New York Health Commissioner Pledges to Fix Medicaid

Physician Nirav Shah was sworn in Jan. 24 by New York Governor Andrew Cuomo as the state’s new Commissioner to the Department of Health, after receiving a unanimous confirmation from the state’s Senate.

Shah, 38, will give up his dual roles as an attending physician at New York’s Bellevue Hospital Center, which serves primarily low-income patients; and as associate investigator at Geisinger Medical Center in rural Pennsylvania, which has a large number of elderly patients.

In an interview with India-West as he was moving his wife Nidhi and their two young children to a new home in Albany, New York’s capital, Shah said his first priority would be to fix the state’s troubled Medicaid system.

New York’s $53 billion Medicaid budget accounts for one-third of the general fund for a state with a current budget deficit of $10 billion. Though New York spends the most of any state on its Medicaid program, it ranks 21st in the country on delivery of health care.

In his “State of the State” address Jan. 7, Cuomo announced his mandate for a new task force that will redesign the Medicaid system, and gave the team a deadline of April 1 to develop a new operating system for the state and federally-funded program which provides health care to low-income people.

“How do you improve the quality of care while maintaining or reducing costs,” queried Shah, noting that reducing Medicaid costs was a tricky proposition, as each dollar the state spends is matched by the federal program.

The state must be proactive, asserted Shah. “We need to prevent people from having to come to the hospital in the first place,” he said.

Shah advocated for “patient-centered health care,” using the examples of school-based clinics to treat children with asthma, and addressing childhood obesity which now affects 40 percent of New York state’s youth and can lead to a host of adult illnesses.

“Our kids are the first generation to have a lower life expectancy,” noted Shah, adding that sicknesses such as diabetes, heart disease, and cancer can be linked to being overweight.

Addressing the issue will require a multi-pronged approach, such as working through schools, parental education to reset cultural norms, promoting substitutes for high-calorie sugary beverages, limiting television, and promoting active play instead, said Shah.

But Carolyn Cannuscio, a social epidemiologist at the University of Pennsylvania, believes the problem of childhood obesity is systemic, and stems from a lack of access to fresh produce and safe places for children to play outdoors.

Presenting her findings from “The Health of Philadelphia-Photodocumentation Project” to reporters last October, Cannuscio described an inner-city neighborhood in that city where single cigarettes – known as “loosies” – were more widely available than fresh fruit. She detailed the lack of safe play areas in the neighborhood, concluding, “Little else registers as a health concern if safety is not assured.”

Shah also commended accountable care organizations, which provide services to Medicaid and Medicare patients while efficiently controlling costs.

Electronic medical records, which allow a physician to see a patient’s entire history, are also enormously useful in preventive care, Shah told India-West, especially with low-income patients who may not have a primary care physician and see new clinicians with each visit.

Shah used the example of congestive heart failure, a frequent cause of hospitalization and death in Medicaid patients.

“We can predict who’s going to get CHF 18 months before they develop it by data mining electronic medical records,” said Shah, imagining a pop-up window that could alert physicians to heart disease in their patients.

“It could be a wake-up call. You could then be very aggressive about controlling the patient’s blood pressure, smoking and cholesterol,” he said, adding, “Once you have heart failure, the cat’s out of the bag.”

Dollars could also be saved by educating the poor about federally qualified health centers – which provide medical care to needy people regardless of their ability to pay – thereby keeping them away from expensive emergency room treatment. FQHCs are federally mandated to provide health care to migrant workers and to the homeless.

Cuomo praised Shah at his confirmation last week. “Dr. Shah’s commitment to reshaping our public health system will serve the people of New York well,” said the newly-elected governor.

Ajeet Singhvi, president of the American Association of Physicians of Indian Origin, said Shah was exactly the right person to serve as New York’s health commissioner.

“Gov. Cuomo has made a great choice. Nirav is young and dynamic. He has a wealth of clinical experience, a strong background in public health and research. It’s rare to find that combination of qualities in one person,” said Singhvi.

“I’m very confident Nirav will bring meaningful and monumental changes to New York’s health care system,” said Singhvi.

Shah, a native of Buffalo, New York, received his M.D. and a masters’ degree in public health from the Yale School of Medicine. He was previously a Robert Wood Johnson clinical scholer at UCLA, and a National Research Service Award Fellow at New York University.