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New York City public health system unveils plan to right its finances

CEO wants to grow the health system’s patient base to 2 million people and double the enrollment of its Metroplus health plan.

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Facing a mounting deficit, the New York City Health and Hospitals Corp, the country’s largest municipal hospital system, released a financial plan this week that it hopes will trim its budget gap while improving care in the city.

CEO Ram Raju, MD, said the plan would improve the patient experience and add members to the system’s insurance plan. By 2020, Raju said, “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.

NYC’s health system faces a $1.7 billion deficit by 2018.

Raju took the helm of the $6.7 billion system last year, in something of a homecoming. An adopted New Yorker by way of his native India and surgical training in London, Raju started his career at Brooklyn’s Lutheran Medical Center before becoming chief medical officer at HHC’s Coney Island Hospital in 2002. In 2006 became CMO of the whole HHC system, working there through the increased demand from uninsured patients during Great Recession.

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He most recently was CEO of Cook County Health and Hospitals System in Chicago.

HHC’s Metroplus health plan 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, high quality primary care service, Raju said.

HHC, which employs 39,000, includes 11 hospitals that have historically made up the bulk of its service and revenue as places for the city’s poor and uninsured seeking 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.

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“Many New Yorkers who have traditionally been our patients, now have insurance. They have a new-found 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.” 

After spending much of his first year meeting with facility 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.

Twitter: @AnthonyBrino

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