New Jersey’s sometimes fractured and inconsistent healthcare system has contributed to some shocking disparities in community health, including clusters of severely obese pre-teens and a tendency for severely mentally ill patients to die a quarter-century sooner than the population at large.
These worrisome outcomes were among the concerns raised by panelists in a session on “Integrated Health: New Hope for Complete Care?” at the NJ Spotlight on Cities Conference at the New Jersey Performing Arts Center, on Friday. And while there is hope in a handful of pilot projects and regulatory changes aimed at better integrating behavioral and physical care, more work remains to create a system that truly treats the “whole patient,” the group agreed.
Participants in the healthcare panel included Carolyn Beauchamp, president and CEO of the Mental Health Association of New Jersey; Barbara Mintz, vice president of healthy living and community wellness at RWJ/Barnabas Health; Gregory Paulson, executive director of the Trenton Health Team; and Sen. Joseph Vitale (D-Middlesex), the longtime leader of the Senate Health Committee. The conference was NJ Spotlight’s second-annual event focused on urban policy in the Garden State.
Mary Ann Christopher, who represented Horizon Blue Cross Blue Shield, the panel’s sponsor, also noted that the insurance company has been working for eight months on a new integrated-care program that seeks to weave addiction treatment, particularly for heroin and opiods, into protocols for other aspects of care.
Despite their diverse backgrounds, the panelists agreed comprehensive “complete” care is essential to achieving better health outcomes and lowering healthcare costs over time. They largely concurred with the findings of Seton Hall researchers who released a report in March suggesting that, despite efforts to reform some guidelines, the state’s regulatory system still stymies full integration, and low provider payment rates only exacerbate the problem.
“Integrated care has been on our agenda for a long time,” Beauchamp said. Better connecting primary care with mental health treatment is “a major part of the solution” to helping those with serious mental illnesses live longer, she said; these individuals now die an average of 25-years sooner than those without similar emotional challenges.
Paulson explained that the Trenton Health Team was founded in part to tackle chronic health issues for residents who were cycling in and out of the two local hospitals, sometimes more than 365 times a year. “Substance abuse and behavioral health needs were really driving that high utilization,” he said.
Now visitors to Trenton’s local Federally Qualified Health Center — one of the few sources for primary care left in the Capitol City — are also screened for behavioral health concerns during their first visit, regardless of the reason they came in, Paulson said. Of the 11,000 patients seen that first year, 4,000 were flagged for a follow up, and 2,000 were provided additional mental health or substance-use disorder treatments.
Earlier this year state regulators issued a waiver designed to make it easier for primary-care providers to also offer behavioral care at the same site. But speakers noted this only addresses half the problem, and more must be done to integrate primary care into existing mental health and substance use disorder facilities.
Beauchamp noted there are at least seven pilot projects underway to address this second half of the challenge — adding physical care to behavioral care facilities — but they are largely focused on screening for chronic diseases, then referring patients for treatment elsewhere. And when the pilot ends, even this service will cease to exist.
“The terrible problem is sustainability,” she said.
[related]For Vitale, concerns about integrated care came to light when he started working on legislation to address the opioid epidemic. Efforts to offer substance-use disorder programs to patients visiting FQHCs were complicated by rules that require separate entrances and filing systems for physical and mental care patients, he recalled.
“Recovery options are in short supply,” he said, “and that’s just crazy.”
Vitale is working on several bills to reduce these regulatory barriers to creating comprehensive treatment centers; with many stakeholders involved, he said, the final product is still evolving. “We’re taking our time and getting it right,” he said, noting the goal is to create “one-stop shopping for all of these services in the same place.”
In addition, Mintz, with RWJ/Barnabas, reminded the audience of the importance of disease prevention and wellness in general. Health, both physical and mental, is directly tied to other issues like decent, toxin-free housing, access to healthy food, safe places to exercise, and clean air and water, as well as the availability of healthcare providers, she said.
“Wellness involves everything that affects a person’s life,” she said. “And if we keep our communities healthy, we will definitely be lowering healthcare costs, but also improving outcomes.”
Mintz, Paulson, and others agreed this is not a job healthcare institutes can do on their own. When RWJ/Barnabas discovered many pre-teens in Newark who topped 300 pounds, they worked with the city’s public school system to create a program designed to reduce obesity; the organization also partners with faith-based groups and engages community members through a greenhouse, garden, and urban farmers market, Mintz said.
“I think we have to leverage the strengths of partnerships in the community. Otherwise, we’ll never get the job done,” she said. “It’s not something a hospital can do alone. But we can do it with other partners out there.”