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Welcome everyone to the Becker's Healthcare podcast series.

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I'm Mariah Muhammad, writer and moderator with Becker's

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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.