The bill, sponsored by Assemblyman Nelson Castro, prohibits hospitals from segregating patients into separate systems of care based on their insurance status. The bill seeks to ensure that all patients receive the same high standard of care in the same settings, as required by Title VI of the Civil Rights Act and the New York State Patient Bill of Rights.

­The hearing drew over 60 supporters for the issue, some wearing stickers proclaiming “Make Health Equality a Reality.” Twenty-one people testified at the hearing, including Dr. Neil Calman, president and CEO of the Institute, and Shena Elrington, the director of the Health Justice program at NYLPI. Two Bronx residents testified that they had been harmed by this separate and unequal system of care, and two pastors spoke to the ways in which health disparities had harmed members of their congregations. Representatives from numerous prominent New York City health care advocacy organizations also testified in support of the bill, including the past president of the NY County Medical Society, the Commission on the Public’s Health System, the Community Service Society, and Health People.

Dr. Calman’s testimony focused on the Institute’s efforts to eliminate the two-tiered system of care and the lower quality of care that it perpetuates. He cited the differences between faculty practices and outpatient specialty care clinics, which provide little or no continuity of care, poor communication and coordination between providers, and no after hours or weekend access. “These differences contribute to both poor health outcomes and increased costs, the exact opposite of what the State and Country are trying to accomplish,” he testified.

Dr. Calman continued stating, “I have met personally with multiple hospital presidents, senior clinical leaders and department heads to understand why they maintain two separate and unequal systems of care. Not one of them is proud of this model and every one states that they would change it if they could. Some state that attracting well-insured patients from outside the city would be hindered if they needed to share facilities with the poor patients who reside in the hospitals’ neighboring community. Still others stand behind the mistaken claim that it is illegal for a hospital to integrate the care of privately insured patients and Medicaid folks in the same clinical setting and bill the appropriate payer.”

Shena Elrington from NYLPI spoke on the illegality of the hospitals’ steering practices, testifying that by separating patients based on insurance status and source of payment, hospitals were in violation of federal, state, and local civil rights laws. Further, testified Ms. Elrington, these hospitals are in violation of the New York State Patient Bill of Rights and are openly flouting guidelines issued by the NYS Department of Health in the New York State Medicaid Managed Care and Family Health Plus Model Contract. “We await further action. We recognize, however, that in the meantime people are suffering – losing limbs, getting sicker and dying. They are not receiving the care to which they are entitled,” concluded Ms. Elrington. “The Health Equity Bill represents an alternative and powerful means for addressing the two-tiered system of care.”

The opposing testimony from GNYHA asserted that the bill calls for all patients to be diverted to the clinic system, a statement that entirely mischaracterizes the bills intent. The bill does nothing to prevent faculty practices and private physicians’ offices from operating; it simply prevents hospitals from discriminating against Medicaid beneficiaries and the uninsured. GNYHA’s claim that integrating care is impractical or impossible is also misinformed. Some departments within premier academic medical centers in New York City and across the country already integrate care, providing the same standard of care to all patients in the same setting regardless of the patients’ insurance status.

Dr. Bert Petersen, the director of the breast surgery clinic at St. Barnabas Hospital in the Bronx, provided testimony on his practice, where he sees all patients at the same time and in the same place. Contrary to what GNYHA asserts, Dr. Petersen testified that he has successfully integrated each practice he has worked in and has had no problem billing the appropriate payer, nor experienced any decline in revenue by seeing Medicaid and privately insured patients at the same time and in the same place.

This week’s episode focused primarily on access to specialty care, especially concerning discriminatory treatment due to a patient’s health insurance status. This issue, which Bronx Health REACH calls segregated care, has been at the forefront of the coalition’s advocacy efforts for over a decade. To read more about segregated care and how this discriminatory practice affects the health of residents in the Bronx and throughout New York City, click here.

Watch Bronx Health REACH and NYLPI on BronxTalk!

Senator Gustavo Rivera expressed his recognition of Mr. Aljaradi’s efforts to offer healthy options to the residents of the Bronx with a proclamation. “Bakil Aljaradi has worked to ensure that his deli, West Tremont Deli Grocery Corp, is an example of how to make the Bronx a better place.” Senator Rivera went on to say, “Through his work, Mr. Aljaradi has inspired the community around his bodega to work together. He has fostered relationships with local community organizations and government officials to effect change and social justice in the Bronx. I believe these changes can serve as an inspiration for other bodega owners and community members in my district to build similar partnerships to increase access to healthy food.”

Bronx Health REACH Project Director Charmaine Ruddock remarked that “Bronx Health REACH is very grateful to Bakil Aljaradi for working with the students in the MS 331 Citizen Schools program to provide healthy food options in the Bronx. We hope that these efforts serve as a model to other community groups seeking to make the Bronx a healthier place to live.”

The event was also attended by:
• Bronx Health REACH staff members Kelly Moltzen and Suneet Goraya;
• Citizen Schools staff members Lauren Long-Garcia, Kristine Perria, and Michael DeWitt;
• Nyaisha Ruiz and Monaze Richardson, MS 331 students from the Adopt-a-Bodega apprenticeship;
• PTA President of PS 306, Margaret Johnson;
• and Alyssa Ruiz, Bronx Outreach Coordinator for the NYC Department of Health’s Healthy Bodegas Initiative.

The event at the bodega was later followed by a visit to MS 331 and PS 306 to view poster presentations by the students. MS 331 student Emely Liz described to Senator Rivera her experience working with the store to offer healthier options. Students also spoke to the larger school community about their Adopt a Bodega apprenticeship at a school event on December 15th. Suneet Goraya, a HealthCorps member for Bronx Health REACH, taught the ‘Adopt a Bodega’ apprenticeship to 14 sixth grade students.

“Together they created a special meal combo that was healthier than what was originally offered and successfully advocated for drinks like water to be placed at eye level as opposed to soda,” said Citizen Schools Program Director Lauren Long-Garcia. “Students learned about the importance of healthy eating and the power that they have to make a positive change in their community.”

Alyssa Ruiz, the Bronx Outreach Coordinator for the Healthy Bodegas Initiative at the NYC Department of Health and Mental Hygiene, worked with the bodega owner for six months to get him to increase his stock of healthier food options. The store received promotional materials and technical assistance from the NYC Health Department as part of the Healthy Bodegas Initiative. Additionally, Kelly Moltzen from Bronx Health REACH attended an “Adopt-a-Bodega” Training hosted by the Healthy Bodegas Initiative and implemented this model at the Citizen Schools apprenticeship program at MS 331. Ms. Ruiz sees community partnerships such as that between Bronx Health REACH and MS 331 as important to successfully changing the neighborhood food environment and sustaining the work of the Healthy Bodegas Initiative.

One of the proposals adopted by the MRT was recommended by Dr. Neil Calman, President and CEO of the Institute for Family Health, and a member of the MRT Health Disparities Work Group. Dr. Calman’s proposed recommendation would ensure that existing standards of care are enforced in teaching hospitals and training clinics. As a result, the care provided to persons who are uninsured or covered by Medicaid would be equivalent to those services provided by the faculty practices to privately-insured patients in the same institutions.

“Teaching hospitals in New York State operate a two-tiered system where Medicaid patients are seen in specialty outpatient clinics and privately insured patients are seen in faculty practices. These two systems provide substantially different care in terms of quality, with clinic patients receiving poorer continuity of care, longer wait times, and poor patient access to physicians after- hours,” said Dr. Calman. “This proposal requires a single level of care for all patients, regardless of insurance status. By ensuring that all New Yorkers are entitled to the same quality of care, we will end the practice of providing inferior care to Medicaid beneficiaries in teaching hospitals and promote equity in the healthcare system. In addition to this being an equity and disparities issue, not providing continuity of care, after hours call coverage and communication to referring providers results in unnecessary ER visits, hospitalizations, and other excess costs. Our patients and the State deserve better than that.”

Other recommendations adopted by the MRT include proposals to:
• improve data collection on race, ethnicity, gender, sexual orientation, disability and housing status by health providers, consistent with federal health reform;
• provide reimbursement to hospitals, clinics and community health centers that make language assistance services available to their limited English proficient patients (LEP);
• ensure that prescription drug labels are easier to understand for patients with low health literacy, seniors and LEP communities, among others;
• reform the state’s distribution of charity care funding to hospitals to ensure that safety net providers who serve the uninsured are appropriately and equitably compensated.

“By recommending this package of proposals to the Governor, the MRT has shown that New York State is willing to be a leader on ensuring equality and fairness for all people of our state,” said Nisha Agarwal, Director of the Health Justice Program at New York Lawyers for the Public Interest, a longtime partner of Bronx Health REACH, and a member of the MRT Health Disparities Work Group. “Disparities on the basis of race, ethnicity, disability and other such factors are an unacceptable and persistent scourge on the healthcare system. New York is finally saying enough is enough.”

The Medicaid Redesign Team was formed by the Governor via executive order in January 2011. It has been the primary vehicle through which the Medicaid budget has been managed this year, and it is the mechanism through which long-term reforms to the New York state healthcare delivery system is being carried out.

Commander Graydon Yatabe, Acting Team Lead for Technical Assistance and Program Support for all REACH programs at the Centers for Disease Control and Prevention, spoke about the role of legacy grantees in eliminating health disparities and how they were uniquely tied to the communities they worked in. Commander Yatabe highlighted the 162 REACH Legacy Communities around the country and pointed out how crucial they are in improving health outcomes in communities of color. The principal investigators of the NY REACH grantees also gave opening remarks and spoke of their programs’ efforts in addressing health disparities. The principal investigators for NY REACH grantees include: Dr. Neil Calman, Founder and CEO of the Institute for Family Health (Bronx Health REACH); Dr. Mariano Rey, Senior Associate Dean of the NYU School of Medicine and Director of the NYU Institute for Community Health and Research (B Free CEED); Ngozi Moses, Executive Director of Brooklyn Perinatal Network; and Dr. Carol Horowitz, Associate Professor of Health Evidence and Policy and Medicine at Mount Sinai School of Medicine (Communities IMPACT Diabetes Center).

A summit highlight was the keynote address from Dr. Robert Fullilove on day one. Dr. Fullilove, the Associate Dean for Community and Minority Affairs and Professor of Clinical Sociomedical Sciences at the Mailman School of Public Health at Columbia University, spoke about the social determinants of health disparities and other factors, such as how the incarceration rates for men of color has led to the breakdown of community and slowed efforts to improve health. His passionate speech about the importance of community action, even when funds are limited, invigorated the audience and set the stage for the rest of the conference.

Day one of the summit closed with a panel discussion on transforming communities from the perspectives of policy-makers and community health advocates/activists. The panel included New York State Senator Gustavo Rivera; Javier Lopez, Director of the NYC Strategic Alliance for Health; Arlee Gist, Deputy Director of the Maryland Office of Minority Health and Health Disparities; Ngozi Moses, Executive Director of the Brooklyn Perinatal Network; and Rev. Dr. Bettye Muwwakkil, President of Prince George’s County Health Action Forum and team lead for the Maryland Racial and Ethnic Health Disparities Action Institute. The panel was moderated by Kate MacKenzie, Director of Policy and Government Relations at City Harvest. All of the panelists spoke about their efforts to reduce health disparities and improve health outcomes in their areas and gave their perspective on how communities and policymakers could work together to achieve greater impact. A highlight of the panel presentations were the successful strategies employed in getting policymakers to support community-led health initiatives.

Day two of the summit opened with a keynote address from Dr. John Chin, Associate Professor and Director of the Graduate Program in Urban Planning at Hunter College, CUNY. Dr. Chin spoke about demanding health equity amidst growing inequality, giving examples of community groups that had affected change even in unfavorable circumstances. Dr. Chin’s work in the HIV field has been instrumental in informing his views on how community organizations can shape the public discourse and he encouraged the audience to speak up and to speak often about issues affecting the health of their neighborhoods. For the remainder of the summit, the participants had the opportunity to attend workshops on grant-writing, program evaluation, and effective dissemination strategies.

Bronx Health REACH would like to thank all of our attendees and speakers for making this year’s summit a great success. We look forward to continuing our work with our partners and grantees to achieve health equity. Special thanks to Health and Human Services Region II Office of Minority Health for hosting the event in their downtown Manhattan building.

The HEA+LTHY Schools NY program is one of Bronx Health REACH’s major school wellness initiatives. Initially, the program focused on nutrition, tobacco, and physical activity, but for this school year the focus has shifted to physical activity. The Where’s My PE? campaign is a central component of the HEA+LTHY Schools NY agenda and is committed to providing at least 120 minutes of physical education for all elementary school students in New York school districts. Bronx Health REACH staff will join other HEA+LTHY Schools NY contractors around the state in helping schools bring their PE programs into compliance with state regulations and improving student access to physical activity opportunities both during and outside school hours. The program will also work with the Department of Education’s Office of School Wellness Programs as it updates the citywide PE plan and expands on its existing wellness policies on physical education and activity.

To learn more about HEA+LTHY Schools NY and Where’s My PE?, as well as to download resources on the importance of physical activity in keeping children healthy and alert throughout the school day, please visit http://www.wheresmype.org.

Pando Projects from Pando Projects on Vimeo.

Ying was inspired to start her project, Growing Gardens Growing Kids, through her work with Bronx Health REACH in the south Bronx. She saw the lack of fresh produce available to children and decided to start a community garden to increase access to fresh foods and vegetables and provide hands-on learning. By using EarthBoxes, specially designed boxes that are mobile and don’t require digging up land, the classes have been able to grow zucchini, tomatoes, strawberries, and more. To learn more about Growing Gardens Growing Kids and see pictures of the gardens and the gardeners, read Ying’s project blog.

Bronx Health REACH supports these efforts and thanks Ying for her dedication and hard work in building a healthier environment in our community. To learn more about the AmeriCorps Community HealthCorps program at the Institute for Family Health and how to apply, visit here.