Testimony Presented by Nirav R. Shah, M.D., M.P.H. - Delivered before the Senate Standing Committee on Health - January 24, 2011
I am honored to have been nominated by Governor Cuomo to serve as New York State Commissioner of Health. And I am very excited about the opportunity to work with the Governor and all of you to protect and improve the health of all New Yorkers.
First I want to acknowledge my family members whose love, support, and encouragement have sustained me and led me on this path to today: My wife, Nidhi Shah and our son Vir, and daughter Amira. We are looking forward to relocating to the Capital Region and starting our new life here.
I am grateful to my parents Ramesh and Rekha Shah for traveling from India to be here today. I also want to acknowledge my uncle Deepak Maniar, who is here from Rochester, and my cousin Dr. Kanan Maniar and her husband Dr. Ravi Gupta here from Washington, DC.
This morning I will briefly discuss my background and then give you an overview of my vision for the future of health in the state of New York. Then, I look forward to responding to your questions and engaging in a productive discussion.
I was fortunate to enjoy the quintessential all-American upbringing in Williamsville, New York, a suburb of Buffalo. In many ways it was the idyllic Upstate New York childhood of block parties, Boy Scouts, summer camp, sports, and many other activities. They were years of innocence and opportunity that we all hope our own children and grandchildren will also enjoy. I received a great education in the Williamsville public schools and graduated from Williamsville East High School.
My values were shaped by my very strong ties to family and community. I am grateful to have been so fortunate. My parents instilled in me at a very early age a strong work ethic and a respect for others, and they provided a support system that allowed me to pursue my dreams. Growing up in Williamsville, I developed a lifelong connection to New York that makes me especially excited to serve our great state.
I earned my undergraduate degree from Harvard, graduating with honors. I went on to receive my MD and master's of public health degree from the Yale School of Medicine. In addition I was a Robert Wood Johnson Clinical Scholar at UCLA and a National Research Service Award Fellow at New York University.
Until my nomination as Commissioner, I was an attending Physician at Bellevue Hospital Center in New York City, Associate Investigator at the Geisinger Center for Health Research, and Assistant Professor of Medicine in the Section of Value & Comparative Effectiveness at New York University Langone Medical Center.
As a general internist at Bellevue, I developed a special interest in the consequences that limited resources always have on the health care for the poor. We decide on that care, and then we vote on how to allocate it to vulnerable populations. We do make choices, and we do cast our votes.
Many of my patients struggle to manage their chronic diseases while also dealing with underemployment, or outright unemployment. They suffer from inadequate housing; lack of childcare; and poor nutrition and limited access to healthy foods. We need to help them more proactively so they can take better care of themselves. As of right now, they suffer disproportionately from the effects of smoking, alcohol, the brutal and crippling isolation that comes with poverty, and substandard schooling. The list goes on.
Over the years of my daily work as a doctor I have seen up close how health and health care touch every aspect of our lives. My experience as an internist has driven home the need for health systems to work interactively with families and communities. That experience has also informed my work as a researcher.
My primary research interests are in the use of systems-based methods to improve patient outcomes, use of large-scale clinical laboratories and electronic health records to improve the effectiveness and efficiency of care, and the methods needed to transition to the future of lower-cost, more patient-centered health care for the 21st century.
With the goal to identify best practices and improve care for vulnerable populations, I have conducted research and development both in the public hospital system of New York City and in the rural, aging population of central Pennsylvania's Geisinger Health System. I have also conducted research to generate new knowledge for advancing preventive care for patients with cardiovascular disease, and for improving the surveillance and the public health surrounding it.
In addition to my practice and research, I am a fellow of American College of Physicians and the New York Academy of Medicine. I have served on the editorial boards of medical journals, published more than 90 peer-reviewed articles, and received more than $4.5 million in research funding.
Given my extensive involvement with research and other efforts in the medical field, I am, of course, working with counsel to ensure appropriate recusals consistent with the Public Officers Law.
Now I will discuss how my experience as a physician and a researcher have shaped my vision for health for New York.
I have mentioned to you some of the immense challenges that face both patients and health professionals in the field in our rapidly changing system. Every day the health news headlines remind us of hospital closings, frustrated providers and patients, shrinking budgets, expanding waistlines, and a crumbling public health infrastructure.
And yet, I want to tell you that this is also a time of hope and opportunity because I truly believe that we can bring together the best minds and ideas to reshape our system. We are fortunate to have generated in recent years a critical mass of new knowledge and models of health care delivery. These provide us with ideas and innovations that, by working together, can help us shape policies and programs going forward.
New York is poised to once again become a national leader in health. And today I want to share with you a vision of the health system of the State of New York, a vision I will do my best to implement if confirmed. In that vision, I see a health system for our state that improves and preserves the health of all New Yorkers. I see a new and sharper focus on quality, safety, access, and prevention. My hope is to help bridge the divide between public health and medical practice by setting clear priorities and acting in partnership with caregivers to give patients the right care at the right time.
I envision a public health landscape in which the State Health Department takes the lead in guiding and assisting all parts of the health care continuum: from patients and families, to communities and hospitals, to systems and networks.
New models of care delivery are showing promise. We will now have the opportunity to align incentives with patient-centered outcomes, rather than sticking with the old mantra of "more care equals better care."
Hospitals are moving from an acute disease, inpatient focus to a chronic disease, community-engagement and whole-patient approach. We can encourage this transition further with our health policies.
New York is embarking on a historic redesign of our state Medicaid system. Under the Governor's leadership, the Department will lead the charge to redesign Medicaid for the 21st century. I had the opportunity to attend the first regional public forum of the Governor's Medicaid Redesign Team in Buffalo last week, where we heard from diverse stakeholders, including providers and patients. I came away from the forum with much hope that we will achieve a more efficient and cost-effective system, while preserving and improving high-quality care and services for the most vulnerable New Yorkers.
As we continue to face dire financial conditions statewide and nationally, we, the health care leaders, have the duty to never lose sight of our underlying values and our responsibility to those we serve, especially the patients who are most in need.
If you confirm me as your Commissioner of Health, I will work closely with you to protect and advance the health of all New Yorkers at this time of great challenge and great opportunity. I am truly honored and humbled by this responsibility.
It is my privilege and pleasure to be here today, and I look forward to your questions. Thank you.