Two numbers struck me after reading Catalyst for Payment Reform’s New Jersey Scorecard: 80 and 20. In our state’s commercial market, the share of total dollars paid to specialists (outpatient and inpatient) is 80 percent compared with just 20 percent to primary care providers. The national figures are only slightly better: 75 and 25 percent.

What’s wrong with this picture?

Nationally, the rise in health care spending is not sustainable. The health share of gross domestic product (GDP) is projected to rise from 17.9 percent in 2016 to 19.7 percent in 2026 — assuming annual increases of 5.5 percent annually. To control spending and achieve better health, purchasers and providers are working to improve the way we pay for health care.

As we move toward more coordinated and value-based care models, we need to right size our investment in preventive health and primary care. We need to shift funding to primary care and support technology that enables providers to electronically share clinical records, as well as communicate with patients and other providers caring for them. Primary care must be team-based, with care coordinators, nurses, mental health providers, social workers, and therapists. Comprehensive primary care is the essential underpinning for all other value-based care.

The Quality Institute has partnered with Catalyst for Payment Reform (CPR) to explore how well New Jersey is moving toward payment models tied to better care and reduced costs. The New Jersey CPR Scorecard is the first look ever in New Jersey at the pace of change by provider type. It is a good first step to track our progress.

If you don’t know about CPR, the non-profit, national organization advocates for health care purchasers to get better value for their health care dollars. CPR leaders joined us on Tuesday at our Quality Breakfast where we released the Scorecard — and we also brought in health care leaders from around New Jersey to discuss its findings.

I was impressed with our panelists, including those who explained their challenging work to bring care coordination to the very center of their practice models. Carefully coordinating and following patients with chronic illness, for instance, can reduce emergency visits and hospitalizations, reducing costs and improving care.

Our providers on the panel said they invested heavily to strengthen care coordination of the patients within their primary care practices, but patients risked getting lost when they went outside their system to, say, nursing homes or specialists who did not always communicate back to the primary care practice.  All acknowledged that the move to value-based payments is challenging.

But everybody in our audience and on our panel — both payers and providers — genuinely appeared to support the need for this work. They believe this is the right direction. Now we need greater investment in our primary care infrastructure, including health information technology, especially since New Jersey has a high percentage of small, independent primary care practices.

Our partnership with CPR and Tuesday’s Quality Breakfast was intended to provide us with a baseline as we move toward payment reform. That’s the right first step. We need to know where we are today before we can move forward.

From left to right: Linda Schwimmer, CEO, the Quality Institute; Kate Gillespie, MBA RN NE-BC, AVP, Orthopedic and Spine Service Line, Virtua Health; Behnaz Baker, CIO and Director of Integration & Population Health, Riverside Medical Group; Dini Ajmani, Assistant Treasurer, Department of the Treasury; Jamie Reedy, MD, MPH- Summit Medical Group, PA and Summit Health Management, LLC; Christine A. Stearns, Director, Gibbons P.C.; Alex Binder, MBA, Vice President, Advanced Care Institute, VNA Health Group Andrea Caballero, MPA, Program Director at CPR; Alejandra Vargas-Johnson, CPR staff.

Michellene Davis, Esq., Executive Vice President and Chief Corporate Affairs Officer, RWJBarnabas Health. Davis leads social impact and community investment across the system and talked to us about transforming the overall health of communities.

Your program works to improve the health of residents beyond the hospital walls. Why did you make that a priority?

As the state’s largest health care system, we realized we had a unique opportunity to do something bigger and broader beyond just what nonprofit healthcare systems are mandated to do. What we understood is that so much of what impacts health outcomes really happens outside of the walls of the hospital. So we wanted to become part of the solution rather than just ignore the problems that exist in society. We thought we could aim, of course, on continuing to provide high-quality, culturally-competent clinical care within our facilities — but also to begin to address, with laser focus, the social determinants of health, those things that affect us outside of the clinical experience. We don’t call this a program. It’s really a mission change.

Can you tell us about the evolution of the concept of hospitals as “anchor institutions” in their communities? 

It’s the recognition that hospitals are large-scale economic engines in their communities, but unless we are intentional about our presence we miss opportunities to create economic stimulus in those communities. So we simply wanted to make certain that we were turning our mind’s eye toward our daily operations. Who are we hiring? How are we buying goods and services? Are we, in fact, helping to create economic revitalization in the communities where our hospitals reside with a level of high intentionality? We are shifting the way we approach our work in order to accomplish lasting impact.

How do you see social determinants of health — and how are you impacting the lives of people in your hospital communities?

I see social determinants of health as economic instability, lack of education, food insecurity, the lack of affordable housing, and neighborhood and unsafe living environments. But really I think it’s easy to look at where people live, work, play, worship, and age. We are taking an opportunity to view where these aspects of peoples’ lives take place with a focus on where vulnerable populations exist at highest concentration. There’s an initiative, Newark 2020, where we partner with the city and with other corporate entities to say, ‘Listen, we have the ability to change the unemployment rate here by simply hiring individuals from here, by training them, and then creating pipelines and pathways for people to earn a livable wage.’ We are an anchor institution in our communities, so we understand that means that some small employers will also need to build capacity. So we’re willing to invest with our collaborative partners, like Rutgers Business School and others, to ensure that local vendors have the capacity to grow and scale their businesses.

Can you provide some concrete examples?

We are conscious, across the System, to use our collective purchasing power to procure from local, minority, and women-owned businesses. In doing so, we are creating more equitable opportunities for individuals who have continuously and historically been denied. In addition, we are intentional about hiring individuals who live in the communities in which we are anchored. RWJBarnabas Health provides living wage careers with opportunities for advancement. Hiring and buying local stimulates economies in a sustainable way.

Other ways that we seek to improve the health of New Jersey residents, address the systemic issues of poverty to eliminate disparities and enhance equity is through the use of strategic policy and innovative programming in our local communities. For example, we host a greenhouse at Newark Beth Israel Medical Center. Its purpose is to offer fresh fruits and vegetables in an area that is a food desert.  Beyond that it offers education on healthy cooking and nutrition.  This hydroponic greenhouse is the first hospital-affiliated greenhouse in the state of New Jersey that accepts SNAP. It really helped us to begin discussions with the state around SNAP and WIC and the fact that automatic enrollment is required, or else, quite frankly, you are not providing access. Policy, combined with evidenced-based programming, is critical to move this work forward.

Do you see RWJBarnabas Health hospitals and other hospitals leveraging the work of the Quality Institute to advance their population health goals? 

Yes, absolutely. The work that we do is evidence-based and data-driven, so, as a result, we consistently turn to work that the Quality Institute is undertaking to create a framework — and then we work with community partners to design an initiative to ask, ‘What are the elements of the social determinants of health?’ I think that, secondly, all of this work happens in collaboration through a collective impact methodology, right? It is incumbent upon hospitals to partner with municipalities and the state and federal governments to effectuate change. And initiatives like the Quality Institute’s Mayors Wellness Campaign enhance those partnerships.

Finally, we often like to ask a question that sheds light on our subjects beyond policy. So can you tell us what people might be surprised to learn about you, and where people could find you on a sunny day away from work?

Because I am a lawyer by training and worked in state government, people are usually surprised to know that I studied as a sous chef in Italy. Cooking is my therapy. And on a sunny day you will likely find me sitting under a tree with a really great book and joyously being interrupted by the company of several of my nine Godchildren.

Published on Asbury Park Press.com.

New Jersey doctors and hospitals are increasingly paid based on quality, but patients aren’t getting the care they need to prevent illnesses and bigger bills down the road, a report released Tuesday said.

Despite incentives to promote good health, the report by Catalyst for Payment Reform found New Jersey has fewer vaccinations, more C-section deliveries and a tougher time controlling patients’ high blood pressure, the report said.

“I’m embarrassed about all these results,” said Dr. Jamie Reedy, senior vice president of population health and quality at Summit Medical Group. “As a state, we should be ashamed, and we should be working harder to improve these results.”

Reedy was among the panelists at the Trenton Country Club at an event sponsored by the New Jersey Health Care Quality Institute, a research group.

The scorecard assessed New Jersey’s progress eight years after the Affordable Care Act, commonly known as Obamacare, went into effect in a bid to slow down the rising cost of health care, which now accounts for nearly 18 percent of the U.S. economy.

Catalyst represents employers seeking to lower their health care costs. It has advocated a shift from the traditional “fee-for-service” model in which providers are paid for each service they provide to “value-based” in which providers are rewarded for their patients’ outcome.

It found 52 percent of payments in 2016 from three major commercial insurers in New Jersey were considered value based. By comparison, just 11 percent of payments nationwide in 2013 were value based, said Andrea Caballero, Catalyst’s program director.

In short, doctors and hospitals get extra money for ensuring their patients meet certain targets like controlling high blood pressure and diabetes. They aren’t penalized if they don’t meet them.

In some cases, New Jersey has made strides; 88 percent of people with diabetes, for example, received a blood sugar test, Caballero said.

But in other key indicators, New Jersey falls short:

  • About 60 percent of children ages 1½ to 3 received all recommended doses of seven key vaccines, compared with 71 percent nationwide.
  • Nearly 30 percent of women with low-risk pregnancies get C-sections anyway, compared with a target rate of 23 percent.
  • Some 52 percent of people with hypertension had adequately controlled blood pressure, compared with 54 percent nationwide.
  • And 84 percent of adults said they received information about how to recover at home, compared with more than 87 percent nationwide.

Tying at least some of the payment model to value is a good start, but “we need to go faster,” Linda Schwimmer, president and chief executive officer of the New Jersey Health Care Quality Institute said. “By putting an emphasis on it and showing that we’re not doing well enough on quality outcomes, that will help. We need to go faster.”

Flipping around the payment system alone might not be enough to improve the state’s collective health.

Health systems still need to invest in technology to help them coordinate care among their doctors. They need to hire social workers and case managers to stay connected with patients.

And primary care doctors still receive just 20 percent of reimbursements even though they are on the front line of the new health care model. Specialists receive 80 percent, Caballero said.

“I do think payment reform can impact these results, but it has to be adequate payment to support the work,” said Reedy, from Summit Medical Group.

NJ Commercial Scorecard_9.25.2018

NJ Commercial Scorecard_9.25.2018

How much and what types of payment reform are happening in New Jersey? Is payment reform delivering on its promise of improving the quality and affordability of health care? As part of the Scorecard on Payment Reform 2.0 initiative, the New Jersey Scorecard on Commercial Payment Reform brings together aggregate data from commercial health plans along with New Jersey’s performance on leading indicators of payment reforms impact at a macro-level.

Funded through a joint grant by the Robert Wood Johnson Foundation and the Laura and John Arnold Foundation, the Scorecard is based on an independent review of data from commercial health plans that collectively insured 4.6 million New Jerseyans (approximately 72% of the commercially-insured lives) in 2016, the year on which the Scorecard bases its findings.

The New Jersey Commercial Scorecard, released in conjunction with the New Jersey Health Care Quality Institute as local sponsor of the effort, sets out to provide baseline information for New Jersey health care stakeholders to promote strategic action towards a more efficient and value-oriented health care marketplace.

Read the press release.

Download the Scorecard info-graphic and methodology report.

New scorecard finds overwhelming majority of payments are still based on fee-for-service

PRINCETON, NJ – September 25, 2018 – Over half of the health care payments (52%) paid to doctors and hospitals in New Jersey by the private sector contain incentives to improve the cost and quality of care patients receive. However, a closer examination of these value-oriented payments shows most (98%) are still based on a fee-for-service approach. These are among the findings of The New Jersey Commercial Scorecard on Payment Reform released today by Catalyst for Payment Reform (CPR) and the New Jersey Health Care Quality Institute.

“The shift toward value-oriented payments is critical for improving the quality and affordability of care in New Jersey,” said Linda Schwimmer, President and CEO of the New Jersey Health Care Quality Institute. “Yet the Scorecard shows that we are not moving fast enough to change our reliance on the antiquated fee-for-service system. This baseline information is a positive first step toward putting us on the right path and showing us how far we have to go.”

Funded through a joint grant by the Robert Wood Johnson Foundation and the Laura and John Arnold Foundation, the Scorecard is based on an independent review of data from commercial health plans that collectively insured 4.6 million New Jerseyans in 2016, the year on which the Scorecard bases its findings.

Additional Scorecard findings include:

  • The majority (82%) of payments paid to primary care providers were tied to value, while only 23% of payments paid to specialists were tied to value
  • Less than 6% of value-oriented payments place health care providers at financial risk for their performance (that is, they stand to lose financially if they overspend or do not meet quality targets)
  • The most common form of value-oriented payment was shared savings (37.9%), which typically gives an upside-only financial incentive for providers to reduce unnecessary health care spending for a defined population of patients, or for an episode of care, by offering providers a percentage of any realized net savings
  • A strategy being used less often, although still common, is pay-for-performance (11.2%), which is typically traditional fee-for-service payment with a bonus for meeting quality or efficiency goals

“The New Jersey Scorecard is groundbreaking as it is the first time we have looked at payment reform adoption alongside state-level indicators that shed light as to whether the changes in how health care is paid for are delivering on their promise of better quality and more affordable health care,” said CPR’s Program Director Andréa Caballero.

In 2015, Catalyst for Payment Reform produced the New York Scorecard on Commercial Payment Reform, measuring value-oriented payment in the commercial sector in New York State. Similarly, CPR provides New Jersey with baseline information about how much payment reform and what types occurred in the commercial sector in 2016. New to the New Jersey assessment, however, this Scorecard also provides data on New Jersey’s performance on metrics that indicate the broader performance of the health care system.

Schwimmer elaborated, “The CPR Scorecard draws attention to that fact that New Jersey performs well when it comes to diabetes care but still has work to do related to the Cesarean section rate among women with low-risk pregnancies and the percentage of young children under three years receiving necessary vaccinations. CPR, advised by a multi-stakeholder advisory committee, selected these indicators and others to assess payment reform’s impact at a macro-level.

About the New Jersey Scorecard on Commercial Payment Reform

The New Jersey Scorecard on Commercial Payment Reform aggregates data from commercial health plans from calendar year 2016. CPR obtained the data through an online survey of health plans, to which three health plans responded, who together cover approximately 72% of the commercially-insured lives in New Jersey. An accompanying methodology report, available for download, provides additional information.

About Catalyst for Payment Reform

Catalyst for Payment Reform is an independent, non-profit organization working on behalf of large employers and other health care purchasers to catalyze employers, public purchasers and others to implement strategies that produce higher-value health care and improve the functioning of the health care marketplace. For more information visit: www.catalyze.org and follow us on Twitter and LinkedIn.

About the New Jersey Quality Institute

The New Jersey Health Care Quality Institute is the only independent, nonpartisan, multi-stakeholder advocate for health care quality in New Jersey. The Quality Institute’s mission is to undertake projects and promote system changes that ensure that quality, safety, accountability and cost-containment are closely linked to the delivery of health care services in New Jersey. Learn more about us at www.njhcqi.org and follow us on TwitterFacebook and LinkedIn.

 

Media Contacts:

Quality Institute – Carol Ann Campbell, cacampbell@njhcqi.org, 973.567.1901

CPR – Cary Conway, cary@conwaycommunication.com, 972.649.4707

Published by U.S. 1 Princeton Info.

Good doctors and hospitals alone are not what keep people well and help them recover when they are ill. “So much about health and what it takes to be healthy is more than the medical system and straight medical care,” says Linda Schwimmer, president and CEO of NJ Healthcare Quality Institute. For “humans to be healthy, thriving people,” also requires housing, food, transportation, and connection to other services in the community.

Community partners, including government agencies and area nonprofits, provide those extra services that “we as a community need to help people with, to have a healthier community,” Schwimmer says.

Schwimmer will moderate a panel on “The Role of Community Partners in Healthcare,” Sunday, September 16, from noon to 3 p.m. at Windsor Athletic Club, 99 Clarksville Road in West Windsor. Other panelists are Shereef Elnahal, commissioner of the New Jersey Department of Health, and Mary Grace Billek, director of human services of Mercer County. To RSVP, go to www.medinahealthcare.org or call 609-273-9488 or 609-270-5067.

Schwimmer offered several examples of how particular community partners have helped improve the quality and even the affordability of healthcare:

Medina Community Clinic. When patients come to the clinic, which provides quality health services, focusing on specialty healthcare, at no cost to the underserved members of the community, they often struggle on all fronts. “For a lot of people, their whole life is in crisis. It’s not only that they can’t control blood sugar levels for diabetes — they haven’t slept with a roof over the head or eaten [healthily],” says Schwimmer, who is a board member of the clinic. So Medina does not just connect them with a physician for care, but also connects them to transportation, housing, food, and other services.

These more multifaceted community efforts to maintain health, Schwimmer says, are “partly government and partly that people are starting to realize that when they talk about the health of a community, it’s really so much broader than the medical system. The medical system is important, to screen and test, but it is only a part of it.”

Nutrition Program for the Elderly. “Hospitals have very specific roles to play — they get you out, prevent you from getting ill, and keep you out. But if you don’t have access to good fruits and vegetables, and you are not in a safe place where you can recreate — these are other things that impact people’s well-being,” says Mary­ Grace Billek, director of the Mercer County Department of Human Services.

Her department runs the Nutrition Program for the Elderly, which feeds 800 Mercer County senior citizens every weekday, mostly through local senior centers. “We provide transportation and provide a meal that is nutritionally sound and gives people one-third of all the things they need to be well,” she says. They also provide special meals for people with hypertension who need to control their salt intake and diabetics who need their sugar controlled.

These centers also serve another critical role for isolated seniors. “What is more important than the meal is the fact that they leave home, go to the senior center, and socialize,” she says. “We can contact family members if there are medical problems or we start to see people forgetting things or saying things that don’t make any sense.”

New Jersey Housing and Mortgage Finance. This agency is funding three housing projects that provide support to people with mental health issues and substance abuse disorders, physical disabilities, and chronic disease. They contract with local agencies to provide case management, linkages to health care, and other services. “There is a lot of coalescing together when you are talking about people with chronic medical conditions, whether they are mental health, drugs, or fragile medical conditions like diabetes and hypertension — you have to make sure people have access to the right kind of food and transportation,” Billek says.

New Jersey Department of Health. Although overall New Jersey ranks among the best in infant mortality overall, says Shereef Elnahal, “for non-Hispanic African American infant mortality in New Jersey, we are seeing staggeringly higher rates” and “this disparity is simply inexcusable.” The problem has been “not getting care and support to where folks are in the community,” both in the inner city and in rural areas without easy access to prenatal care and other forms of support for new mothers. To lower infant mortality the New Jersey Department of Health has developed several programs.

Elnahal’s department will also be funding family planning, with a focus on long-acting reversible contraception, which, he says, “helps women space their births in a way that allows them to prepare for their next child more effectively.” They will also fund increased access across the state to 17P shots for select women who have already had a preterm birth; this reduces the chance of having another preterm birth.

Schwimmer grew up in Long Beach, California. Her mom stayed at home and “took very good care of us.” Her father is a retired obstetrician and gynecologist, who spent his whole career at Kaiser, which she says “is really a model system.”

“He influenced me in that he loved what he did, and he was passionate about what he did every day,” Schwimmer says. “What I was looking for in a career is something I cared a lot about and wanted to do every day.”

Her undergraduate degree is from the University of California, Berkeley, and she graduated from Georgetown University Law Center.

She clerked for a judge at the U.S. Bankruptcy Court, worked as an attorney at the U.S. Pension Benefit Guaranty Corporation, and spent a decade in private practice, specializing in bankruptcy and commercial law.

Schwimmer then worked in state government in policy and counsel positions with the Senate Majority Office and as director of legislation and policy for the New Jersey Department of Banking and Insurance.

Before joining the institute, Schwimmer was director of strategic relations and external affairs at Horizon Healthcare Innovations, a subsidiary of Horizon Blue Cross Blue Shield of New Jersey.

“I was always interested in public policy, the bigger system, how to change things,” Schwimmer says. Now, at the NJ Healthcare Quality Institute, she is working on a number of initiatives, “with a common focus of trying to improve the quality and safety of healthcare, increase the transparency of information for consumers, and to make care more affordable.”

Published by NJ Spotlight

New Jersey lawmakers are pushing the state to modernize and improve its system for determining who is eligible to receive Medicaid and getting people enrolled, a process that has undergone some upgrades but is still criticized as burdensome and inefficient for both patients and administrators.

The Senate Budget Committee will review legislation Thursday that would require the state to create a new digital application for Medicaid, also known as NJ FamilyCare, and a way to track those submissions and reward government agencies that successfully enroll people. It also calls for an ombudsman to help individuals navigate the system.

The measure, sponsored by Senate Health Committee Chairman Joseph Vitale Jr. (D-Middlesex) and Sen. Fred Madden Jr. (D-Camden), draws from recommendations contained in the Medicaid 2.0 Blueprint for the Future, a March 2017 report published by the New Jersey Health Care Quality Institute. Among other things, it called for a full review of the state’s Medicaid intake system, as well as other reforms.

Suggestions include Medicaid ombudsman
The Quality Institute’s plan recommends a number of ways the state’s program could be updated to better meet the needs of its low-income patients and New Jersey taxpayers. This includes the creation of an electronic application system to better monitor the enrollment process and identify problems, along with the appointment of a system-wide enrollment advocate, or ombudsman.

“This is an ambitious bill that we fully support. The IT piece has been a challenge for more than twenty years,” said Linda Schwimmer, the Quality Institute’s president and CEO. In the institute’s Medicaid blueprint, “we specifically called for a comprehensive assessment of the entire intake system, and a way to hold the state-contracted entities that process Medicaid applications accountable for their performance. This bill provides for both,” she said.

Human Services Commissioner Carole Johnson, whose department oversees the state’s Medicaid program and other social services, said her staff is also reviewing the proposal. Johnson has taken several steps to expand Medicaid coverage, modernize the program, and improve transparency — including the creation of a new data dashboard, another priority for the Quality Institute.

There is now a single website, NJHelps, that serves as a portal for multiple social service applications, including FamilyCare, Johnson noted. “We are committed to continuing to build on and enhance our online tools and platform to improve the application process and experience for New Jerseyans,” she said.

Medicaid currently covers more than 1.7 million Garden State residents, or roughly one in five, nearly half of whom are children. While the program has grown slowly in the past year, current members must submit new financial data annually to continue to qualify for the insurance coverage, which is funded by a mix of state and federal dollars.

Disqualifying clients
According to a Quality Institute analysis of Medicaid data from 2013 through 2016, tens of thousands of residents lose coverage each month when they are determined to be ineligible — including several thousand who may still qualify for the program, but could not be reached because they moved, or changed phones, as well as those unable to provide the proper paperwork in time.

“As a direct result of the complexity of the system, beneficiaries who are otherwise eligible lose coverage and then need to be reenrolled — a process referred to as “churn,” the institute notes in its Medicaid 2.0 report. These patients are sometimes forced to seek medical services elsewhere and don’t have the continuity of care provided by regular visits to the same primary-care provider.

The eligibility-processing problems are grounded in the state’s outdated computer system, outdated regulations and contracts, and the complexity of the current process, the Quality Institute noted. As it is, eligibility is now determine by county officers, who handle much of the in-person enrollment, a state contractor that processes the data, and federal officials, who process certain applications as part of the Affordable Care Act.

“The current assortment of entry points is not only confusing to the Medicaid applicant, but places an administrative burden on the State, as it is labor intensive and prone to error. The comparative performance of the entities that process applications is not regularly tracked or reported by the State,” the QI wrote.

To address these concerns, the bill (S-499) — first introduced in November — calls for the DHS to work with the state’s Office of Information Technology to develop a modern online application that could be used by all those involved in enrollment. It also calls for a tracking system to enable state officials to identify hurdles in the sign-up process and monitor the agencies involved, as well as a penalty and reward system to encourage positive results.

In addition, the measure, which passed the Senate Health Committee in March, calls for the DHS to appoint an ombudsman to assist the process, noting that such an advocate exists for those covered by commercial health insurance plans. The bill aims to standardize the process across public agencies, simplify the steps for patients and staff, and create a platform that could also be used to link beneficiaries with other income-based social services, like food stamps or public support.

Long evident to lawmakers
A number of these concerns have long been evident to lawmakers as well. The Assembly Human Services Committee held hearings in 2014 on the state’s efforts to replace what was then a 1980s-era information technology system when it became evident that poor and low-income residents were not able to obtain the services they were qualified for — particularly Medicaid and food stamps, now called the Supplemental Nutrition Program or SNAP.

The state’s efforts to overhaul this system date back to 2007, when a company contracted to modernize its social service IT system for $83 million. But unseen problems arose and costs escalated as the benefit programs were flooded with applicants as a result of the recession. The contract was transferred several times before former Gov. Chris Christie fired the firm in 2014; the state had lost $10 million on the deal and the federal government was out $56 million.

Incremental progress has been made since then. The DHS has received federal waivers that provide additional flexibility within the Medicaid program, which has enabled officials to make some changes to the application process. In 2017 the state also launched NJHelps, the portal for multiple social services, but each program requires a distinct application — even though many low-income families qualify for several — and each application is processed independently.

Ultimately, Johnson said, “individuals can complete our online Medicaid application (on the NJHelps site), which allows for more timely eligibility determinations and assists the Department in better tracking and processing of applications.”

We spoke recently with James Spaulding, BSN, RN, CCRN, who is the Simulation Lab Coordinator at Saint Peter’s University Hospital. Spaulding told us how the lab provides valuable, hands-on training for physicians and other health care professionals to advance quality, safety and cost containment.

As the Sim Lab coordinator, can you explain the overall concept?

Dr. Nayan Kothari, Chief Academic Officer for Saint Peter’s University Hospital, noticed that with the advent of new technologies there was a decline in hands-on interaction and conversations with patients.  He envisioned two elements of the simulation lab. First, the technical aspects could be taught with robots, or medical mannequins. The second part was a focus on bedside medicine, using actors to pose as patients with a script and diagnosis. We want to prepare young doctors in having difficult conversations with patients, perhaps breaking bad news such as a diagnosis of cancer, or discussing end-of-life treatment. We provide feedback of what they could do differently, and they get experience before they interact with real patients. We work with first-, second-, or third-year residents as well as attending physicians and other health care professionals.

How does the work in the Simulation Lab improve health care quality?

We take a situation — maybe a medical emergency that already has happened — where we want the outcome improved. We take that situation and work it into the software of the medical mannequins. We build in objectives; perhaps a patient is really deteriorating. We can provide feedback in real time. How did the doctor perform? What did they miss? Did they think of a particular medicine? In medicine, these emergencies don’t happen all the time, thankfully. So this is a high volume, low risk training exercise. For instance, we have a mannequin mom that delivers a full-term baby but then experiences a hemorrhage. We run the simulation with the team of nurses and obstetric residents and we can run through this repeatedly — wherein the real world this might happen once every four or five months. We run simulations on situations such as drowning, a choking baby, cardiac arrhythmia, and all pediatric advance life support situations.  With hands-on experience, clinicians remember the information better and are better prepared for the real world.

What is the biggest mistake you see health care professionals make?

Occasionally, there could be a misdiagnosis or the wrong medication dispensed. We created the Simulation Lab to provide a culture of safe learning. After we run these training exercises, we see people communicate better with each other, with nurses, and with patients. Everything that happens is on video and we can screen the video to a group of peers. Everyone walks away with more knowledge and confidence.

Does the Sim Lab lower health care costs?

Our aim is to train health care professionals to provide the highest quality care, and there are examples where this effort can reduce costs. For instance, one simulation involves a nurse recognizing when a patient starts to decline. If we can intervene early we may avoid an ICU admission. We’re teaching healthcare professionals to pick up on things before they escalate.

How is your Simulation Laboratory supported? 

We got off the ground through grants and donations and we primarily work with physicians and also health care professionals such as nurses and respiratory therapists. We’re generating some income by providing Basic Life Support and Advanced Life Support training. We also work with sub-acute facilities that send their staff to us to brush up on clinical skills and to learn how to deal with emergencies. We’re working with long-term care facilities to see if we can prevent readmissions to hospitals. So we will look at data to see if we reduce readmissions and make a real difference for patients.