New Jersey creates team of public providers
Goal is to protect public health services
Recognizing the power in numbers, New Jersey public health officials are planning to court managed care providers by forming a network of public health departments that are best qualified to control and prevent infectious diseases.
The unique concept, developed by Elin Gursky, ScED, assistant senior commissioner of health, is New Jersey’s way of ensuring that public health departments continue to deliver services for infectious diseases in the era of managed care, which serves one out of three people in the state.
"I have a strong conviction that public health cannot pull out of the traditional clinical preventive services like tuberculosis," she tells TB Monitor. "At the same time, I perceive a lack of interest on the part of a lot of managed care [companies] to take on something that is labor intensive but low volume."
With public health inserted in every step of the cycle of care for tuberculosis patients, Gursky argues that there is no savings in having clinical services delivered by managed care companies. Indeed, she is concerned that prevention and control may be even more costly under managed care and hopes to conduct a study to determine if that is the case.
At the same time, however, many public health departments have been stuck on the sidelines of the managed care game and, as relatively small entities there are 116 health departments in the state many don’t have the resources to sell themselves to managed care. But that could change if Gursky’s network comes into being.
She envisions a network of eight to 16 top-notch health departments strategically placed in areas with a high prevalence of infectious diseases. The network would have its own business manager, medical director, centralized billing, and the appropriate qualifications for conducting contractual business. The network would then contract with commercial managed care organizations to provide their patients with the services that traditionally public health departments do best, such as contact tracing, preventive therapy, directly observed therapy, and surveillance. The network may also consider contracting for other services, such as health education and home visitations, she adds.
"Managed care is here and public health is out of the loop. Managed care organizations want our services, but they can’t go to 20 health departments," she explains. "So this way we give them one product to buy."
Health departments not in the network would have the option to discontinue services that are not in high demand in their community or which they are not most qualified to perform. For example, many rural health departments have no cases of tuberculosis.
"What this does first is it allows public health to get out of the clinical jobs that they are doing now that they really shouldn’t be in hypertension, dialysis, childhood immunizations. There is a whole litany of things that public health should be giving over to managed care which would ensure better continuity of care," she says. "But in terms of infectious diseases, where treatment of a patient is so integrally tied to the health of a community, it just really doesn’t make fiscal or medical or public health sense for public health not to work toward its strength."
Recently, Gursky sent out announcements of the network formation and received strong responses from more than 20 qualified health departments those that have good clinical facilities and staff and are located in high morbidity areas. An important consideration in choosing members of the network also will be their access to patients, as measured by their proximity to public transportation, Gursky adds.
"If we do this right and go to locations where morbidity and volume are high, then it really is a win-win situation," she says, noting that the state has nearly 60,000 visits from TB patients annually.
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