As we move into the first year of a new decade, we want to highlight some pressing issues in health care, especially areas where the Quality Institute, together with our members, can make a real impact.
Supporting Healthy Aging:
As a state, we aren’t getting any younger. In 2010, people over the age of sixty represented nineteen percent of the state’s population. The figure is expected to rise to twenty-five point six percent by 2030. Yet, nationally, we are unprepared. Most of us want to stay at home as we get older. We want to remain connected to our communities. We hope our minds and bodies will remain healthy. What is our plan for this aging population? Through our Mayors Wellness Campaign (MWC), in partnership with the New Jersey League of Municipalities, and our COYL (Conversation of Your Life) initiative, which is funded in part by The Horizon Foundation for New Jersey, we are working with mayors to help communities be better places to live, work, and age in place — and to have those important conversations about advance care planning. But more work is needed to ensure that as people age, we are ready to support their needs and those of their caregivers. This issue also is important for employers and their employees, who are juggling family responsibilities and work. Our Spring 2020 conference on May 12 will focus on Healthy Aging. We’ll be exploring the best ways to improve aging in New Jersey, and we look forward to working with many of our members who are leaders in this field and who have much to share on ways we can improve aging in New Jersey.
Calling on Telemedicine for 2020:
I’m always struck when innovations we fought for in health care make a difference in my own life. Over the winter break, I visited my older son, a Peace Corps volunteer working in Lesotho, a country within South Africa. As a precaution, I took some antibiotics in my travel bag and, after feeling unwell for two days, wondered if I should take them. I was thankful to be able to text (using a HIPAA compliant App) my primary care physician, who advised me. I was so relieved to have good medical advice from a trusted provider even though I was far from home. I hope 2020 will be the year telemedicine stops becoming a nifty concept and becomes simply another way to interact with our medical providers. The technology is here. Telemedicine should be a part of the continuum of care. At the Quality Institute, we’ve pushed to advance payment models so providers who use the technology know they will be reimbursed for their time and talents. We’ll keep focusing on ways to support this virtual extension of the provider-patient relationship. The laws are already in place. At this point, it is up to all of us to get the word out to patients and providers and to make sure that this practice becomes the norm across all types of insurance coverage.
Strengthening the Small Employer Health (SEH) Insurance market:
This market has been in a steep decline over the last decade with a loss of close to 600,000 lives. Perhaps we should not be surprised that the market is down to about 300,000 lives, especially given that the SEH did not benefit from the ACA. There were no meaningful government subsidies or tax policy changes to help small employers or their employees afford insurance in this market. Since the ACA, employers and employees voted with their feet, moving into government funded plans or non-standard options with fewer restrictions and consumer protections. The decline of the SEH market is of real concern. Without a robust SEH market, will entrepreneurs be less likely to start or expand small businesses? I think so. That is why we need to turn our attention to strengthening the market. The state has several levers to consider — from state tax deductions to direct incentives for providing SEH insurance to employees. The state could reconsider current plan designs to address the underlying spending on health care services, which has risen twenty-two percent between 2012 and 2017. Small employers are the engines of innovation and employment in the state. We must spend 2020 figuring out how to help them. The Quality Institute, working with Senator Joe Vitale, through our Health Care Reform Work Group, will continue looking at ways to reduce the cost of health care and to support New Jersey’s small businesses.
State Purchasing Power Will Have Its Day:
This should be the year the State, under enormous budget pressure, uses its purchasing power to redesign its benefit program to get the highest quality care for its employees while including incentives that reduce wasteful and harmful spending and care. The administration, legislature and unions all appear committed to these goals. By looking at existing successful models of care and taking bold action, such as eliminating payment for care that is harmful or of low value, the state has started down the important path of flexing its purchaser power. Moreover, by demanding more from our health care system and setting quality goals, not only can the state reduce its costs, it can improve overall quality for everyone in New Jersey. We look forward to working with state policy makers and stakeholders as the state works to gain greater benefit from its vast purchasing power.
Finally Integrating Mental and Physical Health for Best Practice Care:
Everyone I know supports integrating physical health and mental health. But integrating this care in the face of complex health care facility infrastructure rules and payment system structures has been challenging. Despite good intentions, the pace of change has been slow. We’d like to see 2020 be the year it happens. At the Quality Institute, we’re part of the Integrated Care for Kids (InCK) project, a comprehensive approach to improving health outcomes for children receiving Medicaid and CHIP. Our partners in the $15.8 million grant from the Centers for Medicare & Medicaid Services are Hackensack Meridian Health and the VNA Central Jersey. Our role will focus on creating an alternative payment model aimed at breaking down barriers, so education, mental health, and family services work together to support children with complex medical and social needs. We’re hoping success in this seven-year-pilot program accelerates the effort to create more holistic care for children and adults throughout the state.
Everything we accomplish requires the combined voices of all our members. Your expertise, knowledge, and experience drives our mission. In the last decade, we made substantial progress on health care coverage and quality, but not enough progress on costs and transparency. Together, let’s kick off the new decade with ambitious plans to continue improving health care safety, quality, and affordability for everyone.