Increasing Access to Affordable, Quality Health Care
New Jersey’s individual health care market is part of the federal exchange. Unfortunately the individual market is risky and unreliable. People who buy insurance through the individual health are buying it because they do not receive insurance from their employer or government sponsored program. New Jersey’s individual market has not been attainable from past experience. This is because of not knowing how many people will buy insurance through the individual market, not enough companies being a part of the market and not enough plans being offered; and constant changes being enforced on the individual market.
The recent changes made on the ACA have impacted how many people use the individual market now. BCBCNJ hopes to move forward and make the individual market more desirable.
They want to create a plan of action for NJ. They proposed that NJ should take responsibility and promote and facilitate enrollment in the individual market. They’ve laid out different ways NJ can do this: state-contracted health care facilitators, state-sponsored advertising and marketing, and forming a public/private partnership to promote the individual market.
Keeping Health Insurance Costs From Skyrocketing
Medical bills are probably the biggest headache when it comes to health care. Medical bills can be a large amount if the care the individual received was performed by an out of network provider. Usually, providers that contract with an insurance company agree to accept “a predetermined amount for the delivery of specific healthcare services and are prohibited from billing the patient for anything other than the patients cost-sharing requirements.” Unfortunately, out of network providers do not have to follow the same regulations and are able to bill as much as they want.
That cost of pharmaceutical drugs has sky rocketed and many people are struggling to afford them. The cost has risen 10% over the year in 2016. PhRMA can higher cost with no reason at all. BCBCNJ proposes that New Jersey examines ways to make certain that there is translucency across all divisions of health care, especially on how health care products are priced.
This part of the article also goes into how New Jersey has no law that “prevents any of its health care state boards from being self-governed.” These boards are made up of members who push for regulations and standards that are biased to their favorable industry. BCBCNJ proposes that the state amends the law so that health care state boards are not self-governed.
Other important topics that they go into great detail of are reducing health care costs by allowing nurses and clinicians to perform services they are qualified to perform, ensuring small businesses are not taken advantage of by bad neighbor insurance companies, preventing fraud and combating the opioid crisis through greater access to prescription drug data, and bringing laws to the modern time by eliminating unnecessary and costly paper material.
New Jersey has been a significant state in managing comprehensive services for Medicaid enrollees. A comprehensive service is where “health care for an individual is organized, coordinated and managed within their health care plan.” This type of managed care coordination is proven to lead to more cost effective and time efficient health care, and most importantly, to better outcomes. Unfortunately behavioral health and substance abuse disorder treatment services are unmanaged and a little sloppy.
Rutgers Biomedical and Health Sciences Center have documented that fifty percent of Medicaid recipients have a mental health diagnosis. Of that ninety five percent, the one percent highest cost members almost always have a behavioral health or substance use disorder diagnosis. These past couple years, opioid-related inpatient stays increased by sixty four percent, and opioid-related emergency room visits increased by ninety nine percent.
BCBCNJ’s main goal here is to increase access to behavioral health services and reduced medical costs. Their proposal is to increase access to care and reduce Medicaid costs by transitioning behavioral health and substance use disorder services to the Medicaid Managed Care Program.
Promoting Patient Centered Care
BCBCNJ believes that health care systems should move away from the traditional fee-for-service model of health care payment to fee-for-value. The focus is on keeping patients healthy and happy with quality health care.
Their proposal is that The State should find legal ways to implement patient centered care models.
BCBCNJ goes into great detail on how to get NJ moving toward patient centered care including providing incentives for health insurers to pay for quality of services instead of quantity.
If you have time, you should really read over the entire article Better Choices Better Care New Jersey provides. Like Cosmo Insurance Agency, they are passionate about providing quality and affordable health care to all Americans. I think we can all agree that there is a lot of work to do to progress towards a better health care model. BCBCNJ provides extensive research and analysis and ways to start moving toward a better health care system.