Q&A with Ramanathan Raju on Health and Hospitals

Q&A with Ramanathan Raju on Health and Hospitals

Q&A with Ramanathan Raju on Health and Hospitals
February 11, 2015

Q: Under the Medicaid waiver, applications for Performing Provider Systems were due in December. How many of the institutions that you oversee applied? Are any seeking to transition into non-hospital roles?
RR: HHC is taking a leadership role in the Delivery System Reform Incentive Payment (DSRIP) process. We have applied to the state as a single, city-wide Performing Provider System (PPS) consisting of all our healthcare facilities, including our nursing homes, community health centers, home health agency and our insurance plan, MetroPlus. The HHC-led PPS, OneCity Health, has approximately 400 community based partners across the city whose work will be guided by the results of comprehensive community health assessments of the areas we serve. In response to those health appraisals, we will launch new initiatives to proactively meet the primary care needs of higher-risk patients, reduce 30-day readmissions, better address chronic health conditions, and enhance mental health and substance abuse programs. OneCity Health closely aligns and expands on HHC’s previous population health work and takes it to a next level of magnitude.

Q: What hospitals, if any, may be closed or downsized in the near future?
RR: Any closure or downsizing needs to be carefully considered within the context of New York City’s overall healthcare landscape. The DSRIP process will bring many changes and we can’t risk leaving our patients without access to effective care. This risk is magnified where hospital closures, bankruptcies and consolidations may have profound effects. The role and value of the HHC healthcare system cannot simply be measured by just the bottom line. HHC’s services are critical to the city’s most underserved populations and to the communities that suffer from the worst health disparities. The health of those populations directly impact everyone else’s health, whether you know it or not. We need to be sure our patients are provided for before making any decisions like that.

Q: How feasible is the goal outlined in the Medicaid waiver of reducing unnecessary hospitalizations by 25 percent within five years? How much progress has been made in the city?
RR: This is the future of healthcare. We have to do this. We are entering a very challenging period involving significant risks to effective community healthcare. Reducing unnecessary hospitalizations by 25 percent is quite feasible, and we can do it by keeping people healthier and not just thinking about them when they’re sick. HHC, together with its hundreds of partners, has seized the opportunity offered by DSRIP to transform care to better reflect the needs of the communities and patients we serve, and reorient the system to focus on chronic disease management and prevention.

Q: How do you anticipate the president’s executive action offering legal reprieve to some undocumented immigrants impacting the city’s healthcare system?
RR: HHC is New York City’s largest provider of healthcare services to undocumented immigrants, as well as its uninsured population. Undocumented immigrants are shut out of the insurance plans on the state health exchange and the subsidies offered by the Affordable Care Act to pay for those plans. But the ACA also decreases the amount of financial support given to care providers who serve the uninsured such as HHC. It’s a serious problem for us because these patients are still going to need our services and we will still provide them. The president’s recent actions under the Deferred Action for Parental Accountability could make Medicaid benefits available to some people who meet eligibility requirements, but not many. Gov. Andrew Cuomo included funding in his recent executive budget for some of these costs, but while the ACA brings many benefits we will remain in a bind between its exclusion of undocumented immigrants and its reduction of payments for uninsured care.

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