Roundtable: Healthcare trends David Baiada, CEO, BAYADA Home Health Care

®oundtable:

Healthcare trends

The pandemic has accelerated advancements within the healthcare industry. While opportunities have been created, some issues remain prevalent.

David Baiada

CEO BAYADA Home Health Care

What is your assessment of home-based care cost structures? We are in a period of transition in terms of how healthcare payment works. The reality is that the vast majority of healthcare remains on a procedural or fee-for-service structure, despite people’s best intentions and the desire to evolve to the mechanisms that incentivize better quality at a lower cost and better experiences at a lower cost. The reality is that hospitals get paid when people receive procedures and we get paid when people get visited at home. We are still quite early into the journey of shifting the way incentives work, the way healthcare is paid for in a way that is going to create sustainable lower costs and better outcomes. What we are seeing is perhaps another innovation that has been catalyzed or accelerated during the pandemic, which is that we do think alignment across segments is going to happen faster. It already is.

How would you characterize South Jersey’s medical talent pool? Labor’s inherent cycles of shortages are not new. We do think we have entered a period of permanent supply constraint where the demand for our services will continue to increase at a rate that is faster than the increase in supply. Unless something structural evolves, there is no reason to believe we’re going to move from the prevalent supply- constrained environment. It is critical to address the issue because it places significant emphasis on how organizations like ours think about differentiation in the labor market — attraction and engagement, retention, development and training — and all the other things that help you adapt to reality and compete more effectively in the labor market.

Anthony DiFabio

President & CEO Acenda Integrated Health

What has been the impact of COVID on mental health? While the initial focus of the pandemic was on everyone’s physical health, one of the most significant legacies will be its widespread impact on mental health and the overall well-being of all community members. No matter how mentally fit we may have felt at the beginning, each of us has been challenged over the past year and a half by fear, isolation and disruption caused by COVID.

Throughout the pandemic, Acenda ensured its clients had seamless access to care and additional supports. Simultaneously, we’ve seen an increase in the number of individuals experiencing significant emotional or psychological distress. Anxiety, depression and substance abuse have become more prevalent in our community. Realizing the growing need for support, we’ve focused on providing quality care for our current clients as well as expanding access to our care for families and individuals who previously thought they would never need help.

How has the pandemic impacted demand for your services? In many instances, those introduced to our care are identified through teachers, coaches, mentors and other community members. In the face of COVID, some of our programs actually saw a reduction in enrollment, at least for a period of time, because those community referral systems were not active. For example, at the beginning our child welfare services declined because COVID shut down schools, sports and neighborhood gathering places which disrupted our access to clients. We’ve seen this bounce back through hybrid models and a reopening of in-person activities.

Barry Ostrowsky

President & CEO RWJBarnabas Health

How does healthcare activity in mid-2021 compare to pre-pandemic levels? We have seen a rush among some people wanting to come back and receive long-deferred care that was dangerous in its deferral. At this time, in early summer, there is still a degree of hesitancy to come back to hospitals for certain services. While some services have fully rebounded, some of that demand is not what it used to be. Patients have gravitated to and embraced telehealth as opposed to going in person to physician offices. Our greatest concern is that there continues to be this deferral of care for a variety of reasons, some of which is the anxiety around the safety of a given facility, and some of which is not wanting to do it because they are back at work and do not want to the take time off because they can’t afford to do that. There is always some commitment financially for someone seeking care, whether it’s $1 or $1,000. There is some personal responsibility financially. In our vulnerable communities, that has become even a more acute problem.

What legislative efforts are set to make a significant impact on healthcare? When it comes to healthcare, we’ve learned a lot through this pandemic. First, we all woefully under-invest in public health. There has not been any real investment in the public health structure nationally, regionally or locally. When we have a pandemic like this or anything close to it, we lack the infrastructure to respond effectively. In the governor’s budget, there are new resources identified to prepare for events like this. That is a welcome opportunity to build out a much more proactive, effective structure to future pandemics. What challenges emerged during the pandemic? For many months throughout the pandemic, we dealt with the major obstacle of medical distancing. People avoided routine check-ups and care for acute issues because they were afraid that they might be exposed to COVID-19. Unfortunately, that created a gap in care that resulted in increased poor health outcomes. Based on many of our metrics, we are largely operating at pre-COVID-19 levels again but we are still digging out of the COVID hole.

How do you expect healthcare demand to evolve? For one thing, we’ve entered an age of consumerism. People are now demanding services in a very different way. I think we need to work on eliminating the friction in the delivery system, because people need accessible, convenient, affordable care. To do this, we need to expand our points of entry and meet people where they are. For instance, over the next year, we need to transition into providing more digital care than ever before.

How are you ensuring healthcare remains affordable? Healthcare cost is a tough topic in the United States; we rank highest in terms of healthcare costs per patient. As a result, the notion of value-based care has emerged. The problem is that it’s very complex. The American Hospital Association has identified 17 different and emerging payment models – highlighting the difficulty in assessment and control. One of the ways to help control costs and spending is to do a better job with health literacy. That is about helping people understand how to better manage their health and take advantage of the most appropriate avenues to seek care.

Dennis Pullin

President & CEO Virtua Health

( ) a global pandemic. A speedy recovery of economic loss is expected as the region puts COVID-19 behind it.

In terms of vaccinations, the government and health professionals were able to work together to produce results for residents of the state. Murphy oversaw an aggressive vaccination campaign that included health workers knocking on doors, incentives such as free beer and wine, passes to state parks, and dinner with the governor himself. The state was able to vaccinate its goal of 4.7 million two weeks before a self-imposed June 30 deadline.

With 77% of its adults vaccinated with at least one dose, New Jersey is safely ahead of President Joe Biden’s nationwide goal of 70% vaccination. There have been some discrepancies along ethnic lines that need to be addressed, however. Of the total number of residents fully vaccinated, only 7% identify as Black and only 15% as Latino, despite making up 15% and 20% of the state’s population, respectively. Despite these issues, the vaccine is available to anyone over the age of 12 and the state is looking forward to opening up fully and reaching herd immunity in the near future.

Performance In terms of medical coverage, New Jersey does slightly better than the rest of the country and has improved dramatically since 2010. As of 2019, 7.9% of New Jersey residents were uninsured, compared to 9.2% nationally. This is an improvement from 13.2% at the decade’s beginning.

Even with this improvement, numbers show that it is South Jersey that bears a lot of this lack of coverage. Furthermore, in a rating of the healthiest counties in New Jersey, it was shown that six of the seven least healthy counties could be found in the southern part

As of July 2021, nearly 60% of the population of New Jersey is fully vaccinated against COVID-19.

Jean-Pierre Issa

President & CEO – Coriell Institute for Medical Research

We are excited about the current administration’s commitment to science and potentially improving science funding. We are very appreciative of the support we receive from the state of New Jersey and the NIH. The most exciting program that has been talked about by the new administration is the serious commitment to curing cancer. Since our growth is currently targeting this, we are very hopeful the new program could translate into more funds coming into South Jersey. There is the realization that there is a need for NIH-funded research, and the role it can play as a very powerful engine for growth.

of the state, with Salem and Cumberland coming in last.

From 2014 to 2020, New Jersey used the federallyfunded health insurance exchange mandated by the Affordable Care Act. As of 2020, New Jersey uses a statemandated system, Get Covered New Jersey — another Murphy innovation — that operates on the federal exchange, meaning that uninsured people have to pay the individual mandate.

This year, the state doubled its enrollment time, which allowed tens of thousands of residents to get medical insurance, sometimes on plans that cost as little as $10 a month.

The last few years have also seen several notable instances of hospital constructions and expansions, many in the South Jersey region. In Gloucester County, there is the Inspira Medical Center, opened in 2019, that offers a 465,000-square-foot, 210-bed facility and was built with a $365 million price tag. The hope is that it will offer a more advanced option to the area’s other, overused hospitals.

Bayshore Medical Center is on the cusp of completing a $48 million expansion that will grow that facility’s emergency care capacity by three times, as well as offer more rooms and imaging capacity.

The Children’s Hospital of Philadelphia has opened a Gender and Sexuality Development Clinic — offering psychological and medical help for transgender youth — at the Voorhees Specialty Care Center in South Jersey.

And a donation of $3 million has been made to the Monmouth Medical Center by a local philanthropist. This gift is part of an effort to establish a new medical campus in Tinton Falls, which will expand medical access in that part of the state. ( )