New York-Presbyterian, a sprawling $5 billion academic medical center complex based in Manhattan, houses two Ivy League medical schools. Yet in recent years, the system has grown to nine hospitals, including several in New York City's outer boroughs and nearby suburbs. Modern Healthcare recently spoke with CEO Dr. Steven Corwin about the system's evolving strategy. This is an edited transcript.
Modern Healthcare: You're taking full ownership of hospitals away from Manhattan, where the medical schools are headquartered. What's driving that strategy?
Dr. Steven Corwin: To do population health, you have to have a regional outlook and a regional system of care. In New York, most of the major academic centers are concentrated in Manhattan. We made a decision that we wanted to expand into Brooklyn, Queens, Westchester County and lower Manhattan to develop a regional system of care. We've done that pretty successfully over the past few years.
MH: You took ownership of Brooklyn's New York Methodist Hospital where before you had an alliance. What drove that decision?
Corwin: Brooklyn is a borough of 3 million people, a borough as large as the city of Chicago. It needs great medical care. There have been a lot of issues with hospitals failing in Brooklyn or coming close to failure. So we felt it was very important for us to establish a very high-quality, tertiary-care institution in Brooklyn. Methodist Hospital had a long affiliation with us, and we decided to take it over fully and to develop it more fully.
MH: How does an academic-based medical center help these outer borough and suburban hospitals foster population health?
Corwin: Population health is based on the premise that you're taking care of a community. Large-scale academic institutions getting referrals from all over the region are not necessarily taking care of individual communities other than those that surround it. So, the ability to go into each of these communities that we're in, develop true strategies around taking care and making those communities healthy and healthier, is an important aspect of what we're trying to do. The power of our partnerships with both Weill Cornell Medical College and with Columbia College of Physicians and Surgeons enables us to do that. We can attract and recruit great doctors to further enhance the care in the communities. We also think that with the educational base we have in public health—the Mailman School of Public Health at Columbia and the department of public health at Weill Cornell—we can marry public health with the hospital system and create a truly unique approach to developing population health strategies. We've done that in the Washington Heights/Inwood area, which is the area surrounding our Columbia campus, and had great success in reducing emergency room visits, reducing admissions and improving the health characteristics of the population. It is easily translatable with the appropriate help to Brooklyn, to Queens, and to other areas that we're going to be in.
MH: What did you do programmatically in the Washington Heights area?
Corwin: We called it the Targeted Care Initiative. We take care of roughly half to 60% of Washington Heights' 250,000 population in our ambulatory-care network. We identified those patients that were at very high risk. We did a pretty extensive predictive analysis. Once we identified those patients, we put targeted-care initiatives in place: community health workers, community mental health workers, home visits. If you visit the home of an asthmatic child and you remove mold and allergens from that home, it dramatically reduces that child's likelihood of coming into the emergency room. You can improve childhood immunizations. You can improve diabetes control. We found all of that. So, of that initial hundred-and-some-odd thousand patients, we targeted 10,000 patients. Of those, we put intensive monitoring in place for about 1,700 patients. That proved to be a big difference for us.
MH: This obviously affects your utilization, and these programs cost money. Where do you come up with the wherewithal to do community outreach programs?
Corwin: We're a not-for-profit institution, so we exist for the public benefit. The board of the hospital has consistently said to me and to our management team, “We exist for the public good, so let's make sure we do the public good.” Having said that, we can't afford these programs unless we generate some margin. And we've been fortunate to be able to do that. We feel very strongly that to help the country reduce its healthcare costs we should be in the vanguard of reducing utilization, improving quality, reducing variation. We think that our strategy is a sound one because we think that our quality will make sure that people come to us who need our care. We're comfortable with our ability to sustain this business model.
MH: Your flagship hospitals in Manhattan face a lot of competition. Some have the same strategy. How do you see the competitive landscape in Manhattan shaping up in the years ahead?
Corwin: New York as a market has been less consolidated than other areas in the country. It is starting to consolidate. Part of the reason for that consolidation is to develop regional systems of care where the stronger hospitals build networks so that community hospitals and weaker hospitals don't go out of business. We're a very large metropolitan area so I think the competition is good. It will be healthy for New York and New Yorkers. I don't foresee this market getting overly concentrated in the near term.
MH: Will network competition emerge here? Will insurers form narrow networks with one hospital system or another?
Corwin: Some people have predicted that. I'm not sure that that will happen here. I think that New Yorkers are going to want to have choice. Choice is good. I do think there will be competition among the networks, but I don't anticipate narrow networks developing in the short term here.
MH: Are you investing in technology to promote population health management?
Corwin: We're big believers in telehealth. We think that it is ultimately going to be a big cost reducer. We've established the first telepsychiatry program in New York state. It enables us to leverage our excellent psychiatric departments to develop regionalized care using psychiatric consults via telehealth. We have telestroke programs with a mobile stroke ambulance that's integrated into that. Telehealth will help with primary-care visits. We're also investing in innovation on mundane things like how you reduce infection rates in the hospital. How do you develop Lean and Six Sigma techniques within the hospital to reduce variation? We're certainly not the only ones by any stretch of the imagination doing this, but I think it's important. And then, of course, what is delivery system reform? Our country is going through a great experiment around what mechanisms of payment, what mechanisms of delivery system reform are going to work to improve the outcomes, improve quality, and ultimately reduce cost. We're well-poised to do those types of research studies as well.
