Committee on City Healthcare Services: 2018 Report October 2018 0 Contents Introduction .................................................................................................................................................. 2 Background and Context ............................................................................................................................... 2 Health Data Summary ................................................................................................................................... 4 Summary of City Healthcare Services ......................................................................................................... 12 Administration for Children’s Services .................................................................................................... 12 Human Resources Administration (Department of Social Services) ....................................................... 13 Department of Homeless Services (Department of Social Services) ...................................................... 15 Department for the Aging ....................................................................................................................... 16 Department of Health and Mental Hygiene ........................................................................................... 18 Department of Education ....................................................................................................................... 20 NYC Health + Hospitals............................................................................................................................ 21 Review of Reports Pertaining to the Provision of Healthcare .................................................................... 22 Summary of Coordination Projects ............................................................................................................. 24 Recommendations ...................................................................................................................................... 26 Appendix A: Text of Enabling Statute ......................................................................................................... 30 Appendix B: List of Committee Members ................................................................................................... 32 Appendix C: Health Data by Community District ........................................................................................ 33 Appendix D: Compendium of Reports……………………………………………………………………………………..…………….38 Appendix E: Addresses of Locations…………………………………………………………………………………….…………………67 1 Introduction The Committee on City Healthcare Services (the “Committee”) is pleased to submit this report. It is provided pursuant to the City Council mandate of Local Law 6 of 2018 (“Local Law 6”). The law, which went into effect in May 2018, requires the creation of this Committee and the development of this initial report by October 15, 2018. Per the law, the Committee includes representatives from each of the City agencies that provide healthcare services (whether directly or by contracting with another entity), two representatives from the City Council, and key external partners appointed by the Mayor and the Council. The law specifies that the Committee shall “review community-based health indicators in New York City [NYC], and evaluate community-level health needs that can be addressed by city healthcare services.” The law further stipulates that the Committee shall issue a report every two years with specific required components, including recommendations for utilization and coordination of City healthcare services. This is the first such report. For reference, the full text of Local Law 6 is included in Appendix A, and a list of the Committee members appointed as of October 2018 is included in Appendix B. The Committee met in the summer and fall of 2018, supported by the prior and ongoing work of City agencies providing healthcare services. Per its charge, the Committee compiled, reviewed, and evaluated mandated information and data, adding additional areas of focus based on members’ insight and priorities. Following these discussions and additional opportunities for input, the Committee has advised on recommendations for long-term planning and study to utilize, coordinate, and optimize City healthcare services. The Committee is energized by this mission and looks forward to continuing its work well beyond this first report. Background and Context Most healthcare in NYC is provided in hospitals, clinics, and independent physician practices. However, these settings may not be best positioned to meet the healthcare needs of some of NYC’s most vulnerable populations. There are unique considerations for serving these diverse communities, and City healthcare services are an important resource to address their specific needs. The Committee identified seven City agencies that provide healthcare services, though there are necessarily variations in the services provided, the populations served, and the length and extent of the clinical relationship. For example, City agencies such as the Administration for Children’s Services (ACS) and the Department of Homeless Services (DHS) only provide healthcare to individuals who are already in their care, either awaiting placement in foster care or in homeless shelters or programs, respectively. Other New Yorkers receive more traditional care in City settings like the school-based healthcare provided by the Department of Education (DOE) in collaboration with the Department of Health and Mental Hygiene (DOHMH) or the hospitals and clinics run by NYC Health + Hospitals1 (H+H) Though these are extensive enterprises, the City does not attempt to supplant all private 1 Note that H+H is not a normative City agency. It is a State-created public benefit corporation. As such, its participation on this Committee and process is voluntary, per the underlying law. 2 healthcare services with them. Rather, much of the City’s healthcare system is strategically tailored to best serve specific healthcare needs that otherwise go unmet. The City’s objective is to facilitate the provision of quality and culturally competent care, as well as the coordination and integration of care across City agencies, and when appropriate, to connect individuals to primary and preventive care in traditional healthcare settings. The Committee has reviewed the existing City healthcare services and, per its mandate, deliberated on recommendations for utilizing these services to address the needs of, and engage in outreach to, vulnerable populations. Many of these recommendations include proposals to improve coordination across City agencies and make optimal use of existing services, in keeping with the law’s requirements. The City’s healthcare services function within the context of the larger local healthcare delivery system, and State and Federal oversight thereof. Inasmuch as the City cannot regulate private healthcare providers, its focus is on effectively serving the vulnerable populations who access public services and facilitating access to care overall. In one step to advance these goals, the City works extensively to enroll New Yorkers into health insurance to enable them to receive healthcare services at both public and private providers. Since the Affordable Care Act’s first open enrollment period in 2014, the City has implemented multiple iterations of GetCoveredNYC, an on-the ground and media campaign that helps New Yorkers sign up for health insurance. This effort has resulted in historically low rates of uninsurance in NYC. In 2016, 7.8 percent of all NYC residents were uninsured, compared to 11.4 percent in 2014.[1] Of course, City agencies and H+H continue to provide services regardless of insurance status. Further, the direct provision of individual healthcare services is only one way in which the City protects and promotes the health and well-being of vulnerable New Yorkers. City public health efforts like Take Care New York 2020, plus non-health-specific initiatives like Universal Pre-K and expanding a Living Wage, are more systemic approaches to the environmental, social, and economic factors that affect health in NYC. The Committee recognizes that addressing these social determinants of health can impact health and wellness in NYC communities and notes that more City agencies than are represented in this Committee contribute to New Yorkers’ health. This broader context is critical to understanding the role of City healthcare services, and it is an important part of Committee discussion and analyses. However, these important initiatives are not City healthcare services per se and are thus outside the scope of this report. That said, the Committee is deliberate about framing its recommendations and future work within a larger policy context. Committee members are mindful of recent Federal administrative and legislative attempts to weaken the Affordable Care Act, reduce available funding for health services, inhibit access to benefits, and take other actions that negatively impact vulnerable populations. Now more than ever, the Committee finds it is critical to study, support, and coordinate City healthcare services in the face of those policy and financial pressures. We are hopeful that the Committee’s work will play a key role in understanding the healthcare needs of vulnerable populations and providing meaningful, viable recommendations on how the City can make optimal use of its