The year ahead will be one of great change. We will have a new president and will elect a new governor. The shifting political landscape will change the world of health care in ways that are still evolving. I believe our voices, as members of the Quality Institute, will be more critical than ever.
Here’s my take on the top health care issues of 2017 and how your involvement with the Quality Institute can make a difference in the year ahead.
The Affordable Care Act. The future of the ACA is “the” issue for 2017. I believe we need a clear replacement plan in place before we dismantle a system, which, though imperfect, nonetheless provides health coverage to millions of Americans, including 194,000 more people through New Jersey’s Medicaid program and an increase of about 250,000 people in the individual market in New Jersey. Indeed, Republican governors and leaders in states such as Michigan, Ohio and Kentucky are calling for the same caution and protection of their most vulnerable citizens. To prepare for these looming changes, the Quality Institute, in partnership with key NJ leaders, will convene a multi-stakeholder work group to develop preservation strategies for the Medicaid expansion and devise long-term strategies to support individuals who purchase their own insurance through the marketplace.
New Jersey’s safety net. If the ACA is repealed, as we expect, hospitals will face newly uninsured people coming to their emergency rooms for care that previously could have been provided by community providers. The impact on our health care system, which is also the largest employer in many communities, will be significant. We’ve made great strides over the last six years in promoting population health, Medicaid ACOs and community-based coalitions that also focus on food insecurity, housing, and social needs. This work will continue. We expect to be significantly engaged in planning for what the future funding strategies will look like — especially through the work of our Medicaid 2.0 initiative.
Alternative Payment Models and MACRA. Even if the ACA is repealed, there is reason to believe that our health care system is moving forward with alternative payment models, such as Patient Centered Medical Homes, Bundled Payments for Episodes of Care, and Accountable Care Organizations. Our QI Collaborative is working closely with both the Medicaid ACOs and with the New Jersey Innovation Institute’s Garden Practice Transformation Network to support physicians and the health system for the changes ahead. We expect the work to continue and expect we will see more focus on the use of Health Information Exchanges, which are real time data sharing platforms to make care more coordinated and focused on quality outcomes.
Maternal & Child Health. New Jersey’s high cesarean section rates, low birth weights, potential cuts to prenatal care and family planning all make maternal and child health an area to closely watch in 2017. We are working to create an employer/payer/ provider coalition to support a C-section Reduction Initiative in 2017. Our May 9th Spring All Council keynote speaker is Neel Shah, MD, an expert on the topic. He will share his research on the reasons for high C-section rates and provide strategies to reduce those rates. We look forward to working with many of our members on these important topics.
The State Budget and Benefits Program. The state’s pension and benefit woes are not going away. Yet, shifting to high deductible plans has been proven to be unsuccessful for best managing the long-term workforce’s health care costs and outcomes. Better ways exist to improve health care for state employees and retirees while also improving quality: find better ways to leverage the state’s purchasing power; use data to design high quality and efficient networks and then incentivize employees to chose those networks; and create incentives to encourage the use of comprehensive primary care. I recently presented some of these ideas to the Plan Design Committee of the State Health Benefits Program. The Quality Institute will continue its role as an independent resource to the state.
Improving Quality While Reducing Costs
As household, state, and federal budgets tighten, it is ever more critical to spend our health care dollars wisely. At the Quality Institute, we want to make sure that we are paying for and demanding quality and safety and cutting costs that do not add value. We are launching Quarterly Quality Breakfasts in 2017 and our first breakfast features eight hospitals that are doing things right to deliver quality care. Other issues we intend to stay engaged in are:
Out of Network and Surprise Bills. These unwelcome charges that are many multiples of commercial in-network rates add to the cost of insurance and are a burden on consumers, employers, and the State Health Benefits Program. Most stakeholders seem ready to put this issue to rest with a reasonable compromise that allows for a fair payment range and arbitration for unresolved claims. Hopefully, 2017 will be the year that something is done.
Telehealth and Expanded Access to Care. We’ll also continue to explore expanded access to care via innovations like telehealth. Most New Jersey residents have not used telehealth services, but are comfortable with trying to communicate virtually with their providers. Telehealth holds great promise to increase access to care. Having clear laws and regulations on licensing, payment, and privacy will help health systems invest in and expand its use. The Quality Institute supports the growth of telehealth and recently commissioned a poll, with Rutgers Eagleton Center for Public Interest Polling that you will hear more about soon. The poll looks at New Jersey residents’ attitudes on telehealth and should inform the discussion and legislation in New Jersey.
Lastly, we’ll be continuing our work of promoting conversations around end-of-life care at the community level. Specifically, we’ll be expanding our “Conversation of Your Life” program in Bergen, Mercer and Camden counties. We intend to bring more mayors and counties into the conversation throughout 2017. Watch our new video blog here.
Throughout 2017, the Quality Institute will continue to be an important, non-partisan, trusted voice in health care quality, cost and transparency in New Jersey —supported by the expertise, insight and experience of our board and members.