healthcare feature

University Hospital names Elnahal its CEO; health commissioner will leave Murphy administration

The University Hospital board of directors voted Wednesday afternoon to approve state Department of Health Commissioner Dr. Shereef Elnahal as the Newark medical center’s new CEO and president.

Elnahal was one of at least three finalists and was expected to be named, several sources previously told ROI-NJ.

Sources familiar with Elnahal’s thinking but who were not authorized to speak publicly said he was interested in the Newark-based position — after being approached to apply — because of the amount of time he was already spending on the hospital.

University Hospital’s board voted to install Elnahal, who will replace interim CEO Judith Persichilli, on July 15.

In a statement Wednesday, Elnahal said he was excited for the new role.

“It’s been my greatest honor to serve in the (Gov. Phil) Murphy administration,” he said.

During my tenure, we accomplished much to advance the governor’s agenda for social justice in health: restoring funding for women’s health care to reach over 10,000 additional women, serving thousands of women of color to target black infant and maternal mortality, setting the foundation for the state’s public health approach to the opioid epidemic, improving the state’s psychiatric hospitals, helping to preserve the gains New Jersey has made with the Affordable Care Act and overseeing the largest expansion of the state’s medical marijuana program in its history.”

Elnahal said he intends to revive the community’s trust in the hospital, which was recently damaged by its handling of virus outbreaks and infections.

Gov. Phil Murphy, who appointed Elnahal to the commissioner role, expressed his support for the decision.

University Hospital
University Hospital in Newark.

“It is bittersweet to see Dr. Elnahal leave the Department of Health for his new role as the CEO of University Hospital,” he said in a statement.

“Over the past year and a half, Shereef has proven again and again that he was the perfect choice for our administration’s first commissioner of health. Whether it was guiding the state through a troubling viral outbreak, working with the first lady to tackle maternal health disparities or ensuring that more patients than ever before will have access to medical marijuana, he has made us proud. While I am sad to see him leave the Department of Health, I am immensely happy to see him continue his service to the people of New Jersey and some of our most underserved residents at University Hospital.”

University Hospital board Chair Tanya Freeman thanked Persichilli for her work and welcomed Elnahal.

“We are confident that his strong leadership and creativity will be the driving force necessary to continue the momentum we have begun to develop over the last several months as we craft a strategic plan for the future,” she said. “The board is also deeply grateful to the selfless work of Judy Persichilli during this transition period. She has brought a culture of transparency and gratitude to the leadership team that is felt by our patients, employees, and community.”

Health Care Quality Institute CEO Linda Schwimmer also expressed her support for the choice.

“I’ve worked with Dr. Elnahal since we served as co-chairs of Gov. Murphy’s health transition team,” she said in a statement.

“I’ve seen firsthand his incredible energy and commitment to quality, safety and equity in health care. He’s a strong and compassionate leader who will be a trusted partner for the Newark community. Dr. Elnahal’s experience at the (Veterans Administration) and New Jersey Department of Health will help him create and execute a vision for the future of University Hospital and its role as a patient-centered research and teaching hospital. It’s an inspired selection. The state was also lucky to have someone of Judy Persichilli’s caliber and experience willing to step in and take the helm during such a challenging time in the history of University Hospital.”

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Humanizing health care is key to messaging, Montclair’s OptiBrand Rx says

Explaining that it takes a decade and millions of dollars to bring a drug to market doesn’t evoke sympathy from an irate public.

Explaining how drugs save lives does.

And it’s helped Montclair-based OptiBrand Rx, a global consulting company, find a niche in the life sciences industry.

OptiBrand Rx is helping pharmaceutical companies change from traditional brand marketing to a more targeted approach.

The stories of how those drugs have saved lives, targeting whom they are meant for through advertising and discussing the value proposition in relation to a patient’s life are some of the ways OptiBrand Rx is helping the industry change its messaging to a value proposition approach.

Dominick Cirigliano, OptiBrand’s executive vice president of strategic research, said the idea is catching on.

“We’ve doubled the size of our business in the last year and a half,” he said.

Payor and insurance companies have the pertinent information — the costs of each disease or problem — and weighing that overall cost with the cost of the new medication is where the value proposition comes from.

The strategy of educating clients and honing in on a message — rather than hoping for mass-market success — has been a successful service line the company began offering in 2012.

“We found out very quickly people valued our thinking quite a bit,” Cirigliano said.

The company does about $20 million in revenues annually and has grown from just two to 40 employees.

It has projected another 30% growth this year — but Cirigliano said the company already is on pace to beat that expectation.

The company has figured out how to bridge the gap between the scientists who create the drugs and the business minds who run the pharma companies and focus on selling and mass-producing it.

“A lot of these pharma companies, they’re scientists,” Cirigliano said. “They’ve invented these drugs, they’ve dedicated their lives to bringing them to market, so they’re not communicators, necessarily.”

Which is why there isn’t enough education around the products and who they are best for, Cirigiliano said.

“That’s what we help do,” he said. “We help make sure it’s clear to physicians, clear to patients … even pharmacists and payors.”

The pressure on the pharma industry due to a public outcry over rising drug costs, paired with the spotlight on sales and advertising from court cases over the opioid crisis, also has changed the spending habits of the drug companies, Cirigliano said.

Cirigliano said the biggest thing is that pharma has backed off spending on ads and promotion, and is spending more time on communicating how to use products better.

“It’s a big change,” he said. “The old days of merchandising and acting more as a traditional consumer goods company has stopped.”

In addition, the science has improved.

Drugs are more efficacious and have fewer side effects, and are able to target specific diseases, Cirigliano said.

This means that they are successful in keeping people alive longer, which increases their value, which is why costs go up, he said.

The goal is to show the value proposition, the end benefit for the patient and the cost savings, Cirigliano said.

Especially since drugs affect different people differently.

“There’s always going to be some individualities to taking medication,” Cirigliano said.

That includes patients who are noncompliant. If a patient doesn’t feel the symptoms, they may stop taking medication, and that could complicate matters and land them in a hospital — which then increases their cost of care, he said.

One thing OptiBrand can’t do is figure out how patients can access cheaper drugs.

The problem, in Cirigliano’s opinion, is that cheaper drugs will be less effective than the brand-name drugs, so the patient will get what they pay for.

“We’re not an education company, we’re not out there to educate the general public,” he said.

“It’s really our job to help the pharmaceutical companies with what is the market perception, what are the things they’re going to have to consider when telling the story about their products.”

The company also focuses on over-the-counter drugs, which pose their own problems.

“The challenge is people are more educated, there’s a lot more information available thanks to the internet — (and) not all of it is good information,” he said. “So, trying to educate people is less physician- or practitioner-oriented, it’s a little more weighted towards consumers.

“So, how do you talk to consumers so they understand the different options and they can make a more educated decision? You have to make sure you’re clear and you have to be honest. If you fool somebody once and they use your product and they don’t have a good experience with it, they’re never going to buy it again.

“So, it’s important that the right people are using the right product at the right time.”

But the company hasn’t always been focused on pharmaceuticals; it has also had clients in the consumer brand space. A look at its website reveals an expansive list of top brands such as Starbucks, M&Ms, McDonald’s, Burger King, GM, Mercedes-Benz and Gerber.

“It’s a small part of our business, but it’s something we get requests (for) and it’s good to have diversity,” he said.

The company moved its global headquarters from New York City to Montclair in 2009, after which it has opened satellite offices in Florida and Quebec, along with NYC.

“Most of our big clients are here in New Jersey,” Cirigliano said. “Obviously, it’s a pharma hotbed. Also, a lot of the companies headquartered in New York had left.”

Being outside of New Jersey is important, too.

“A lot of that is the research, we do a lot of global work, so we have a presence in Montreal and Europe … we do a lot of work out of Switzerland,” Cirigliano said.

Cirigliano said the company also is hoping to expand to the Midwest and West Coast, and sees the pharmaceutical industry as the place to be.

“We’re not here to make sure our clients make the most money, we are here to make sure the patients benefit from the product properly,” he said. “When that happens, everyone wins, including the pharma companies.

“That’s been the change over the years is recognizing the fact that being clear and specific about using the product is much more beneficial than traditional marketing methods of blasting it out.”

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Murphy signs law requiring insurers to cover mental health as they do physical health

Gov. Phil Murphy signed a mental health parity law Thursday to help strengthen existing federal and state laws that require health insurers to cover mental health in the same way they cover physical health.

The bill, sponsored by 49 legislators, including Assembly Speaker Craig Coughlin (D-Woodbridge), Senate Minority Leader Tom Kean (R-Westfield) and Sen. Joseph Vitale (D-Woodbridge), changes how behavioral health is defined, and allows the state greater authority in enforcing the law and fining insurers who are found in violation.

Department of Banking and Insurance Commissioner Marlene Caride said the new law will help the department hold insurers accountable.

“Carriers must demonstrate to the department compliance with the mental health parity laws,” she said. “Digital oversight … will provide clarity to consumers and allow the department to gain the information needed for compliance.”

The changes redefine behavioral health to ensure greater compliance with the 2008 federal law sponsored by a former Democratic Congressman from Rhode Island, and current Brigantine resident, Patrick Kennedy.

Behavioral health was previously defined as “a mental or nervous condition that is caused by a biological disorder of the brain and results in a clinically significant or psychological syndrome or pattern that substantially limits the functioning of the person with the illness, including but not limited to, schizophrenia, schizoaffective disorder, major depressive disorder, bipolar disorder, paranoia and other psychotic disorders, obsessive compulsive disorder, panic disorder and pervasive developmental disorder or autism” to “procedures or services rendered by a health care provider or health care facility for the treatment of mental illness, emotional disorders, pervasive developmental disorder and autism, or drug or alcohol abuse.”

Sue Devlin, executive director at Comprehensive Behavioral Healthcare in Hackensack, said as much in a statement.

“This is the exact reason the Mental Health Parity and Addiction Equity Act of 2008 was passed, but insurance companies still have denied coverage for patients with conditions ranging from seasonal depression to bipolar disorder and schizophrenia, denying access to top-rated prescription drugs, and only paid for generic or less-proven medications,” she said.

“I know, from the 4,000 consumers we serve every year at CBH Care, how important access to therapy sessions and the proper medications — rather than the cheapest ones — can be in managing mental health disorders and preventing mental health crises.”

Murphy gave a shout-out to Kennedy at the bill signing event Thursday, and reinforced that the new law is a supplement to existing law.

“Mental health parity is … already part of our federal and state law,” he said. “For too many individuals, true parity still does not fully exist; unless we take the steps to close gaps in access, individuals with mental health issues will continue to fall through those gaps.”

That is true whether individuals have health care coverage through the federal (and eventually state-based) health care marketplace, or through their employers, Murphy said.

The New Jersey Association of Mental Health and Addiction Agencies said the governor signing the bill signaled yet another commitment to helping fight the opioid epidemic.

“The governor has shown us repeatedly how dedicated he is not only to health care for all, but specifically to fighting the opioid epidemic,” CEO and President Debra Wentz said.

“The parity law provides new standards by which to measure the success of those efforts, as well as the progress in expanding access to all mental health and substance use treatment and services.”

Caride said the department will be holding public sessions throughout the state to provide information to providers, advocates and families on how the new law will be applied.

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A new way to pay: Ostrowsky fighting costs of chronic illnesses

Like any health care executive, RWJBarnabas Health CEO Barry Ostrowsky knows that caring for chronic illness takes the most resources and costs the most money.

That’s why he’s continuing his pitch to change the way such patients are cared for. And, more importantly, how it is paid for.

Ostrowsky said he is trying to change all this through his relationship with Horizon Blue Cross Blue Shield of New Jersey. The two organizations, he said, are focusing their efforts on figuring out how to reimburse for non-clinical care that keeps a patient away from costly hospital visits.

In a recent interview with ROI-NJ, Ostrowsky detailed his side of the focus on social determinants, and how things have developed in the past year.

“There still is this lag by conventional reimbursement programs in terms of paying for these social programs,” Ostrowsky said. 

“And the problem is, I’m not going to be able to point to a data point in the next fiscal quarter that says, ‘See, we did this and that’s why we’re making a lot of money.’ That doesn’t happen.”

Ostrowsky said the payment system for the chronically ill is reversed, with those responsible for paying — insurance companies and the federal government — doing so after the onset of the illness.

Ostrowsky is pushing for money up front, which would then go to preventing an issue, and, ultimately, he said, resulting in less money spent and healthier people.

Because chronically ill patients utilize the health care system a higher number of times, if the payor set a cap rate that providers would budget annually for each chronically ill patient, there would be a lower cost associated with chronic illnesses, Ostrowsky said.

“If someone gives us an annual payment and says, ‘Please take care of (this person) and we’re going to audit you for access of that patient, for quality, for patient satisfaction — frankly, we don’t care if you visit that patient every day or twice a day’ — if you want to put that in the budget, put that in the budget,” Ostrowsky said. 

“It would, at that point, fall to us to decide what’s the most effective way to treat someone with chronic illness.”

Ostrowsky admits it wouldn’t be a cure-all. And it wouldn’t cure all of the conditions of the chronically ill.

Plus, he said, it’s not something that RWJBarnabas Health can do on its own.

Chronic illnesses require commitment on the part of the patient, he said.

“There is a patient responsibility here that has nothing to do with money,” Ostrowsky said. “So, we need you to commit to a better diet. And we’ll call you every morning, if that’s what it takes. The data suggests if you do it, you make the patient healthier and you save an awful lot of money.”

Which is why insurers and government payors could provide essentially an annual payment per patient for chronic patients. 

Of course, Ostrowsky knows that’s easier said than done.

“The problem is … every system in New Jersey is not yet ready to take that financial risk because the behavior of health care delivery in New Jersey is not yet efficient enough to live within the kind of budget that most programs are willing to offer for an annual capitation,” he said. 

“We’re moving in that direction, but it’s probably going to be a little bit sometime before we’re prepared to do that.”

Ostrowsky said this change in payment structure is not limited to chronically ill patients. It also could be applied to senior care, which is paid for by Medicare.

“If the house in which the senior lived had railings and bars in the bathroom and better floor covering and better lighting and things were on a lower shelf instead of a higher shelf, you would preclude a certain number of (hospital visits),” Ostrowsky said. 

“The cost of seniorizing a house is less than $3,000; the cost of fixing of pelvic fracture on average is $70,000. So, if you were running the Medicare program and someone presented that data to you, I would assume you’d say, ‘Well, I’d rather give you $3,000 so that I don’t end up having to pay $60,000-plus when that person falls.’”

And, if payors like the government, through Medicare and Medicaid, and commercial insurers or self-funded employer plans all focus on things like this, it could lower the cost of health care overall.

“Eventually, the folks who pay for sickness care will come to the realization that they’d be better off making an investment and keeping people well so that they don’t have to pay for sickness care,” Ostrowsky said. 

“Obviously, we’re not going to eradicate sickness, but we can take a big chunk out of it.”

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Federal judge’s insurance ruling is big win for N.J., which joined other states in fight

A ruling by a federal judge to shut down association health plans — which allowed companies located in a contiguous area to set up self-funded plans — will have little impact on New Jersey’s insurance market, because the state has only two AHPs.

But, state officials said Friday, it is a big win for the state.

New Jersey was one of the 11 states that sued the federal government to halt the sale of AHPs last June.

New Jersey Commissioner of Banking and Insurance Marlene Caride said in a statement to ROI-NJ that the ruling is helping maintain the Affordable Care Act.

“The Trump administration’s Association Health Plan rule was part of its ongoing effort to dismantle the Affordable Care Act,” Caride said. “The court appropriately called the rule an ‘end-run around the ACA.’ New Jersey joined with its partner states in standing against this attack through the unlawful expansion of association health plans that fail to provide important protections that residents deserve.”

New Jersey’s laws have often been called as stringent, if not more, as the Affordable Care Act, which was cited by the judge as the reason AHPs were being pushed by President Donald Trump’s administration.

U.S. District Judge John Bates said as much in his 43-page ruling.

“The (AHP rule) is clearly an end-run around the ACA,” he wrote. “Indeed, as the president directed, and the secretary of labor confirmed, the (AHP rule) was designed to expand access to AHPs in order to avoid the most stringent requirements of the ACA.”

Caride said any insurer operating in the state must abide by state laws.

“Association health plans are subject to state regulation in New Jersey and must comply with strict standards. Notably, if they are covering small employers, their plans must provide benefits equal to plans sold in the small employer market,” she said.

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Should behavioral health, substance abuse patients be able to get treatment in primary care settings? DOH head Elnahal says, ‘Yes’

Making good on a commitment he made earlier in the year, state Department of Health Commissioner Shereef Elnahal published guidance Monday that he hopes will allow health care providers to better serve behavioral health and substance abuse patients in the same clinical setting as primary care.

Currently, regulations make it difficult for those services to coexist in the same facility, because there are different departments and agencies regulating these three sectors. Elnahal hopes this recommendation will set the tone for permanent regulatory changes he is pursuing.

In January, at the announcement of the merger of Carrier Clinic and Hackensack Meridian Health, Elnahal told ROI-NJ that the current regulations are cumbersome because they assume these health care services will only be provided in separate facilities.

He particularly noted that the rules of their buildout show the disfunction. Elnahal and others have specifically noted the specifications for hallway sizes, locations of janitor’s closets, separate waiting rooms and other such rules, which make it hard to build out in a hospital.

“That makes no sense,” Elnahal said in January. “It increases costs, it makes it harder to deliver the right care and it’s not evidence-based. So, the single license is among the most important things we are doing.”

The guidance released by the DOH on Monday was well-received by the mental health community.

Former Carrier Clinic CEO Don Parker said the rules not only are a welcome change, but will impact the bottom line.

“You have three different groups coming down to inspect you on an annual basis, you have three different groups requiring different things from you from a regulatory point of view,” Parker said.

“So, your inspection cost is tripled, your response to the new requirements is tripled, it triples everything that you do, so operations are times three. That means you have to hire more people for regulatory issues, for confidentiality, for maintenance — you name it, it’s triple. It amounts to almost 5 percent of our budget is just dealing with regulations alone.”

The New Jersey Association of Mental Health and Addiction Agencies CEO and President Debra Wentz also agreed it is a good interim step for the DOH.

“They are looking at what they have in their toolkit to increase access as they still move forward in the process for the single, integrated license,” Wentz said.

The guidance, she said, helps remove a barrier to care that has existed for some time, keeping parts of the health care industry in silos to the detriment of patients.

The new guidance helps indicate how the DOH is viewing and pursing streamlined licensing.

In the words of one behavioral health CEO, the guidance issued Monday is what providers need.

“What this does is, it moves behavioral health care into the world of health care,” CarePlus New Jersey CEO Joseph Masciandaro said.

The changes being pursued by the DOH, in coordination with the Department of Human Services, are being credited to a 2016 report by Seton Hall University, through a grant by the Nicholson Foundation, led by professor John Jacobi.

“They’ve published some informational materials on their website that I think does a lot to help health care providers pin down what the rules are, which might sound like a funny thing, but they’re really complicated,” Jacobi said.

“What the department has done, in a very transparent way, is describe to the regulated public what the Department of Health believes its regulations require. And that is a big step.”

Parker joked that the timing of the move by the DOH is personally beneficial — since it comes while he is still working in the field of behavioral health.

“It’ll make the last several years of my career special,” he said.

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Bear necessity: Hackensack Meridian’s innovation effort expanding to all 17 hospitals

Bear’s Den, the Hackensack Meridian Health version of “Shark Tank,” is expanding from its current home in the New Jersey Innovation Institute to satellite locations in all of the health system’s 17 hospitals.

Hackensack Meridian CEO Robert Garrett said the move ensures that all 34,000 employees have an opportunity to pitch their innovative ideas.

“Bear’s Den has been a winning strategy for Hackensack Meridian Health by supporting the next breakthroughs in care delivery, and it’s time to include our dedicated team members who know best how to innovate from their valuable frontline experience,” Garrett said.

The state’s largest health system pledged $25 million in a fund to help support innovative ideas.

To-date, that includes a Boston-based company’s in-home health robot, Pillo, and a New York City-based company that uses light technology to disinfect surfaces.

Pillo will soon be part of a study led by Dr. Laurie Jacobs, chair and professor of medicine, Hackensack Meridian School of Medicine, according to a statement from the health system.

The first new Bear’s Den ribbon-cutting will be held at Riverview Medical Center.

“The study will include about 100 patients who receive care for congestive heart failure from physicians at Hackensack University Medical Center, the network’s flagship hospital,” according to the statement.

“Pillo reminds people to take medication at the appropriate time, dispenses their medications, digitally coordinates prescription refills and connects individuals in their homes with physicians, caregivers and loved ones.”

Bear’s Den is comprised of business and industry experts, including Garrett, who vet proposals from entrepreneurs.

“Innovation is in our DNA at Hackensack Meridian Health,’’ said Dr. Andrew Pecora, president of physician enterprise and chief innovation officer at HMH.

By expanding the innovation development space in all 17 hospitals, all team members will have greater access to the support system for sharing ideas that can help the health system.

A series of ribbon-cuttings will be held this month and in April at most of the hospitals.

The first will be March 15 at Riverview Medical Center.

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Charity care funding to remain unchanged at $262M — but, this year, it comes with requirements

The fact that the state is proposing to maintain the current level of funding for charity care, which helps hospitals cover the costs of uninsured and poor patients, was lauded Tuesday by health care officials.

But the stable funding — $262 million in Gov. Phil Murphy’s Fiscal Year 2020 budget proposal — comes with strings attached.

First, the hospitals receiving charity care can only do so if they are connected to the New Jersey Health Information Network, a network of electronic health records of all patients in the state.

In addition, what charity care dollars cover will be changing.

Charity care dollars are used by the state’s acute care hospitals, and matched by federal dollars, to help cover the costs of uninsured and poor patients.

In the past few years, the funding has decreased with the onset of the Affordable Care Act, which helped drive the number of uninsured down. Since the individual mandate was repealed at the federal level, charity care funding is back in the spotlight.

The Murphy administration is using this to impact how health care is delivered in the state.

File photo
Cathleen Bennett of the NJHA.

“Hospitals that receive charity care funds will also be required to connect with the New Jersey Health Information Network to improve interoperability,” according to the budget proposal.

NJHIN began under the former Department of Health commissioner, and the current New Jersey Hospital Association CEO and president, Cathleen Bennett.

Commissioner Shereef Elnahal told ROI-NJ on Wednesday that the HIN has 62 of the 72 acute care hospitals in the state participating. He hopes the budget proposal will lift that number to 100 percent participation.

The HIN requirement lines up with federal requirements for hospitals to have patients able to access their information electronically, Elnahal said, so hospitals should already have the equipment necessary for that.

The administration has made gathering data a key moving forward.

“To encourage improvements in health care access and quality, one-12th of each participating hospital’s charity care will be contingent on the reporting of key indicators,” according to the budget proposal.

Those indicators include the number of charity care patients who are connected to follow up preventative and primary care upon discharge.

This changes the dynamic of charity care dollars being used as a crutch for emergency visits, as some hospitals have been accused of doing in the past.

Elnahal said the state conducted a survey last year to determine what was being done to help charity care patients avoid costly emergency room visits.

The majority of the answers, he said, indicated use of Federally Qualified Health Centers and hospitals using their ambulatory care sites.

The latter would qualify for charity care dollars, he said.

The state will be issuing more details on the requirements once the budget is enacted, Elnahal said.

After the budget address Tuesday, the Fair Share Hospitals Collaborative said in a statement that keeping funding flat was the right thing to do.

File photo
Shereef Elnahal, New Jersey’s commissioner of health.

“All hospitals are safety nets for their communities and rely on the Charity Care program to help offset the cost of treating low-income and uninsured patients,” according to FSHC.

“For the past several years, Fair Share Hospital Collaborative member hospitals have disproportionately borne the brunt of the previous administration’s drastic cuts to the Charity Care program, yet continue to provide high-quality, cost-efficient care to all New Jersey residents, regardless of their ability to pay for services.

“We are happy to see Gov. Murphy recognizes the critical role all hospitals provide in serving their community and has chosen to maintain last year’s increase of $10 million to the Charity Care Program. It’s a great step towards restoring funding to statutory levels for all New Jersey’s hospitals.”

The NJHA also lauded the funding, but it pushed for greater focus on post-acute care and elderly care facilities.

“Our health care system is in a transformative period, focusing on value, population health and the expectations of our health care consumers,” Bennett said.

“Health care providers are investing energy, resources and some really innovative thinking into these areas — as they should. And yet, New Jersey hospitals continue to face the age-old challenges of caring for people without health insurance:

  • “In 2016, the most recent year data is available, our hospitals provided $565 million in charity care services to individuals. With the governor’s proposed funding of $262 million, New Jersey’s hospitals will shoulder the burden of $303 million in unreimbursed care for our state’s most vulnerable residents.
  • “Meanwhile, the number of N.J. residents insured through the ACA’s online marketplace has declined by 40,000 the last two years, and the state’s uninsured rate is once again on the rise — from 7.7 percent in 2017, to 8 percent in 2018, to 9 percent today.”

That being said, Bennett and NJHA increasingly have been focused on the aging population of the state — an issue that has taken hold nationally as one of the most important for the health care industry to focus on.

“We appreciate a budget proposal that recognizes those same goals, and we welcome the opportunity for further discussion with elected leaders on the present — and the future — of our health care system, including the pressing need to adequately fund nursing homes and other providers who care for our seniors in post-acute settings,” she said.

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‘Kevin and Mazz’ sounds like TV sitcom, but it’s really future of Cooper … and, maybe, health care

The co-CEO model, and whether or not it works and is sustainable, has been debated around the country for years. Large health systems have dabbled with it nationally, but, in New Jersey, only one system has experimented with it to date.

Cooper University Health Care will be the second in the state to do so, with newly-appointed co-CEOs Kevin O’Dowd and Anthony Mazzarelli taking on their new titles in June.

O’Dowd, a former chief of staff to Gov. Chris Christie, will take on the business operations, while Mazzarelli, a longtime emergency physician at Cooper, will be the lead on the clinical side. The two are currently serving as co-presidents of the organization.

They have clearly defined their roles, but want to ensure that only they have to worry about the differences.

“There’s obviously crossover in the day-to-day,” O’Dowd told ROI-NJ in a recent interview.

Mazzarelli agreed.

“If someone comes to me and it has something ultimately that has something to do with Kevin, I won’t say go talk to Kevin, we’ll have that conversation … we work hard not to confuse people, and it increases the communication between us,” he said.

In fact, the titles are just a formality. Mazzarelli, affectionately called “Mazz” by many, will continue to be called by his nickname.

“A lot of people have their identity through their title — you know, their title is what defines them — and titles are important, to be sure, but the titles that Mazz and I have outside of Cooper are more important to us — dad, husband, brother, son,” O’Dowd said.

“So, this isn’t our identity. We are convinced this is the right structure to serve our patients and to serve our employees.”

How does that play out for the future of the standalone health system? O’Dowd and Mazzarelli explained.

ROI-NJ: Any concerns about this new leadership style? Did you get a say in it?

Kevin O’Dowd: The concept of approaching the leadership of the of the organization in a dyad fashion, in a partnership fashion, is something that Mazz and I have talked about for years, not knowing if that opportunity would ever be ultimately available to us. But it’s how we run our business at the various service lines, so it’s a model that is very familiar to us — having both a physician and an administrative person running the business within the business. It’s not a model that is uncommon in health care. Other businesses throughout the U.S. are moving into more of a shared governance, shared leadership model. But, that said, it’s not for everyone. It has to be the right fit, it has to be the right people, it has to be people who are confident. It has to be people who have a partnership where they can trust each other. If you are not confident and you can’t trust your partner, it’s not for you.

Anthony Mazzarelli: We were able to spend several years working together. As Kevin said, we have reorganized how we look at all our business lines. To be organized in a dyad model.

ROI: What do you see as the biggest goal you have to achieve?

AM: Our big goal is to never give anyone a reason to leave New Jersey for their health care — particularly not to leave South Jersey. Over the last 6-7 years, we have really focused on what we can do from a tertiary care perspective. We really want to be the tertiary care provider of choice and not have people go across the river to Philadelphia. There’s about $2 billion that goes across that bridge, and we want that to be here. New Jersey and Pennsylvania have required reporting of inpatient admissions, so you can calculate that.

KO: We’ve had tremendous growth here the last couple years. We sit as a $1.3 billion revenue organization … the premier academic medical center in the region. What a lot of people don’t realize is, while we are a single hospital system, (we) reach beyond just our core hospital here. In addition to our 650-bed academic medical center and our MD Anderson cancer center across the street, we have 100 outpatient centers … ranging from Mercer County all the way down through Salem County … and all the way out to Atlantic County. So, we have a significant reach that isn’t necessarily top of mind when people think of what Cooper was.

Over the period of the past 5-7 years, there has been significant growth here with a mindset of (how) we will continue to control our destiny and define our own future using some of the partnerships, like MD Anderson, our Inspira cardiac partnership, which has been extremely successful for us. We know that, as health care evolves so rapidly in this age of consumerism, we shift from ‘The doctor will see you now’ to ‘The patient will see you now.’

Cooper University Health Care
Cooper University Health Care is a prominent South Jersey system with numerous partnerships.

ROI: Partnerships appear to be the new way around consolidation. Is Cooper still looking to acquire anyone, or are the partnerships the new strategy here, too?

AM: We are not close-minded to the idea of partnering with others in greater ways that could end up being in some kind of consolidation, but we are not chomping at the bit that it has to happen. We announced our affiliation with Advanced Recovery Systems, so we are going to be opening an addiction recovery hospital inpatient facility, so we are going to be dissolving our addiction care in Cherry Hill. So, those kind of partnerships with people who have expertise.

KO: We are not looking at mergers or acquisitions of other health systems or hospitals. We are constantly looking for the right kind of partnership and right kind of affiliation.

ROI: There are a lot of pricing pressures today in health care. How are you handling that?

AM: As the world has gone price-sensitive — there’s a difference between price and cost — as primary care physicans get paid more on total cost of care, as physicians take risks on pay for performance, we have made sure we are the tertiary care provider of choice because we are actually lower-cost than the tertiary care across the river. So, in a price-sensitive world, that’s what we are preparing for. We had a strategic plan in 2012, and a lot of that has been, how do we lower our costs? We look at not just our costs or the price to people, but also, what are our utilization rates and what are the tests and are our physicians using more care at end of life than others? Some of that data, particularly Medicare data, you can look at.

ROI: On that note, investing in AmeriHealth New Jersey was a part of that, correct?

KO: It was a window into, as we move into a value-based environment, and health systems are going to be on this journey to take risk, it was a way to learn this business, get a familiarity with risk-bearing entities and how they manage risk. That’s not a gear, that’s not a muscle that health systems necessarily had. We are not involved in management of the company and are less than a 1 percent minority owner.

AM: If you think about it, 2012-2013 wasn’t that long ago, but it is, and, particularly then, we were in the business of sick care, and insurance companies were in the business of health care. They made money when people were healthy, we made money only when people were sick. We saw this future where that’s going to change, so we need to try and figure and get insight into what happens when we start to take on risk. That was the original idea.

ROI: Where do you see the greatest growth sectors of health care? And how does this all relate to the future of health care education?

Our big goal is to never give anyone a reason to leave New Jersey for their health care — particularly not to leave South Jersey. Anthony Mazzarelli

AM: There are 10,000 new people on the Medicare rolls every day, so there are things around that — cancer still has a lot of growth potential, so does neurosciences and so does orthopedic. I see us growing in those areas. The newer medical schools have very similar models to the one we have, where it’s a health system that wanted to push having a medical school and they have an academic partner. In the hospital, we employ the physicians and they are the faculty for the school. We didn’t create this model — Harvard has had this model; there is no Harvard hospital, they work with Mass General (and others). That model has been around for a while, and Harvard was really the first to do it. But newer medical schools are driven by the health systems, which seems to make a lot of sense. We are fortunate, because we are a brand-new medical school with a 30-year history of graduating medical students. We were a clinical campus for (what was previously) Robert Wood Johnson University Health, so we already had that model. We are seeing a spike in applicants — 7,000 applications for 100 spots. We are doing a lot more students. In the old model, you used to take a biology class before you saw a patient. They are seeing patients and involved in the system as first-years, and a lot of our physicians teach in small group fashion and do case-based learning. I’m jealous of the curriculum they’ve been through. That’s the wave of all the medical schools.

ROI: How is this helping with keeping more physicians local, rather than having them leave the state?

AM: We have tracks where you can go to medical school for three years instead of four. If you agree early in that track to do primary care or pediatrics, we put you right in our residency programs and you can do one less year of medical school. We do loan reimbursement, if you were one of those people who chooses the primary care track and you do your residency here and then we hire you here, between the loan reimbursement and only doing three years, you really begin to eat into the total cost of medical school.

Cooper has a partnership with cancer care giant MD Anderson, among others.

ROI: There has been growth in community-based hospital care rather than a focus on brands like MD Anderson and Memorial Sloan Kettering. How do you see the brand affiliation you have with MD Anderson playing out in this environment?

AM: If you only partner with someone for a brand, that doesn’t help anybody. The reason we are sitting in this room is because administration was initially on the second floor of this hospital and with our relationships with MD Anderson, it’s very prescriptive — to meet their quality standards, we had to double the size of our pharmacy and move out of that space. So, we look at the partnership as not a brand play, it was actually a way to improve the care that we give to cancer patients, along with the idea that people know they are the best in the world. All of our physicians are credentialed through MD Anderson; we want there to be no daylight between the care you would get in Houston and the care you get here. In fact, when Houston had all their flooding problems, we were ready to credential people and we were the one site they talked about sending patients up here. If you just do it as a branding play, maybe you get a little short-term gain, but you don’t get the long-term impact that we are seeing.

ROI: You recently released a report about your ambulance response times, which is a result of a fight two years ago that took place between Cooper and Virtua in which Cooper emphasized its Trauma I status to win the battle. In a world of more outpatient care and a focus on lowering cost (ERs are notoriously expensive visits), why did you go after the ambulances, and why is your trauma designation so important?

AM: It’s interesting to hear about the political hubbub about EMS, whereas, as an emergency doctor here at Cooper, the faculty was continually frustrated with the service that was being provided. That was an outcry of quality needs and now, very happy to be a part of shaping that. So, no matter how much we try to keep people out of the emergency department, there will still be an emergency department. So, we want to make sure people get the best treatment. We actually have physicians that go on EMS rounds now. That didn’t happen before. And the concern about having a hand in that pre-hospital space before those patients come in is important. We cracked 80,000 visits (annually) in our emergency department for the first time ever; even if we get it down to a lower number, you’re still going to get the sickest people. And, in fact, if you keep people out of the hospital, only the sickest people will come, so you’re always going to be able to do those things. I would love a world where trauma centers aren’t needed, but we are always going to have car accidents and those kinds of things. So, that’s a big part of what we do. And the cost structure, in order to do the things you have to do, it helps with the infrastructure of cancer care and other things.

ROI: What are you doing in the tech space?

AM: We are constantly diversifying the way in which we do things. So, we are looking at wearables and other technologies. Telehealth is an interesting one because those that jumped in early did so assuming that everyone would want it. It’s not necessarily panning out as quickly, so we don’t mind not being the first in on that technology. We want to use it in the right circumstances. So, that is something we use, for example, in our stroke care, with neurology consults. The use of technology, and the responsible use of technology, is important. We are doing telepsychiatry, teleneurology and telestroke. On wearables, we have done a program where we gave Apple Watches out for a very limited number of things, but we try to focus on, how does this directly support the patient?

ROI: What other trends are you on top of? I know Cooper played a role in getting the Camden Coalition off the ground.

AM: We still play a major role with them. We took an interesting model a few years ago where the head of the coalition was also one of our physicians. So, we designed a clinic because of the social determinants and those issues, where we had the doctors rotate around the patients rather than have the patients going to different offices.

KO: We’ve also established a coder program for students who graduate Camden High School. It’s a two-year program and it’s tuition-free and, when they come out, they have a guaranteed job with Cooper. Cooper led the way with the $15 minimum wage, which just became the law. We’re at $15 right now, we’re not part of a phase-in, so the advantage we have of being out in front (is) attracting and retaining talent.

ROI: Last question, for Mazz, are you still going to see patients even when you become co-CEO?

AM: Yes. That is the core business we do. I get to see exactly how things work. The $15 per hour (as an example) was about investing in our workforce, and I get to see how that works. Every hospital is four different hospitals — it’s a day hospital, a night hospital, a weekend hospital and a holiday hospital. So, it gives me a chance to see that. Our senior team has rounds after hours because the night team has a tendency to not feel — that started with us doing it — like they get as much attention. We got to see how it all works. If you’re going to have a future world where you have lower costs and providing just as much care, you need your workforce to be invested.

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From hacking to health care: McCarter & English attorney says advancing tech paints cybercrime bull’s-eye on industry

Scott Christie led the computer hacking division for the U.S. Department of Justice’s Newark office, where he went after big-time cybercrime intrusions.

It has a surprising overlap with his current gig — representing health care clients.

Christie is an attorney that assists these clients with data privacy matters and cybersecurity issues. And this industry is one of the top targets for cyberattacks, with various sources putting the dollar figure in terms of damages within the ballpark of an annual $5 billion, or sometimes more.

The longtime expert on hacks said that picture is only getting more complicated. The same technologies in the health care industry that sound most exciting also bring the potential of opening up new vulnerabilities to hackers and making for a murky legal landscape.

“All of the technology that is revolutionizing medical care carries with it concerns that may not be fully addressed — some might not have even been considered,” Christie said. “The proliferation of technology as well as health care data ups the consequences.”

The health care industry is perhaps better than most industries at thwarting these threats, but with the pace of medical technology being also more rapid than most, the assurances are few.

Christie, who practices at McCarter & English LLP, said health care innovations in some cases might be trading security for greater flexibility. Telemedicine might be one of the most broadly adopted of recent health care technologies — and it’s certainly not immune.

“As we sit here today, telemedicine is becoming a much more common and accepted practice with new advances in technology,” Christie said. “Platforms such as Skype or Facetime are becoming more popular for this real-time interactivity. And videoconferencing tools have ratcheted telemedicine up a level.”

From a legal perspective, there are clear benefits — doctors have an objective record of what is said to a patient if there were to be a claim that led to a malpractice lawsuit. Patients profit from that session being preserved because they have something to refer back to when part of the conversation was missed.

But, with any sensitive information transmitted electronically — particularly when it’s potentially being stored — there’s a target for hackers. Christie said those concerns are intensified by the fact that the content might be a patient in some state of undress, as might be required to diagnose a condition.

Besides privacy matters, there are other legal challenges that come up, including the uncertainty regarding where a patient is located and how that interacts with a physician’s licensing.

“So, you run the risk if you’re dealing in a telemedical manner with people as a New Jersey doctor, that you’re unwittingly treating a patient in Hawaii or some other state in which the doctor is not licensed to practice,” Christie said, adding that third-party services were cropping up now to validate the state of residence of patients that contract with doctors permitted to practice there.

Patients should expect the same level of care and professionalism during a telemedicine visit as with an in-office visit. That means the medical staff follows all HIPAA laws and information is secure.”— James C. Wittig, chairman, orthopedic surgery, Morristown Medical Center

Telemedicine has many local pioneers; Atlantic Health System is definitely one. Among the many new ways it is used by the organization is to connect neurologists with patients who are having strokes, beginning an assessment of the time-sensitive condition during the ambulance trip to the hospital. That’s starting to be introduced as well for cardiac patients and those suspected to have sepsis.

James C. Wittig, chairman in the orthopedic surgery arm of Atlantic’s Morristown Medical Center, said that, last year, the system also began offering around-the-clock access to physicians with “virtual visits.” The remote appointment is sometimes done on a live video conference.

Wittig, who also serves as a medical director for orthopedic surgery, orthopedic oncology and sarcoma surgery, said the service is conducted using a platform called MDLive. It’s a secure tool, he said, designed specifically for the purpose of these virtual doctor visits.

“Atlantic Health System has produced a series of standards, guidelines and best practices for providers to ensure that they are using these online platforms responsibly,” he said. “Patients should expect the same level of care and professionalism during a telemedicine visit as with an in-office visit. That means the medical staff follows all HIPAA laws and information is secure.”

While local health care providers are finding the right protective mechanisms for current telemedicine uses, an attorney such as Christie sees potential pitfalls in the way these technologies may start to be utilized as it becomes even more widespread.

Also on Christie’s radar are some next-gen medical innovations that might be extraordinarily difficult to totally secure. 

For example, radio-frequency identification — or RFID — is a technology that’s starting to gain more relevance in the health care setting. This technology is starting to be more widely adopted for keeping track of scalpels and other instruments in the surgical theater, to make sure everything is located where it should be.

“But, very quickly, this technology is not used for things as narrow as tracking surgical instruments but also to help identify the location of patients in a hospital,” he said. “These RFID tags on a bracelet can store data, much more than you could print on those bracelets. … Attendant to that are privacy issues, because this sensitive data — unless you could encrypt the radio-frequency content — could be intercepted in transmission. That’s a problem.”

Even further on the horizon, Christie expects virtual reality to introduce additional privacy problems, particularly once it begins to realize its potential to be used for treatment of dementia or other mental illnesses.

If Christie seems to see the potential for a hacker disruption anywhere, it’s because time dealing with them has taught him this: When it comes to new technology, he said, “It’s only a matter of time before a hack occurs.”

Conversation Starter

Reach Scott Christie of McCarter & English LLP at: schristie@mccarter.com, or 973-848-5388.

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