PCDC Testifies to the Medicaid Redesign Team Health Systems Redesign: Brooklyn Work Group

Thank you, Chairman Berger and members of the MRT Health Systems Redesign Brooklyn Work Group.  My name is Dan Lowenstein, Director of External Affairs for PCDC – the Primary Care Development Corporation, which, along with the Community Healthcare Association of New York State, the American College of Physicians and other organizations, is a member of New York State’s Primary Care Coalition.

PCDC provides low cost financing to expand primary care capacity, and technical assistance to help providers use that capacity in the most efficient ways possible.  PCDC has worked with hundreds of providers in underserved communities throughout New York and financed more than 90 primary care projects valued at nearly $300 million, expanding access to care to more than 600,000 patients.  This includes nearly $60 million in financing to expand primary care throughout Brooklyn. Providers whose facilities we have helped finance include the Bedford Stuyvesant Family Health Center, Brownsville Multi-Service Family Health Center, Community Healthcare Network’s health center in Bushwick, Opportunity Development Association (ODA) in Williamsburg, Housing Works and Jamaica Hospital’s health center in East New York, Cerebral Palsy Association’s health center in East Flatbush, YAI/Premier in Flatbush and Brooklyn Heights, Lutheran’s Brooklyn-Chinese health center in Sunset Park, and Maimonides’ Family Health Centers in Flatbush and Sheepshead Bay.

Brooklyn is particularly challenged in terms of primary are capacity.  While it is home to some very good primary care providers, they are too few and too far between.  The results are high rates of avoidable ER visits and hospitalizations, leading to higher costs and worse outcomes, particularly for the high-need, high-cost patients that are most at risk.

Brooklyn needs primary care that is coordinated, accessible, and focused on the patient.  Whether delivered by independent practices, federally qualified health centers, social service providers or large health care systems, primary care should not be an appendage of the health care delivery system, but the heart of that system.

Yet when a hospital closes or downsizes, the hospital’s primary care capacity is often the first to go.  This comes at a time when we need to expand primary care capacity to achieve healthcare cost-savings goals and meet the patient demand that will occur by the enrollment of hundreds of thousands of patients into health plans.

We urge that the Work Group adopt the policy that in the event of a hospital closure or downsizing, primary care capacity associated with that hospital be preserved, strengthened, and expanded. PCDC has been part of several successful efforts in which providers have greatly expanded primary care following the closure or downsizing of a hospital system. Based on our experience, and our nearly 20 years developing primary care capacity in New York State, we offer the following recommendations:

• From the earliest sign that a facility may close, downsize or restructure, New York State should develop a comprehensive plan for preserving and expanding primary care in the impacted community.
• Maintain continuity of service. Closing, even for a day, threatens patients who will lose confidence and simply stop coming. Regaining the patient base will be a major challenge.
• Providers selected to take over primary care capacity should be financially stable, have a track record of delivering cost-effective, patient-centered primary care, be attuned to the needs of the community, and have a proven ability to absorb and rapidly scale up primary care capacity.
• Simplify primary care acquisition and merger processes by providing clear information about regulatory requirements; single points of contact and coordination and streamlining of State approval processes, including the Certificate of Need process.
• Support the expansion of primary care capacity by providing HEAL funds.  These resources can be particularly useful when combined with private sector financing to lower the borrowing costs for primary care expansion.
• Fund start‐up costs of individual health center facility transitions or larger mergers/acquisitions, as warranted, including the period between issuance of emergency certificate of need and receipt of final CON and Medicaid payment approvals.

Working with our partners in Brooklyn’s communities, in State government and on  the MRT and this Work Group, PCDC offers its resources and experience to help preserve, strengthen, and expand primary care in Brooklyn and throughout New York State.

Thank you.