Senate President Stephen Sweeney
Deputy Speaker John Burzichelli
Assemblyman Adam Taliaferro

The Record -THE COST of providing health care to many Americans remains a problem in the United States. Hundreds of millions are spent each year that, in the end, does little to alleviate the problems and ills folks are encountering. Meanwhile, doctors are inundated with more patients, meaning less time is spent diagnosing what’s wrong and more time spent on making sure every patient is just seen. The concept of “patient-centered” health care, however, has the potential to dramatically change the cost and quality of health care.

Declining reimbursement from health insurers means doctors are taking on more patients to cover costs. Moreover, doctors are paid on a “fee for service” basis, which means that rather than being paid a salary, the amount doctors are paid is based on the number of patients they see each day.

This payment model incentivizes doctors to see as many patients as possible and limit the length of visits to as little as five minutes. For these reasons, the overall quality of care is suffering.

By contrast, some providers of patient-centered health care are paid an annual salary for taking responsibility for the care of a limited number of patients. This allows the primary care doctor to spend more time with each patient, learning about each patient’s lifestyle preferences, developing personalized health plans and helping patients meet their individual health goals.

In the patient-centered care model, the primary care doctor acts as the patient’s health care quarterback by calling plays for the patient’s team of nurses and specialists. Centralizing a patient’s care under the primary care doctor facilitates a coordinated approach in which all of the patient’s providers communicate in order to avoid unnecessary services, errors, or delays in treatment.

Personalized strategies

In addition, the team helps the patient manage any chronic conditions by developing personalized strategies to improve health and avoid unnecessary tests and visits to specialists or the emergency room.

All of the duplicative and unneeded testing adds up. The Institute of Medicine out of Washington, D.C., estimates that $750 billion is spent each year in the United States on health care costs that do nothing to improve health conditions. The World Health Organization and the United StatesCenters for Disease Control and Prevention estimated that at least 80 percent of all heart disease, stroke and type 2 diabetes can be prevented. Imagine how much would be saved, both financially and in terms of pain and suffering, if we could make that a reality?

Another reason for concern is that, starting in 2018, a 40 percent tax rate will be placed on the comparatively richest “Cadillac” health insurance plans, with future tax rates tied to the CPI. Unfortunately, due to ever-rising costs, this means health insurance premiums for many New Jerseyans will eventually become subject to the tax rate. This is another area where patient-centered care can be helpful. By keeping costs low, it could save many in our state from having to pay the tax.

The patient-centered care model has been proven to improve efficiency, reduce costs and improve the overall quality of patient care. For example, Paladina Health, a nationwide primary care provider, offers an innovative patient-centered program. Each Paladina primary care doctor has 75 percent fewer patients than traditional providers, meaning they can spend more time with each individual.

Where Paladina’s patient-centered care model has been adopted, health outcomes for patients with conditions such as diabetes and hypertension beat national averages. Cancer screenings are up and patient visits to emergency rooms are down by as much as 50 percent. With these changes, overall cost of care for Paladina patients typically falls from 5 percent to 15 percent.

Successful program

Horizon Blue Cross Blue Shield of New Jersey has enrolled more than 200,000 of its members into its patient-centered programs. Earlier this year, they released a report touting the success of the program. There was a 14 percent higher rate in improved diabetes control, 12 percent higher rate in cholesterol control and an 8 percent higher rate in breast cancer screenings. Moreover, visits to the emergency room were down 4 percent for this group, and the total cost of care also decreased by that same amount. The savings amounted to millions of dollars.

Patient centered care is something New Jersey needs to start examining. At a time when every dollar is needed in our state for a variety of issues – from schools, to roads, to pensions – we could see potentially millions in savings. But perhaps most importantly, we could see an improvement in the way people are treated and the general health of New Jersey.

Stephen Sweeney, D-Gloucester, is state Senate president. Send comments to Peter Grad, Op-Ed Page editor, at grad@northjersey.com.