Event Recap: The Future of New York Healthcare: Where Are We and What Happens Next?

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Event Recap: The Future of New York Healthcare: Where Are We and What Happens Next?

“There’s no better place in the world if you get sick than the US. But that’s not the ideal model for healthcare,” said Dan McCarthy, Chief Operating Officer for Healthfirst — a sentiment echoed by other panelists at Wednesday night’s discussion “The Future of New York Healthcare: Where Are We and What Happens Next?”

New York City Health Business Leaders’ latest event, hosted by Cooley LLP, revisits our earlier conversation from 2014 to consider the impact of the Affordable Care Act on the healthcare marketplace in New York City, as well as the potential impact of the proposed American Health Care Act.

Dr. Amanda Parsons, Vice President of Community & Population Health with the Montefiore Health System, returned to NYCHBL and revealed that although the number of self-insured (i.e. uninsured) patients at Montefiore decreased 25% from 2011 to 2015, Montefiore’s operating margin shrunk to 0.0% despite significantly larger patient numbers.

Dr. Parsons also stressed the need for healthcare systems to move away from traditional fee-for-service models and utilize population health management as a way to direct resources towards high-risk communities and ultimately prevent hospital visits.

Dr. Parsons was joined by fellow returnee Mario Schlosser, whose health insurance startup Oscar now has well over 100,000 members. Mr. Schlosser stressed the efficacy of technological innovation in facilitating interactions that can help route individuals’ care to the best providers.

Rounding out the panel were Dan McCarthy of Healthfirst, a not-for-profit insurance provider that insures one of every eight New Yorkers, as well as Staten Island Performing Provider System’s Joseph Conte, who demonstrated how SIPPS maps patient data to identify communities with high rates of super utilizers.

Moderator Wendy Goldstein, Partner at Cooley, began by asking the panelists how healthcare organizations might shift the paradigm of care away from fee-for-service and towards value-based models.

Mr. McCarthy believed that there will be more value-based payment systems in the future, but saw this shift happening with government-sponsored programs like Medicare and Medicaid (whose recipients constitute up the bulk of Healthfirst’s patients) before commercial providers.

Mr. Schlosser added that rising medical costs are necessitating a move towards value-based care. “One of the great things about the individual market is that you get to see on the singular level how a patient behaves when they can make their own choices,” he said. “Patients want lower premiums… They’re often okay with higher deductibles.”

Dr. Parsons cautioned that it is difficult for a healthcare system such as Montefiore to fully implement a value-based care model when parts of the system insist on being fee-for service. In particular, Dr. Parsons took issue with high prescription drug costs, especially with drugs that have been around for decades.

When Ms. Goldstein asked the panelists what their biggest fears are about potential changes to the healthcare marketplace, Dr. Parsons responded “The AHCA as proposed would be a disaster for us… We’re staring at potentially a $100 million loss a year.”

Mr. Conte expressed skepticism of a single-payer healthcare system, which he argued would have negative effects on the quality of care for patients.

Mr. McCarthy agreed, criticizing both the single-payer healthcare system and the AHCA for taking a universalist approach to a complicated and intensely localized healthcare system. Mr. Schlosser also criticized the single-payer system, albeit for different reasons; he argued that more market-based reforms and more consumerization would best improve quality of care for patients.

The discussion concluded with questions from the audience, one of which asked: do we need to invest and bring technology home to patients?

To which the answer seems to be: to an extent, but no app can replace the expertise of a doctor. “You need a physician to connect dots that you’ve never going to be able to connect,” said Mr. McCarthy. Dr. Parsons similarly argued that apps can help provide general guidelines, but fail to address what an individual patient needs in a specific episode.

Dr. Parsons, however, also believed that tele-care might be able to improve efficiency of care and prevent unnecessary hospital visits. “We have people who come into the emergency room for pregnancy tests and refills,” she said. “Our patients would love to Skype us when they just have a quick question.”