To fix financial woes, New York City's taxpayer-owned health system is plotting a comeback and planning to give more residents a kind of public option for health insurance.
The New York City Health and Hospitals Corporation, the country's largest municipally-owned hospital system, is staring down a "troubled" financial outlook, with deficits that could more than double between this year and 2018, to $1.7 billion amid a raft of federal-state financing changes and trends in hospital utilization.
The NYC HHC's president and CEO, Ram Raju, MD, believes that the public health system can do what its peer in Chicago did under his 2-year-leadership--improve the patient experience, grow an affordable insurance plan for Medicare, Medicaid and exchanges, and become self-sustaining financially.
Raju took the helm of the $6.7 billion HHC system last year, in what was kind of a homecoming, amid a post-Recession recovery and structural changes for it and other public hospital systems. "Many New Yorkers who have traditionally been our patients, now have insurance. They have a newfound option to seek care wherever they choose," Raju said. "In this new environment, the marketplace will dictate which hospitals will remain open, which hospitals will struggle, and which hospitals will close."
Raju is an adopted New Yorker. Born and educated India and trained in surgery in London, he started his medical career at Brooklyn's Lutheran Medical Center, became CMO at HHC's Coney Island Hospital in 2002 and in 2006 became CMO of the whole HHC system, working there through the increased demand from uninsured patients during Great Recession, until 2011.
Now back from a post as CEO of Cook County Health and Hospitals System, Raju gave New Yorkers an ambitious vision for the future of the NYC HHC, while promising that he likes "Brooklyn pizza better than Chicago's deep dish" and "could never root for the Cubs."
By 2020, Raju said, "as never before, we will embrace ambulatory care models that emphasize primary care, preventive care and population health." Raju wants to grow the health system's patient base to 2 million people, and double the enrollment of its Metroplus health plan.
HHC's Metroplus currently covers about 500,000 New Yorkers in Medicare, Medicaid and, more recently, subsidized exchange plans. Part of the pitch of the health plan will be an affordable premium and access to high quality, convenient primary care service, Raju said.
HHC, with some 39,000 employees, includes 11 hospitals that have historically made up the bulk of its service and revenue, as places for the city's poor and uninsured resident to seek emergency and acute healthcare. The HHC also has more than 70 community-based clinics, which Raju wants to leverage as a way to scale its patient centered medical home model.
"We are committed to reducing primary care wait time to a maximum average of 14 days, and no more than 5 days for pediatric clinics," he said. By 2020, the goal is to have inpatient satisfaction scores of 80 percent and outpatient satisfaction scores of 93 percent.
After spending much of his first year meeting with facility years, nurses, physicians and patients, "I think we're on the right track," Raju said.
While preparing for a new focus on bringing patients strong primary care, the HHC has made some financing wins, growing patient service revenue 10 percent and its Metroplus health plan revenue 6 percent, garnering an A+ bond rating from Fitch, and negotiating a release of additional Medicaid upper payment limit funding.
HHC also scored $1.7 billion from the Federal Emergency Management Agency to cover reconstruction and repair to damages from Hurricane Sandy. However, the health system is still seeking authority from the New York State Health Department to revise its Medicaid Disproportionate Share Hospital funding. The Affordable Care Act's reductions to federal DSH payments will leave HHC without nearly $3 billion between fiscal years 2017 and 2014.
Whether or not Raju's ideas gain traction, with the MetroPlus health plan attracting New Yorkers who can pick other insurers with other networks remains to be seen--as does Raju's legacy on the Third Coast.
Raju was credited with putting the Cook County Health and Hospitals Systems on the right path, after six CEOs tried and failed to lead the 11 hospital system over the seven years prior to his arrival. Under Raju, the CCHHS did narrow a perennial deficit, from an expected $300 plus million in 2011 to some $50 million more recently, and launched its the Medicaid managed care plan to serve in Illinois' Medicaid ACO program. The CCHHS' CountyCare plan has enrolled some 70,000 new Medicaid members and brought in more than $120 million, but the long-term county subsidies for of the health system remain a concern.