September 26, 2018 by Michael L. Diamond

NJ upends how doctors get paid, so why do vaccination, C-section rates lag?

New Jersey doctors and hospitals are increasingly paid based on quality, but patients aren't getting the care they need to prevent illnesses and bigger bills down the road, a report released Tuesday said.

Despite incentives to promote good health, the report by Catalyst for Payment Reform found New Jersey has fewer vaccinations, more C-section deliveries and a tougher time controlling patients' high blood pressure, the report said.

"I’m embarrassed about all these results," said Dr. Jamie Reedy, senior vice president of population health and quality at Summit Medical Group. "As a state, we should be ashamed, and we should be working harder to improve these results.”

Reedy was among the panelists at the Trenton Country Club at an event sponsored by the New Jersey Health Care Quality Institute, a research group.

The scorecard assessed New Jersey's progress eight years after the Affordable Care Act, commonly known as Obamacare, went into effect in a bid to slow down the rising cost of health care, which now accounts for nearly 18 percent of the U.S. economy.

Catalyst represents employers seeking to lower their health care costs. It has advocated a shift from the traditional "fee-for-service" model in which providers are paid for each service they provide to "value-based" in which providers are rewarded for their patients' outcome.

It found 52 percent of payments in 2016 from three major commercial insurers in New Jersey were considered value based. By comparison, just 11 percent of payments nationwide in 2013 were value based, said Andrea Caballero, Catalyst's program director.

In short, doctors and hospitals get extra money for ensuring their patients meet certain targets like controlling high blood pressure and diabetes. They aren't penalized if they don't meet them.

In some cases, New Jersey has made strides; 88 percent of people with diabetes, for example, received a blood sugar test, Caballero said.

But in other key indicators, New Jersey falls short:

  • About 60 percent of children ages 1½ to 3 received all recommended doses of seven key vaccines, compared with 71 percent nationwide.
  • Nearly 30 percent of women with low-risk pregnancies get C-sections anyway, compared with a target rate of 23 percent.
  • Some 52 percent of people with hypertension had adequately controlled blood pressure, compared with 54 percent nationwide.
  • And 84 percent of adults said they received information about how to recover at home, compared with more than 87 percent nationwide.

Tying at least some of the payment model to value is a good start, but "we need to go faster," Linda Schwimmer, president and chief executive officer of the New Jersey Health Care Quality Institute said. "By putting an emphasis on it and showing that we're not doing well enough on quality outcomes, that will help. We need to go faster."

 

Dr. Jamie Reedy of Summit Medical Group, left, discusses ways to improve health care in New Jersey.
(Photo: Michael L. Diamond)

Flipping around the payment system alone might not be enough to improve the state's collective health.

Health systems still need to invest in technology to help them coordinate care among their doctors. They need to hire social workers and case managers to stay connected with patients.

And primary care doctors still receive just 20 percent of reimbursements even though they are on the front line of the new health care model. Specialists receive 80 percent, Caballero said.

"I do think payment reform can impact these results, but it has to be adequate payment to support the work," said Reedy, from Summit Medical Group.

Read more about value-based health care in NJ