Mayor de Blasio Announces One New York Health + Hospitals Transformation Plan

April 26, 2016

Download the report

Comprehensive plan will restructure outdated care model while expanding access to high-quality healthcare in high-needs communities

Focus on improving health outcomes and financial stabilization of public hospital system which serves high number of low income and immigrant patients

NEW YORK––Mayor Bill de Blasio today unveiled One New York: Health Care for Our Neighborhoods, a comprehensive report outlining the City’s plan to address a growing Health + Hospitals financial shortfall forecasted, without intervention, to reach $1.8 billion by FY20. The plan will focus on four primary goals for the city hospital system’s success: stabilizing funding, expanding community-based healthcare, improving efficiency and remodeling an outdated system. Health + Hospitals has long functioned as a safety-net for the City’s underserved New Yorkers, specifically those who are uninsured as well as Medicaid patients (collectively representing 70 percent of patients served).

“Over the past 13 years, 18 private hospitals have closed throughout New York City. This plan will not close any more hospitals or layoff any workers, but expand comprehensive healthcare, especially in high-need communities,” said Mayor Bill de Blasio. “We are implementing long-term sustainable solutions, rather than a band-aid fix, to stabilize hospital finances and save our public healthcare system. Public hospitals across the country are facing the same structural challenges – our plan will preserve our institutions while ensuring quality care in-community services.”

“By providing significant new investments to support our essential public health care system, the mayor’s One New York plan will ensure we don’t have the tale of two cities when it comes to quality health care,” said Dr. Ram Raju, President and CEO of NYC Health + Hospitals. “This comprehensive approach sets a path to stabilize funding, expand access to care in high needs neighborhoods and further support our Vision 2020 agenda for growth. We are committed to doing all we can to bring additional efficiencies and reforms to preserve our mission and deliver equitable health services to all New Yorkers.”

Over the past decade, the healthcare industry has begun an important transition in response to the changing landscape of patient care – which includes an emphasis on preventive community-based care embedded where people work and live. This shift from “sick care” to health care recognizes that health care should help people stay healthy and not just treat them once they become sick. It is critical for all New Yorkers, and particular the most vulnerable, that Health + Hospitals adapt to this new model so that everyone across the city enjoys access to the best in modern medicine without financial risk. Though community-based care cannot and should not replace hospitals, it is vital that New York City recognize that the current care model is over-reliant on emergency room service and uncoordinated episodic care, Furthermore, declining funding on the federal and state levels that is expected to total nearly $1 billion. At the same time, under this outdated model, patients lack sufficient primary and preventative care that proactively keeps them healthy.

As part of the Executive Budget, New York City will continue its support of Health + Hospitals by adding $160 million in FY16, which grows to $180 million thereafter. This will bring the City’s total commitment to Health + Hospitals to nearly $2 billion in FY20. The City will also make a $100 million capital investment in critical, new infrastructure shifting from inpatient care to ambulatory care and outpatient services. Even with this unprecedented City investment, Health + Hospitals must close a $1.8 billion budget gap in FY20 through a bold transformation plan, which includes $700 million of expense reductions and $1.1 billion of new revenue. As part of this plan, the City will advocate for fairer reimbursement from the state and federal governments for care provided to the uninsured and to low-income populations enrolled in Medicaid.

The transformation plan will additionally embed more healthcare centers in local communities, while improving overall operational efficiency of the Health + Hospitals system. Today’s healthcare landscape has seen increased competition for Medicaid patients, while usage of public hospitals has declined overall. This new vision will re-focus resources to comprehensive, accessible and affordable healthcare for New Yorkers, regardless of income or legal status. The City also will focus on increasing productivity and generating revenue through a variety of means including: enrolling uninsured in affordable health insurance; expanding the City’s coordinated care models (like ActionHealthNYC) across all of Health + Hospitals facilities to serve New Yorkers currently ineligible for insurance; and using technology platforms to streamline day-to-day operations. Technological advancements are exemplified by the recent launch of a new electronic health record system, the industry gold-standard Epic.

Health + Hospitals must embrace the challenge of restructuring its system to reflect the changing healthcare landscape, with a focus on four primary goals:

Stabilizing funding: Health + Hospitals must secure a sustainable funding source to provide care for the uninsured.

• Health + Hospitals will build on existing efforts with targeted, community-based outreach to enroll people who are eligible for coverage but remain uninsured.
• New York City will seek to work with state and federal officials to launch a program that commits to support coordinated care for uninsured New Yorkers.
• Secure more equitable New York State funding formula for safety net hospitals like Health + Hospitals.

Expand community-based care, strengthen coordination and care management, and integrate social supports to improve health outcomes. Even as Health + Hospitals becomes leaner in some areas, it must also grow to better serve high-need communities. That effort will include:

• Embedding more health centers in communities.
• Expanding the capacity of community-based sites, through longer operating hours and new services.
• Partnering across City agencies and with the City’s many outstanding community-based providers.

All of these steps are especially critical when it comes to treating high-risk patients, who require convenient access to multiple providers in a coordinated fashion. These efforts will also improve broader health outcomes within the target communities.

Consolidate hospital services and improve operational efficiency. This effort will proceed on multiple fronts:

• Assess hospital services to ensure that we are efficiently delivering safe, high-quality and effective care.
• Operate more efficiently and maximize revenue.
• Develop vacant and under-utilized parcels of land on Health + Hospitals campuses to address social determinants of health while raising revenue.

Restructure payments and build partnerships to support the health outcomes of communities. Health + Hospitals will shift from a model that rewards doing more services to a model that aligns financial incentives with evidence-based practice and positive health outcomes.

• Move from payments based on volume to payments based on improving patient health.
• Build cross-provider care management arrangements so patients can get coordinated care across the City, which improves health outcomes.

“Health + Hospitals provides essential care to my constituents and to New Yorkers throughout the city, and making sure they have stable financial footing is critical to ensuring that they will be able to continue to meet the needs of the communities they serve. New York City has suffered far too many hospital closures, particularly in my district in Queens and the Bronx, and I will continue to fight to keep New York City’s hospitals standing strong,” said Congressman Joe Crowley, Vice Chair of the Democratic Caucus.

"I commend Mayor de Blasio’s efforts and dedication to the Health + Hospitals transformation plan. Providing affordable coverage and ensuring quality healthcare services to those in need is necessary to promote community health and well-being. Furthermore, the restructuring detailed in the Health + Hospitals transformation plan will allow for New Yorkers to retain their jobs while working in a more efficient and productive work environment," said State Senator Roxanne J. Persaud.

“Mayor de Blasio has presented a progressive, intelligent strategy, backed with an unprecedented investment, to reshape NYC Health + Hospitals, focusing on expanding primary and preventive care, outpatient services, and social support services. Active community involvement will be critical in implementing this vision,” said Assembly Member Richard N. Gottfried, Chair of the Committee on Health. “New York City’s strong commitment to making sure every resident has access to a quality health care system goes back to colonial times. Now we need a similar commitment from Albany and Washington.”

“New York City’s public hospitals provide critical health and wellness services for 1.2 million people annually. Mayor de Blasio’s One New York: Health Care for Our Neighborhoods seeks to stabilize the finances of our hospitals while making wellness care more broadly available,” said Assembly Member Latrice Walker. “The administration’s substantial funding plan will support the expansion of a newly modeled infrastructure that focuses on outpatient services to keep New Yorkers healthy.”

“This Administration's commitment to eliminating health disparities is unmatched," said Corey Johnson, Chair of the Committee on Health. "One New York: Health Care for Our Neighborhoods makes a historic contribution to Health + Hospitals while furthering the vision of providing comprehensive health care to all New Yorkers in their communities. This announcement is just a start and I look forward to working with Mayor De Blasio, Deputy Mayor Dr. Herminia Palacio and Health + Hospitals President Dr. Ram Raju to ensuring that our safety net system receives its fair share."

“The deficits at Health + Hospitals put at risk the safety net that, without exaggeration, is the difference between life and death for many New Yorkers. This plan and the City’s financial commitment will start the turnaround towards stability for the doctors, nurses, staff and patients,” said Council Member Andrew Cohen, Chair of the Committee on Mental Health.

"This multi-billion dollar investment will stabilize and improve our city's public healthcare system," said Council Member Daniel Dromm. "Elmhurst Hospital, a public hospital in my district, serves thousands of uninsured and undocumented New Yorkers each month. These dollars will help ensure that facilities like Elmhurst Hospital are adequately staffed and have the resources they need to care for all New Yorkers regardless of immigration status or income level. I am proud to support this effort which will directly impact the lives of families across the five boroughs.”

Council Member Steve Levin said, “The plan released today is a positive step toward ensuring that all New Yorkers have access to quality, affordable healthcare. The administration’s commitment to Health + Hospitals for FY17 and beyond will make critical new investments in ambulatory care and outpatient services, secure fairer reimbursements to support the uninsured and Medicaid recipients, and will enable more uninsured residents to apply for Medicaid and ActionHealthNYC. I look forward to working with the administration on implementation.”

“NYC Health + Hospitals is a much needed health care safety net for New Yorkers from all walks of life. Our health is at the foundation of everything we do, and New Yorkers need high-quality, comprehensive health and wellness care to work, raise families, and make our neighborhoods great places to live. The mayor’s blue ribbon panel and $2 billion investment will help keep our city healthy and make NYC Health + Hospitals sustainable for years to come,” said Majority Leader Jimmy Van Brammer.

Council Member Vanessa Gibson said, “I thank the Mayor for recognizing the serious issues we face as a City if our health system is underfunded or not financially stable. Despite the agency's funding gap, I am optimistic that the panel Mayor de Blasio is convening will find real, long-term solutions to ensure Health + Hospitals' longevity. In the meantime, the $2 billion the Mayor is dedicating to Health + Hospitals in his executive budget will preserve health services for undeserved New Yorkers, and I thank the Mayor for his continued foresight and leadership.”

“New York City hospitals serve hundreds of thousands of patients each year and make up a vital part of our healthcare services,” said Council Member Ydanis Rodriguez. “Ensuring they are adequately funded should always be a priority, and I am glad the de Blasio administration is taking these concerns seriously in the short and medium-term. Compounded with funding for revitalized ambulatory care services, these investments will expand the reach of healthcare into otherwise disconnected areas, a boon to residents in every corner of the city.”

“All New Yorkers deserve to receive quality health care, and an investment of nearly $2 billion into New York City Health + Hospitals helps ensure that our public hospital system is fully equipped to make sure our city’s men, women, children, and senior citizens receive the care they deserve,” said Council Member Mathieu Eugene. “New York City has some of the best health care facilities in the world, and this funding for our health care system is a commitment to New Yorkers’ health that will have a positive impact for decades to come. I commend Mayor Bill de Blasio for making such an incredible investment for the people of our city.”

Javier H. Valdés, co-Executive Director of Make the Road New York, said, "Health + Hospitals is the crucial safety net healthcare provider for New York City's immigrant communities. It is imperative that Health + Hospitals stays on firm footing so that it can continue to serve all New York City communities into the future. Make the Road New York looks forward to working with the administration and other stakeholders to ensure that every New Yorker can access high-quality care."

“The Community Service Society of New York (CSS) enthusiastically agrees with the recommendations of this report which stress the importance of finding sustainable vehicles to provide coverage and access to care for the uninsured,” said David R. Jones, President and CEO of the Community Service Society of New York. “We especially encourage Health + Hospitals to leverage relationships with community-based groups whose constituents are one and the same as Health + Hospitals patients.”

Naomi Post, Executive Director of Children's Defense Fund-New York, said, "The Children's Defense Fund - New York applauds Mayor de Blasio for investing in preventive health care and service expansion for communities that otherwise don't have access to a coordinated system of care. Investing in the health and well-being of vulnerable families – including a focus on community health planning – is critical to advancing health equity for all in New York City."