The Year Ahead for HHC: A Conversation with Alan D. Aviles

For HHC President Alan D. Aviles, 2013 was the year HHC invested in a stronger primary care network and a new Electronic Medical Records system, tackled a $1 billion budget gap, and successfully launched a new health insurance product on the New York State health exchange to attract new patients. Here he talks about the challenges and opportunities he sees for 2014, and reflects on HHC’s leadership role in health reform, fending off financial upheaval and closing the healthcare inequality gap.

Q. The New Year is often a time of reflection and a time to inventory accomplishments. What do you see as HHC’s greatest achievement?

A. HHC’s single greatest accomplishment relates to Mayor deBlasio’s concern about the “Tale of Two Cities.” Twenty years ago, there were two starkly different healthcare systems: the public one for the poor and the private sector for the more affluent. The public system was floundering, unable to deliver consistently high quality care. Some of our hospitals were on the brink of losing accreditation. Over the course of the last decade, we have managed to eliminate the inequitable two-tier system. I’m proud to say that care rendered across HHC today is equal to, and often better than, the care offered in some of our City’s brand-name hospitals. This is not just a subjective assessment - it’s reflected in an array of quality and patient safety performance measures that are now publicly reported.

Q. What are some of those performance indicators that show better patient health outcomes?

A. Our hospitals have made huge strides in reducing hospital-acquired infections and our extremely low rates of ventilator-associated pneumonia are now among the best in the country. Our health plan, MetroPlus, has been ranked first in quality and patient satisfaction for six of the last seven years. Our achievements in improving quality of care and patient safety across many fronts have been recognized with awards from the Joint Commission, the National Quality Forum, the American Hospital Association, the American Cancer Society, the American College of Surgeons, among others. We’ve also received national awards for the quality of our palliative care programs and our use of information technology to drive improvements in care.

Q. 2013 was another year of great financial pressure on hospitals and moved several more voluntary sector hospitals to the brink of closure. How did the NYC public hospitals manage to avoid facility closures?

A. We face the same challenges, driven by extremely deep cuts in our reimbursements and skyrocketing employee pension costs. But early on our leadership team and workforce came together to execute a four-year $600 million cost containment and restructuring plan and completed it a full year ahead of schedule. Although a further projected budget gap has now opened up, we are in a much better position to deal with it.

Q. How were you able to quickly put that ambitious $600 million gap-closing plan in place?

A. Most of those who work for HHC care deeply for its mission, and the obvious threat to our mission fueled extraordinary efforts to achieve financial stability and prevent painful closures or service cuts. As part of those efforts, we asked our employees to do more with less. Our staff have really come through and it’s been amazingly seamless to our patients.

Q. What are the big things to come in 2014?

A. First, we’ll be reaping the rewards of our first venture into commercial insurance with our health plan, MetroPlus, participating in the New York health exchange. Second, 2014 is the year that our new electronic medical records system will go live in one of our six HHC networks. Both initiatives help position us to succeed as healthcare reform continues to unfold.

Q. Why was it important to have MetroPlus offer an insurance plan option on the NY health exchange?

A. It’s a great opportunity to attract more than 40,000 newly insured patients to the HHC system by the end of 2014. In fact, we already have more than 14,000 new patients who enrolled in MetroPlus from the exchange. We estimate that these enrollments will yield more than $100 million in new revenue to help offset some of our deficit from the uncompensated care we provide.

Q. HHC has been using an EMR for nearly 20 years. Why is the new system such a big deal?

A. As a pioneer of electronic medical records, we’ve leveraged our existing system as much as possible. However, a new, state-of-the-art EMR system will offer much more advanced functionality, and will give our clinicians greater capacity to improve quality and care coordination, as well as increase efficiency. I’m particularly excited about the new system’s patient portal, which will give patients access to their clinical information and better empower them to be partners in their care. We’ll launch the new system in two hospitals by the end of this year and roll it out to the rest of the facilities over the following 2 to3 years.

Q. You’ve been at HHC for 17 years now. Were there any new lessons learned in 2013?

A. Frankly, the biggest wake-up call for me this year came directly from our workforce. Our employees are deeply connected to our mission and many work here because of it, often forgoing higher paying jobs in the private sector. But I learned that many feel disconnected with the important changes taking place. They want more information and more opportunities to develop in their career. That’s why in 2014 we will expand our staff recognition, education and professional development programs. It’s personally important to me that we make sure everyone in this organization has a voice and that each HHC staff member is respected and valued.

Q. HHC has seen steady leadership for nearly a decade under Mayor Bloomberg and your senior leadership team. What do you expect from the new de Blasio administration?

A. The new deputy mayor for health and human services, LilliamBarrios-Paoli, is someone we have worked with, and we know she is a strong supporter of our mission. And our new mayor has voiced very clearly his strong support for our public hospital system, so we fully expect that the crucial support we have enjoyed during the last 12 years will continue into the new administration.

January 2014