Lowering state health care costs: Trade organization sends recommendations to Murphy
NJBIZ | Vince Calio
Better Choices, Better Care NJ, a health care industry trade group whose leadership includes New Jersey Chamber of Commerce President Tom Bracken and John Harmon, CEO of the African American Chamber of Commerce of New Jersey, has issued a report that includes 15 recommendations to lower the cost of health care in the state.
The effort is being spurred by both uncertainty in Washington and the fact New Jersey has among the highest health care costs in the country.
Recommendations range from prohibiting small employers from creating self-funded health care plans to requiring out-of-network specialists to participate in the same network in which the hospitals they are practicing.
The report is being sent to Gov.-elect Phil Murphy and members of the state Legislature, and has five distinct goals in mind: increasing access to affordable, quality health care; keeping health insurance costs affordable; reforming Medicaid; and promoting value-based health care delivery.
A full copy of the report can be found here.
“This organization launched with the goal of engaging and educating the public, employers and elected representatives on how to change health care for the better,” said a Better Choices Better Care spokesperson. “The past year, however, has shown us that we can no longer remain on the sidelines. Health care has been a topic of intense national debate, but that debate has not yielded any significant positive policy changes or done much to lower the cost of care. With this plan, we are presenting 15 measures that we believe will actually lower costs, while providing better quality health care.”
The 15 recommendations are:
- That New Jersey adopt a standard that imposes requirements that providers offering services at hospitals participate in the same networks as such hospitals, and that providers and facilities publicly disclose the networks in which they participate.
- That the state create its own individual mandate for health insurance should the federal government abolish the individual mandate under the Affordable Care Act or work on ways to incentivize the business community to fill that void.
- Amend state law so that health care related state boards are not self-governed. Instead, require that at least half of any of these individual board’s memberships be comprised of individuals whose professions are not directly regulated by that board, and who would be representative of consumers that utilize the services overseen by the board. In addition, the state should examine and issue a report on best practices utilized by other states for health care related state boards.
- Amend state law (through the Division of Consumer Affairs) to expand the kinds of services nurses, physician assistants or therapists can perform without supervision and in general.
- Revise state law to prohibit and eliminate self-funded arrangements in the small employer market. This, in turn, will reduce costs for small business owners and their employees. Reforms, however, should ensure that small employers’ ability to join a Multiple Employer Welfare Arrangement (MEWA) or other alternative health insurance coverage model would not be impeded.
- Provide Medicaid organizations and commercial insurers access to the state’s Prescription Monitoring Program, thereby limiting the number of opioids and other such drugs that could be abused or sold illegally.
- Revise state law to allow for the electronic delivery of insurance materials and provide for such delivery as the default method, while allowing consumers to opt in to the delivery of paper materials if they wish.
- Transition behavioral health and substance use disorder services to the Medicaid Managed Care Program in order to provide greater opportunity to implement coordination of health care services for consumers.
- Work with the Center for Medicare and Medicaid Services (CMS) to request flexibility to implement a comprehensive blending of Medicare and Medicaid funding and aligned program administration.
- Prepare a contingency plan of New Jersey-based solutions should Washington lawmakers and the president mandate reductions in Medicaid coverage and funding.
- Examine ways to ensure there is transparency across all divisions of health care, with a specific focus on how consumer products are priced.
- Require the state’s Department of Banking and Insurance (DOBI) to more strictly enforce measures already in place to ensure independent utilization review organizations (IUROs) are complying with the terms of their contract. Moreover, ensure that IURO’s are using applicable clinical protocols and/or practice guidelines developed or used by the Division of Medical Assistance and Health Services and carriers.
- Pursue appropriate federal waivers and legislative and regulatory activities in order to accelerate the implementation of innovation service delivery and patient-centered care models.
- Revise state rules to allow insurers to include expenditures made toward quality improvement programs, patient-centered care initiatives, and fraud, waste and abuse detection and deterrence efforts as medical costs in their calculations. New Jersey law should also allow for medical loss ratio (MLR) calculations over a three-year period, instead of the current one-year limit. Before doing so, however, an economic impact study should be completed to look at the overall impact to consumers, businesses and insurers of making such changes.
- Undertake efforts to promote, market and facilitate enrollment in the individual market. This could include state-contracted health care facilitators to link consumers with health insurance plans, state-sponsored advertising and marketing, and the formation of a public/private partnership for the promotion of the individual market. The state should also consider creating its own exchange.
“We strongly believe these actions will make health care in New Jersey less costly, of higher quality and more accessible,” according to the report. “As we head into 2018 and beyond, Better Choices, Better Care NJ will be actively engaged in ensuring the ideas outlined in this document are discussed, acted upon and implemented.”