Latest / Becker’s Payer Issues Podcast / Protecting Access and Advancing Care: Erfan Karim on Medicaid, Innovation, and Health Equity

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Protecting Access and Advancing Care: Erfan Karim on Medicaid, Innovation, and Health Equity · Becker’s Payer Issues Podcast

• 0:00
  Welcome everyone to the Becker's Healthcare podcast series.
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  I'm Mariah Muhammad, writer and moderator with Becker's
• 0:05
  Healthcare. And I'm thrilled to have with me
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  today Irfan Karim, chief clinical operations officer at
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  NYC Health and Hospitals,
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  Bellevue.
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  Sari, welcome to the podcast. We're very excited
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  to have you join us today. To get
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  us started, would you mind please introducing yourself
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  and telling us a bit about your background?
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  Yes. Thank you. Thank you for having me,
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  Maria. My name is Irfan Karim. I serve
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  as the chief clinical operations officer at New
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  York City Health and Hospitals Bellevue. I've been
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  with New York City Health and Hospitals over
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  a decade, helping lead system wide initiatives
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  that span digital health, mobile care delivery, and
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  clinical operations across the largest public health system
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  in the country.
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  But before I was a hospital leader, I
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  was a patient. I'm a first generation immigrant
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  who grew up in the best place in
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  the world, Queens, New York.
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  Go next. My family and I relied on
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  Elmhurst Hospital as the only accessible source of
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  care day to day, as I was growing
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  up. We didn't have private insurance or financial
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  flexibility, so Medicaid and the public hospital system
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  weren't just a safety net. They were essential
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  lifelines
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  for us.
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  That personal experience informs how I approach health
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  care today, with the deep belief that access
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  to care should never depend on your income,
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  immigration status, or ZIP code.
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  Yeah. Absolutely. Thank you so much for giving
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  us that background. So,
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  with everything that you're focused on this year,
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  what are some of the biggest issues you're
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  following in health care for this year and
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  into next year?
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  Well, as of this morning, the big beautiful
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  bill passed the house. So one of the
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  most urgent issues,
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  is the threat to Medicaid reductions. At New
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  York City Health and Hospitals,
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  more than 450,000
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  patients relied on Medicaid as their primary insurance
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  in 2024,
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  and that includes hundred and 75,000
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  children 18,
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  nearly thirty eight percent of our Medicaid patients.
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  So Medicaid is not a marginal problem. It
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  is the backbone of care for some of
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  our most vulnerable neighbors.
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  I'm so closely following that.
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  I'm also closely following
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  how the health systems adapt post COVID. You
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  know, during the public health emergency,
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  temporarily,
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  Medicaid recertifications
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  were paused that increased access.
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  But since recertification has
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  seen a drop in Medicaid enrollment, especially amongst
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  adult children who may not realize they're eligible
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  or face administrative hurdles to stay covered.
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  So finally, we're watching the ripple effects across
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  core services. For example, Medicaid and uninsured patients
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  typically use the emergency medicine, emergency rooms,
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  OBGYN or maternal health services, being for health
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  and primary care. And if funding is cut,
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  these very services will be most impacted.
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  So we'll be adding nearly 10,000,000
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  additional uninsured patients,
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  in the country to the general populations.
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  And, also, more locally at Bellevue,
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  we had a recent closure of,
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  our neighboring community hospital, Mount Sinai in Beth
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  Israel, and that has intensified the demand for
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  our services, challenging challenging us to uphold the
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  same exceptional standard of care we've maintained for
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  nearly three centuries with additional patients coming on.
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  Wonderful. Thank you so much for giving us
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  that information. Yeah. I definitely read about that
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  this morning.
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  And I think that's one of the things
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  that's making me nervous. Is there anything else
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  that,
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  I guess, is making you nervous from the
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  news, or anything you're working on personally or
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  anything that's making you excited?
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  So, I mean, I think everything's not always,
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  in the negative. Right? I think we should
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  focus on positives as well. So I'm incredibly
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  energized by how we're reimagining
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  access through innovations such as virtual care, home
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  based care, juvenile health, especially for the Medicaid
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  population that I just spoke about with historically
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  face barriers to traditional brick and mortar systems.
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  But, again, the concern exists,
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  for our patients in the Medicaid funds. Right?
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  Seventy five seventy percent of our patients are
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  18, cover Medicaid.
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  Seventy percent of our inpatient discharges are covered
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  by Medicaid. Sixty percent of our patient visits
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  are covered by Medicaid.
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  So, you know, you can't just divest in
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  Medicaid without divest
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  disinvesting
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  in kids,
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  seniors, working families, and communities of colors.
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  And then I'm worried about how the economics
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  are impacted
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  for
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  our community. Right?
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  Over 80,000
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  patients of us, experience homelessness or housing insecurity,
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  and that includes 17,000
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  children.
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  So we need more, not less investment in
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  public health infrastructure. Right? Health and hospitals
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  has a workforce of seventy seventy thousand plus,
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  and our team members reflect our communities
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  and create almost 18,000,000,000 in economic activity as
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  does many hospitals throughout the country. So these
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  cuts are going to deeply impact the day
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  to day of patients' lives, but our communities
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  and our workforce.
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  Yeah. Yeah. Absolutely. Thank you so much for
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  giving us that info. And then last, lastly,
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  before I let you go, in your opinion,
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  what would the most effective health care leaders
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  need in order to be successful in in
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  the next two to three years, do you
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  think?
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  Great question. I think, I think every generation
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  said these are changing times, but the most
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  effective leaders will,
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  have to operate at the intersection of operational
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  discipline and social mission. They'll need to be
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  fiscally responsible while relentlessly
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  protecting the care of those who have the
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  least.
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  They'll need to champion innovations that extend beyond
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  the four wheels of the hospital that includes
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  mobile care, telehealth, community partnerships, but then they
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  still have to maintain the excellence across our
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  traditional delivery models. Right? It's additive,
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  not a replacement.
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  And finally, I think leaders must be policy
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  savvy advocates as health care today is deeply
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  shaped by legislation as we've seen this morning.
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  Preserving Medicaid, you know, it just isn't good
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  public health policy. It's essential
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  for millions of,
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  people throughout the country, nearly 80,000,000,000. Right? In
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  New York City, we serve nearly 1,000,000 New
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  Yorkers, with 6,000,000 visits, including 50,000
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  Medicaid covered births. So this isn't about abstract
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  numbers. It's about real people, real lives, and
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  a public system that reflects our shared value
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  as a country.
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  Absolutely. Thank you so much for those final
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  thoughts. It's definitely been a very informative discussion.
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  So, again, I wanna thank you so much
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  for coming on Becker's Healthcare, especially for the
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  first time, and I look forward to connecting
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  with you again soon.
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  Likewise. Thank you for having me.