Op-Ed: Healthcare Reform for New Jersey, Now What?

The American economy is based on competition, and this is particularly true as states attempt to interpret the recent Supreme Court decision on the Affordable Care Act

The historic Supreme Court decision on June 28, 2012 upheld the individual mandate, a key provision of the Affordable Care Act. It also ruled that the states had the right to choose their participation in the Medicaid expansion without any penalty or loss of federal match for the state Medicaid program if they wanted to opt out. No matter what our position is on the ruling, the reality is that the Patient Protection and Affordable Care Act of 2010 is the law of the land. We must seize this opportunity to look for ways to bring improvements and innovations to our current healthcare system. Many participants in the healthcare system — consumers/patients, physicians/providers, hospitals, government agencies, policy makers, insurance companies, pharmaceuticals, and others will be impacted by this. It is going to be important that we work together in private-public partnerships to achieve our goal of high-quality, coordinated, cost-effective access to care, while ensuring that our system is not burdened with bureaucracy and regulatory control.

What are the factors that make New Jersey’s needs unique from other states and why do we need to create a system than meets them? New Jersey ranks third nationally in population diversity and is among the top 10 states with the number of residents age 65 and older. With advanced age we consume more medical care, thus the need to coordinate that care becomes even more important, and New Jersey can, and must, institute its own market-based solutions. Well-designed pilots, such as Accountable Care Organizations (ACOs), High ER Utilizer programs, integration of behavioral health services and streamlining end-of-life care should be pursued and customized to support regional healthcare resources. In the area of long-term care, home- and community-based options that support independence, dignity, and consumer choice need to be expanded. They are more cost-effective than nursing homes, and are generally preferred among those in need of long-term care services.

What role can automation play? A 2006 RAND study found that the U.S. healthcare system could save more than $81 billion annually if Healthcare Information Technology (HIT) was widely adopted. Electronic Medical Records (EMRs) can ensure the availability of all relevant, patient-specific medical information at the point of clinical decision-making. The electronic sharing of disparate data can increase administrative efficiencies and help in the evaluation of new techniques and evidence-based medicine by providers. Existing, fragmented systems reduce effectiveness and cause harm, whereas efficient systems can and will save lives.

Do we have enough providers? The best-designed healthcare system cannot work without the clinicians who provide the services directly to patients. In 2010, New Jersey dealt with a shortage of 945 physicians. This number is expected to triple in ten years, without taking into account the increased demand nationwide under reform expanding Medicaid populations. Of 860 doctors who complete residency in New Jersey each year, only 32 percent plan to practice medicine here. The numbers are similar for the other professionals who provide for patients. Thus the environment in New Jersey must be created that will cultivate, retain and attract more healthcare professionals. Medical school capacities, along with educational partnership opportunities, must be expanded. And new opportunities must be created for retired and volunteer healthcare professionals to increase much-needed access to care and correspondingly malpractice and tort system must also be fixed. The current system promotes frivolous lawsuits, encourages the practice of defensive wasteful medicine and results in physician exodus, exacerbating our physician shortage.

As a physician, previous health insurance executive and the former commissioner of health, I know our collective objective is to ensure access to high-quality healthcare for all New Jerseyans. It’s no secret that our nation’s healthcare system has become unsustainable and that left alone it is on track to insolvency. So we should view the current situation as an opportunity to achieve a real and sustainable outcome that will provide the world-class healthcare system standard our patients and taxpayers deserve and can afford.

Indeed, our state policy makers, legislators, and the governor should carefully assess and evaluate all the critical factors involved to ensure the final outcome is void of cumbersome and undue burden on the Garden State taxpayers and business community while addressing the critical deficiencies in the status quo.