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New York Public Health Now
s2e09 The NYC Care Model: Dr. Ted Long Discusses Providing Universal Access to Primary Care in New York City
In the season 2 finale of New York Public Health Now, Commissioner McDonald and Executive Deputy Commissioner Morne welcome Dr. Ted Long from NYC Health + Hospitals to discuss expanding access to primary care through the NYC Care program.
Dr. Long views healthcare as a basic human right, and shares how the NYC Care program provides universal healthcare access regardless of ability to pay and immigration status, with positive health outcomes including improved control of chronic conditions like diabetes and high blood pressure.
If you have an idea for topics we should discuss, please let us know: PublicHealthNowPodcast@health.ny.gov
Welcome to New York Public Health now. Hello, I am Dr. Jim McDonald, Commissioner of the New York State Department of Health.
Johanne Morne:I'm Johanne Morne the Executive Deputy Commissioner here at the department.
Jim McDonald:Welcome back to where we talk about the why so you can decide what to do. And today we're recording again from the 14th floor of Corning Tower, here at the Empire State Plaza. So I'm glad to have a friend of mine on, Dr. Ted Long, Senior Vice President of Ambulatory Care and population health at New York City Health and Hospitals. Before welcoming Dr. Long, I'd like to just make sure that Johanne, you know, Ted and I used to work together in Rhode Island many years ago.
Johanne Morne:Oh, wow, that's great!
Jim McDonald:You know, it's rare that we actually find somebody who I used to work with a Rhode Island, but have one now, and we go way, way back.
Johanne Morne:It's good to have long standing friends. So, glad to join you, and I'm really delighted that Dr. Long is joining us remotely today from New York City to talk about the work with New York City Health and Hospitals, the largest public health care system in the country, which services over a million New Yorkers across New York City's five boroughs.
Jim McDonald:You know, one of our goals for the second season of this podcast is to talk to experts outside the New York State Department of Health and just talk a little bit about what's interesting to them that might be interesting to everyone who lives in New York and beyond. Dr. Long's commitment to expanding access to primary care is one I share and I think it's a very important issue. I mean, primary care to me, is one of the most important forms of care you can get. Dr. Long is the Senior Vice President of Ambulatory Care and population health at New York City Health and Hospitals, where he formerly directed the NYC Test and Treat Corps, New York City's comprehensive effort to provide accessible COVID-19 testing free of charge, as well as connections to treatment.
Johanne Morne:And just as a little bit of history, Dr. Long previously served as Senior Medical Officer for the quality measurement and value based incentives group at the Centers for Medicare and Medicaid Services. There he led more than 20 federal programs. Before that Dr. Long served as medical director at the Rhode Island State Department of Health, where he led healthcare planning for the state. Dr. Long earned his medical degree from the University of Southern California's Keck School of Medicine, and did his undergraduate work, residency training and postgraduate master's work in health services research at Yale University. A clinical professor of NYU Langone's Department of Population Health, Dr. Long also serves on the faculty at the Yale School of Medicine, and the Harvard Medical School Center for Primary Care, where he teaches about health policy and administration.
Jim McDonald:You know, in case you didn't think Dr. Long wasn't busy enough, he's authored more than 50 peer-reviewed articles that have appeared in journals such as JAMA, Nature, Lancet Public Health. So Ted, good to have you with us today.
Ted Long:Thank you. It's an honor to be with you all.
Jim McDonald:So Ted, why don't we just start with just can you just I know, we talk a little bit about you just why don't you tell us a little bit about yourself?
Ted Long:Yeah, so I, first and foremost, am a primary care doctor. I'm a primary care doctor in the Bronx. I've seen my patients throughout COVID. I saw my patients before COVID, and I see my patients every single week now. And the way that I view healthcare is I view healthcare as a human right. It is the front door of that human right means everybody must have access to a primary care doctor like me to be your quarterback to make a plan with you, and to help you to execute on the plan for your health, coming from you. And going forward, I'm looking forward to telling you about some of the ways that New York City Health and Hospitals that we make health care a right in New York City every day, extending health care access to hundreds of thousands of people that previously didn't have it.
Jim McDonald:Yeah, that's awesome. That's great, and I think, you know, I think of primary care, almost as just like, the connective tissue throughout your career, and I think people sometimes have different concepts of what exactly primary care is, but why don't you just tell us: What is the scope of primary care?
Ted Long:So, primary care is the front door to the healthcare system. Or in other words, because healthcare is a human right, it's your front door to being able to access that right. Whether you're a New Yorker that's been here for 50 years, 50 days or 50 minutes, healthcare is still, your right in New York City. Primary care to me is for my patients, I'm their quarterback, I first and foremost, listen, I hear what their priorities are. I diagnose them with conditions, and we make a plan together. But as their quarterback, my job is to make that plan and help them to execute on that plan for their health. Whether that's diagnosing one of my patients with a chronic condition, helping them through something acute, being able to solve a problem that day or passing the ball to a specialist if we need to ask for help from a cardiologist, a pulmonologist but whatever we need from the from the words of my patients to me, that's my job is to move heaven and earth and to do everything in my power to get them what they want to make them as healthy as I can make them.
Johanne Morne:Wow, that's amazing. I'm really very interested to hear you talk about your commitment to the patients and all that you do in that process. So we're hoping today that we can talk a bit about the New York City Care. I wonder if you can start by telling us about the vast network that got it started, including New York City Health and Hospitals. We know it's the largest public health care system in the country. I know that was said earlier as well. So what does that mean? And what does it all encompass?
Ted Long:New York City Health and Hospitals, we refer to ourselves as the largest public health care system in the country. Another way to put that, is that we're the largest municipal or city-run public health care, meaning hospitals and clinics, system in the country. In particular, in New York City, we have 10 hospitals on 11 different campuses, with hospitals is as large and famed as Bellevue Hospital, and overall, we have about 50 community health centers and outpatient or primary care practices within our hospitals. So we're in every single borough, so wherever you are, we want to see you in primary care so that we can do everything that we can to help you to achieve your goals and keep you and make you healthy.
Jim McDonald:So let's pivot to NYC Care, which was launched in 2019, right before the pandemic, so can you talk about how and why it got started? And by the way, is this a health insurance program?
Ted Long:NYC Care is a program that is very near and dear to my heart as a primary care doctor, and really, I think is emblematic of our mission, and how we can really help people in New York City. I'll actually tell you about the program through the eyes of one of my patients. This is my first NYC Care patient that I saw back in 2019, in the Bronx, and I remember she came into my office, she was a new patient. And the first thing that she shared with me was that she hadn't seen a doctor in 43 years, meaning she hadn't had access to having a mammogram, colonoscopy, she didn't know she had diabetes, she hadn't been up to date in her vaccines. She hadn't had all of those elements that really constitute her human right to be able to live a healthy life in our country. But that day, all that changed. That day, I brought her up to speed on all of those preventive health care measures that she'd literally never had before. [I] talked to her about everything we were doing, all the labs are going to send off to make sure that we knew what was going on with her body. And at the end of it, I couldn't resist but asking her I said, "Why today? It had been 43 years, you could have always come to New York City Health and Hospitals. Why? What changed today? Why? Why did you come to my office today?" She started crying, and she said that, she before today, didn't believe that she deserved medical care. I then of course, started crying too, and we had a really special and important moment, because she that day, felt for the first time that she deserved her human right of health care. And the reason that she came to my office that day was because of the NYC Care program, you can and should come into primary care at New York City Health and Hospitals. And there's availability, there's access, call this number 646-NYC-CARE, and they'll take care of you. They'll change your life as I took a small step forward to change in the life of my patient who again hadn't seen a doctor in 43 years.
Jim McDonald:You know, I'm trying to process someone feeling like they didn't deserve to see a doctor, because that's a lot. I think that's really, to me emblematic of just... I love the way you talk about primary care as a human right. To me, quite frankly, when you don't have health insurance, it's uncomfortable. It really is. But it's not really health insurance. It's really, you're just welcome at every Health and Hospitals primary care clinic, and they're not going to charge you, is that what it is?
Ted Long:So, NYC Care is health insurance-like, if you will. It's an access to care program. And if you take nothing else away from the program, it's that it's a safe place where everybody can come to access care starting with primary care, without exception, regardless of your immigration status or ability to pay. For my patient, it was that place that she, on some level, had been looking for for 43 years, but didn't feel like she'd found until she saw the advertisements for the program. She called the number realized she could get into care. And when she stepped through my office, the reason that she was crying at the end of our visit, is that she felt for the first time that she again deserved care and had been able to access care. So it is an access to care program for everyone. And all you have to do is call 646-NYC-CARE and we will offer you an appointment within two weeks.
Jim McDonald:So does someone pay to be part of the NY Care program or do they have to pay the visit or is it paid by someone else? How does the money work?
Ted Long:So we have a fee scale based on your individual income. And just because cost is a certainly a barrier to people being able to access care or feeling like they can access care. We actually print for you on a card that we send you a membership card to the NYC Care Program. Your individual fee scale, or copay, as some people like to refer to it, for any type of visit, ranging from seeing me in primary care, needing to go to the emergency room, or needing a medication. So you never have to worry about the uncertainty of how much it could cost, whether it's $2, $4,$10, whatever it is, your individual payment will be on your card. So before you even see me, you'll know exactly what it's going to cost, and you can plan ahead.
Jim McDonald:So is it really affordable? Like is it $2, $6,$10 to go see a doctor? Is it really that affordable?
Ted Long:Yeah, actually, for many people, they don't make enough money to even enter into our fee scale. So for many New Yorkers, it actually is free. But if you do based on your income, make enough money to trigger our fee scale, which is the same as we use in our federally qualified health center, then there would be small payments that you'd make based on that. For many people, to answer your question, $2 is the real amount that they would pay for medication. Zero or $2, I, I believe are the most common amounts paid or not paid.
Jim McDonald:So in 2023, NYC Care members scheduled more than 200,000 visits with primary care providers. So as a practicing primary care doctor, can you talk about the importance of primary care and why it matters?
Ted Long:The NYC Care program in 2019: We didn't know how it was going to go. We didn't know how many people would enroll. We set a goal of being able to enroll 100,000 New Yorkers that were going without into the program. The exciting update that we have is that recently, we surpassed 125,000 New Yorkers that are now part of the NYC care program. So all of them now have the ability to, in a cost effective way for them, get all the preventive care that they were going without. Get the vaccinations they were going without, be able to talk to a doctor like me to understand what's going on with their bodies or to answer any medical questions that they would have. And about half, I think it's just over half of all of the people that enrolled in the program, were new patients. In other words, didn't necessarily have a primary care doctor or hadn't seen one in a very long time. And that's why it's so meaningful to me that my first patient, as a primary care doctor, for the NYC Care program, hadn't seen a doctor, again, in 43 years.
Johanne Morne:The life story that you share about the individual who hadn't received care in 43 years is so impactful. It's amazing what we will deny ourselves if we feel that we're not worthy. So thank you for creating a space for people that feel worthy. For anyone just joining we are speaking today with Dr. Ted Long, Senior Vice President of Ambulatory Care and Population Health at New York City Health and Hospitals, and you have been talking about the New York City Care or NYC Care program, and the fact that you've surpassed the goals as far as enrolling 100,000 individuals, is there a limit or a cap as to how many people can be enrolled?
Ted Long:No, there is not, and we will keep going until we've enrolled every New Yorker that wants to access primary care in the New York City Health and Hospital System. In my mind, again, healthcare is a core human right, and the way that we meet that right, as a city and country, starts with giving everybody access to the front door of the healthcare system, and that's primary care. So again, we started off with the goal of having 100,000 New Yorkers be able to access their human right of starting primary care in our system. We've now blown past that, because I think many other New Yorkers have gone and told their friends that there is this program where they can finally get the care that they deserve, and now we've passed 125,000 members, and we're still growing every day.
Johanne Morne:And it sounds like more than just open doors. It sounds like you're offering compassionate care, which is which is just amazing. So my understanding so far from our conversation, NYC Care provides access to primary care visits, behavioral health, medication, emergency services, and further examples like that. I know you talked about the cost to the individual. But where does the funding actua
Ted Long:The funding for the program both comes from the fee scale of the individual, and also comes from New York City that's chosen to invest in this program, which to me, makes me incredibly proud to be the New Yorker, because there's no better way to stand behind our conviction that healthcare is a human right, than to invest in a program like this, which literally gives access to that right, that health care, for over 125,000 people a year.
Jim McDonald:So what kind of positive health outcomes are you seeing from members enrolled in NYC Care? I mean, you think the program is working?
Ted Long:Yeah, I mean, for me, I will tell you, Dr. McDonald, when my first patient, again who hadn't seen a doctor in 43 years, was sitting in front of me crying because she was able to finally access health care that she didn't previously felt like she deserved; That was it for me. I would have considered the program a success on day one.
Jim McDonald:Yeah, I'm with you. Yeah.
Ted Long:But going forward from there, we've actually seen some very interesting outcomes. I think the basis of a lot of this is that so many people had been going without in New York City, and this program made them finally believe that there was a safe place for them to access health care, which I think is at everyone's core, everybody wants to make sure that they're healthy. But again, there's a variety of barriers that prevent people from getting the care that they need, and that is their right. But once we've been able to remove some of those barriers, with the NYC Care program, we've seen, for example, over half of the patients in our program that have diabetes, or high blood pressure, have had an improvement in their diabetes or high blood pressure since enrolling in the program. Maybe more impressively than that, nearly three quarters, nearly three out of every four people enrolled in the program, after having been in NYC Care for six months, have controlled their diabetes, and controlled their high blood pressure.
Jim McDonald:That's impressive!
Ted Long:I think that just goes to show that so many people didn't even know they had diabetes, or high blood pressure they enroll in the program, they have me is one of their doctors, and we're able to really control a chronic condition that again, they might not have known that they had, but once they know they have it, we will move heaven and earth to help them.
Jim McDonald:I think that's just a great example, though, because if you control diabetes, you're less likely to go on to have heart disease or kidney disease from that. And if you can control hypertension, you're less likely to have a stroke or heart attack. And I think it really gets to that, you know, that old adage, an ounce of prevention is worth a pound of cure. When I think about the primary care provider, which I've been one for over 33 years, so often says, you know, come see me, I'll try my best to keep you well. If you're sick, I'll try my best to make you well.
Ted Long:Perfectly said.
Jim McDonald:But you know, as a primary care provider, you'd be amazed what I can do to keep you healthy.
Johanne Morne:I know you've talked about who is eligible to enroll in the program, also about the great partnership with community based organizations that truly have the relationships with members of the community. Can you talk about enrollment? What's the process to actually be enrolled in the program?
Ted Long:Yeah, thanks for asking that. So, to enroll in the program, we wanted to keep it simple. All you need to do is call 646-NYC-CARE, allow me to repeat 646-NYC-CARE, and you or friends or family can enroll in the program just like that. As part of enrollment, we do want to check to make sure that you're not eligible for insurance in New York State. If you're eligible for an insurance plan, we want to encourage you and help you to enroll in that plan. So for example, Metro plus, which is part of our health care system has been an instrumental partner in helping us to get people either enrolled in health insurance or enrolled in this program. And the enrollment in this program, if you're not eligible for health insurance, is a simple process. We ask a couple of questions including about your income, just so that we can print on your card, again, your precise fee scale, or the amount of money you would have to pay as an individual for any of the services we offer, ranging from your cost of a medication to a cost to see me. We want to make sure that we're tearing down that sort of lack of transparency, cost barrier that many people perceive, so that you can feel comfortable getting the care that you deserve.
Jim McDonald:You know, that makes a lot of sense. If someone calls 646-NYC-CARE, it's a brief interview process. But one of the first questions is maybe you're eligible for Medicaid, maybe you're eligible for one of the Affordable Care Insurance plans like the Essential Plan. So we often talk about the Essential Plan in New York state. So if you don't qualify for those insurance [plans], NYC Care will kind of fill in the gap there, and then you have an access to care product, because really, it's not an insurance program. It's an access to care program, as you've said. I understand since 2019, enrollments up nearly 400%. What do you think are the main drivers of the program's rapid growth? And any particular success stories, by the way?
Ted Long:Yeah. See, it's very interesting for me, again, as a primary care doctor, to think about why the program has really exploded and grown as fast as it has, because we, in New York City Health and Hospitals, for all practical purposes here, have existed forever. We've, been in New York City for a very long time. Bellevue has been around for hundreds of years, and it's true that my patients in the Bronx could have always come to us. But it's also true that they didn't come to us. In fact, they didn't seek health care at all, and that was my my proof of that is my first patient who hadn't seen a doctor in 43 years. I think what the program really uniquely did is it showed people that we could tear down these perceived barriers of accessing care of cost. And I think one of the ways that we did that is we really did focus on improving access to care before we started this program. The first thing I did when I joined New York City Health and Hospitals a little over six years ago, again, as a prideful primary care doctor, I said, we need to do everything we can to make sure that we have good access to primary care for every New Yorker. It used to be that our wait times were not so good. It used to take over a month to get into primary care in New York City Health and Hospitals, were able to cut that down to 14 days, then below 14 days. So imagine yourself if you're a new patient that wants to seek primary care, if you call us and say, you want to come into our system, and we say, it's gonna be a few months, not very motivational for you to follow through, and you certainly aren't going to go tell your friends and family, you had a good experience. What if we can offer you an appointment in 10 days, well, then you're gonna get in much quicker, you're gonna have a better experience from the get go. And you're more likely to go until your friends Hey, there actually is access to care now at Health and Hospitals. So that was one of the first things that I focused on that we changed. Again, we cut the wait times down by more than 50%, then we started this program. So I think that to answer your question, that was a really important piece of the of the puzzle is by improving access to care at its core, in our system, we were able to make a very public commitment to every New Yorker, that we would offer you an appointment within two weeks with your new primary care doctor. And we delivered on that I believe it was 97% of the time for the first several years. But I think that proved to people that we were serious, and that we really cared. And we were standing behind what we said. And I think that made a big, big difference and being able to have this program succeed and helping people.
Johanne Morne:And as described, it sounds as if you certainly have a very proven, effective program. So, based on that, I just wonder if you're seeing other models around the country that are similar or replicated from NYC Care? Are you getting calls from other public health officials saying, you know, we want to increase access to care, too? How do we do it?
Jim McDonald:We've been talking today to Dr. Ted Long from
Ted Long:Yeah, I love that question. In San Francisco and Los Angeles, there have been programs with a similar basis to NYC Care. Now in California, they're making a variety of insurance changes. So NYC Care is certainly I think maybe now is the largest program of its type, which is a universal access to care program. But to answer your question, and this is I will give my my public commitment to this, I would love to talk to any city or state in the country about our program. I really believe in it. My patients have shown me and told me how important is to them. And I think the fact that we've been able to get nearly three quarters of all of our diabetic and hypertensive patients under control which could save their life. I think every city or state in the country could consider a program like this, and I'd love to tell them how we did it, share best practices and see what's possible across the country. Health and Hospitals about NYC Care. When we talk about the why, this is an access to care program. Why it matters is everyone really needs to have a primary care provider. It's great way to prevent having long term disease and chronic diseases to have a primary care provider, find your problem, the help you need. Everyone needs to have a doctor and it's been great to have you represent Health and Hospitals today. I did visit Bellevue last month and you're right it isn't an iconic structure in healthcare in America. It really is quite an icon. It just it's it was great for me to visit there. So Ted, thank you for joining us today. It's been an honor to join you both, and it is an honor to be a New Yorker and your leadership Commissioner McDonald. Thank you for having me. I'm Johanne Morne.
Jim McDonald:So as season two of our podcast, New York Public And I'm Dr. Ted Long. Health Now comes to a close, we're going to take the summer off, and look forward to joining you again in the fall. We'll And thank you for listening. have more guests, talking about more public health topics of interest to everyone. If you have a topic you want us to talk
Monica Pomeroy:New York Public Health now is a production of about it, go ahead and send us an email PublicHealthNowPodcasts@health.ny.gov for the New York Public Health Now Podcast. I'm Dr. Jim McDonald. New York State Department of Health's public affairs group. Michael Wren is the executive producer and engineer with additional production support provided by Sarah Snyder Genine Babakian, Barbara Stubblebine, Alicia Biggs, Monica Pomeroy, and Kyle Kotary. Copyright 2024, All rights reserved. We welcome your feedback - please email us at PublicHealthNowPodcast@health.ny.gov.
