Quality, affordable health care: The next step

Quality, affordable health care: The next step

It was a bruising, often vitriolic, battle, but health insurance reform is now the law of the land. Some changes enacted — the ability of young adults up to 26 years of age to continue coverage under their parents’ policies and the elimination of pre-existing condition denials for children, for example — become effective immediately, while others, like the development of health insurance exchanges, will take several years to become reality.

The changes mandated by this bill will have many implications for our system of health care. It behooves us now to rationally analyze those implications and together devise ways of dealing with them.

The addition of tens of millions of people to the rolls of the insured — one of the primary goals and victories of this legislation — will mean that the health-care system must gear up to accommodate them. In New Jersey, it is estimated that almost a million people will eventually receive coverage because of this act. How will care be delivered?

Since last fall, the Healthcare Foundation of New Jersey has been working with Steve Adubato, Jr. and his Caucus Education Corporation to convene conversations with key informants in the healthcare field in this community. We have held two spirited conversations with the leadership of many area hospitals, city and state legislators and government administrators, and service delivery agencies to determine how as a community we should be prioritizing our human and financial resources to strengthen community health-care delivery.

Four important areas were identified by participants for further exploration: the stabilization/increase in charity care reimbursements; increasing access to primary care; solving the looming nursing shortage; and installing a network of electronic medical records to improve the quality and speed of diagnosis and care.

It is well recognized in the health-care community that many of the poor and uninsured use emergency rooms as their primary avenue for health care. Some arrive at emergency rooms with disease that is advanced because they have waited to receive care. But emergency rooms are also used for primary care because — especially in our inner cities — few primary care physicians are available to treat patients who need them. This is a complicated and expensive problem with more than one possible solution. Solve it we must.

We must focus on providing young medical students and residents with incentives for becoming primary care physicians; provide reimbursement for primary care that is delivered by qualified nurse practitioners appropriately supervised by physicians; open more neighborhood clinics that deliver primary care, whether in pharmacies, community centers, schools, or other venues; and address the shortage of nurses and nursing faculty to make this possible.

The looming shortage of nurses is potentially so severe that the Robert Wood Johnson Foundation, together with local partners, has devoted approximately $13.5 million to develop solutions at nine New Jersey nursing schools. Joining with the New Jersey Chamber of Commerce Foundation, they have formed the New Jersey Nursing Initiative to transform nurse education by providing a faculty preparation program to attract nurses to pursue graduate studies and join the faculty of the state’s nursing schools, so that more slots can be opened for nursing students. They estimate that in five years, based on attrition and population growth in our state, 18,734 RNs will be needed just to maintain the current nursing supply. In 2009, however, only 2,951 students graduated from among the 43 nursing schools in New Jersey, more than 50 percent of which had to limit student enrollment because of lack of faculty.

Installation of electronic medical record systems has been a particular challenge because of the extraordinary costs involved, both for hospitals and physicians in solo or small group practices. It was announced on March 25, however, that New Jersey will be the recipient of $11.4 million in federal funds over the next four years to finance four electronic health records projects designed to allow hospitals, doctors, and health insurance companies to share records in real time over secure networks. Although the details are not known at this writing, it sounds like a big step in the right direction for our state.

Since its founding in 1996, the Healthcare Foundation of New Jersey has been working to improve access to quality health care for the most vulnerable populations in both the Jewish community of MetroWest and those who live in the greater Newark area. Over $85 million in grants have been awarded to accomplish that mission.

We have seeded projects in the Jewish community to support the frail elderly, people with special needs, synagogue members with counseling needs, and victims of domestic violence.

We have funded school-based health centers and early childhood mental health initiatives; underwritten medications for indigent patients who cannot afford them upon discharge from the hospital; and supported the installation of EMR technology in emergency vehicles and electronic medical record systems at some of the area hospitals.

There is much work to be done to ensure that all of us have access to quality, affordable health care. Health insurance reform is a first step. We urge everyone to work together to reach the ultimate goal.

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