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Christie's Medicaid program welcomed by heath care providers

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Gov. Chris Christie's goal to make New Jersey's $12 billion-a-year Medicaid program more efficient, unveiled in his Tuesday budget address, was welcomed by Dr. Jeff Brenner, who heads the Camden Coalition of Healthcare Providers.

Christie's speech was "very exciting," Brenner said.

The Coalition has gained national recognition for its efforts to improve population health and reduce excessive hospital care. New Jersey is among the states opting to expand Medicaid under the Affordable Care Act.

"As the state expands Medicaid they will have to simultaneously think about redesigning and rethinking the delivery models and making sure that we are delivering care efficiently, effectively, and delivering better care at lower cost. So I think the timing is perfect," Brenner said.

Christie in his speech cited the Medicaid Accountable Care Organization three-year pilot program that was created by state law is due to launch later this year. Camden, Trenton and other cities with large Medicaid populations are expected to form Medicaid ACOs, in which all the hospitals and many of the health care providers in a region join forces and seek to both improve health care and reduce costs. The ACO would then share in the savings that Medicaid realizes through more efficient care. The cost of Medicaid is shared equally by the state and federal government.

One of the earliest Medicaid ACO advocates was the New Jersey Chamber of Commerce, which argued that by making the state's health care delivery system more efficient, New Jersey would be a more attractive location for business.

In his budget address, Christie said Medicaid covers 1.4 million people and that last year, 5 percent of Medicaid recipients accounted for half the program's spending. Christie noted that the state has received federal approval for changes to Medicaid that will emphasize home and community based care.

The Medicaid ACO will "look at how care management and coordination can help lower costs for this population while improving care," he said.

Christie said 16,000 Medicaid recipients visited emergency rooms six or more times last year.

Horizon Blue Cross Blue Shield spokesman Tom Vincz said “We support the Governor’s focus on health care innovation. Horizon has taken a leadership role in New Jersey by working with physicians and hospitals to develop value-based programs that are delivering better quality outcomes for more than 500,000 Horizon members while containing health care costs. We are also bringing innovation to our Medicaid business. We are in the process of collaborating with organizations statewide that are aligned with the Governor’s vision and can further the goal of improving health care quality and efficiency in New Jersey. “

Brenner said the Camden Coalition, and a sister group in Trenton, the Trenton Health Team, have been working for years to improve primary care to low income city dwellers and help them avoid hospital admissions that often result when chronic conditions like diabetes and heart disease are not under control. The coalition intends to launch a Medicaid ACO once the regulations are final and applications are accepted, he said. But, he said in advance of the ACO launch, the Coalition in December reached an ACO-type agreement with UnitedHealthcare, which is one of the four managed care companies that deliver the Medicaid program to New Jersey residents. Brenner said UnitedHealthcare is providing funding up front to the coalition to pay for care coordination efforts needed to improve Medicaid efficiency. After a year, UnitedHealthcare will share the savings with the coalition.

"United is putting its hands up and saying, we're ready, we're going to move forward and we're opting into the model" of the Medicaid ACO, Brenner said.

Brenner said the coalition has been piloting a community-based approach to improving health care that targets the sickest patients who spend the most time in hospitals.

"Our goal is to catch every hospitalized patient: we think that's the quickest way to save money," he said.

Brenner said a pilot program that has been underway for several years is aiming to make sure patients being discharged are situated in a well-run primary care office and understand their medications and follow up plans.

He said the Camden Coalition staff "go right to the bedside. We meet the patient in the hospital and we ask them, 'are you tired of being sick and tired? Are you tired of being in the hospital over and over?'"

He said the staff visits the patients in their homes and accompanies them to their primary care doctors and specialists.

"We stick to them for 90 days. We find that to be a really crucial teachable moment. We can kind of nudge and steer people toward a different set of choices, so that they get reattached to their primary care office and break out of the cycle of going to the hospital over and over," he said.

He said there are many success stories citing the work of the Trenton Health Team that worked with a patient that had gone to the hospital several hundred times in one year. And after the intervention of the Trenton Health Team, in the following year the patient went to the hospital 18 times.

"We have a lot of stories like that in Camden as well: people were going to the hospital over and over and over, we get involved on the case, and they stop going. That is routinely what we are seeing," Brenner said.

He said the coalition is now launching a one-year study to determine if its work is having an impact on health care in the city.

By focusing on the sickest people in Camden, Brenner said the coalition has worked with about 10 percent of the city's patients.

"Our goal in the next year to two is to touch 100 percent of the patients in some way shape or form," he said.

In Camden, about 1 percent of the patients account for about 30 percent of the costs to Medicaid, Medicare and commercial health insurance, said Brenner. The problem with the health care system is that it hasn't paid enough attention to the sickest people.

"We don't deliver organized care or personalized care to very sick patients. Instead of meeting them where they are, they end up going to the hospital over and over," he said.


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