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New York


Ronda Kotelchuck, Primary Care Development Corporation ... Assembly Health Committee Chair Richard Gottfried, New York City Council Speaker ... – PowerPoint PPT presentation

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Title: New York

New Yorks Primary Care Coalition
  • Presentation to the
  • Florida Association of Community Health Centers
  • _________________________
  • Ronda Kotelchuck, Primary Care Development
  • Kate Breslin, Community Health Care Association
    of New York State
  • July 29, 2008

  • Backdrop
  • The Opportunity
  • The Response Coalition
  • The Purpose
  • Coalition Arguments
  • The Primary Care Agenda
  • Coalition Tactics
  • Outcomes
  • Challenges and Reflections

The Backdrop
  • Historically, New York has
  • An extremely strong acute care system and an
    undersized, disorganized primary care sector.
  • High and rising health care costs (including but
    not limited to Medicaid) with mediocre health
  • Large disparities in access outcomes.
  • Highest Medicaid spending in the US, with
    mediocre outcomes.

The Opportunity
  • State attention to growing costs.
  • State efforts to address cost concerns task
    forces, reports, Commission on Health Care
    Facilities in the 21st Century (Hospital Closing
  • A new Governor bringing a new Administration

The Response Formation of the Primary Care
  • Primary Care Development Corporation
  • Community Health Care Association of New York
  • Area Health Education Centers System
  • American College of Physicians
  • Academy of Family Physicians

Coalition Leaders Primary Care Development
Corporation (PCDC)
  • 15-year old nonprofit dedicated to making
    available strong, effective primary and
    preventive care to underserved communities.
  • Operates as a public-private partnership, with
    close relationships with the City, State,
    business and private foundations.
  • Strategies Providing programs and services to
    primary care centers
  • Capital financing 221 million of investment in
    over 70 capital healthcare projects, creating
    capacity for 450,000 patients.
  • Performance Improvement Assisted 350 health
    center teams reduce patient waiting times,
    provide same-day appointments, improve emergency
    preparedness, increase revenues, and implement
    electronic health records

Coalition Leaders Community Health Care
Association of NYS (CHCANYS)
  • New Yorks Primary Care Association.
  • Statewide association of community health centers
    -- 50 CHCs with more than 425 sites, providing
    care for more than 1.1 million people across New
    York State
  • Strong policy department working on behalf of
    CHCs and strengthening expanding community
    based primary care.

Coalition Purpose
  • Purpose To place primary and preventive care at
    the center of New York States health reform
    agenda with the objective of assuring a strong,
    effective primary care home for every New Yorker.
  • Strategy To build the consensus, visibility and
    momentum needed to do this.

Coalition Arguments
  • A strong, effective primary care sector is
    essential to solving three key problems facing
    the health system
  • Rising costs
  • Improved health outcomes
  • Eliminating disparities
  • Especially true with prevalence of chronic
    illness as a driver of health status and health
    care cost.
  • Health care reform has two inextricable agendas
    universal coverage and delivery system reform
  • Laying the Foundation Health System Reform
    In NYS and the Primary Care Imperative,
    Rosenbaum and Shin

The Primary Care Agenda
  • Reform the payment system to encourage primary
    care by enhancing reimbursement for primary care
  • Preserve and expand primary care infrastructure
    and workforce capacity
  • Transform the current model of care to a
    patient-centered healthcare home
  • Aggressively promote the use and adoption of
    health information technology among providers of
    primary care services and
  • Expand and improve coverage to remove financial
    barriers to care

Coalition Tactics
  • Targets
  • State Executive, Legislature, Hospital Closing
  • New York City Mayor, City Council
  • Tactics
  • Credible justification Rosenbaum/Shin Report
  • Statewide testimony, meetings
  • Getting support sign-on, broad outreach
  • Press conferences
  • Media Strategy including hiring of media
    specialist use of press conferences, editorial
    board meetings, placement of articles,
    editorials, op-eds
  • Coalition Listserv, Website (www.nyprimarycarehome

Press Releases, Press Conferences
  • Stefan Friedman (212) 561-8730 June 8, 2006
  • Broad coalition from business, labor, and
    political communities join healthcare
  • advocates in urging statewide taskforce to
    include primary and preventive care
  • on agenda of New Yorks healthcare future
    Healthcare experts release New York-
  • based study documenting benefits of Primary Care
  • (NEW YORK) As the Commission on Healthcare
    Facilities in the 21st Century met
  • today to discuss the future of healthcare in New
    York State, a coalition spearheaded by
  • Assembly Health Committee Chair Richard
    Gottfried, New York City Council Speaker
  • Christine Quinn, the Community Health Care
    Association of New York State, the Primary
  • Care Development Corporation, the New York State
    . . . .

Policy Research
  • Primary care need and capacity
  • A Primary Care Capacity Shortage in NYC and the
    Potential Impact of Hospital Closures (PCDC and
  • A Zip Code Analysis of Primary Care Need in NYS
  • The Future of Primary Care in NYS (ACP)
  • Payment reform
  • New Yorks Primary Care Reimbursement System A
    Roadmap To Better Outcomes (PCDC)
  • Commercial Insurers Reimbursement Rate to New
    Yorks Community Health Centers Jeopardizes Care

Cycle of Influence
  • Influenced Hospital Closing Commission to include
    primary care recommendations
  • Inserted primary care policy into the
    gubernatorial primary and election campaigns
  • Sponsored, broadly distributed and publicized
    signature study Laying the Foundation Health
    System Reform in NYS and the Primary Care
  • Established a website (
    and a listserv
  • Brief key officials testify at state and local
    hearings, consult and advise local officials
  • Obtain regular statewide press coverage,
    including feature articles, editorials, op-eds
    and letters to the editor.
  • Obtained upstate and downstate Assembly hearings
    on primary care

  • New York State
  • FY 2008-09 budget includes 340M in annual
    increases to primary care, including
  • Groundbreaking increases in primary care payment
    rates as part of a four-year plan to shift
    resources from inpatient to primary care
  • Reimbursement for important primary care
    enhancements (weekend/evening operations,
    asthma/diabetes educators)
  • New Doctors-Across-NY program to attract
    physicians to underserved communities (physician
    loan forgiveness and practice start-up
  • Dedicated 200M special grant funding to expand
    primary care capacity, assist in HIT adoption.
  • New York City
  • 27M Mayoral initiative to implement electronic
    medical records
  • 27M City Council initiative to expand primary
    care 6.2M appropriation for IT infrastructure

Whats Next?
  • Assure continued success of the 4-year reform
    agenda in the face of growing hospital
    opposition, State budget crisis.
  • Strategy
  • Ally with behavioral health, consumer advocacy
  • Bring the next circle of support to the table
    (business, labor, county governments)

Coalition Operations
  • Core funding organizational self-assessments,
    augmented by additional funds as available.
  • Coalition leaders supply the policy expertise
  • Media specialist, given the need for a campaign
  • A part-time coordinator
  • Coalition partners commit themselves to weekly
    war-room calls periodic 1-day strategy
  • Decision-making is collective requires rapid
    response from all partners on media issues

The Fit With A National Agenda
Access for All America NACHCs AAA Plan The Primary Care Imperative aka the Rosenbaum report New Yorks Primary Care Campaign
Capacity Preserve, strengthen, expand on stable base Primary care home, stem the erosion of primary care capacity Transform to PCMH expand capacity
Reimbursement Expand revenue grants and reimbursement Reimbursement reform Reform payment systems to support primary care
Workforce Assure workforce Invest in development of primary care workforce Develop a primary care workforce
Capital Augment capital resources Stimulate capital investment in primary care Support for primary care capital and HIT adoption
Infrastructure Implement support systems and TA Pay for quality and HIT adoption Increase capacity through workforce, capital, HIT
Big Challenges
  • Policy Challenges
  • Primary and preventive care are a silent need ?
    difficult to light on fire as an issue.
  • Historic underfunding ? lack of power and
    visibility compared to other health care sectors.
  • Health care reform defined as insurance expansion
  • Coalition Challenges
  • Consensus decision-making
  • Resources, organizational capacity

Reflections The Policy Front
  • The importance of campaign skills
  • The need for credibility
  • Expanded Coverage vs. Delivery System Reform
    Why you cant have one without the other

Reflections All Fronts
  • The Importance of
  • Building clarity, consensus on the problems
  • Having actionable strategies
  • Building stakeholders/partnerships
  • Remembering that we are stronger together than we
    are apart

For More Information
  • PCDC
  • Ronda Kotelchuck at (212) 437-3917
  • Kate Breslin at (518) 434-0767
  • The NYS Primary Care Coalition