Stella Maris Mission 2026: Transforming Lives on the Banks of the Ozama

 

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Social Care Networks Come to New York State

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A New Heaven on a New Earth

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Quality Care for the Underserved: The Story of SOMOS

At the heart of the success of a unique network of 2,500 independent physicians serving one million of New York City's most vulnerable Medicaid patients lies the conviction that medicine is more than a diagnosis, treatment, or cure. Instead, the medical profession is called to integrate a humanistic element that faith, life experience, or drive shapes in every doctor, and that is decisive in how physicians ply this ancient trade of seeking to prevent illness and heal the sick.

Before creating the physician's network, SOMOS Community Care, SOMOS Chairman and Founder Dr. Ramon Tallaj, an immigrant from the Dominican Republic, learned that independent doctors were isolated. They occasionally crossed paths, but in their private practices, they were exposed to a system that increasingly devoured them in every sphere: pressure from insurance companies, competition with hospitals, and the demands of government bureaucracy.

Dr. Tallaj set out to unite doctors, inviting them to join the Corinthian Medical Group, a precursor of SOMOS. Working together, they were able to benefit from respective individual experiences and unite as a collective in negotiating with insurers and providers. Joining CMG proved to be a significant step toward the progress and stability of doctors' practices.

In August 2014, SOMOS began participating in the application for the DSRIP or Delivery System Reform Incentive Payment (DSRIP) program, an initiative launched by former New York Governor Andrew Cuomo to significantly reduce Medicaid expenses and reform the reigning healthcare model as much as possible.

DSRIP embraced a noble purpose, seeking to improve medical care for those most in need. But from its inception, the hospitals tried to set the tone and prevent a network of independent doctors such as SOMOS – not affiliated with a hospital system and with many of its doctors living in the same neighborhoods as their patients – from being included among the 25 medical service provider systems that would be approved to join the initiative. Hospital systems were very interested in removing SOMOS from New York City's medical landscape. Vested interests put up major roadblocks for SOMOS. But in the end, SOMOS became a Performing Provider System under DSRIP serving African Americans, Chinese Americans, and Hispanics, including many immigrants.

Still, SOMOS was not deemed reliable. Hence, a hospital was imposed upon the organization as a trustee, charged with monitoring SOMOS spending and approving organizational decisions. Happily for SOMOS, Montefiore Hospital was eventually engaged as a SOMOS trustee, leading to the creation of a robust and collaborative partnership.

For decades, the US healthcare system has focused on maintaining the status quo. Even when there were Hispanic leaders at the helm of hospital systems, health care was always dependent solely on hospitals. The United States has the best disease service in the world, but not the best health service that puts a premium on prevention. The underserved, elderly, immigrants, etc., have had to go to hospital emergency rooms even for a headache. And then, the astronomical bills come. All this has been known for years, but no one wanted to do anything. It was better to stay on the side of the big powerful groups than to risk a political career to benefit the neediest.

It should be noted that, under DSRIP, SOMOS was paid only for services rendered. The SOMOS Board closely managed its spending. Nothing is approved with the mere stroke of a pen, without prior consultations, discussion, and, above all, verification.

SOMOS booked notable success: by keeping patients out of the ER and hospital beds, it saved the federal government $48M a year for five straight years; New York State taxpayers saved more than $300M due to a 25 percent reduction in visits to the ER and hospitalizations; pilot programs enhanced the quality of the services rendered to patients; and SOMOS earned Innovator status in New York State, in recognition of its pioneering work featuring the Value-Based Payment formula, enhancing physicians' fees in accord with patients' longer-term health outcomes.

Key to SOMOS' success has been the cultivation of strong doctor-patient relationships. A major factor in this regard is the fact that many SOMOS doctors live and work in the same neighborhoods as their patients, with whom, in many cases, they share the same language and cultural background. Plus, aided by Community Health Workers, doctors get a sense of the social, family, and emotional circumstances of their patients' lives—the so-called Social Determinants of Health. For example, poverty may prevent families from consuming nutritious meals, which may cause obesity, or diabetes, along with attendant stress.

Unlike hospitals and the countless Urgent Care facilities, SOMOS doesn't wait for patients to show up at their doctor's door. Since the beginning of DSRIP, SOMOS has been developing extensive health education campaigns and distributing healthy eating models and plans. Working with invited personalities from the Latino world, it developed an app with exercise plans and nutritional suggestions. Health education is provided in medical offices, at community gatherings, in churches, and on the street.

SOMOS seeks out, talks to, teaches, and educates people so that they do not come to their doctor with perfectly preventable diseases. SOMOS sees the patient holistically, within a 360-degree viewing radius, considering many factors that other healthcare approaches do not consider. The highest moral principles inspire SOMOS staff and doctors in their pursuit of the common good. They are dedicated to the health and well-being of the people served by SOMOS.

The SOMOS difference between hospitals and the traditional health system lies in the formula of prevention before treatment. Our doctors are in the neighborhoods, immersed in the same life dynamic as many of their patients, whom they also know and have cared for generations. This intimate familiarity with patients' lives is key to preventive care. It is ironic that what was once traditional, the family or neighborhood doctor, is now revolutionary. This has its explanation in the stalemate that large hospital systems have created as the defining power of health care for years. Hospital systems, in general, evolved from healthcare facilities to interest groups and lobbyists that influence and determine health policies at the state and federal levels. This makes them key factors in a disease-based health system, but not a healthcare system that has the patient at the center of its vision and mission.

For these large systems established on the idea that the sicker people are, the better the economic results, it is a nuisance that a group of 2,000 independent doctors has acquired power and reputation with their work within the community. They are also concerned that they are losing money on emergency room visits because SOMOS doctors are treating hundreds of thousands of people, trying to keep them from getting chronically ill, or having to go to emergency rooms because they have no one to treat them. In the SOMOS vision, hospitals attend to only patients with the most urgent and prioritized needs.

The end of the first DSRIP mandate coincided with the onset of the COVID-19 pandemic. On this front, too, SOMOS took a course decidedly different than that of the healthcare establishment, which focused on hospitalization and the purchase of costly ventilators and other medical equipment. SOMOS focused on educating the community as to the importance of isolating people struck by the virus and protecting family members living together in close quarters. Here, too, the focus was on prevention rather than treatment of the disease. SOMOS fought hard every day so that our message of isolation and protection reached all communities. The strategy flew in the face of large institutions seeking to maintain the status quo of a disease system.

Our doctors took to the streets. SOMOS bought and set up tents in different neighborhoods to administer COVID-19 tests which SOMOS often bought with its own funds. SOMOS took to the radio stations, television stations, and the press with messages that people had to social-distance, and that they had to isolate the sick, especially from the elderly. Messages were delivered in English, Spanish, and Chinese. SOMOS educational campaigns were comprehensive and efficient. Eventually, SOMOS convinced authorities of the need for people to isolate themselves and of the importance of educational and outreach campaigns among those most in need.

When, after lengthy delays, SOMOS was mandated to distribute the COVID-19 vaccine, it did so at distribution points in the community, going to the people and facilitating access to the vaccine for the neediest. From the start of the pandemic, SOMOS also delivered food to the neighborhoods, working in tandem with major charitable organizations. SOMOS is yet to be reimbursed by the State for all its work and contributions in fighting the pandemic.

Dr. Tallaj, concluding a recent report on the history of SOMOS, put it thus: "My mission, and as such the mission of the network of doctors I lead, is to educate our community, our children, and our youth today; and treat them preventively, if possible, to prevent avoidable chronic diseases from conditioning their lives in the future."

"This has an economic benefit for the government as a beneficiary of health programs and for insurance companies. But the greatest benefit is for the person, the human being, who will be able to live and function well in our society. If we manage to see the role of the doctor like this, if we can convince politicians of the fundamental importance of the primary physician (general practitioner or family doctor) and of the need to allocate funds to those doctors so that the neighborhoods, regardless of the social class that resides in them, become conglomerates of healthy people, it will have been worth facing so many challenges... and to have kept fighting."

 

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SOMOS Network Physicians Will Give Vaccine

NEW YORK GOVERNOR ANDREW CUOMO has authorized a network of independent doctors in New York City to give the coronavirus vaccine to some of the city’s poorest residents, the bulk of them people of color—communities that have been underserved thus far in the distribution of the vaccine. SOMOS Community Care, a network of 2,500 physicians—most of them primary care physicians serving 1 million Hispanic, Asian-American, and African American Medicaid patients—will be given up to 1 million doses of the vaccine.

At a March 26, 2021 news conference in the Bronx announcing the move, Gov. Cuomo said that “the state is going to be providing vaccines directly to SOMOS so they can get those needles in those arms in those hard-to-reach communities.” The governor noted that New York City’s vaccination efforts have thus far failed to give sufficient access to minorities.

“We need to do vaccine equity,” he said, noting that, for example, the city is 27 percent black, yet only 19 percent of that population is vaccinated; by contrast, the city is 53 percent white and already 55 percent of these residents has been vaccinated.

Initially, 75 SOMOS medical practices will begin distributing the vaccine in the coming weeks; 100 practices will be involved in the effort pending supply of the vaccine. That means patients can make an appointment directly through SOMOS (somosvacunas.com), go to their regular doctor and get vaccinated right in the doctor’s office.

Thus far, New York State has relied primarily on hospitals and other medical facilities to distribute the vaccine, an infrastructure that is harder to navigate and gain access to for the poor, especially people of color. What’s more, Blacks and Hispanics, stressed the governor, have “less trust in the system” and have been skeptical about the safety and efficacy of the vaccine.

SOMOS doctors will rely on their unique relationship with their patients to create a level of trust and comfort, moving people to become willing to be vaccinated. That strong doctor-patient bond—with the physician functioning like the family doctor of old—hinges on several factors:

The majority of SOMOS doctors speak the same language and share the cultural background of the people they serve and in whose communities the physicians are based. This cultural competence has proven to be key factor in doctors understanding the needs of the people in their care.

The SOMOS network also puts a premium on the contribution of Community Health Workers, who visit patients’ homes, reminding them of medical appointments and assessing circumstances in the home or family that can impact people’s health. The latter fall in the category of the Social Determinants of Health—substandard housing, unemployment, criminal justice issues, etc. SOMOS doctors work closely with Community-Based Organizations that can address some of the issues.

SOMOS physicians also carefully integrate behavioral health into patients’ overall treatment. In sum, SOMOS doctors’ offices are a gateway to quality, holistic, comprehensive care, which makes for better longer-term health outcomes; and the doctors are compensated accordingly, earning more as their patients do better and, for example, stay out of costly hospital beds.

SOMOS has been functioning in accord with the Value-Based Payment system that rewards superior care—in contrast with the transactional payment formula of the traditional Medicaid model that is prone to waste and fraud.

SOMOS got its start thanks to Gov. Cuomo authorizing, in 2014, the Delivery System Reform Incentive Payment program, which ran through 2020 and laid the foundation that enabled SOMOS to provide superior care to New York City’s poorest residents. A new chapter in the SOMOS record of service to the most vulnerable has now begun with the vaccination program.

In his remarks at the news conference, Dr. Ramon Tallaj, founder and chairman of SOMOS, recalled that this is not the first time that New York’s governor called on the organization for vital aid. In March 2020, right at the start of the pandemic, the governor asked SOMOS to begin testing staff at the New York Stock Exchange, which it would do through the summer. SOMOS ran numerous testing sites throughout the city—as well as in Texas, Florida, and Georgia. To-date, said Dr. Tallaj, SOMOS has administered 1 million test and helped distribute 2 million meals to New York families hard-hit by unemployment as a result of the economic fall-out of the pandemic.

SOMOS doctors have success with their patients, said Dr. Tallaj, because “we understand their culture—because we are immigrants like them, we are the same people … we serve poor people in our neighborhoods, near their homes, near their apartments, because medicine is local and because people tend to choose doctors based on their values.”

Speaking of SOMOS’ new task, Dr. Tallaj said that his doctors—“champions of preventive medicine”—will distribute “the vaccine of hope to end the virus of loneliness, which has people dying.”

Mario J. Paredes is CEO of SOMOS Community Care, a network of 2,500 independent physicians—most of them primary care providers—serving close to a million of New York City’s most vulnerable Medicaid patients. 

SOMOS doctors actively do their part in fighting the pandemic

WITH MOST OF THE FOCUS on state, city and governments tackling the coronavirus pandemic, a remarkable network of doctors has been on the frontlines in the battle against COVID-19 in New York City since the very start. These physicians, who are the backbone of SOMOS Community Care, have not drawn the limelight but have quietly done their job fighting the ravages of the pandemic.

SOMOS has proven its effectiveness and earned its stripes. No doubt, its record in the battle against the coronavirus—showing that primary care physicians can play a key role—helped persuade New York State health authorities to give SOMOS doctors the privileged task of administering the vaccine.

This network of more than 2,500 community-based, independent physicians—most of them primary care providers—are caring for vulnerable African American, Hispanic and Chinese American Medicaid patients throughout the city. The populations have been particularly vulnerable to the virus, because of a high incidence of underlying conditions, cramped living conditions among other factors. These neediest patients have been the focus of SOMOS Community Care from the very start.

Months ago, when it came to encouraging people to get tested for the virus, SOMOS doctors’ close relationships with their patients—in whose lives they play the role of the family doctor of old—made all the difference. Plus, there is the fact that in many cases the physicians speak the same language and share the same cultural background as they people in their care.

These advantages also come into play now that these doctors have begun administering the vaccine. SOMOS doctors can establish patients’ trust and confidence about the safety of the vaccine and ensure the equitable distribution of the vaccine in communities of color.

The work of SOMOS’ fight against the virus began right when the pandemic first hit the US, in March 2020. At the request of Governor Andrew Cuomo, SOMOS doctors and staff began testing personnel at the New York Stock Exchange, a vital institution in the life of the US economy. The testing there began in mid-March and continued through the summer and fall of last year.

The organization has been operating more than 51 tri-lingual testing sites, with service in Spanish, English, and Chinese, based at Catholic and Protestant churches throughout New York City, while SOMOS is also testing at 33 office sites and two drive-thru locations. SOMOS, to-date, has administered more than 500,000 coronavirus tests. The count at SOMOS-run sites in Texas, Arizona, Florida, and Georgia bring the total up to 1 million. SOMOS has also been testing at more than 400 public schools in the city. Some 400 SOMOS practices—half of the total—play a part in the testing process.

At the same time, SOMOS partnered with restaurants and entrepreneurs in some of the communities it serves to provide meals to families hard-hit by the economic fall-out from the pandemic, families whose breadwinners lost their jobs and were plunged into poverty. To-date, more than 5M prepared meals have been distributed. SOMOS also worked with local grocers and other community-based organizations to purchase, package, and distribute food products. SOMOS also helped struggling small businesses in minority communities get back on their feet financially.

SOMOS has also finance the purchase and delivery of personal protective equipment (PPE) and consumable medical supplies necessary for COVID-19 testing; medical waste disposal related to COVID-19 testing; labor costs associated with medical staff providing COVID-19 testing; and additional costs for testing sites, including costs related to lease, mobilization, and demobilization costs, as well as certain operating and maintenance costs.

All the while SOMOS engaged in significant outreach and communications efforts to disseminate public information regarding health and safety measures and provide warnings about risks and hazards. This communication effort encompassed all forms of media, including radio, newspaper, pamphlets, and television. This work continues now in service of the vaccination process.

With hundreds of doctors now vaccinated, SOMOS doctors feel confident that they can immunize their entire patient body—at least those over 65—in the coming weeks. Mayor Bill de Blasio announced earlier this year that SOMOS doctors will be vaccinating first responders at Taft High School in the Bronx, George Wingate High School in Brooklyn, and Brandeis High School in Manhattan. SOMOS doctors is also administering the vaccine at Yankee Stadium and the Aqueduct Racetrack.

SOMOS’s participation in the vaccination process will balance hospital-based distribution and make getting the vaccine more convenient for many New Yorkers. The SOMOS doctors were engaged thanks to the lobbying efforts of SOMOS President Dr. Henry Chen and SOMOS Founder and Chairman Dr. Ramon Tallaj, who is an advisor for the execution of New York State’s COVID-19 Vaccination Program.

All of SOMOS’ activities dealing with the pandemic are closely coordinated with the New York State Department of Health and the City of New York. To help both the testing and vaccination process, SOMOS has stablished two urgent care centers: one in the Bronx and one in Manhattan.

SOMOS has been on the frontlines from the start and paid in treasure (some $20M) and blood—a dozen SOMOS doctors died from the virus and many fell ill doing their jobs. Meanwhile, more than half of SOMOS practices remain closed.

The fight will continue until the virus is defeated—and SOMOS will not quit.

Mario J. Paredes is the CEO of SOMOS Community Care.