Healthcare experts have urged the Murphy administration to prioritize efforts to grow and sustain insurance coverage, better integrate behavioral and physical care systems, improve end-of-life planning, and boost the use of data and other technologies.
Those are among the recommendations outlined by the healthcare transition team for New Jersey Gov. Phil Murphy’s first one hundred days in office, according to a report released by the Democratic governor’s office in late January.
The 17-page report reflects broad goals to improve social equity and boost the state’s productivity — common themes in Murphy’s campaign last year — and includes a half-dozen priorities with detailed policy guidance, much of which echo recommendations made in the past by key members of the transition team. While New Jersey’s healthcare system is strong in many ways, significant racial and economic disparities remain when it comes to some conditions.
The authors also stress the need to protect existing healthcare programs, like the Affordable Care Act, which attract billions of dollars in federal funding to provide care for some of the state’s most vulnerable residents. Murphy has underscored the importance of defending against recent federal attacks on these initiatives and has appointed a number of department leaders with national experience to help with this strategy.
“Health is a prerequisite for full participation in the labor market and public life,” the report states. “A fairer economy requires that we invest in improving the health of the entire state’s population and address health disparities to ensure all New Jerseyans have access to quality, affordable healthcare and improved health outcomes.”
End of an era
In releasing the transition report, Murphy said the era of “ad-hoc policymaking” had come to an end. “We have thoroughly reviewed the Transition reports and have already started acting on some of the recommendations. We are excited to continue making progress and move toward a stronger and fairer New Jersey,” he said.
In fact, a number of priorities flagged by the transition team are already being addressed by the administration or the state Legislature, which must adopt measures to initiate several of the healthcare reforms. Efforts are underway to restore funding for women’s healthcare, to address costly out-of-network medical charges, and boost enrollment in the state’s Medicaid or FamilyCare program.
Healthcare programs in New Jersey are administered primarily by the Department of Health, which oversees public health, licenses facilities and — as of last fall — runs the state’s addiction and mental healthcare systems, and the Department of Human Services, which runs Medicaid, among other initiatives. Healthcare programs absorb roughly $20 billion annually, according to the transition report, including nearly $15 billion for Medicaid alone.
Some two-thirds of Medicaid’s funding comes from the federal government. Spending on the Affordable Care Act, much of which flows through Medicaid, has been a top concern for Republicans in Washington, D.C., leading to an ongoing effort to reduce the cost of these massive federal programs — changes Murphy and many others have said could be dangerous to the Garden State.
“The importance of Medicaid to its beneficiaries and to the entire system cannot be overstated. Any federal changes to this system will have significant cradle-to-grave care repercussions and will dramatically alter New Jersey’s overall healthcare system,” the report notes.
Murphy’s healthcare transition team included more than five dozen experts representing hospitals of all sizes, physicians, and public health professionals, mental health and addiction care providers, nursing homes, organizations serving individuals with disabilities, insurance companies, and other healthcare payers, academic and policy organizations, and community-based providers that work in some of New Jersey’s most challenging communities.
The group’s chairs included former state health commissioner Heather Howard, now at Princeton University, and Murphy’s nominee to lead the DOH, Dr. Shereef Elnahal, a former leader at the U.S. Veterans Administration.
In its report, the group calls for an overarching “health in all policies” (or HiAP) approach that, according to the American Public Health Association, requires leaders across multiple departments or agencies to work together to address underlying factors influencing health, like access to healthy food and safe homes, now known as “social determinants of health.”
The strategy can leverage “creative, cross-sector solutions” to address complex challenges without “crowding out” other priorities, the transition report notes. “Multi-agency strategies that engage external stakeholders and employ public-private partnerships are the next generation of health-promoting cost savers,” it states.
To help achieve this interdepartmental collaboration, the report calls for the state to create an Office of Healthcare Transformation to address issues that have in the past been handled by ad hoc committees established by the governor’s office. The entity could tackle complex efforts to improve Medicaid and the State Health Benefits Plan, which covers state workers, and establish and enforce statewide efficiency goals and other healthcare program targets.
This recommendation is one of several that mirror goals outlined in the New Jersey Health Care Quality Institute’s Medicaid 2.0, a blueprint for reform released nearly a year ago; Linda Schwimmer, the Quality Institute’s president and CEO, was also a chair of the healthcare transition team. It also stresses the need for a statewide database with insurance claims information to help policymakers identify trends and monitor costs — another issue favored by Schwimmer.
Addressing the opioid epidemic
The report also underscores the importance of addressing the state’s opioid epidemic, which killed more than 2,000 residents last year and became the top priority for former Gov. Chris Christie, a Republican. It calls for more education on the dangers of prescription drugs, expanding needle-exchange programs, investing in proven treatment programs, and organizing bulk purchases of overdose reversal agents like Narcan.
In addition, the report’s authors stress the need to better integrate mental health and addiction care — many patients are impacted by multiple diagnoses — and also coordinate these treatments with physical medical services. “New Jersey’s regulatory systems unnecessarily frustrate the implementation of integrated clinical care, leading to shortage of appropriate care for those in crisis, and for those whom crisis could be avoided,” it states.
The recommendations would build on efforts by Christie to improve services by reshuffling state oversight, calling for state officials to meet with advocates within the first 100 days. Within six months, they should clear a backlog of applications from providers seeking to integrate care programs, establish a working group to discuss reimbursement rates, and initiate efforts to create an up-to-date directory of treatment services.
Much of the report addresses strategies to expand enrollment in the state’s Medicaid program, which now insures some 1.8 million people, including nearly 500,000 who joined as a result of the ACA expansion. In his first week in office, Murphy signed an executive order calling on state agencies to study how they can promote and publicize access to these subsidized programs.
It also recommends the use of best-practice methods, especially to improve maternal care — an area in which New Jersey has fallen behind other states, in a country that significantly lags other western nations. The racial disparity in maternal death rates is among the worst in the nation, the report notes.
Medicaid pays for 42 percent of the births in the state and low-cost changes, like expanding prenatal care and codifying clinical practices, can go a long way toward improving outcomes, the authors stress.
Other efficiencies can come from better documenting and coordinating end-of-life care — Medicaid also funds 65 percent of nursing home care, which isn’t covered by Medicare, and advanced planning can significantly reduce costs at this stage. The transition team urged Murphy to build on the state’s existing efforts to institute a comprehensive program to track residents’ wishes for final treatments.
The report also calls for the state to review its Medicaid managed-care contracts, which cost the state billions each year, improve provider oversight, and consolidate all pharmaceutical purchases within one office; the state now spends $2 billion annually, after rebates, on drugs for Medicaid patients and government workers.