Charlene Holzbaur, who recently stepped down as Director of the Office of Management and Budget for New Jersey, has joined the Quality Institute’s Board of Directors.
You were the treasury department’s budget director for 16 years, making you the state’s longest-serving budget director, apparently going as far back as 1865. As someone with deep experience in state government and budgets you will be a great asset to the Quality Institute. What about the Quality Institute’s work prompted you to join the board?
I have a long-standing interest in health care in New Jersey. I became immersed in health care when I was a budget analyst in the Office of Management and Budget and got involved in the work of Medicaid. That was an extremely challenging position, both on the policy aspects and on the financial aspects. After that I became the Chief Financial Officer for the Division of Medical Assistance and Health Services. I’ve always kept my interest in health care and thought I would find a position on the Quality Institute’s board exciting. The Quality Institute’s Medicaid 2.0 initiative, to provide recommendations for improved quality of care while lowering costs, is exciting. And the Quality Institute’s varied board — from health care providers to a former governor to insurers and advocates — also makes the work very appealing to me.
You are now working as a financial management specialist with the Centers for Medicare and Medicaid Services (CMS) Region II, where you review components of New York’s Medicaid program. Do you have insight into what may happen on the health care landscape in the coming years?
We are entering an extraordinarily challenging time of change on the federal level and on the state level, as we will have a new governor in 2018. We may see significant changes. Of course, we’ve seen great change in the world of health care over the past ten years. Nothing has remained stable. Finances are tighter and more people are interested in quality as well as the impact of health care on their own budgets. And, with Congress drafting proposals to perhaps end and then revamp the Affordable Care Act, the over 500,000 New Jersey residents with new insurance may see their health care coverage changed or lost.
You’ve worked more on the finance side of health care than on policy. Are you interested now to get more involved in the policy aspects of health care?
My concern has primarily been on the financial impact on the state’s budget. But at the same time, New Jersey has made significant investments and continues to invest in quality. We can see the interrelationships of everything. If someone needs dialysis, well, how will they get there? Are they in a wheelchair? What other health concerns do they have? … I believe we need to pilot innovative ideas and then evaluate them before full implementation. Innovation is not one big bang.
Have you had experiences that have influenced your perspective?
I was a caregiver for my mother at a time when she needed full time care to stay in her home. On an individual level, for the caregiver, it’s an enormous and emotional undertaking. You really can’t navigate it all without it taking a personal toll. During that time I got a close-up view of the larger health care system. I could see how things were interconnected but also how care was not interwoven into the community. It seemed to me many aspects were disjointed.
You have worked with governors on both sides of the political aisle, going back to Governor Christine Todd Whitman. What have you learned from working for such a varied group of governors when it comes to health care?
Each governor had a definite interest in quality and finances surrounding health care because of the financial impact to the State’s budget and the health care impact on New Jersey’s citizens. Every governor brought with them a different area of expertise and interest. For the Christie Administration, the Office of Management and Budget was deeply involved in the analysis of the financial impact and federal funding from the Affordable Care Act. I have found that it is important to appreciate the full impact of change and to evaluate any change compared to the current condition. There is no perfect solution and only through incremental improvements can real progress be achieved.