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Solving Brooklyn's Health Care Crisis

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Recently, we learned that Long Island College Hospital in Brooklyn plans to close. Additionally, SUNY Downstate Hospital faces serious financial problems. The fact is, numerous studies have repeatedly illustrated the precarious state of Brooklyn's health care delivery system, which serves 2.5 million residents with disproportionally high rates of chronic illnesses, including diabetes and obesity.

Further complicating matters for Brooklynites is the fact that many Brooklyn communities are Health Professional Shortage Areas -- which explains, in part, why so many individuals rely on local hospital emergency departments for non-urgent care.

Solving Brooklyn's health care system crisis can't wait. Luckily, there's one solution that is being implemented and, if done right, could go a long way toward improving Brooklyn's health services.

That solution can be found in a coordinated health care system fashioned on the principles of New York State's Health Homes, a patient-focused program that invests in primary and preventative care.

Health Homes is based on a care management service model whereby all professionals involved in an individual's care communicate with one another so that all needs -- medical, behavioral and social -- are addressed in a comprehensive manner.

Community Healthcare Network's (CHN) Health Home model works like this: our care coordination team develops a single, integrated care plan with the patient, providing each client with 24/7 access to a care manager. The team coordinates all service providers on behalf of the patient, develops a shared care plan, holds interdisciplinary case conferences, and coordinates care transitions (such as hospital discharges.) It also provides referrals to community, outpatient medical, mental health and substance abuse services, and social support services, including housing.

CHN's Brooklyn Health Home program includes 20 outside service providers who receive member assignments and are also responsible for care coordination. The larger network includes hundreds of additional providers.

In addition to meaningful partnerships, the investment in Health Information Technology, HIT, is proving critical to the success of care coordination. HIT allows providers across the spectrum and consumers to have information which encourages shared decision making.

The program is showing signs of success because it smartly involves all health care partners: hospitals, specialists, health plans, Federally Qualified Health Centers and supportive services that help improve a patient's health. Done right, the model will reduce reliance on emergency departments for primary care services, greatly improve the health of patients and reduce duplicative costs.

Despite the progress we are seeing, however, major challenges remain, including: the need for greater investment in primary care and HIT funding, insufficient infrastructure to support shared information technology, and, most importantly, a culture change from competition to partnership. Every partner in the health system is critical to the systems success. That success is dependent on mutual respect for each other's expertise and the willingness to share information and work in a truly collaborative manner.

Care coordination and an integrated health care system won't solve all the problems for health care delivery in Brooklyn -- particularly the problems the hospitals face. But they can and will increase Brooklynites' access to care and improve their health outcomes. We -- all the players in Brooklyn's health care delivery system as well as our government partners -- need to work together to ensure it.