Push on to rebuild health system after COVID-19

Advocates detail widespread changes they want to correct faults exposed by pandemic
Credit: (AP Photo/Wilson Ring)
Medicare rule changes during the pandemic allow this patient to meet with her doctor remotely to discuss her diabetes treatment.

Greater investment in New Jersey’s public health infrastructure and workforce development. Additional focus on addressing the underlying causes of health inequities. Rethinking how to pay for things like elder care and telehealth and even the current home-rule nature of the local health system.

Those are among the two dozen recommendations in “Emerging from COVID-19: An Action Plan for a Healthier State,” a report released Wednesday by BioNJ, the state’s life sciences trade association, and the New Jersey Health Care Quality Institute, a nonprofit seeking to improve health safety, outcomes and affordability.

The action plan seeks to address long-standing issues within New Jersey’s health system that were further exposed by the pandemic, including caregiver shortages, structural and operational challenges at nursing homes, a fractured and insufficient behavioral health network and a fragmented, isolated and under-resourced public health operation. In 2019, New Jersey ranked last in terms of federal public health funding, according to Trust for America’s Health.

In addition, the plan highlights the need to address underlying social issues, like poverty and poor housing, that have an outsize impact on individual health and equitable health outcomes. “The pandemic really brought a lot of (these racial inequities) to light and there is just so much more that needs to be done,” said Debbie Hart, president and CEO of BioNJ, noting that Black and Hispanic communities suffered with an outsize burden under COVID-19.

The action plan also urges the state to build on some of the changes driven by the pandemic, like the enormous expansion in telehealth use, which Hart said became a critical tool for pharmaceutical research studies. But more must be done to ensure telemedicine is accessible to everyone and is effective in delivering quality care, she notes.

READ: New Jersey gets less funding for public health from CDC than many states

WATCH: No one was prepared.’ NJ’s top health officials assess the year of COVID-19

The plan’s recommendations reflect input from more than 60 stakeholders — including health care providers, insurance companies, government regulators and advocates — who spent hours discussing their COVID-19 experience and sharing thoughts on reforms, the sponsors said. Hart said the BioNJ board was looking to compile some of the lessons learned during the crisis and partnered with the quality institute last fall to convene the work group.

“We tried to really lean into what everyone was saying, but also push and get consensus on these recommendations,” said Linda Schwimmer, the quality institute’s president and CEO. That consensus “was important to us because it makes (the recommendations) actionable,” she said.

The right time for action

Some of the recommendations — like a call for unified state licensing of behavioral and physical health facilities — received state support years ago but have yet to be implemented. Others — like allowing some health care providers to take on new responsibilities — have long been the subject of disputes between professional groups. And the suggestion to increase collaboration and resource sharing among the state’s municipal and county public health offices challenges New Jersey’s historic nature as a home-rule state.

But Hart and Schwimmer said there is a now a passion and commitment to change that did not previously exist. There is also research supporting these concepts and “billions of dollars” in federal coronavirus relief the state expects to collect, Schwimmer said, and together these factors make it the right time to advance the plan.

“It’s definitely not an accident we’re releasing this now,” Schwimmer said, noting the state has also experienced record-high tax revenue from alcohol and cigarettes, money that could be committed to public health initiatives. There is no specific price tag on the plan’s recommendations, she said, but at least half would involve short- and long-term savings.

“We’ve seen an insufficient investment in public health and not as much concentrated action as we need on some of these issues, especially around mental health,” Schwimmer said. Members of the workgroup “feel really emotional about this. They really want to see change. They don’t want to go through another crisis and see these issues” not addressed, she said.

New Jersey has recorded more than 930,000 cases of COVID-19 since March 2020, when the novel coronavirus first emerged here, and is now facing a third wave of rising cases, according to state officials. The outbreak took a particular toll on the residents and staff in long-term care facilities, and fatalities at those sites make up nearly one-third of the state’s nearly 25,000 deaths.

Next up: talking to politicians

Some of the recommendations in the plan require actions from Gov. Phil Murphy’s administration, while others involve legislation; Schwimmer said the two organizations will share the plan with elected leaders in both parties to discuss next steps. Others depend on additional data collection, technology upgrades and input from appointed commissions.

Highlights of the recommendations include:

  • Multiple steps to create a more diverse, resilient health care workforce, including creating a council to develop a 10-year plan, reviewing the state’s licensing process and improving access to behavioral health services for frontline caregivers;
  • Reviewing telehealth expansions under the pandemic and recommendations for improvement;
  • Implementing the Manatt Health report, a consultants’ review of nursing homes published in June that identified weaknesses in the workforce, physical layout and operations at these facilities;
  • Creating a statewide plan for healthy aging and adjusting public policy and insurance strategies to better support home-based care models that would allow more seniors to remain independent instead of entering long-term care;
  • Finalizing an ongoing licensing reform designed to make it easier for behavioral and physical health care programs to operate as one unit; shifting behavioral health services under Medicaid’s managed-care umbrella so members have more comprehensive care;
  • Expanding demographic data collection and reporting on health outcomes — including community engagement when shaping public health programs — and doing more to focus on social determinants of health, the underlying factors that greatly effect wellness;
  • Assessing how New Jersey invests in public health and its structure on the local level; better aligning local offices with health care providers and other stakeholders.

READ: Coronavirus exacts greater toll on communities of color

WATCH: Survey highlights black-white gap on connection between health and racism