The Year Ahead
||HHC President Alan D. Aviles
A Conversation with HHC President Alan D. Aviles
In 2012 HHC weathered Hurricane Sandy, moved forward to implement initiatives that align with the Affordable Care Act, and provided essential healthcare services to 1.4 million New Yorkers. HHC President Alan Aviles reflects on the achievements of 2012 and talks about the ambitious goals he has set for the city's public healthcare system in 2013.
Q. How has Hurricane Sandy affected HHC's priorities for 2013?
A. First I want to say that I am extremely proud of the performance of the HHC workforce during Hurricane Sandy and its aftermath. I witnessed so many HHC employees overcoming formidable storm-related challenges and exemplifying consummate professionalism, united by a shared commitment to helping our fellow New Yorkers in need. The trauma of Hurricane Sandy has not changed our strategic direction. However, because we are now focused on the fastest possible restoration and recovery from the storm, it has caused us to re-prioritize what we have to accomplish during these first few months of 2013.
Q. What is the status of Bellevue and Coney Island hospitals?
A. Bellevue remains closed to inpatients but it's been operating outpatient services, 24-hour walk-in urgent care, and pharmacy services since Nov. 19th. The Emergency Department started accepting ambulances again on Monday, Dec. 24th for non-critical cases and we anticipate the hospital will resume its Level 1 trauma and inpatient services in early February. Coney Island remains closed to all but psychiatric inpatient services but it's been operating outpatient clinics, 24-hour walk-in urgent care, and pharmacy services since just a few days after the storm. We anticipate inpatient service will resume by mid-January. There is also restoration work being done at other facilities that did not close, including both campuses of Coler-Goldwater Specialty Hospital, as well as Harlem and Metropolitan hospitals.
Q. The U.S. Supreme Court upheld President Obama's Affordable Care Act in 2012. What does that mean for HHC in 2013?
A. We will continue our strategic positioning of HHC at the leading edge of healthcare reform. We will embrace new service delivery models that aim to improve, streamline and better coordinate care, such as the Accountable Care Organization, or ACO. This year we expect to be designated an ACO for Medicare patients by the federal government. As an ACO, we will be assigned Medicare patients for whom we must manage and coordinate care. If our clinical teams are successful in helping these patients improve their health and avoid unneeded emergency department or inpatient care, we will get to share in the cost savings that result.
Q. What other models is HHC implementing?
A. The Patient-Centered Medical Home, or PCMH, is a model that is central to health care reform. In the traditional model, medical care is frequently episodic, and too often initiated by an emergency room visit. In the PCMH model, medical care is a long-term relationship between a patient and his or her designated team of providers. HHC provides primary care services at dozens of sites across all five boroughs, and at every one of them, teams are putting together procedures and staffing plans to ensure that the PCMH model is established successfully. The PCMH provides robust primary and preventive care that does a better job of helping patients manage their chronic disease and serves to coordinate care across all of the care settings that patients cross, particularly for those patients who have more complex medical conditions.
Q. HHC and the MetroPlus health plan recently earned Health Home designation from the state. What does that mean?
A. The Health Home is another new model of health care integration, and will focus on more effectively coordinating care for a special population of high cost/high need Medicaid recipients who suffer from two or more chronic diseases, or from a persistent psychiatric or substance abuse disorder. Health Homes receive payments to provide targeted care management and support that improves overall health and reduces the need for unnecessary and expensive emergency department or inpatient services. Now that HHC and MetroPlus together have earned Health Home designation in the four most populous boroughs of our City, we'll receive state funding to begin creating the care management and care coordination infrastructure that we need to really impact the health status of patients in a positive way. We are seeking additional targeted federal funds to cover the cost of providing health home services to all of our patients, including the uninsured.
Q. Two years ago HHC embarked on a comprehensive restructuring and cost containment strategy to reduce a projected budget deficit of $1 billion. How's that going?
A. To date, our efforts have reduced our budget gap by about $450 million and we've received about $300 million dollars in additional annual support from the City. However, we must still close a projected gap of several hundred million dollars so our cost containment efforts continue.
Q. What more can be done?
A. One of the best ways to provide services in a more cost effective manner is through Breakthrough, our process improvement program. HHC staff who do the work are often best at determining how to improve our work processes and reduce waste. Over the past four years, Breakthrough-related improvements have resulted in more than $250 million in combined savings and new revenue, quite an impressive result. Another benefit is that through Breakthrough team activity, we are seeing amazing leadership potential emerge among our staff members.
Q. How else is HHC engaging employees?
A. We've begun to focus on offering training to some of our employees for the healthcare jobs of the future that relate to healthcare reform. We're going to need more employees who can function as care managers, care coordinators, patient navigators, etc. We certainly will need more employees who are skilled in information technology to fully develop and support our new electronic medical records system. These should be growth areas in the healthcare workforce for many years to come.
Q. Any final comments?
A. HHC is poised to become a national model for how healthcare organizations must change and adapt to thrive as healthcare reform takes hold. We have a lot going for us, including our own first-rate health plan, MetroPlus, and our home care division. Both will play increasingly critical roles going forward. And we're getting better at leveraging the power of collaboration and teamwork, as well as developing standard work that helps to more reliably disseminate operational improvements and best clinical practices across our vast system. With all of that, together with our collective deep commitment to our mission and our exceptional workforce, I am more confident than ever that HHC will successfully navigate the turbulence and challenges ahead. We're public and we're proud… and we should be.