Opinion: How to reduce Medicaid spending in NJ

Care team member visits patient in Camden

In an opinion piece published by both the Cherry Hill Courier Post and NorthJersey.com, Natassia Rozario, Senior Director of External Affairs for the Camden Coalition of Healthcare Providers, outlines the need for intelligent spending of Medicaid dollars in New Jersey. Read the op-ed below.

Courier Post online        northjersey.com

Healthcare Recommendations for Phil Murphy

New Jersey spends about $14.5 billion a year on Medicaid, more than anything else in the budget except education. Given that expense and the uncertainty in Washington around healthcare, it’s crucial that Governor-elect Phil Murphy spend those dollars intelligently and efficiently.

The Good Care Collaborative met last month in Trenton to discuss recommendations for the next governor about how to deliver the right care in the right place at the right time to reduce waste and achieve better health outcomes. We represent a diverse set of stakeholders in the health care system from across New Jersey, including hospitals, providers, patients and faith leaders.

Our focus is on people with complex health and social needs, the five percent who represent 50 percent of health care costs nationwide. In New Jersey, 10 percent of individuals on Medicaid account for about 75 percent of state expenditures.

New Jersey’s healthcare system, like the rest of the American healthcare system, has evolved to serve the typical person with typical health needs. It’s not built to serve people with multiple chronic illnesses, usually exacerbated by social stresses like housing or food instability. Individuals with complex needs often have struggled with addiction, have had contact with the criminal justice system, or have a history of childhood trauma.

There is no one type of person who has complex health and social needs. They might look like Robert, who was experiencing homelessness on the streets in Camden and struggling to manage his substance use disorder and COPD. Or Shirley, who is a middle-income woman with a graduate degree, severe anxiety, and is living with uncontrolled diabetes.

For healthcare consumers like Robert and Shirley, care is fragmented, uncoordinated and sometimes duplicative. Their care is marked by repeated emergency room visits, over-testing, hospital readmissions and other unnecessary or inefficient uses of Medicaid.

It’s well known that the United States spends far more on healthcare than other developed countries without achieving better health outcomes. It’s less commonly known that we spend far less than other developed countries on social services. Research shows that the conditions in which people live, work and play have an enormous impact on health.

The Good Care Collaborative held a robust policy discussion to envision an improved Medicaid system that would help those most in need and shift costs to ensure that taxpayer money is being spent on care that is appropriate. When people with complex needs get the right care in the right place at the right time, we all win.

We congratulate the governor-elect and offer a few recommendations that would prioritize smart Medicaid reform.

-Integrate healthcare with social services. We have found that social barriers such as homelessness or the lack of access to reliable transportation have huge impacts on patients’ health.

-Innovate locally. Strengthen and develop our Accountable Care Organizations, which are finding ways to design and scale community-based, data-driven models in Newark, Trenton and Camden.

-Use data to build a smarter healthcare system. New Jersey is already a national leader in the use of data to determine what’s working and what’s not. The administration should support successful initiatives like the Integrated Population Health Data Project at Rutgers that use data to strengthen accountability.

-Focus on mental health, addiction and pain. These are foundational conditions that cost lives and strain the system. We must get rid of barriers to the use of evidence-based treatments like buprenorphine for opioid addiction.

-Ensure access to healthcare for all New Jerseyans. An efficient system that provides coordinated care to individuals in their community and before they’re in a crisis is the way to provide the right care in the right place at the right time. The next administration should fight threats to the Affordable Care Act that would shrink Medicaid and deny care for the most vulnerable.

Without access to community-based treatment, people delay care and end up in the most inefficient and expensive care settings, including emergency rooms, inpatient care, long-term care, or worse, the criminal justice systems.

Medicaid is our second biggest expenditure. We’re making great strides toward reducing the inefficiencies in the system, and given the lack of clarity at the federal level, now is the time to double down on evidence-based, data-driven solutions here in New Jersey.

We can reduce avoidable hospital stays, emergency room visits and lost lives. Better care at lower cost is possible, but only if we transform our systems so that they work for us when we need them most.

Published on December 13th, 2017

Policy Recommendations for the New Administration

As the federal and state government look to reform the Medicaid system, the next gubernatorial administration has the opportunity to set a national example for the Medicaid program. In collaboration with partners across the state we have developed strategic policy recommendations to improve quality, outcomes, and efficiencies in New Jersey’s Medicaid program. Although the recommendations detailed in the below policy position papers are focused on individuals with the most complexity, the lessons from this work may be applied to the broader Medicaid population, as well as beneficiaries across payor types. It is our hope that the incoming administration is able to use these recommendations to guide their strategies for advancing complex care in New Jersey.

The Policy Position Papers

Recommendations Overview

Housing First

Non-Emergency Medical Transportation

Integrated Data

Community-Based Medicaid Accountable Care Organizations

Introduction to the Camden Coalition

 

National Center for Complex Health and Social Needs: 

Community-Based Care Management

Published on October 30th, 2017

Complex Care in New Jersey Medicaid: Setting a Vision

3rd Annual GCC Conference

Josh Bamberger asks a question for Keynote, Frederick Isasi

September 19th, 2017  |  Trenton, NJ

With health care reform in and out of the national spotlight and a governor’s race approaching in November, national and state Medicaid experts, policymakers, and community members gathered in Trenton for the third annual Good Care Collaborative conference, Complex Care in New Jersey Medicaid: Setting a Vision. After hearing from panelists about bright spots of innovation across the country and state, the 130 attendees had the chance to write suggestions to the new state administration to advance complex care in New Jersey.


Keynote Speakers

Toyin Ajayi, MD, MPhil
Chief Health Officer of Care Lab at Sidewalk Labs, where she is building personalized social care models for patients and communities with complex health and social needs. She is a true leader in designing, implementing, and evaluating clinical interventions to improve the quality, patient-centeredness, and cost of health care delivery in complex and multi-morbid patient populations. Previously, as the Chief Medical Officer at the Commonwealth Care Alliance (CCA) in Boston, MA, Toyin oversaw clinical delivery and clinical operations.

 

Frederick Isasi, JD, MPH
As Executive Director of Families USA, a leading national health care advocacy organization, Frederick pursues the goal of high-quality, affordable health care for all. In his previous roles, as Health Division Director for the National Governor’s Association Center for Best Practices and as Vice President for Health Policy at the Advisory Board Company, Frederick fought for health care service delivery and payment reform, state employee and retiree health benefits, maternal and child health, prescription drug abuse prevention, and health insurance exchange implementation.

Published on June 13th, 2017

Community-based ACOs: Powerful models to improve behavioral health

A Housing First patient in Camden, NJ in her new home.

A Housing First patient in Camden, NJ in her new home.

A recent report published by Rutgers identified that about 86 percent of the top 1 percent highest-spending Medicaid patients in our state suffer from a behavioral health diagnosis. Given these statistics, New Jersey’s three certified community-based ACOs recognize that addressing behavioral health issues in their local communities is a key component of their success. The Camden, Trenton, and Newark ACOs serve individuals who present with mental health and substance abuse issues at a significantly high rate—approximately 1 in 4 ACO patients has a behavioral health diagnosis.

Bringing community-based, coordinated care to complex patients in New Jersey, the three ACOs are advancing behavioral health initiatives in their communities.

  • The Housing First program for medical super users in Camden supports many individuals with mental health and substance abuse issues. Preliminary results of this program show a 40 percent reduction in hospital utilization.

  • Citywide quality improvement initiatives to increase access, capacity, and treatment options for patients suffering from mental health and substance abuse. Focusing on improving local access and provider capacity to write prescriptions for suboxone, a medication assisted treatment for opioid use.

  • Sharing protocols for patients with substance use issues in the ED. The Trenton ACO is working to develop shared protocols and procedures among their three area hospitals for patients presenting with substance abuse issues in the ED.

  • ACO data and technology infrastructure as well as its unique ability to convene multiple and competing stakeholders has allowed the Camden Coalition to serve a key role in the South Jersey Behavioral Health Innovation Collaborative (SJBHIC), which aims to improve the coordination and delivery of behavioral health care in the five participating south jersey hospitals.

The ACOs, their communities and patients have all deeply invested in the Demonstration Project and are committed to improving quality, outcomes and efficiencies in a highly complex and entangled Medicaid system. In the areas of behavioral health, we are beginning to see their promise. The three ACOs were able to use state funding to build and sustain important data and information infrastructure to support population health initiatives, support stakeholder engagement to allow for improved community-wide coordination and collaboration, and build capacity for city-wide and targeted quality improvement work. The ACOs need continued state funding to see the Demonstration Project through to completion and continue to build upon the good work, the data and quality improvements each has begun to see in their communities, especially in the area of behavioral health.

Published on April 24th, 2017

The Transformative Impact of New Jersey’s Medicaid Accountable Care Organizations

New Jersey's 3 Medicaid ACOs (Camden, Trenton, & Newark)

Thomas Edison University  |  Trenton, NJ

Thursday March 23

Last Thursday, on the 7th anniversary of the Affordable Care Act (ACA), community leaders highlighted the promise of local models. A Medicaid Accountable Care Organization (ACO) is an evidenced-based model that aims to improve outcomes for individuals with complex health and social needs by improving the coordination and delivery of their care. The Good Care Collaborative convened providers, advocates, and policy leaders for a forum to discuss early impact and future implications of New Jersey’s community-based Medicaid Accountable Care Organizations.

Leaders from across the state shared lessons learned and discussed how this work can continue to reshape New Jersey’s health care landscape. With limited resources and increasing uncertainty at the federal level regarding the future of Medicaid, the Medicaid ACOs provide innovative, evidence based, regional approaches to improving quality, outcomes and efficiencies for vulnerable patients.
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Published on February 14th, 2017