Healthcare: Service Delivery Reform
Consistent with the national healthcare reform agenda, the Foundation strives to improve quality, enhance outcomes, and reduce the costs of New Jersey’s healthcare services. Achieving this aim is particularly important for the State’s vulnerable populations, who often lack timely access to healthcare providers and experience fragmented and uncoordinated care.
The projects we fund are helping safety-net providers develop new and improved ways to deliver accessible, coordinated, and patient-centered primary and specialty care. For example, we are supporting:
- A model of guided practice, called Project ECHO for Pain Management, that uses telecommunications technology and case-based learning to foster mentoring partnerships between specialists and primary care providers. The model enhances the ability of primary care providers to provide comprehensive, best-practice care to underserved patients with chronic pain, which can help improve health outcomes and reduce expensive hospital care.
- A randomized controlled study evaluating the impact of adding a pharmacist to the primary care team caring for patients with diabetes at a Federally Qualified Health Center located in Trenton.
Integrating Behavioral Health within Primary Care
The projects we fund address another pressing problem—the need to better integrate physical and behavioral healthcare. Behavioral healthcare refers to both substance misuse and mental health treatment. This issue is especially acute for Medicaid populations with chronic conditions, where the prevalence of behavioral health conditions is more than twice that of the general population.
Traditionally, behavioral healthcare has been separated from the medical care delivery system. This lack of integration has led to poorer health outcomes and higher costs. Primary care providers are often the provider of choice for individuals with behavioral healthcare needs. We are helping primary care clinics enhance their capacity to identify, diagnose, and treat behavioral health conditions that can be effectively and appropriately treated within the primary care setting. We also are helping to ameliorate the regulatory and fiscal barriers that impede integrated care. For example, we are funding:
- The addition of behavioral health providers within primary care.
- Access to screening and evidence-based cognitive behavioral therapy using computerized web-based applications available to patients at primary care sites and in their homes.
- A briefing paper analyzing the legal, policy, fiscal, and regulatory barriers that hinder the integration of behavioral health care and primary care services for Medicaid recipients.
For additional information about behavioral health integration, visit the Agency for Healthcare Quality and Research’s Academy for Integrating Behavioral Health and Primary Care website. The Academy provides a range of useful tools, including two resources on healthcare workforce practices for successful integration of behavioral and primary care.
Fostering Innovation Within Healthcare
The Foundation also is exploring new strategies that better meet the needs of the underserved and can be brought to scale to transform the healthcare delivery system. We are doing this through projects designed specifically to stimulate innovation among safety-net health care institutions. These projects aim to help healthcare systems test new models and approaches that can improve care delivery and lower costs of care for vulnerable and underserved populations. For example, we are funding:
- The development of a new outpatient multi-specialty healthcare delivery model. This model features coordinated, team-based primary and specialty care; group visits, which allows team members to treat and educate multiple patients simultaneously; and open access scheduling, which improves access to timely care. The model features techniques used in other sectors to improve quality and reduce costs, including consistent use of standard protocols, task shifting from physicians to less specialized health workers, and development of easy-to-read data dashboards to track performance.
- Teams from nine safety-net healthcare organizations to learn techniques that promote innovation by transforming their approach to problem solving. The teams receive training in human-centered design and individually work with innovation coaches to develop a solution for an identified challenge at their organization. The teams also create an implementation plan to carry out the solution.
- A project, in collaboration with the New Jersey Health Foundation, to develop and implement an Innovation Grants Program that supports eight researchers at four New Jersey universities to advance promising early stage healthcare treatments and technologies. The grantees will be given a year to hone their ideas and implement their projects. They will be given strategic assistance to support the incubation of market-based solutions to improve healthcare for vulnerable populations.
Visit our Projects page to learn more about The Nicholson Foundation’s funded projects.