Health care is essential to everyone in New Jersey. Today our uninsured rate (8.75%) is at a 30 year low. Proposals to decrease funding for Medicaid and political threats of eliminating subsidies for people to buy insurance are harmful to NJ’s insurance market and NJ residents. People want to go to work, enjoy their weekends, and not have to worry about losing their health insurance. The more we can do, together, to lower the cost of health care, and extend health insurance to everyone in NJ, the better. That is what our leaders need to focus on.

New Jersey leaders should focus on keeping the Medicaid expansion alive and well to make sure that the 550,000 newly insured people, many of whom have received needed care for substance abuse and mental illness, can continue to receive treatment. Our leaders should focus on increasing efficiencies and reducing waste in the State Medicaid program. The New Jersey Health Care Quality Institute issued Medicaid 2.0: Blueprint for the Future which contains 24 consensus recommendations to assist the State in modernizing its program.

Our leaders should focus on eliminating “surprise medical bills,” a problem that harms patients, employers, and taxpayers throughout the Garden State.

We must improve health care quality and make it more affordable in NJ. Indeed, if the current administration wants to increase transparency, it can make plenty of data, regulatory reports and filings public on its websites tomorrow — no new laws needed. We would support such a move and have been calling for greater access to information.

The newest proposal to put paid political appointees on Horizon’s board is unhelpful when greater fiscal restraint and a more consumer focused strategy is needed for New Jersey’s largest insurer. And proposals to raid its reserves without any findings that the reserves are excessive or anti-competitive are troubling given our dire need to protect and improve health care in our State.

It’s time to focus on helping our residents keep their health care.

Do you know anyone who wants to die in a hospital ICU, perhaps intubated and on dialysis, surrounded by strangers? I don’t. Most New Jerseyans want to die at home surrounded by the people they love. They want comfort and compassion. They don’t want interventions that have little value to patients with advanced illness.

Yet year after year data show that people in our state receive among the highest rates of aggressive medicine at the end of life — medicine that rarely extends lives or improves the quality of lives.

CMS just released 1991-2014 health care spending data by state, and New Jersey had the nation’s highest per enrollee Medicare spending in 2014 at $12,614. That’s roughly 15 percent above the national average of $10,986. And the Dartmouth Atlas of Health Care, which also explores Medicare spending, continually finds that we far exceed the national average on end-of-life care utilization — from days spent in the hospital, to hospital care intensity, to number of physicians seen.

And we’re near the bottom when in comes to days spent in hospice care.

But we can change the way we die in New Jersey. The first place to start is a low-tech, low-cost intervention: A Conversation … with your physician, with your family members, with people in your community. It’s not just about changing the culture of medicine but also about changing the culture of our communities around end-of-life care issues. The Quality Institute’s Conversation of Your Life (COYL) program — part of our Mayors Wellness Campaign — attempts nothing less.

This June marks the third year of COYL, which is funded by The Horizon Foundation for New Jersey. COYL local task force members, who are all volunteers, organize activities in their communities to help patients and their families better understand the benefits of advance care planning and the choices available to them.

COYL helps people feel more empowered to implement the steps needed to make sure their end-of-life care wishes are honored. Advance directives are a gift to a person’s loved ones. Without directives, we know that family members can have differing views about medical interventions. Conflicts can arise in these tense times that fracture families.

We started COYL in three towns: Gloucester, Princeton and Tenafly. Communities embraced our program and many of our events were standing-room-only. Our program spread further throughout Camden, Mercer and Bergen counties. Now we are continuing to develop the program in these three counties and are adding four more: Middlesex, Somerset, Burlington and Gloucester.

We need your help. As we move into four new counties and expand in the existing three, we need volunteers to serve on COYL task forces, to engage clergy, health care professionals, and community leaders, and to provide meeting space, communications and resources to support this important work.

None of us can do this alone. Here’s what I’d like you to do:

  • Check out our COYL
  • If you want to help, as a task force member, communications advisor, subject matter expert, community or health care professional connector, contact me or Deborah Levine at dlevine@njhcqi.org.
  • Get engaged in towns where we already have programs or start a COYL in your community. Learn more from our tool kit

Our Quality Institute members are leaders in their communities and can truly make a difference.

Don McDaniel, Chief Executive Officer, Continuum Health. Continuum Health is a member of the Quality Institute’s Leadership Council.

What is the role of Continuum Health in today’s quickly changing health care landscape?

Continuum Health has a legacy of supporting and working with physician organizations. That’s the reason we get up in the morning. Physicians should be at the center of change. Our job is to enable physicians and help them optimize their practices, their business models, and keep them up to speed with all the regulatory things that are happening in Washington. We’re seeing fundamental change driven principally by reform that pays for performance. It really changes the entire business model for physicians. Are practices ready? At the end of the day what we’re really trying to do is help physicians be participants in high-performing, community-based, clinically integrated networks. We’re the support arm for our physician partners.

NJ has one of the highest rates of small and solo practitioner practices? Is that going to change — and should it change?

A couple of things are happening around the work force. We’ve seen a permanent change from physicians who want to be truly independent to physicians who want employment, no debt, and predictable work hours. All those things are true. For physicians who want to be employed, what are their alternatives? On the employment side, we encourage our physician partners to build physician-led organizations where physician can find employment. For small and solo practices, we’re working very hard to build new business models that allow those practices to stay independent to not just survive but also to thrive. We can do that through clinical integration. Our worldview is that there will be a physician renaissance and physicians have to take the mantle of leadership to drive change. We’re in the business to help them do that.

We have seen that changing payment models changes care models. How important is physician leadership in alternative payment?

It’s absolutely critical. The fee-for-service system set up by Medicare in the 1960s has completely undermined, in my estimation, quality, cost and transparency. All the incentives are now aligned by incentives based on fee-for-service. And so if you think about in the 80 percent part of our lives that are not health related we take so many things for granted economically that are all obstacles in health care. In health care we rarely talk about results.

We talk about process measures. Are you talking to your patients about smoking? Nobody asks, ‘Were you able to help your patients stop smoking?’ We need to move to a results-oriented system. Whether you like McDonald’s or not, you can get on a consistent basis the same French fry experience no matter where you visit in the world. But you can go to Philadelphia and you can have 20 different joint replacement experiences. You will have price variations. Quality variations. We need physician leaders to lead change. We need physician entrepreneurs. I believe that physicians want to do the right thing and want to change the system in a positive way. … We need a system that destroys the trillion-dollar waste that’s medically unnecessary, or waste, fraud and abuse. We feel this is a golden opportunity to change and physicians need to be represented in the battle.

How do you see the role of data in practice transformation?

Data and insights are at the center of our pivot. We have and will make significant investments in data capabilities. Here’s what I’ve learned about physicians. Telling a physician they are doing something wrong you might as well hit your head against the wall. But showing them what they are doing and how that compares with other physicians who are getting better results is golden. This notion of building data-driven environment is very powerful. The capabilities in health care are so archaic. The intelligent engine in a plane generates one terabyte of data on the typical trip between Cleveland and New York. People in financial services, media and electronics … they laugh at us. We’re behind in data driven support at the point of need.

Let’s say you go to your primary care physician and the physician needs to make a referral. The current method is for the physician to refer to someone he or she always refers to, maybe someone they played golf with. Now imagine if that primary care physician had at the point of decision a data pack of information that could inform that referral choice. That changes the game. The primary care physician consumes six percent of total spend. But they control through the pad about 80- percent of total spend. We have to try to make primary care physician more efficient and make primary care more attractive. We have to help primary care physicians think more holistically.

It’s a day off and the sun is shining. Where can we find you?

I have six kids, and our youngest two are in high school. So there are always various sports and activities and I am shepherding my children around. I do a lot of travel for work and so when I am not working I am with my family. We’re close-knit. I love watching sports and I love to read. But mostly my free time surrounds my wife and my children. It’s all about family.