Matthew D’Oria, a Quality Institute Senior Fellow, is leading Medicaid 2.0. He spoke recently to Symptoms & Cures.
First, can you tell us about this ambitious and important initiative called Medicaid 2.0?
Sure. At the Quality Institute we’re beginning an effort, funded by The Nicholson Foundation, to re-envision Medicaid in New Jersey. We want to develop a blue print for the future. We want to improve the program for people who rely on Medicaid for their health care, and we want to make Medicaid more efficient. We believe that both are possible: cutting costs and improving care. This is critical now that Medicaid covers one out of every five New Jersey residents.
Where do you even begin? Is this like turning around the Queen Mary, as they say?
I think moving forward will be challenging, but I do believe we have the resources and the innovative thinkers here in New Jersey and at the Quality Institute to develop strategies to improve Medicaid. We’ll be working with stakeholders from around the state and we’ll be exploring effective delivery models in New Jersey and around the nation. We’ll have input from consumers — they are, after all, on the front lines — as well as from state government, safety-net hospitals, physicians, substance abuse health care providers, nurses, nursing homes … and many others.
Are there specific areas that you will examine?
There are. We know that signing up and staying on the program is cumbersome and bureaucratic. Some people often drop off the rolls. Then they get sick and have no coverage or doctor and end up in the emergency department. So we will look at the process of applying for and continuing coverage. We also know we need to better connect behavioral health with physical health. Studies continually show us that people with mental illness have co-existing medical conditions that go untreated. And we have to better coordinate care for people who receive care from a Medicaid HMO but who also have Medicare. Every one agrees we need to find better ways to treat dual-eligible recipients, but the question is: How do we do that? These are just some of the areas we’ll be examining.
Is changing the payment system a good way to change behavior?
It is one important way. We will examine payment solutions that reward quality and value to improve both the provider and patient experience. We know we can better leverage the State’s power as the largest purchaser of health benefits to move toward value-based purchasing. We want to reward providers who can keep people well.
Why is the Quality Institute the best entity to lead this effort?
New Jersey Medicaid is a $12 billion program. There are different interests, different perspectives. I think the Quality Institute is really the only entity in the state that has the credibility, the objectivity and the expertise to bring all the stakeholders together. We are setting a long table. At the Quality Institute we’re proud that The Nicholson Foundation has turned to us for this important project, which has the potential to change the lives of some of our state’s most vulnerable residents. Of course we will keep all the Quality Institute members up-to date as we move forward and we welcome their insight.