New York City Council Health Committee
Budget and Oversight Hearing on Fiscal Year 2020 Preliminary Budget
March 18, 2019
Thank you for the opportunity to share our recommendations with the committee today. Founded in 1993 by Mayor David Dinkins and a visionary group of health and civic leaders, the Primary Care Development Corporation (PCDC) is a nonprofit organization and a community development financial institution that has partnered with the City of New York for 25 years to build equity and excellence in primary care for millions of New Yorkers in neighborhoods across all five boroughs.
PCDC’s mission is to create healthier, more equitable communities by building, expanding, and strengthening primary care through strategic capital investment and practice transformation as well as policy and advocacy.
We are dedicated to financing, enhancing, and advocating for primary care because primary care makes the difference between a life-threatening chronic condition and a manageable or treatable condition. Primary care is essential to better health outcomes, lower costs, and healthier families and communities by preventing and treating illnesses before they become more serious, costly, and difficult to treat.
New Yorkers need hospital beds for when we are seriously sick and emergency rooms for emergencies — and we need primary care services to stay healthy, maintain our health from infancy to old age, and avoid costly hospital stays and emergency room visits.
PCDC’s History of Impact and Service
PCDC has worked with over 400 health care sites across all five boroughs to increase and improve the delivery of primary care and other vital health services for millions of New Yorkers. We have financed and enhanced health care facilities and practices in 50 out of 51 City Council districts, including financing half of all Federally Qualified Health Centers in New York City.
Nationally, PCDC has improved primary care access for more than 1 million patients by leveraging more than $1 billion to finance over 130 primary care projects. Our strategic community investments have built the capacity to provide 3.5 million medical visits annually, created or preserved more than 10,000 jobs in low-income communities, and transformed 1.8 million square feet of space into fully functioning primary care practices. Through our capacity building programs, PCDC has trained and coached more than 7,000 health workers to deliver superior patient-centered care, including at NYC Health + Hospitals, where we have provided technical assistance for ambulatory care redesign for more than 15 years. We have also assisted more than 475 primary care practices — encompassing some 2,250 providers — in New York and beyond to achieve Patient-Centered Medical Home (PCMH) recognition, improving care for more than 5 million patients nationwide.
In partnership with the Montefiore School Health Program and New York School-Based Health Alliance, PCDC helped developed the first and only nationwide recognition program approved by the National Committee for Quality Assurance (NCQA) for school-based health centers.
Additional Primary Care Expansion Opportunities
New York City’s underserved and underinvested communities have the most pressing need for primary care services but are served by dwindling numbers of providers and institutions that often lack resources to expand and improve services. Without primary care, families risk costly and serious complications from illnesses that can threaten their long-term well-being and financial security as well as worsen other social and economic inequities.
This past October at the Global Conference on Primary Health Care, the World Health Organization (WHO), UNICEF (United Nations Children’s Fund), and world leaders declared that “strengthening primary health care is the most inclusive, effective and efficient approach to enhance people’s physical and mental health, as well as social well-being, and that primary health care is a cornerstone of a sustainable health system for universal health coverage and health-related Sustainable Development Goals.”
Primary care is the foundation for integrating the full spectrum of health and social services to improve health outcomes and the key to sustainable, accessible, and equitable health systems. It is a cornerstone of healthy, thriving communities and helps keep families healthy, children ready to learn, and adults able to pursue their careers.
Primary care is not the solution to every health issue but there are few chronic health conditions that can be managed better without primary care.
That is why PCDC strongly supports the investments and commitments made in recent years by the City Council, NYC Health + Hospitals, the Department of Health and Mental Hygiene (DOHMH), and the de Blasio administration to enhance and expand access to primary care, including through funding for DOHMH’s Prevention and Primary Care program’s Bureau of Primary Care Access and Planning (PCAP) and Bureau of Primary Care Information Project (PCIP) as well as through initiatives such as Caring Neighborhoods, One New York: Health Care for Our Neighborhoods transformation plan for H+H, and most recently, NYC Care.
PCDC encourages the City Council to explore additional opportunities to promote primary care by:
Investing in FQHCs
New York City’s nonprofit community-based Federally Qualified Health Centers provide quality primary care and other vital health services to 1.2 million patients, regardless of their ability to pay or their health insurance or immigration status. The City Council’s continued investment with discretionary funding for FQHCs will ensure their ability to sustain programs and services to serve all New Yorkers in need of high-quality, comprehensive care.
Supporting Primary Care and Behavioral Health Integration
ThriveNYC has shined the spotlight on mental health and the need to expand screening and connecting New Yorkers to mental health care. Patients with serious mental illness are often affected by chronic medical conditions. Just as it is important to integrate behavioral health into primary care settings, we must also integrate primary care into behavioral health settings to help prevent and reduce chronic conditions and promote wellness of New Yorkers.
PCDC administers the New York State Community Health Care Revolving Capital Fund, made possible by the state legislature, which provides affordable and flexible loans to Article 28 health centers, Article 31 mental health centers, and Article 32 substance use disorder treatment centers to finance the construction, expansion, and renovation of facilities and programs statewide to promote primary care integration. We would welcome the opportunity to explore strategies with the City Council and relevant agencies to utilize this resource for eligible projects.
Developing a Primary Care Plan for New York City
PCDC recommends the development of a comprehensive citywide plan to create a stronger, more sustainable and connected primary care system. Plan components could seek to address fundamentals such as the assessment of citywide primary care capacity, performance, and needs; how primary care workforce recruitment and transformation can be supported; and capital and financing needs for facility and program expansion and sustainability.
Continue Investments in PCDC Services
PCDC respectfully requests support for the following City Council discretionary funding for our following proposals to help enhance and strengthen primary care for all New Yorkers:
Interactive Portal of Primary Care Data | Speaker’s Initiatives #78827
Thanks to previous discretionary funding support from the City Council, PCDC is completing Primary Care Profiles for all 51 City Council districts to provide actionable information about gaps in service availability and inequities in care access. These findings can be used to inform priority-setting, decision-making, and resource allocation, in the overall effort to promote improved and more equitable care for New York City’s residents and communities. The profiles are unique in that they include key measures of primary care access that are either unavailable or very difficult to locate without expertise in data systems and analysis — and aggregate and analyze provider and health data from federal, state, local, and proprietary sources that are not typically broken out by City Council districts.
Building upon our Council District Primary Care Profiles project, PCDC requests $200,000 for FY20 to support the creation of an interactive web-based and searchable portal to transform the profiles from static data reports into a set of dynamic, interactive, and easy-to-use resources that promote accurate and compelling information sharing, advocacy, and decision-making.
Promoting Culturally Responsive Primary Care for LGBQ and TGNC Individuals
Speaker’s Initiatives / Transgender Specific Healthcare Training #78927
DOHMH and large New York City-based health care organizations, such as NYC Health + Hospitals, are implementing changes to promote health equity for lesbian, gay, bisexual, queer & transgender and gender non-conforming (LGBQ and TGNC) individuals. Yet, many of NYC’s community-based health care providers who serve New Yorkers every day do not have the resources to secure staff training on culturally responsive care for LGBQ and TGNC patients — training that is essential to creating and sustaining a welcoming, inclusive, and respectful environment of care.
PCDC requests $250,000 for FY20 to support “Promoting Culturally Responsive Primary Care for LGBQ and TGNC Individuals” — our new training series for New York City’s community-based primary care providers and their staffs.
With overwhelming evidence of its positive impact on improving health care quality and outcomes while lowering health care costs, primary care is the most reliable means of ensuring patient and community health. To meet its responsibility, primary care must be reinforced with sound policies and adequate resources. We look forward to working with the City Council and Mayor de Blasio to ensure that the FY20 New York City Budget supports these goals.
Thank you for your consideration of our recommendations and requests to help build and strengthen New York City’s primary care infrastructure.
Louise Cohen, Chief Executive Officer
Primary Care Development Corporation
45 Broadway, 5th Floor, New York, NY 10006
(212) 437-3917 | firstname.lastname@example.org
Patrick Kwan, Senior Director of Advocacy and Communications
Primary Care Development Corporation
45 Broadway, 5th Floor, New York, NY 10006
(212) 437-3927 | email@example.com