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The Year Ahead

HHC President Alan D. Aviles

A Conversation with HHC President Alan D. Aviles

With vision and a steady presence, Alan D.Aviles, HHC’s longest-serving president, is positioning the organization to advance a number of major initiatives in 2012. In this Q&A, Aviles discusses some of the goals and challenges facing the nation’s largest municipal healthcare system. HHC Today spoke with Mr. Aviles on December 30, 2011.

Any special thoughts at the start of the new year?
Definitely. I’d like to thank every HHC employee and say that, whatever their jobs, our employees’ commitment to our mission and to our patients continues to motivate and inspire me. So, I sincerely wish for all HHC employees a happy and healthy 2012.

What are some of the highlights of the last year?
In 2011, we entered our third year of The Road Ahead cost-containment program. Together we’ve done a pretty good job responding to unrelenting financial challenges. We have cut our costs and we continue to find new ways to work better and smarter with fewer resources. And we’ve done this while continuing to take care of growing numbers of New Yorkers who rely on our services.

What are some of the priorities for 2012?
I’ll mention three goals that are part of an ambitious agenda. First, we will keep tackling the ongoing financial challenges that come from increased expenses, growing numbers of uninsured patients, and falling revenues. Second, we will continue moving toward a patient-centered care delivery system that is truly integrated and able to provide coordinated services for our patients across the continuum of care. Third, we will leverage our most valuable asset -- our dedicated workforce. As we ask our staff to help us redesign our operations, and sometimes their own jobs, we will provide tools and support to enable them to succeed.

Tell us a little more about the financial challenges.
In these difficult times, healthcare, especially public healthcare, is the eye of the budget storm. We are dealing with the uncertain fate of federal healthcare reform as well as repeated cuts in government support at all levels. More federal cuts to Medicare and Medicaid are expected, and continuing City and State budget deficits make more cuts likely at the local level as well. Beyond that, dramatic cuts in supplemental Medicaid funding that supports public hospitals across the country are slated to begin in two years. It’s a tough situation, but with the state now getting serious about health system reform, I see light at the end of the tunnel.

What are some of the tools you’ll use to help HHC meet these challenges?
One key tool will be Breakthrough, our process improvement system, which we will continue to deploy to help our staff solve problems, make our operations more efficient and reduce waste. It is effective because it empowers the people who do the work to make decisions about how to change and improve it. To date Breakthrough teams have helped us find more than $200 million in new revenues and savings from increased efficiencies. As more staff are trained in Breakthrough, I know there is much more to come.

How will HHC work differently to deliver the patient-centered care you talk about?
Our work to develop strong Patient Centered Medical Homes and an effective care management program are already helping us improve care coordination for our patients. This coming year, we will start a multi-year project to transition to a new, state-of-the-art electronic medical record system to better support care coordination and effective care management across our system. And we will continue to build critical partnerships with primary care doctors, community based organizations, and city agencies like the Department of Aging.

What will change for HHC patients?
By focusing even more on comprehensive primary and preventive care, with more support for chronic disease management, we will partner more closely with our patients around improving their health status and sustaining wellness. Increased access and convenience will help us to build enduring relationships between patients and HHC care teams. And by coordinating care with partners outside our own system walls, HHC will connect patients to a community of providers working together to improve their health. This should lead to better health outcomes for the vast majority of our patients.

Didn’t everything used to be easier?
In a sense, yes. For decades now, we became used to getting paid for simply providing medical services… the more services rendered, the more was paid. In effect, we were reimbursed fairly generously for dealing with sickness and especially for hospital admissions, but poorly for promoting health. Not surprisingly, there was little incentive to make investments in primary and preventive care that keep patients out of the hospital. Now, new reimbursement models are evolving to do what we all know makes sense – reward us for achieving good patient outcomes instead of for the volume of services – procedures, tests, hospital admissions. The Health Home program, launched this month, will reimburse us for finding and coordinating care for our most complex patients who drive the majority of costs. Our facilities, working with MetroPlus, Health and Home Care, and partners outside of HHC, expect to profoundly alter the health of these patients for the better.

You demonstrate great pride in the HHC workforce. What’s new for them in 2012?
We will launch a comprehensive workforce development effort to help us fully tap the commitment, energy, experience, and creativity of our staff. This is an area of needed investment we have neglected for too long. We will foster and support continuous learning; reward innovation and adaptive change; and promote and sustain a culture of teamwork, mutual respect, and accountability. We will invest in talent by identifying, developing and mentoring leaders at all levels. Ultimately, we will create a corporate learning academy to drive this work.

Any final comments?
2012 will be another challenging year, but it will position us for a brighter future. We are poised to become a national model for how healthcare organizations change and grow to thrive as healthcare reform takes hold. Our past success, our exceptional workforce, and our increasing ability to adapt and perform well at the leading edge of change make me confident that HHC will emerge stronger than ever and steadfast in its mission.


January 2012

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HHC 2014 Stats

  • Staffed Beds: 6,684
  • Clinic Visits: 4,472,960
  • ER Visits: 1,179,436
  • Discharges: 205,791
  • Births: 18,564
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