State health officials staked out a fresh approach to public policy at Wednesday’s budget hearing. It calls for improvements to programs that distribute hospital funding, address opioid addiction, reduce racial health disparities, and provide integrated care for some of New Jersey’s most vulnerable residents.
Health Commissioner Dr. Shereef Elnahal outlined this new direction when he and his key staff testified before the Assembly budget committee about Gov. Phil Murphy’s $2.9 billion spending proposal for the Department of Health. The DOH oversees public health, facility licensing, and behavioral health services.
Elnahal discussed reforms that are already underway, including work to expand access to the state’s medical marijuana program, reduce violence at state psychiatric hospitals, and improve maternal health services among vulnerable communities and black women, who die of childbirth-related conditions at rates more than three times that of white women. He said the state is also reassessing how it addresses opiate addiction, a priority for former Gov. Chris Christie.
Exploring all options
While some funding plans — like the proposal to distribute of $252 million in charity care to help hospitals treat uninsured patients — are based on models developed by the Christie administration, Elnahal said his staff is already exploring future changes. The department will be working with participating hospitals to identify and share successful strategies for connecting patients with primary care and reducing costly in-patient treatment, he said.
“We want to see these dollars go further and go toward achieving better healthcare outcomes,” Elnahal said, noting that the goal is to determine, “are we actually delivering on the outcomes that we want for patients that are underinsured?”
Committee members from both political parties pressed Elnahal for more details on charity care, and Assemblyman John DiMaio (R-Somerset) urged him to add another $100 million to the fund and distribute the dollars more evenly among the 71 recipient hospitals — a change supported by a number of suburban and rural hospitals.
Committee chairwoman Eliana Pintor-Marin (D-Essex), raised concerns about a request to add a trauma center at Trinitas Regional Medical Center, in Elizabeth, which she feared would undermine the care and stability of University Hospital, which has a trauma center in Newark. Elnahal said he could not comment while the proposal is under department review.
Other members asked about the changes to the medical marijuana program and wondered about the impact of legalizing recreational cannabis, as Murphy is eager to do. They also pushed him to defend cuts to a number of small-dollar programs that have become legislative priorities: funding for cancer research, hospice care, lead remediation, needle exchange, and smoking prevention, among others.
Elnahal noted that while these may be valuable programs, the administration had followed a zero-based budgeting approach in which all expenditures must be fully justified, and tough decisions were required. The DOH is still considering which programs to fund in some categories, like opioid addiction, so several of these legislative priorities may still receive support, he said.
The department is also seeking to rebuild its workforce — which declined significantly under Christie — institute more rigorous program metrics and analyses, and operate in a more responsive, transparent way with the Legislature and the public, Elnahal said. “We’re trying to change the culture in the way that we operate, in that we’re continually delivering on outcomes and reporting back to you in the Legislature,” he added.
Elnahal’s budget testimony echoed the message of progressive healthcare reform that he, Murphy, and other state officials have delivered at a variety of forums since the governor took office in January. Murphy has championed his initial changes to the medical marijuana program as restoring compassion to an initiative that was constrained under Christie, and Elnahal and his team have stressed that the state must do more to reduce racial health disparities.
The health commissioner’s budget testimony added more meat to those bones. Elnahal said the DOH would soon launch a public-awareness campaign to publicize the medical marijuana reforms and, as a physician, he will be working with other doctors and medical students to encourage them to consider cannabis for their patients.
“In my career as a physician, I have spoken to patients who have described how medicinal marijuana has relieved their pain and reduced their reliance on opioids. And studies have demonstrated a strong correlation between the availability of medical marijuana and the reduction of opioid prescriptions,” he said. While demand for the medicine has largely come from patients, Elnahal added, “we want to turn the tide on that and have more physicians telling their patients about medical marijuana as an effective therapy.”
Lawmakers also pressed Elnahal for updates on troubled programs his team inherited from the Christie administration. Assembly committee vice chair John Burzichelli (R-Gloucester) raised concerns about a payment-reform process that has caused difficulties for community mental health providers, and Assemblyman Daniel Benson (D-Mercer) asked about an interactive computer system that was causing problems for providers and families involved with the state’s early intervention program to diagnose and address developmental disabilities in young children.
Elnahal stressed that his staff is well aware of the glitches in both systems and has been working closely with those on the ground to keep these efforts on track. But his staff conceded that a panel that was supposed to monitor the payment transition process does not in fact exist, largely because Christie never appointed the members, as required by the law he signed in May.
Benson also worried out loud about continuing reports of violence at the state’s four psychiatric hospitals, which care for more than 1,300 of the most vulnerable mental health patients. Elnahal said this is the “most important” issue his team has focused on and noted they are working with consultants to identify strategies for improvement and are adding staff at several facilities to provide safer, more effective care.
“The most important thing I will say, assemblyman, is that we need to change the culture around these hospitals to make sure it is clinically oriented,” Elnahal said, noting that this shift remains an ongoing process. “You will not see progress clinically,” he said, “without ensuring these patients (and staff) a safe environment.”
Control of these hospitals was only transferred to the DOH last fall, as part of a massive effort to shift all mental health and addiction services oversight from the Department of Human Services, which runs Medicaid and social services. The goal was to create more coordinated, integrated, and comprehensive care by consolidating all treatment programs — for physical and behavioral health — under the health department.
Elnahal said an integrated system of care is the best model and one he helped to improve during his tenure with the federal Department of Veterans Affairs. But the move was made quickly he said, based on a decision by the Christie administration, and the current setup is not cast in stone.
While staff is working hard to minimize any disruptions and improve integration, he said, “that is not to say we’re not considering all options on the table for optimizing these services.”
The DOH is scheduled to appear before the Senate budget committee on May 15.