In testimony before the New York City Council today, PCDC highlighted its findings on primary care access disparities, measured on a City Council District level.

By examining all 51 districts, the Primary Care Access Profiles provide a multidimensional view of gaps in access, help support advocacy for additional services, and inform siting of new primary care facilities. A citywide report is also available.

“Literature shows that the more primary care providers in a community, the better the health outcomes,” said Mary Ford, Director of Evaluation and Analytics, at the joint hearing. “This holds especially true in New York City, where strategic support of and investment in primary care is essential to achieving health equity.”

PCDC also discussed the importance of partnering with the City and other entities, maximizing funds to meet the needs of community health providers.

“The strategy is to finance the construction, expansion, and renovation of facilities and programs through a variety of capital instruments, including public and private loans, debt, and grants,” said Patrick Kwan, Senior Director for Advocacy and Communications.

“This ensures that scarce public resources are matched with private dollars to finance more and larger projects, all to meet the immediate and substantial needs in our communities,” Kwan said.

[Read both testimonies below.]

_____________________________________________________________________________________________

MARY FORD

Testimony in Support of INT 1668-2019
New York City Council Health Committee and Hospitals Committee
Joint Hearing

October 31, 2019

Thank you for the opportunity to testify before the committee today. I am Mary Ford, the Director of Evaluation and Analytics at the Primary Care Development Corporation (PCDC). PCDC is a New York-based nonprofit organization and a U.S. Treasury-certified community development financial institution dedicated to building equity and excellence in primary care. PCDC was formed as a public-private partnership by the City of New York, including the City Council, and has a Council Member serving on our board (currently Mark Levine). Our mission is to create healthier and more equitable communities by building, expanding, and strengthening primary care through capital investment and practice transformation as well as policy and advocacy.

Over the last 25 years, PCDC has provided capital and technical assistance to 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 City Council districts, including financing half of all Federally Qualified Health Centers in New York City. Thanks in part to the New York State Legislature, we have financed and enhanced health care facilities and practices in more than 92 percent of New York’s Senate Districts and 77 percent of Assembly Districts to increase and improve the delivery of primary care and other vital health services for millions of New Yorkers.

Nationally, PCDC has improved primary care access for more than 1 million patients by leveraging more than $1.1 billion to finance primary care projects. Our strategic community investments have built the capacity to provide 3.8 million medical visits annually, created or preserved more than 10,600 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 9,300 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.

Since 2017, PCDC has received a generous discretionary award from the City Council which we have used in recent years to examine primary care access across the City. This analysis is the first and only City Council district assessment of primary care access. We are extremely thankful to the City Council, Speaker Johnson, and the many members of the Committees on Health and Hospitals for your continued support.

We found significant inequities in access to primary care in many Council Districts. There were stark differences in the ratio of primary care providers to constituents – in some Manhattan Districts (CD2) there were up to 64 PCPs per 10,000 people compared with only 2 PCPs per 10,000 in Brooklyn and Queens (CD 34). This means there are nearly 20 times more providers in some Districts than others – with Districts with few PCPs also characterized by high poverty and unemployment and higher rates of diabetes and potentially preventable emergency room visits. What results is lower access to quality resources in many high-need neighborhoods.

The rate of health insurance coverage also varies notably, with rates of nearly 40 percent uninsured in Districts in Queens (CD 21) compared to less than 5 percent uninsured in Manhattan (CD 4)

Our research also indicates that providers in higher poverty neighborhoods are more likely to accept Medicaid and Medicare and to be PCMH-recognized — reflecting responsiveness of providers to lower income residents in these areas. Given the few providers serving these neighborhoods, it is essential that they accept all types of insurance, especially in the safety net.

Literature shows the more primary care providers in a community, the better the health outcomes. This holds especially true in New York City, where strategic support of and investment in primary care is essential to achieving health equity.

 

Contact:
Mary M. Ford, Director of Evaluation and Analytics
Primary Care Development Corporation
45 Broadway, 5^th Floor, New York, NY 10006
(212) 437-3942 | mford@pcdc.org

_______________________________________________________________________________________________

PATRICK KWAN

Testimony in Support of INT 1668-2019
New York City Council Health Committee and Hospitals Committee
Joint Hearing

October 31, 2019

Thank you to the City Council and committee chairs, Council Member Mark Levine and Council Member Carlina Rivera, for today’s hearing on expanding access to primary care and for the opportunity to share our recommendations. I am Patrick Kwan, Senior Director for Advocacy and Communications for the Primary Care Development Corporation (PCDC).

Founded in 1993 by Mayor David Dinkins and a visionary group of health and civic leaders, PCDC is a nonprofit organization and a U.S. Treasury-certified community development financial institution that has partnered with the City of New York for over 25 years to build equity and excellence in primary care for millions of New Yorkers. PCDC has worked with over 400 health care sites to increase and improve the delivery of primary care and other vital health services across all five boroughs. 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 (FQHCs) – from the smallest to the largest — in New York City.

Through our capacity building programs, PCDC has trained and coached more than 9,000 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 500 primary care practices 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.

Our mission is to create healthier and more equitable communities by providing the capital, advocacy, research, and expertise needed to build, expand, and strengthen our primary care infrastructure. We believe every New Yorker in every neighborhood should have access to high-quality primary care.

Support Int 1668-2019 to Expand Access to Primary Care

PCDC is 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.

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 (H+H), 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.

We are pleased to support Int 1668-2019 as another major effort to expand primary care access by amending the administrative code. This will establish a citywide primary care program to help connect New Yorkers to coordinated, personalized care at H+H facilities as well as at FQHCs and other not-for-profit and private medical service providers.

New York City’s nonprofit community-based FQHCs 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 support and 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.

Maximize City Council Grant Funds for Additional Primary Care Expansion 

About 25 years ago, when PCDC was founded, New York City’s primary care landscape was bleak. A front-page New York Times story reported on a “severe deficit of doctors in poor urban neighborhoods” and a devastating study that found “only 28 properly qualified doctors to serve a population of 1.7 million in nine low-income neighborhoods in Harlem, north central Brooklyn and the South Bronx.” The 1993 story also highlighted PCDC’s founding to finance health facilities to bring high quality and culturally competent care to underserved communities through a $17 million investment by the City.  At the same time, then-Mayor Dinkins also provided the Health and Hospitals Corporation with $48 million in capital and operating funds to build 20 family health care centers in 13 of New York City’s most medically underserved communities. It was then called CommuniCare and is now known as Gotham Health.

While New York City’s primary care infrastructure has improved dramatically over the last 25 years — as demonstrated in PCDC’s Primary Access Profiles examining all 51 Council Districts — federal actions are creating a bleak outlook for the City’s health care safety net, directly undermining health care access, coverage, and service delivery for millions. Now is a critical time to examine and work to accelerate access to quality health care for all New Yorkers.

New York’s underserved communities need primary care services most, relying on the care and services provided by community-based providers. These same providers lack resources to expand and improve services. While the City Council has made important and generous investments in community providers, these investments have not and will not meet the substantial capital needs of providers throughout the City.

For example, there is a substantial need for supporting primary care and behavioral health integration. Patients with serious mental illness are often affected by chronic 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 has been a strong and willing partner to the City across administrations. As a U.S. Treasury-certified community development financial institution with a mission-driven expertise in financing community-based health care, PCDC has found the most success in leveraging our resources to partner with the City and other entities, jointly financing projects for community primary care providers without recourse to bank capital. The strategy is to finance the construction, expansion, and renovation of facilities and programs through a variety of capital instruments, including public and private loans, debt, and grants. This enables the financing of key projects and ensures that scarce public resources are matched with private dollars to finance more and larger projects, all to meet the immediate and substantial needs in our communities. In addition to our technical assistance capacity, we have a variety of financing mechanisms and technical assistance available to support new or renovated primary care facilities.

Our recent financing in New York City for projects such as Apicha Community Health Center in Lower Manhattan, Callen-Lorde Community Health Center in Downtown Brooklyn, the Institute for Community Living and Community Healthcare Network’s East New York Health Hub, and the Joseph P. Addabbo Family Health Center in the Rockaways have included federal New Markets Tax Credits, New York State Community Health Care Revolving Capital Fund, and private investments in addition to City Council grants. We look forward to working with the City Council on a comprehensive strategy to maximize grant funds for financing primary care infrastructure expansion and improvement needs in our communities.

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 to support these goals.

Thank you for your consideration of our recommendations to help build and strengthen New York City’s primary care infrastructure.

Contact:
Patrick Kwan, Senior Director of Advocacy and Communications
Primary Care Development Corporation
45 Broadway, 5^th Floor, New York, NY 10006
(212) 437-3927 | pkwan@pcdc.org