Though healthcare spending overall has risen faster in New Jersey than nationwide, the state has been consistently implementing strategies designed to reduce healthcare costs and increase healthcare value. The state is ground zero for the hotspot concept of healthcare delivery, an innovative strategy that was famously chronicled in Atul Gawande’s 2011 New Yorker article, “The Hot Spotters.” This strategy identifies areas with high levels of hospital utilization and then allocating resources to those areas much in the same way police departments identify and respond to areas with high crime rates. More recently, the state has worked to improve patient health data exchanges through the New Jersey Health Information Network, hoping to improve population health and reduce healthcare costs by making information sharing more efficient.
New Jersey has implemented numerous additional strategies to improve healthcare value in recent years; in fact, the 2018 moves to adopt a reinsurance program and to create a state-based insurance mandate are credited with lowering the cost of health insurance plans in the state’s individual marketplace in 2019. The state has implemented one of the strongest approaches to protecting consumers from balance billing, holding consumers harmless in cases of surprise medical bills stemming from emergency or unintentional care and prohibiting providers from engaging in balance billing. The states has also enacted measures that protect against skimpy and confusing short-term plan designs.
Like most states, however, New Jersey still has far to go in terms of addressing excess healthcare prices, waste in the system and the affordability concerns of residents. In 2013 New Jersey legislators declined to create a state all-payer claims database, citing the annual cost as the primary deterrent.
In response to inequitable vaccine rollout in New Jersey, state officials have created a ‘vulnerable populations plan,’ which calls for partnerships with community centers and places of worship to create vaccine clinics focused on specific communities, reports NJ Spotlight News. These partnerships are expected to bring dedicated vaccines to racially diverse and vulnerable communities hardest hit by the pandemic. The partnerships will operate temporarily, with each seeking to vaccinate some 3,000 people over two weeks and then reopening several weeks later to provide second doses of the vaccine.
As part of the Nurture NJ Maternal and Infant Health Strategic Plan, New Jersey’s Medicaid program is adopting several new initiatives to improve maternal and infant health within the state, the Governor’s office reports. New Jersey’s Medicaid program will expand coverage to include doula care; will no longer pay for non-medical early elective deliveries; and will require obstetrical providers, nurse midwives or other licensed healthcare professionals to complete a perinatal risk assessment form during a beneficiary’s first prenatal visit to help identify trends in risk factors. These initiatives also contribute to the Strategic Plan’s aims of combating the state’s maternal and infant health mortality crisis by reducing racial disparities in these areas.
The Governor of New Jersey signed an Executive Order directing the Office of Health Care Affordability and Transparency to convene an Interagency Health Care Affordability Workgroup to identify opportunities within the administration and across the public and private sectors to advance healthcare affordability, accessibility and transparency. The Executive Order also directs the Department of Banking and Insurance to develop plans to implement both healthcare cost growth benchmarks and affordability standards to ensure increased oversight and accountability. Additionally, the Order establishes the Health Care Affordability Advisory Board, comprised of healthcare industry stakeholders, consumer advocates, and policy leaders, to guide the development and implementation of the cost growth benchmarks.
Horizon Blue Cross Blue Shield of New Jersey and Atlantic Health System have seen early success in their payer-provider shared accountability program in which they tie payments for services directly to outcomes in achieving quality and cost goals, reports New Jersey Business Magazine. The program represents a step away from traditional “fee for service” models and have has resulted in more than a 9 percent reduction in unnecessary hospitalizations and a 5 percent reduction in the total cost of care for patients and members in its first program year. The program used prior cost trends to jointly set a total cost of care target for certain members, and the reimbursement is adjusted annually based on performance as compared to cost targets, quality of care and patient outcomes.
The Medical Society of New Jersey has launched a new insurance denial registry for physicians’ offices to help track denials of healthcare services to New Jersey consumers, reports New Jersey 101.5. Until now, there hasn’t been a systematic way of tracing which companies, which procedures and what types of drugs are routinely denied. Understanding the reasons for insurance denials will help physicians get patients the care they need. A spokesperson for the Medical Society of New Jersey explained that such denials disrupt patient care and office workflow, and they expect many physicians' offices to contribute data.
A 2016 New Jersey law gave the state flexibility to share bid information submitted by all pharmacy benefit managers (PBMs) in order to incentivize them to submit lower offers in additional bidding rounds – known as a reverse auction. This approach was implemented in 2017 and is now projected to save $2.5 billion in drug spending for public employees between 2017 and 2022, according to NASHP. Several other states have followed New Jersey’s lead, with Maryland approving legislation to conduct reverse auctions for PBM procurement in 2020 and the New Hampshire State Senate passing similar legislation (however, the House suspended consideration of the bill in late June 2020).
Half of New Jersey adults experienced problems affording healthcare in the past year and three-fourths worry about affording it in the future, according to the latest Consumer Healthcare Experience State Survey by the Healthcare Value Hub. In a press conference consumer advocates from New Jersey, a patient facing high drug costs, U.S. Senator Cory Booker and New Jersey Assemblyman John McKeon all spoke on the issues of high drug costs facing their communities and constituents. Assemblyman McKeon has sponsored a bill to create a Prescription Drug Affordability Review Board, reports New Jersey 101.5, to meet every six weeks, evaluate drug prices and set limits on how much payers pay for high-cost prescription medications – a policy that received widespread bipartisan support in the Hub’s New Jersey survey.
Despite state and federal requirements that health plans must cover a wide range of costs related to COVID-19 testing and care, New Jersey hospitals say they aren’t being properly paid, reports NJ Spotlight. Thirty acute care facilities in the state reported that more than 1,000 claims related to COVID-19 patients were denied by various health insurance companies between March and the end of June, according to the New Jersey Hospital Association. In half of the cases, the company questioned the medical necessity of the treatment. One hospital alone reported nearly 1,500 denials related to testing services, regardless of the requirements that these services be covered.
A new New Jersey law imposes a 2.5 percent tax on health insurance companies in order to help subsidize individual marketplace premiums, reports NJ.com. The Department of Banking and Insurance will levy the tax based on the amount of money insurance companies collect in premiums. The proceeds – estimated at about $200 million – will be deposited into the Health Insurance Affordability Fund and used to subsidize the cost of insurance for people who earn no more than four times the federal poverty level. An estimated $77 million of the tax money will bolster the state’s existing reinsurance program to cover high-cost claims and lower premium costs in the individual market.
New Jersey teachers will participate in a reformed health benefits system that supporters say is designed to save taxpayers hundreds of millions of dollars, reduce the cost for educators and protect the quality of their healthcare, reports NJ Spotlight. The new law seeks to reduce taxpayer costs for teacher benefits by at least $300 million by reducing the number of health plans options and shifting from an employee-contribution system tied to premium price to one linked to earnings. Teachers will have access to three plans in which premium costs are tied to salary.
A study published in the American Journal of Accountable Care found that New Jersey's DSRIP program was successful in catalyzing many aspects of hospital industry transformation toward data-driven population health management. Specifically, hospital capacity for collection of data to fulfill DSRIP reporting requirements increased, data exchanges with outpatients partners facilitated use of rapid-cycle evaluation tools and the value of data sharing for improving quality of care and population health was perceived more positively over time. These findings may help inform future initiatives in value-based provider care in the Medicaid delivery system.
A new law in New Jersey extends the time period for which individuals can receive coverage and providers can bill for services using telemedicine and telehealth for 90 days following the end of the COVID-19 public health emergency and the state of emergency. Included in the law are telehealth and telemedicine services delivered under the Medicaid and NJ FamilyCare programs.
New Jersey’s hospitals and healthcare professionals responding to the coronavirus are now largely protected from legal liability if a patient is injured or dies while under their care during the current pandemic crisis, reports NJ Spotlight. The new law, retroactive to March 9, is designed to ensure that there are no impediments to providing medical treatment to COVID-19 patients, but many lawmakers raised questions about the lack pf public input on the bill, its broad scope of immunity and the impact it could have on communities of color that are suffering disproportionately in the pandemic.
According to NJ Spotlight, New Jersey passed two new laws (A-5916 and A-5918) that respectively authorize the state Department of Health to notify elected officials of fiscal difficulties encountered by hospitals and make hospital reporting requirements more stringent. The goal is to ensure acute-care facilities do not suddenly halt services and leave residents without healthcare in their communities. Concern driving these bills was raised by a March 2019 State Committee of Investigation (SCI) report that spotlighted $157 million in apparently duplicative management and consulting fees paid to third-party companies by CarePoint Health, which owned three Hudson County hospitals.
The New Jersey Department of Banking and Insurance will offer $2 million for health navigators to help enrollees and re-enrollees with the transition from a federally-facilitated exchange to a state-based exchange on a federal platform, and eventually to an autonomous state-based exchange, according to HealthPayerIntelligence. Because the state remained on the federal platform but will facilitate the exchange itself, New Jersey has access to more funding for health navigators since it can use it's own funding, adding over six times the previous amount to the enrollment fund. The state is now responsible for approving qualified health plans, setting up assisters to help with the enrollment process and conducting outreach to the population looking for insurance. It seems likely that the state will remain on the federal platform for a year before transitioning toward complete autonomy from the federal exchange.
The New Jersey Department of Banking and Insurance announced that premiums sold on and off the ACA exchange will increase by an average of 8.7%, according to the Burlington County Times. State officials believe that rising medical costs were largely responsible for the increase, but also point to the reinstatement of a federal tax surcharge that had been suspended in 2019. Had this surcharge not been reinstated, the state's rate increases would have been 2.7% lower. Despite this increase, state officials say that on average, prices remain lower than they were in 2018.
University Hospital in Newark, New Jersey, has partnered with Hitch Health to help patients with appointments for select services to get free rides to and from those appointments via Lyft or medical transport vehicles, if necessary, according to NJ Spotlight. The service was designed to help the overwhelming majority of Newark parients who frequently use its services and for whom getting to the facility is a major challenge. Hitch's system integrates patients' electronic health records, allowing them to identify eligible patients and connect with them in advance, making the service easier for both doctors and patients.
Due to a recently-legislated incremental minimum-wage increase from $8.85 in 2019 to $15 by 2024, some New Jersey workers could lose Medicaid eligibility, according to a report by the Urban Institute. However, the report notes that the number of those who will lose eligibility and coverage will be small relative to the number who will experience a wage increase. Those at risk of losing Medicaid coverage constitute less than 5 percent of all nondisabled, nonelderly adult Medicaid enrollees in the state, and all of those who would lose Medicaid eligibility would remain in the income range allowing them to qualify for subsidized coverage on the marketplace.
Horizon Blue Cross Blue Shield – New Jersey’s largest health insurance company – has developed a software tool that enables prescribers to get quick access to a list of lower-cost drug options tailored to address a patient’s unique needs and definitively covered by their specific prescription drug plan, according to NJ Spotlight. The rising price of prescription drugs has triggered problems for patients and their physicians: high out-of-pocket costs can lead individuals to skip or ration their medications. The pilot, launched in April, has since spread to some 5,000 prescribers, with Horizon hoping to double that usage by the end of 2019.
With the rising costs of healthcare concerning most residents, New Jersey may be surprised to learn it ranks as one of the most affordable when it comes to home healthcare, according to ROI-NJ. Using data from the U.S. Census Bureau, Genworth and the Centers for Medicare and Medicaid Services, SeniorLiving.org released a study describing that New Jersey patients spend nearly 72 percent of their annual household income on care inside the home. This score places New Jersey as 5th in the nation for most affordable home healthcare, while the national median percentage is 91 percent. Demand for home health aides is expected to surge through 2027, rising by 47 percent.
Heart attack patients treated at New Jersey hospitals with low hospital performance scores have a higher chance of having another heart attack or dying of cardiovascular causes than those treated at hospitals with high performance scores, according to NJ Spotlight. The study by Rutgers University, published in the American Journal of Cardiology, found that 3 percent of heart attack patients treated at low-scoring hospitals return to the low-scoring hospitals due to a new heart attack within 30 days. Those admitted to a teaching hospital were 25 percent less likely to be readmitted after a month than those admitted to a non-teaching hospital, and their chances of suffering cardiovascular death after a year were 10 percent lower.
New Jersey has passed a state law creating a state-based health insurance exchange to be funded by a 3.5 percent user fee on premiums, which currently goes to the federal government, according to Medical Daily. New Jersey estimates that the user fee will allow it to collect around $50 million a year to pay for marketing and enrollment fees. This action follows a 2018 law requiring all New Jersey residents to have health coverage or pay a penalty.
An analysis of New Jersey data on Medicare’s mandatory bundling program shows that, while there are noticeable changes in discharge status trends correlated to types of bundled payment programs, more research is needed, according to Yahoo Finance. The recent report by NJHA’s Center for Health Analytics, Research & Transformation compared data for hospitals participating in the Comprehensive Care for Joint Replacement (CJR) bundle, hospitals participating in the Bundled Payment Care for Improvement “Classis” program (BPCI) and hospitals that participated in neither initiative. Results show that since CJR was mandated for 38 New Jersey hospitals in 2016, length of stay for joint replacement patients declined for all the hospital groups; CJR hospitals saw a 19-percentage point decrease in patients discharged to skilled nursing facilities and a 26-percentage point increase in patients discharged to home with home health assistance. Meanwhile, BPCI hospitals saw a large uptick in discharge to home with self-care and a large decrease in discharge to home with health assistance. Hospitals not participating in a bundling initiative, however, saw the greatest change in the increase of patients discharged to home with self-care, from 28 to 46 percent. Though the findings show that CJR bundles worked to reduce length of stay, there is a need for more investigation of whether complex patients who would have previously gone to inpatient rehabilitation are receiving the required services at skilled nursing facilities or outpatient care.
Though many advocates believe New Jersey’s surprise-billing law is working as intended, some doctors claim that they have been forced to take lower payments from insurance carriers, threatening their practices. According to NJ Spotlight, hospitals similarly argue that the law has reduced their leverage in contract negotiations with insurers over in-network payment rates. Signed in 2018, New Jersey’s surprise-billing law required greater disclosure from both insurance companies and providers and ensured that patients weren’t responsible for excess costs.
Creating health equity through public policies is the focus of a new report. The report identifies 13 policy priorities for improving health and well-being in the state, and recommends a comprehensive series of actions to close health gaps, broaden opportunity and ensure that everyone in New Jersey—no matter who they are, where they live or how much money they make—can live the healthiest life possible.
A study by the Health Care Cost Institute at the request of the New Jersey Health Care Quality Institute found that fewer people are being admitted to New Jersey hospitals in recent years, with improvements in medical care and a growth in less-costly outpatient options. However, according to NJSpotlight, with the price of inpatient care escalating by nearly 40 percent over four years, spending on this category continues to climb.
New Jersey has received approval from CMS to implement a five-year reinsurance program that aims to lower individual health plan premiums by 15 percent. The program will operate from 2019 to 2023 and provide $218 million in reinsurance assistance to New Jersey’s individual health plans during the first year of operation. With lower premiums, the state predicts that enrollment in the individual market will rise by 2.7 percent in 2019, 2.6 percent in 2020, and 2.6 percent in 2021.
On May 30, New Jersey became the second state in the nation, after Massachusetts in 2006, to adopt a state-level individual health insurance mandate, according to Politico. The new legislation, the New Jersey Health Insurance Market Preservation Act, will go into effect on Jan. 1, 2019. Revenue collected from New Jersey’s individual mandate penalty will help fund a state-based reinsurance program established under separate legislation also signed into law on May 30.
The New Jersey Health Care Quality Institute (NJHCQI) will serve as Catalyst for Payment Reform's lead New Jersey partner to help facilitate the Scorecard on Payment Reform, which will measure how much and what type of payment reform is happening in New Jersey. Linda Schwimmer, President & CEO of NJHCQI, said the Scorecard will be helpful for several Quality Institute initiatives, including the Maternity Episodes of Care workgroup, which is designing a global episode payment for maternity care in Medicaid. The Scorecard will also provide valuable information for the Quality Institute’s QI Collaborative, which is working on New Jersey’s Transforming Clinical Practice Initiative to help providers prepare for their participation in alternative payment models.
New Jersey hospitals saved $641 million by preventing more than 77,000 adverse events during the past five years, according to NJ.com. The savings were noted in a report by the New Jersey Hospital Association which received $10.3 million through the Affordable Care Act to fund training initiatives to prevent hospital acquired infections, bed sores and other adverse events.
Healthcare advocates will continue to push a bill restricting the practice of so-called ‘surprise’ medical bills in 2017, according to the Press of Atlantic City. The legislation will likely get a hearing in January as stakeholders attempt to finalize how the bill would restrict the practice. Current draft legislation ties out-of-network reimbursements to Medicare rates.
New Jersey hospitals are pushing back against efforts to pass legislation capping the amount that they can charge for involuntary out-of-network services, according to Modern Healthcare. A study commissioned by for-profit hospital operator CarePoint Health estimated that the law would lead to operating losses at 48 percent to 70 percent of hospitals, depending on how high the cap was set. “Hospitals live off the margins from these out-of-network payments,” said the lead author of the study. But other analyses have found that New Jersey has some of the highest hospital rates in the nation. Several states, including California, Connecticut, Florida and New York, have passed legislation to protect patients from surprise bills and require health plans and hospitals to set up an arbitration process to work out any billing issues.
The latest legislative effort to protect consumers from surprise out-of-network charges remains slow to make progress following stakeholder meetings held in August, according to NJ Spotlight. The bill, SB1285, would ensure that patients are given accurate information about what is and is not covered by their insurance. Despite strong support from patient advocates, insurers have voiced concerns about the bill and the binding arbitration process that it contains for resolving disputes.
New Jersey was one of fourteen states recently selected by the Centers for Medicare and Medicaid Services to participate in a five-year program aimed at overhauling the way in which healthcare providers are paid by insurers, according to NJ Spotlight. The Comprehensive Primary Care Plus (CPC+) program builds on an existing initiative in allowing Medicare and participating private insurers to pay providers according to one of two different value-based payment models. The project is expected to impact as many as 20,000 physicians and 3.5 million patients nationwide.
Projects have been launched in New Jersey to improve the integration of behavioral and physical healthcare in publicly financed programs, according to a Health Affairs blog post. Through this process, many stakeholders have come to recognize that one of the most significant barriers to success is the lack of a clear understanding of the state’s licensing rules and financing mechanisms. The Nicholson Foundation commissioned a detailed report with findings and recommendations with respect to improving New Jersey’s regulations on licensure and reimbursement.
The results of a year-long study have detailed the factors driving the high costs associated with the state’s fragmented mental healthcare system, according to the New Jersey Business Journal. This work (which has not yet been published), conducted by Jeffrey Brenner of the Camden Coalition of Healthcare Providers, focused on the interactions between housing security, police interactions, chronic conditions, ER visits, and mental health. This effort is part of a collaboration involving five New Jersey health systems that aims to identify and address shortcomings in the delivery of mental health care.
Controversy surrounding the rollout of Horizon Blue Cross Blue Shield’s tiered OMNIA health plans has continued to grow, leading lawmakers to consider ways of ensuring such networks are designed in a manner that is transparent and evidence-based, according to NJ Spotlight. When the plans debuted, they promised lower out-of-pocket costs to patients through the establishment of two tiers of providers. Although more than 200,000 people have since signed up for the low-cost plans, hospitals excluded from Tier 1 (the lower cost tier) have complained that the selection process was unfair and that such networks will ultimately harm both consumers and their bottom line.
Governor Chris Christie vetoed a bill that would have allowed nonprofit hospitals to keep their tax exemptions in exchange for regular payments to the municipalities in which they reside, according to Modern Healthcare. The bill was drafted after a state tax court pulled Morristown Medical Center’s property tax exemption, saying it operated in many ways like a for-profit business. Hospital supporters worry that the failure to pass similar legislation will lead more municipalities to pursue lawsuits attempting to take property taxes from non-profit hospitals.
A bill intended to prevent costly surprise medical bills is on hold following resistance from the healthcare and insurance industries, according to The Record. Advocates argue that as a result patients will continue to be on the hook for excessive bills.
Jeffrey Brenner and the Camden Coalition of Healthcare Providers analyzed local hospital claims data and discovered that a small percentage of patients were responsible for a substantial proportion of hospital costs, according to this Health Affairs blog post. Building upon this work, New Jersey subsequently launched a Medicaid Accountable Care Organization Demonstration Project — the Camden Coalition of Healthcare Providers, the Healthy Greater Newark ACO, and the Trenton Health Team.
This state profile for New Jersey (PDF) was prepared to assist the state with identifying key issues and opportunities under the Center for Medicare and Medicaid Improvement’s State Innovation Models program. Pulling together information from a wide range of data sources, the profile provides a state-level overview of key healthcare indicators, with comparisons to national averages.