I recently re-read the blog that I wrote in January, which outlined the Quality Institute’s priorities for 2020. Of course, there’s no mention of PPEs, masks, or COVID-19. But our overall goals and ideas to drive quality, community health, and affordability have not changed during this turbulent year. I’d like to update you as we enter the fall, and a possible resurgence of COVID-19, as well as a challenging economy with joblessness at record levels.
Our 2020 priorities were:
Supporting Healthy Aging by improving conditions for aging adults and their caregivers in New Jersey. Now this goal should be underlined and in all caps. Our current Medicare system is not designed to support the personal care that is most important in the final stages of life. The number of Americans age 85 and older will more than triple from 5.8 million to 18 million in 2050. We must recognize this new phase of “super seniors” and develop and support programs that respond to this change as quickly as possible.
Our Call for Telehealth for 2020 was answered, albeit as a result of a pandemic. We struggled to get payers and providers to adopt telehealth as an essential part of the care continuum. As a result of COVID-19, state licensing regulations that limited telehealth payment and regulations, that limited the use of standard applications were pushed aside. Some of these protections should be reviewed and revisited. Nonetheless, telehealth has emerged as an essential service for patients across the country — and a financial lifeline for providers. Now the questions can focus on how to improve telehealth rather than whether to support and pay for this important step forward for access, quality, and affordability.
Small Employer Based Insurance Market cannot be ignored. The situation has only worsened since I wrote about this topic in January. Since then, thousands of small businesses have been forced to close their doors for the sake of our collective health. We won’t know the full extent of the pandemic’s effect on enrollment until the next cycle of open enrollment in the fall, but brokers and other experts are projecting that the market will shrink further. At the Quality Institute, we published a white paper with recommendations on how to support small employers and their employees so they can obtain affordable coverage. I encourage you to read it and consider additional steps the state can take. One idea we have is to create a “Best Evidence Plan” that would be centered on primary care and would allow greater payment for the care of highest value. The goal is to encourage people to seek out care that’s essential and proven to work. These plan designs would be in contrast to high deductible plans and plans tied to metallic tiers with high out-of-pocket costs.
State Purchasing Power. Despite the challenges of the pandemic, the state has moved forward on several initiatives to flex its purchasing power to drive high quality and high value care. We urge state leaders to continue this momentum. As more people obtain coverage through Medicaid or the State Based Exchange, the role of government-funded benefits will continue to grow. States like California have used its might to demand quality and change how the state government pays for things. We look forward to seeing more innovation here. Here’s just one example in New Jersey. Medicaid recently stopped paying for early elective deliveries that were not medically necessary. SHBP/SHEBP will stop paying for them on January 1, 2021.
Integrating Mental Health and Physical Health. One thing we’ve all learned, if we did not already know it, is just how critical mental health care is to our entire well-being. Splitting the brain from the body is untenable and must stop. It’s been four years since I listened to a NJ Spotlight Webinar featuring John Jacobi, JD of Seton Hall University Law School and Dr. Kemi Alli, CEO of Henry J. Austin Health Center, and a board member of the Quality Institute. They discussed the regulatory hurdles to providing integrated care and the steps needed to address these barriers. The Quality Institute included these recommendations in our Medicaid 2.0 Blueprint as Recommendation #11. Since then, there have been executive orders, work groups, and legislation — but true integration of care and payment for care still eludes us. We must finally recognize and pay for mental health care at rates that providers will accept, and that will prompt them to join provider networks, so that we have greater access to integrated care. The advancement of telehealth should help move this forward to this better model of care.
In January, I never envisioned that soon we would be re-imagining our in-person gatherings as virtual events. Or that I would not be able to share an in-person coffee or glass of wine with all of you. But I am grateful to all of you and proud that because of your dedication and commitment to the mission we all share that we’ve continued to drive our work forward during this most challenging of years.