real-life response to a special pathogens exposure. Medical professionals from three care sites—NYC Health + Hospitals/Bellevue, NYC Health + Hospitals/Elmhurst, and NYC Health + Hospitals/Gotham Health, Morrisania—were challenged with identifying and treating two patients with symptoms of Lassa fever and Middle Eastern Respiratory Syndrome (MERS-CoV) that they didn’t know to expect. The scope and complexity of the exercise gave participants a hands-on opportunity to develop strategic skills necessary to keep the public safe in the event that the city confronts a real-life special pathogens exposure.

I am also pleased to report that 22 patient care locations in the NYC Health + Hospitals system have received the designation “2017 Leader in LGBTQ Healthcare Equality” from the Human Rights Campaign Foundation, the nation’s leading LGBTQ rights advocacy organization. The 22 patient care locations are found in all five boroughs—including in Brooklyn, where no other provider was so recognized. The honor acknowledges hospitals, community health centers, and nursing homes across the country that embrace LGBTQ inclusion and patient-centered care. Implicit in receiving this designation is the fact that NYC Health + Hospitals has been a leader in caring for LGBTQ patients in New York City. We are committed to providing staff with specialized trainings so LGBTQ patients receive responsive health care in a welcoming environment, and we have zero tolerance for discrimination based on sexual orientation and gender identity.

Last month the Joint Commission (TJC) conducted an unannounced survey of NYC Health + Hospitals/Woodhull, six weeks ahead of schedule. I am pleased to report that Woodhull will be accredited for the next three years. Over four days, TJC conducted an intensive and rigorous survey involving numerous tracers on inpatient units, ambulatory care clinics, and off-site clinics. Surveyors reviewed processes around central sterile, malignant hyperthermia, medication management, performance improvement, competencies, contracts, facility structure and the environment, including cleanliness. Congratulations to Gregory Calliste, CEO, Ed Fishkin, MD, Chief Medical Officer, Angela Edwards, RN, Chief Nurse Executive, and Sharon Neysmith-Crawford, Associate Executive Director, Quality Management, and the staff of NYC H+H/Woodhull, on a successful survey. Thank you as well to Board Member Josephine Bolus, RN, for representing the Board.

OneCity Health continues to work on initiatives designed to advance population health by building relationships with community health and social service providers to strengthen continuity of care and keeping more of our patients from unnecessary hospitalizations.

• As part of our efforts to improve cultural competence and health literacy (CCHL), seven partner sites, including five NYC Health + Hospitals sites have completed self-assessments, using the C-CAT survey and other tools, to understand the current state, strengths and opportunities for improvement. Forty-eight additional sites are continuing with the assessment. This initiative will provide the OneCity Health network with additional insights on disparities and gaps in service delivery, and promote best clinical and administrative processes to improve them.
• In addition, 14 community partners will soon begin to conduct focus groups with patients or consumers from our identified priority populations. Feedback from our patients and clients will add to the data on sites and their staff that One City Health is collecting through the CCHL self-assessments. Partners will conduct up to 28 focus groups.
• OneCity Health recently concluded a pilot with our partner First MedCare to create a connection from their Electronic Medical Record to the Regional Health Information Organization (RHIO). Soon we will begin to connect our next wave of partners to the RHIO to ensure our partners can exchange data across our IDS.
• The Greater New York Hospital Association (GNYHA) recently issued a Population Health Curriculum Guide for hospitals and health systems participating in the Delivery System Reform Incentive Payment (DSRIP) program. The guide includes concepts and practices for front-end staff, providers, and partners. Marlee Ickowicz, Project Manager for Workforce and Special Projects at OneCity Health, is a member of the GNYHA DSRIP Workforce Workgroup and provided guidance on the curriculum guide. We are currently developing a strategy to share the curriculum across our IDS.
• To enhance both quality and access to primary care, we’ve coordinated two trainings for our primary care partners: Through a partnership we have coordinated with The Center to Advance Palliative Care (CAPC), nearly 200 staff members from our community partners have registered to become members. Members will receive access to tools, training and technical assistance aimed at improving both clinical as well as operational skills for the delivery of palliative care, treatment and support services within the primary care environment.
• For our community partners whom we are helping to achieve Patient Centered Medical Home (PCMH) recognition as well as our primary care partners, we will soon host our third learning collaborative which will introduce key concepts in care management. Nearly 80 people attended our first two learning collaboratives.

• OneCity Health is continuing to expand a number of our transformation efforts:

• We recently expanded our Health Home At-Risk pilot to NYC Health + Hospitals/Bellevue, in addition to our ongoing pilots in five NYC Health + Hospital/ Gotham sites and four community partner primary care practices (Community Healthcare Network, SUNY Downstate Medical Center, Center for Comprehensive Health Practice and Brightpoint Health). Through this intervention, primary care practitioners can make referrals to care coordinators provided by OneCity Health’s Health Home lead agencies, which are NYC Health + Hospitals, Community Healthcare Network and Community Care Management Partners.
• A Transition Management Team (TMT) is now in place at NYC Health + Hospitals/Lincoln, where it will provide 30 days of supportive care management for patients at high risk of readmission. Teams also continue to support patients at NYC Health + Hospitals/Bellevue and NYC Health + Hospitals/Kings County. To date, over 900 patients have been followed by TMT’s into the community.
• As part of our clinical asthma program, our partners have assigned nearly 200 patients to Community Health Workers (CHWs). Seven NYC Health + Hospital facilities (Elmhurst, East New York, Gouverneur, Harlem, Kings, Lincoln + Queens) and two of our community partners (Urban Health Plan and Gentle Touch Medical) are generating referrals to our partners with CHWs. The CHWs – from VillageCare, CABS Home Attendants Service, St. Mary’s Healthcare System for Children, Asian Community Care Management, Make the Road New York, a.i.r NYC and NYC Health + Hospitals – complete an asthma assessment, reinforce recommendations from the clinical team, and conduct home visits to evaluate the environment for asthma “triggers.”