The Montefiore Health System in New York: a case study

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The Montefiore Health System in the Bronx, New York, has found ways of helping even the most deprived by stepping beyond the bounds of conventional health services. 

This commissioned report builds on the overview of the Montefiore Health System we published in April 2018 and explores building primary and community care, managing patients with complex needs, supporting infrastructure, and elements of a high-performing system.

Every day in New York, the number 4 train running from Brooklyn to the Bronx achieves an astonishing process of social segregation. Picking up the train in midtown Manhattan, you join a representative mix of the New York population: suited professionals, manual workers, children going to school. As the train crosses 85th Street, running parallel to Central Park, the residents of the Upper East Side above you have an average household income of $180,000; smoking, obesity and chronic diseases are well below the national average; life expectancy stands at 85, better even than Japan.

By the time you cross 150th Street, the heart of the Bronx, almost all the white people and all the suited professionals have exited the train. Average household income has shrivelled from $180,000 to just $45,000; unemployment has doubled; in the South Bronx, 65 per cent of children are born into poverty. From 85th Street to 150th Street, life expectancy drops by a decade: 6 months for every minute on the subway; 3.2 years for every mile travelled. The residents of projects in Fordham Heights might glimpse Trump Tower in the distance but, like the view from Oldham to Manchester, or Tower Hamlets to the City of London, the wealth there may as well be on another planet (County Health Rankings 2018; Virginia Commonwealth University 2016).

Few health care organisations have been a match for such inequality. The social and environmental forces propelling poor people into sickness are too great; the tools of traditional health care – the pills and the operations – inadequate to the challenge. Yet the Montefiore Health System, a ‘safety net’ health system in the heart of the Bronx, has found ways of helping even the most deprived, while contributing to the recovery of a struggling community. It has done so, in large part, by stepping beyond the bounds of conventional health services.

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Comments

DAVID PEACH

Position
Retired,
Organisation
NHS Patient
Comment date
30 July 2018

You mean using soup kitchens and veg & fruit that has got a short use by date Mickey Mouse Medicine

Roger Steer

Position
Director,
Organisation
HAC
Comment date
02 August 2018

"The Fund decided to complete a case study of Montefiore because of its high performance scores within the Pioneer accountable care organisation programme and its reputation for innovation and excellence in managing population health. The Fund relied on information provided by interviewees and did not itself validate assessments of Montefiore's performance."
This is propaganda in other words. The Kings Fund is losing its way.

Bhutta

Position
Finance lead,
Organisation
AFI Consulting
Comment date
09 August 2018

The paper provides some clear insight into how a systems can be developed over time, especially if politics does not get in the way. However to compare this to the NHS system would be difficult, when the NHSi, NHSe, NHS digital, Commissioners, local authorities, acute and mental health providers, community services, federations, NHS property, primary care and independent contractors have different agendas and are performance managed as separate entities. Montefiore model was able to commission, control, direct, develop and enhance not just hospital services but also community, social services and primary care services, vertical and horizontal integration and make decisions on capital and estates. Something not available in the current NHS way of working. The model reads well and may even feel as if there is a better method out there and not withstanding the opportunity to learn from the model, but not wanting to sound pessimistic, not much of the structural performance regime is changing in NHS any soon.

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