Adelisa Perez, a Registered Nurse, is the Quality Institute’s new Director of Quality.

Can you outline the focus of your role?

I will oversee all of our quality initiatives, such as our work with the Leapfrog Group, and I will work with Linda Schwimmer on the National Quality Forum. I’ll also oversee the Mayors Wellness Campaign (MWC) and Conversation of Your Life (COYL).

Your background is clinical and not in the policy world. Can you tell us about your experience and why you joined the Quality Institute?

I am a Registered Nurse with about ten years of clinical experience and I hold a Cardio-Vascular Certification. Right now, I’m enrolled in the Master of Science program with specialization in Nursing Leadership at Rutgers University and I’ll finish up in the fall. As part of the program, I interned with the Quality Institute, and that experience, along with my studies, showed me how nurses can have real impact outside hospital walls. Through my internship, I participated in the COYL initiative and continued to volunteer on the Monmouth County COYL task force.

How will your nursing background strengthen your policy work at the Quality Institute?

I think my hospital experience gives me a unique perspective. I have advocated on behalf of my patients and saw firsthand how quality initiatives work inside hospitals. I’ve worked on Leapfrog quality measures internally and on audits regarding infection control as well as other quality improvement data. Having been on the other side of Leapfrog, I can help our hospitals with questions they may have about how to improve.

Will your clinical background support the Quality Institute’s community-based programs?

Yes, absolutely. There is widespread understanding that health outcomes are greatly influenced by the communities in which people live. My clinical expertise and insight gives me the ability to make connections between our members, such as hospitals and insurers, and our programs, such as MWC. I can encourage our members to leverage our community programs to advance their population health initiatives. We support many community programs, for example, walking school buses, nutrition and exercise programs, and Mental Health First Aid Training, which aim to improve the health and well-being of New Jersey communities.

Can you share some of your passions outside your professional work? 

I am definitely an outdoors person. I love hiking, kayaking, and paddling. I also love to read, as well as travel outside the country several times each year … Spain, Amsterdam, Paris, Ireland, Scotland … lots of places.

Every day Maternity Care is in the news, as interest and focus on this topic continually grows. In our state, the Murphy administration and others are investing in improving maternal and child health. With so many different grants, quality collaboratives, and competing priorities we need an effective path forward to create sustainable change. That’s why I want to point you toward the recently released National Partnership of Women & Families Blueprint for Advancing High-Value Maternity Care Through Physiologic Childbearing. At the Quality Institute, we’re using this Blueprint to guide our work in maternal child health.

The Blueprint contains six strategies that we’ll be sharing more on in the future, but today I want to focus on Strategy 1: Improve Maternity Care Through Innovative Delivery and Payment Systems and Quality Improvement Initiatives. Behind the lengthy title are key strategies to connect quality improvements to the payment system.

Right now in New Jersey, there are statewide quality improvement initiatives at the health system level, as well as through the New Jersey Perinatal Quality Collaborative, a statewide partnership of committed stakeholders working together to improve the quality and safety of care provided to New Jersey’s mothers and babies, which is funded by the Centers for Disease Control and Prevention. The Quality Institute is also participating in their work. Additionally, with support from the Horizon Foundation for New Jersey, we have been partnering with the Greater Newark Healthcare Coalition to use best practices learned from high-performing hospitals around the state to improve maternity care in Newark.

This is all valuable work. But very little is happening in New Jersey to link quality improvement to the payment system.

About a year ago, I met with the benefits manager for a large New Jersey pharmaceutical company who was concerned that the Cesarean Section rate for her employees was around 40%. As a follow-up, she shared data on the number of employee births and the hospitals where the births took place. The total for the year was less than 20 births. While each birth is important, and while the costs to employers can be significant for each birth, 20 or even fewer births does not create the market power needed to create lasting change.

But if an even larger purchaser, the largest purchaser in the state, demanded change and built that change into its benefit designs and contracts then change and improvements to maternity care would happen across all hospital systems and communities. We’ve seen exactly that happen in California and other places.

We could see that change here as well.

I encourage you all to read the National Partnership Blueprint Strategy #1 and to also review the Quality Institute’s Medicaid 2.0 Blueprint for the Future, Recommendation #21 a., where we call for similar payment reforms, such as building a maternity episode of care and supporting programs such as Strong Start, maternity medical homes, community health workers, and other supports for improving maternity care.

Our traditional fee-for-service payment models foster care that generates payments regardless of quality outcomes or the value or need for services. Well-designed payment models will support higher quality and value care. The State, through Medicaid and the State Health Benefits Program, pays for over half of all births in New Jersey. Our state is a payer with some serious leverage. Let’s get going. I encourage you to join me in this call to action and to read these blueprints.

Published by NJ Spotlight
New report says NJ does well on cancer screenings and general care, not as well on palliative care and pain medication. But report omits recent state initiatives
Cancer patient

New Jersey does well when it comes to helping patients obtain cancer screenings and care, according to a new national report, but it could improve efforts to support palliative care and access to pain medications. However, the recommendations may not account for recent changes to state policy.

The American Cancer Society Cancer Action Network released its 16th annual report yesterday, ranking all 50 states and American territories on nine public-policy areas related to prevention and treatment for these diseases. The organization considers issues like the availability of insurance coverage, the prevalence of smoke-free laws, and policies governing end-of-life care.

This year’s report, “Do You Measure Up?,” also includes a separate section warning that state-based policies to curb opioid abuse, in some cases, have had unintended consequences for cancer patents who are trying to obtain pain medicine. In 2017, New Jersey adopted one of the nation’s strictest limits for prescription opiates, but these restrictions do not apply to cancer patients and individuals in palliative care; the assessment, which gives the state mid-level marks in this area, does not seem to take this new law into account in its review.

Obstacles to pain relief

“We’re in the midst of a national epidemic related to opioid abuse and misuse. As lawmakers scramble to address this crisis, a flurry of legislation is being passed in states that can have unintended consequences,” the report notes, commenting on an issue that came up during debate on the Garden State prescription limits, which allow for only five days’ worth of addictive pain pills for new patients. “Although well intended, these swift actions in many cases are leaving people, like cancer patients and survivors, facing unnecessary barriers to accessing the pain relief they legitimately need.”

Dr. Shereef Elnahal, state Department of Health Commissioner, also stressed that it is important for the exemptions in the Garden State’s law — designed to protect cancer and other palliative-care patients — to be clearly communicated to physicians.

The annual report, which involves data from previous years, also does not recognize several new initiatives implemented in recent months in New Jersey. Since Gov. Phil Murphy took office in January, the state has expanded Medicaid coverage for smoking cessation programs, for example, and started to dedicate far more tobacco-tax revenue to prevention programs.

Higher cancer rates in NJ than nationally

Cancer rates overall have been falling over the past five years in New Jersey, but we still have a slightly higher incidence of these diseases than the nation overall — nearly 478 cases per 100,000 people, versus 441, according to federal data for 2011 through 2015. The state’s mortality rate for cancer is lower than the national average, however, with 158 deaths per 100,000, versus 164.

That said, some cancers — including those attacking the liver and bile ducts, pancreas and thyroid — are on the rise, and some 53,000 Garden State residents will be diagnosed with some form of the disease in the coming year, according to ACS.

Cancer patient

“We owe it to them and everyone at risk of developing the disease, to do what we know works to prevent cancer and improve access to screenings and treatment,” said ACS CAN managing director of government relations Bill Sherman, noting that the report offers lawmakers and advocates a blueprint for change.

The publication underscores the importance of access to care in general and praises states, like New Jersey, that embraced the federal Affordable Care Act to expand insurance coverage for working-poor residents; nearly 800,000 people were added to the insurance rolls here under the program. But while it suggests the Garden State provides only limited cancer-care benefits under Medicaid, the report does not factor in a July 1 change that extended coverage of smoking-cessation products and programs. According to the state Department of Human Services, which oversees Medicaid, the program now provides benefits for prevention, early detection, diagnosis, treatment and hospice care, and palliative care for children.

“The Murphy Administration is committed to a healthier New Jersey, as shown by its success improving Medicaid benefits — including encouraging cancer prevention by making it easier to receive tobacco cessation medications and counseling — and its many efforts to protect access to quality health care,” state DHS Commissioner Carole Johnson said. “We will continue to find ways to improve Medicaid benefits and remove barriers to care.”

Good marks for treatment of breast and cervical cancers

Breast cancer ribbon

Credit: Creative Commons

New Jersey also gets high marks, or green ratings, in the ACS report, for good performance — yellow indicates there’s room for improvement, and red flags a problem policy — for its work to expand access to free and low-cost cancer screenings, particularly for breast and cervical cancers.The state dedicates nearly $11 million in state and federal funding to this work, which is carried out through county health departments, local clinics, hospitals and other providers, and more than 18,000 individuals were screened during the fiscal year that ended in June, according to the DOH.

The report also praises New Jersey’s performance when it comes to smoke-free laws. According to ACS, it is one of two dozen states that fully bans the use of tobacco — including smokeless devices — in workplaces and restaurants. Murphy also signed a law late last month that extends that prohibition to parks and beaches, a move former Gov. Chris Christie had resisted.

The Garden State also has a sufficient tobacco tax ($2.70 per pack), according to the report, but ACS CAN is among a group of organizations that has repeatedly criticized state officials for not investing more of these dollars, or other funds, into anti-smoking programs.

Palliative care found wanting

The state had been committing about $11 million a year to this work, according to the DOH, and is likely to put an additional $7 million toward these initiatives in the coming year as a result of a new law that diverts more tax revenue to prevention. This funding will go to community-based programs, an education campaign about the dangers of smokeless devices, and an effort to target young adults.

The report also assigns a yellow, or mid-level, mark to New Jersey’s effort to address palliative care — treatment designed to provide comfort and quality of life for cancer patients, especially those who are terminally ill. The findings suggest the state lacks a formal advisory body for these policies, unlike the entities that are in place in at least two dozen other states.

But the DOH points out that it does house the New Jersey Advisory Council on End of Life Care, which is slated to release recommendations soon — more than 18 months after it was first scheduled to deliver a report. The council will call for the creation of a statewide board to solicit stakeholder input on these policies, more robust training in palliative care for providers, and standardized protocols for palliative-care screenings and delivery, the department said — recommendations that are likely to dovetail with a recently released blueprint on improving palliative care by the New Jersey Health Care Quality Institute.