We have all sustained an injury or illness at one time in our life, but when the moment strikes, not all of us are fortunate enough to have access to quality health care services that we can afford.
In 2010, President Barack Obama sought to tackle this issue head-on through the Affordable Care Act. While Congress continues to bicker over a law that is now six years old, the rest of the country has moved on because they have seen the benefits firsthand. Over 20 million Americans are now insured thanks to “Obamacare.”
Moreover, the ACA has done more than just provide insurance to those in need. It has changed the conversation on how health insurance is provided.
Nowhere is this discussion more important than in New Jersey. For decades, New Jersey has maintained a “fee-for-service” system that was based on the number of patients doctors and hospitals were able to see, forcing them to spend less quality time with each one and resulting in New Jersey having the second highest health care costs in the country.
The ACA, however, is pushing states away from this method by encouraging a system known as value based or patient centered care where incentives are given to doctors who work collaboratively with patients and providers to determine what is best for the patient. The focus is on keeping people healthy, not on simply conducting more tests. As a result, health care premiums go down.
I have embraced this approach to bringing down health care costs here in New Jersey.
I recently introduced legislation (A318) that would establish a patient-centered medical home program in our state to enhance care coordination and promote high-quality, cost-effective care by engaging patients and their primary care providers. This model may attract new providers to New Jersey because it is effective, sustainable, replicable in small communities, and will help slow the continuing escalation of health care costs while improving outcomes.
However, we continue to struggle in New Jersey with rising health insurance premiums and unaffordable deductibles. That is why innovation and an aggressive recalibration of the health care marketplace are needed.
In 2014 for instance, our state’s largest health insurer, Horizon Blue Cross Blue Shield, partnered with 51 specialists to improve patients’ outcomes, reduce readmissions, and lower the cost of health care. This effort led to reductions in readmissions: 100 percent fewer for knee arthroscopy, 37 percent fewer for hip replacement, 22 percent fewer for knee replacement, and a 32 percent reduction in unnecessary C-section deliveries.
Not only that, but these reduced admissions meant over $3 million in savings that could then be passed back to the consumers.
In 2015 Horizon, Aetna and several other health insurance providers announced they would expand their value-based care programs. Since joining the market in 2016, 234,000 individuals have signed up for Horizon’s value-based OMNIA, over 41,000 of whom were previously without health care. This is directly linked to the ability of tiered health insurance plans to control costs without compromising quality of care.
Unfortunately, there have been efforts of late to try to stop the progress made by value-based care plans. That is why I introduced another piece of legislation (A3266), which provides that a contract between a participating health care provider and a carrier that offers a managed care plan shall not contain any provision, commonly referred to as an “anti-tiering clause,” that prohibits or limits a carrier’s right to use a tiered-network plan.
While transparency and patient accountability are essential in the development of tiered networks, calls to prohibit their use will only stymie the progress made toward more affordable and accessible health care.
Many of us are fortunate enough to have access to quality, affordable health care. But for too many others, this still remains elusive. We are the wealthiest nation in the world. That means everyone should be able to go about their daily lives without fear that the next injury or illness could bankrupt them.