It’s why Linda Schwimmer, CEO and president of the New Jersey Health Care Quality Institute, and state Sen. Joe Vitale (D-Woodbridge) are working together, along with other thought leaders, on coming up with the next step — hoping to be ahead of the curve in the event the burden of sustaining Medicaid falls on the state.
The issue looms heavily over New Jersey, which expanded Medicaid under the ACA and dedicates 20 percent, or $15 billion, of its budget annually to the program, according to a report released Monday.
Roughly one in five Garden State residents relies on Medicaid.
On Monday, Schwimmer, in conjunction with The Nicholson Foundation, released the report, or “blueprint,” for a new iteration of Medicaid, which culminates a yearlong effort to identify existing obstacles and inefficiencies in Medicaid.
“The report’s recommendations could save New Jersey’s Medicaid program approximately $100 million to more than $300 million of New Jersey’s projected annual direct spending of $11 billion, not including the costs of the upfront state investment required to realize the full potential of reform,” according to a statement from the HCQI.
But the report concedes that does not include any cost of implementing the recommendations from the blueprint.
The Medicaid 2.0 Initiative, funded by the foundation, found 24 points of interest, which include modernizing the program and its infrastructure, as well as focusing on areas of underserved clinical needs.
This includes an oversight department at the state level, transparency of Medicaid data and the use of telehealth.
It also includes recommendations on incorporating behavioral and mental health initiatives, greater pharmaceutical cost savings and a focus on a better network of care for children (since 40 percent of the state’s children are on Medicaid).
The clinical recommendations include improving access to contraception, improving end of life care and improving maternity care.
“Together, the recommendations in the blueprint have the potential to save New Jersey Medicaid between 1 to 3 percent of the projected direct spending of $11 billion (not including the $4 billion that is earmarked for special programs and administration). This savings estimate does not include any upfront administrative costs to establish a new program(s),” according to the report.
The Nicholson Foundation recognizes the issues are not unique to New Jersey, but funded the initiative to help the state consider its options.
“The current Medicaid program has often not met the needs of its recipients,” said Joan Randell, chief operating officer of the foundation. “There are obstacles to access. Care is fragmented. And there is limited capacity to treat the whole person by concurrently addressing physical, behavioral and health-related social needs. If the status quo persists, the costs of the program will continue to grow without demonstrable improvements in health outcomes.”
If you take a look at the blueprint’s appendix, you will see a list of 140 organizations that collaborated to develop it, Randell said.
Schwimmer concluded that the blueprint was not etched in stone.
“Improvement to New Jersey’s Medicaid program has been, and will always be, an ongoing exercise. The Quality Institute has spent the last year investigating best practices across the nation and convening stakeholders to build consensus for modernizing Medicaid in New Jersey. The goal was to produce a strategic blueprint that policymakers can use to re-engineer the state’s Medicaid program over the next decade, regardless of politics and funding, and achieve genuine transformation,” Schwimmer said. “Each year, the state budget process demands more efficient ways to operate the program. While the blueprint is not a solution to drastic cuts in federal funding, it identifies multiyear solutions and provides an effective roadmap that will improve the state’s Medicaid program.”
The issue is one that Vitale is keeping an eye on; he is convening a work group to begin drafting policies that could address some of the issues.