It is also being used as the basis for targeting up to $250 million in long term tax exempt bonds for primary care center construction, through the City's newly established Primary Care Development Corporation.

In 1990, in one medium sized rural county in Northeastern New York, only 11 primary care physicians and even fewer specialists provided significant levels of care to Medicaid clients. Today, following nearly a year long planning process conducted by the Health Systems Agency of Northeastern New York (HSA/NENY), local Department of Social Services and numerous community service providers, 30 primary care physicians and many more specialists are providing high quality accessible health care services to the Medicaid population in the program.

However, there are still many barriers to overcome there. There is an insufficient number of physicians in the community hospital and community based clinics are still not enrolling Managed Care clients; utilization of midlevel practitioners is far too low, and transportation services for clients in remote locations are needed. Through its ongoing participation in the county's Medicaid Managed Care Committee, HSA/NENY will provide the professional planning services and skillful community organization activities necessary to fully implement this vital new program.

I've also taken the opportunity to include a document on some of the recent activities of

all of the HSAs in New York State that clearly demonstrate the contribution of local planning to reconfiguring services (Exhibits I and II).

CONCLUSION

In conclusion, I would reiterate, that local involvement in the Implementation of health care reform is essential. Health care delivery is a local product. Regardless of the paradigm used, a vehicle is needed to move the system from where we are to where we want to be. Planning is that vehicle. We urge your committee to include specific provisions for community based health care planning in the final Federal Health Care Reform legislation.

Thank You, Mr. Chairman I'll be happy to answer any questions that the Committee would like to ask me.

DEFINITIONS OF COMPOSITE INDICATORS FOR MEASURING
OVERALL HEALTH NEEDS

HEALTH STATUS INDEX

The Health Systems Agency of New York City's Health Status Index (HSI) measures problems related to primary and preventive care. This Index represents an area's total point value, ranging from 0 to 100, based on percentage above the City average for the following six indicators:

The Health Systems Agency of New York City's Epidemic Health Status Index (EHSI) is designed to identify the communities that are being hardest hit by several interrelated health epidemics. This Index represents an area's total point value, ranging from 0 to 100, based on percentage above the City average for the foilowing four indicators: