Program Area: Healthcare
Improving Healthcare for Vulnerable Populations
In 2002, The Nicholson Foundation began working in New Jersey’s urban areas to improve the lives of vulnerable populations, principally through enhancing the design, delivery, and effectiveness of human services. As this work progressed, the Foundation realized that it could not maximize the success of existing program areas—at-risk youth, offender reentry, and fragile families—without also addressing access to healthcare and the organization and delivery of healthcare services.
Data indicate that New Jersey’s healthcare system results in high cost and only average quality, with little association between costs and outcomes. Relative to other states, New Jersey falls in the middle on many indicators, such as access to care, prevention and treatment quality, and healthcare equity, but it ranks a poor 48th on cost and avoidable hospital use. Currently, 1.3 million of the State’s residents (15% of the non-elderly population) are uninsured. In response to these realities, staff at The Nicholson Foundation began to look for opportunities to foster healthcare initiatives that could benefit vulnerable residents of New Jersey’s urban areas. They were particularly interested in promising projects that could be even more successful or achieve goals faster with the Foundation’s support.
Since 2009, The Nicholson Foundation has provided grants and technical assistance and has collaborated with numerous stakeholders to support the development and implementation of innovative, sustainable healthcare programs. These programs, which are aimed at improving the physical and behavioral health of New Jersey’s vulnerable residents and reducing the cost of providing healthcare, focus on several key themes.
One major theme is accelerating and improving healthcare reform efforts in New Jersey and its surrounding regions. Nicholson is integrating the principles of national healthcare reform, such as care coordination, data collection and analysis, enhancement of primary care services, and linking of funding to outcomes, into its healthcare grants and technical assistance activities. For example, one Foundation grantee, the Camden Coalition of Healthcare Providers, is using these principles to improve care delivery and health outcomes for at-risk Camden residents who have very high healthcare costs. The Camden Coalition model, which has received national attention for its groundbreaking approach, is being replicated by similar Nicholson-supported healthcare coalitions in Newark and Trenton.
With Nicholson support, all three coalitions also are preparing to become Medicaid Accountable Care Organizations (ACOs) under the three-year Medicaid ACO Demonstration Program that became law in New Jersey in August 2011. In this program, providers and institutions that meet certain criteria collaborate with the State’s Medicaid Division and with Medicaid managed care companies to improve quality and reduce costs of all Medicaid recipients in a region. The ACO can retain a share of any savings, a feature called gainsharing. In an extension of this work, the Foundation has partnered with New Jersey healthcare stakeholders to educate their organizations about the Medicaid ACO program and to help them prepare to participate in it.
Integrating behavioral health (mental health and addiction) into primary care and strengthening behavioral health treatment services is a second key theme in the Foundation’s healthcare activities. Many people with mental health and/or substance abuse disorders remain undiagnosed or untreated, and efforts to integrate physical and behavioral healthcare have been shown to improve overall health outcomes as well as reduce care costs. To address this issue, the Foundation is funding an integrated care model in two community health centers. It also has helped establish regional collaboratives to improve the quality of addiction services so that more New Jersey residents remain in and complete treatment. A third project builds on evidence that employment is the best predictor of long-term recovery from addiction for individuals leaving prison and those in community-based substance abuse treatment. This project has helped several hundred people in the target population find jobs and remain employed. It also has enabled them to obtain employer-sponsored health insurance that helps pay for substance abuse and other treatment.
Other Foundation projects have pursued a variety of approaches aimed at improving the quality and delivery of healthcare services, reducing the cost of care, and improving the health of New Jersey residents who are not well served by the healthcare delivery system. Projects have helped establish neighborhood healthcare problem-solving partnerships, expanded the use of chronic disease self-management programs, and provided health literacy training to providers. Foundation initiatives also have engaged a variety of organizations in promoting the adoption of health information technologies. In addition, projects have explored ways to expand access to and use of prenatal care services.
Multiple stakeholders—healthcare providers, government agencies, Medicaid managed-care companies, community-based organizations, individuals, and Nicholson and other foundations—are working together to improve the organization and delivery of healthcare services in New Jersey. These efforts are already bearing fruit, perhaps nowhere more so than in the Medicaid ACO Demonstration Program. By passing the ACO legislation, New Jersey is now leading the nation in healthcare reform for vulnerable populations. There is still much work to be done, but emerging and ongoing efforts are already supporting sustainable systems changes that are resulting in reduced costs and improved health for many New Jersey residents.
© 2011, The Nicholson Foundation
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