Interesting Times

It's an interesting time to be working in health policy. Since the 2016 elections we've been living through a period of unprecedented uncertainty at the federal level, in which even apparently small decisions can cause ripples throughout the health system, potentially destabilizing insurance and provider markets and affecting care for millions of Americans.

Ironically, that cloud of uncertainty has clarified the continued relevance and importance of United Hospital Fund's mission—to build a more effective health care system for every New Yorker.

When I assumed the leadership of UHF, I came to an organization well known for understanding how interconnected all the moving parts of that system are. During the 24-year tenure of now-President Emeritus James R. Tallon, Jr., whose accomplishments here were both impressive and inspiring, that became evident in the two major foci of our work: improving coverage and access, and ensuring the quality and efficiency of our health care system.

Despite tremendous gains in insurance coverage in New York State over recent decades—through Child Health Plus and Family Health Plus, the Medicaid expansion, and the aggressive implementation of the Affordable Care Act—over 1 million New Yorkers remain uninsured. Our objective, independent policy analysis—tracking trends, uncovering flaws, and pointing toward potential solutions—is needed both to protect the gains that we have made and to ensure coverage and access for those who are still left out. Over the next few years, the work of our Medicaid Institute will be particularly important as Congress continues to debate the role of that essential program in our broader health system. In New York, there is no doubt of its importance: it not only covers 6 million people but also drives many of the efforts at health care delivery system reform.

As we've known for decades, however, coverage and access alone are not enough to guarantee high-quality, patient-centered health care. We've made great progress, yet study after study has confirmed the persistence of wide variations in quality of care. That is why we continue our work to advance high-quality care for everyone, through a mix of strategies: improving the measurement of quality; increasing providers' quality improvement capacity through our multi-hospital collaboratives and our Clinical Quality Fellowship Program; promoting effective, innovative models of care, such as the patient-centered medical home; and bringing patients' voices to the fore to ensure a better experience of care.

While coverage and quality remain pillars of our work, we recognize their limits as well, and are increasingly investing in efforts to improve health by reaching beyond the health care system.

Researchers have long understood that care provided in the hospital or doctor's office accounts for less than 20 percent of our health status, with much of the rest influenced by where we live, work, play, and learn. Clinicians, especially those who work with disadvantaged populations, understand this as well.

I witnessed this daily at my first job as a physician, serving immigrant and refugee families at a community-based mental health clinic in Oakland, CA. Though I provided the best care I could, my patients' health and mental health were vastly more dependent on the root causes of their problems—poverty, social and cultural isolation, language barriers, food insecurity. Yet until recently, providers were almost solely focused on optimal clinical care, and not paying enough attention to the broader determinants of health.

That's changing now, with new payment and service delivery models that draw attention to patients' overall health, not just the health care they receive. To succeed in this new paradigm providers will have to work closely with their communities and community-based organizations to address issues such as poverty, homelessness, and food insecurity as well as specific health care needs. One of our signature efforts, the Children's Health Initiative, puts UHF at the forefront of this work, connecting pediatric clinics to community-based agencies to address social and environmental risks to health. It builds on our historic efforts outside the clinical care system, like our recently completed Aging in Place initiative and our ongoing work to support the role of family caregivers in health care.

We'll continue to expand such clinical-community collaborations, as well as advance the broader role that health care systems play in improving community health.

I'll end where I started: these are interesting times to be working in health policy. I'm proud to be at UHF, where we're helping to solve the complex problems of today's health care system, and anticipating the challenges ahead of us. I thank you for your interest and support, and look forward to working together to improve the health of all New Yorkers.

Feb. 14, 2018
Focus Area
Coverage and Access
CommentaryPresident's Letter
Health Insurance Project