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.