Dear Lt. Governor Guadagno and Ambassador Murphy:
This November, the people of New Jersey will likely elect one of you to lead our state. You will face both great opportunities and great challenges. I write to ask that you pay close attention to health care, which affects all of our citizens — and accounts for over a third of the state’s budget. There is no other issue as important to the lives and economy of our state.
At the Quality Institute, we work to improve health care while also containing costs. Both are possible, very possible, with innovative leadership, especially as the federal government considers replacing the Affordable Care Act (ACA) and shifting a larger share of health care costs to states.
Here are my recommendations to make health care in New Jersey more effective and efficient, while also less costly.
Create an Office of Health Care Transformation. The state’s health care system is too fragmented — regulated by no less than seven state agencies. This fractured system creates competing priorities, prevents a cohesive approach to implementing statewide health care policies, and fails to leverage the considerable purchasing power of the state as a whole. Creating this small yet strategic and powerful office within the Governor’s Office would demonstrate your commitment to focusing on improving health care and controlling costs at the highest level. Work on this office should start now to enable you to create a statewide plan for health care priorities, policies, and purchasing on day one.
You can read more about our call for the creation of this office in Medicaid 2.0 — Blueprint for the Future.
Recommendation # 2
Forcefully advocate for the preservation of New Jersey’s insurance market for 2018 or until a clear alternative is adopted. Insurance relies on predictability. Work with our Democratic and Republican representatives and stakeholders, including New Jersey health plans, hospitals, and physicians to ensure that the ACA cost-sharing payments and premium supports for individuals continue through 2018. No ACA replacement is ready and we need a stable insurance market in the meantime. New Jersey insurers will be filing their proposed 2018 rates this month. They need to know that the individual mandate will be enforced and that federal promises to pay for cost sharing and premiums subsidies will be kept. If the ACA is repealed or replaced, as Governor, you will need time to create state-based solutions. In the meantime, we’ll all need predictability and enforcement of the ACA to maintain a stable market where people without employer-sponsored health care can buy insurance. We can’t allow our insurance market to collapse by intentionally creating uncertainty. We can’t allow people in the midst of chemotherapy, say, or people who need life-saving medications for asthma and diabetes, to suddenly find themselves without health care. By stabilizing the market, you’ll give yourself needed time to find solutions.
Build a technology backbone to support health care. Over the last decade, health care has been slowly moving from paper to the electronic world. This move must be accelerated and better focused. Doing so will improve quality and increase coordination of care across various providers. Similarly, it should reduce duplicate tests and procedures and alert us to problems or negative trends in care. All of these steps will better align incentives and support the move from fee-for-service to value-based payments. The state has a role here as a purchaser (SHBP and Medicaid), through its universities and researchers, and as a regulator of our health systems.
In addition to electronic health records, the state systems around Medicaid enrollment and eligibility must be improved and streamlined to make sure that eligible people are not improperly being dropped from Medicaid. Mechanizing the system, tracking performance, and improving accuracy in the enrollment process will prevent eligible people from losing coverage, preserve funds wasted on re-enrollment, and decrease disruptions in care that can result in costly hospitalizations down the road. There is federal funding for these investments. Access it.
You can read more about our recommendation to improve eligibility processing in Medicaid 2.0 — Blueprint for the Future.