Health Centers in Trenton and Newark: Building New Jersey’s Primary Care Safety Net Feasibility Study of Trenton, New Jersey Submitted by: Nurse Practitioner Healthcare Foundation and New Jersey Health Care Quality Institute Support for this project was provided by a grant from The Nicholson Foundation July 10, 2016 In Appreciation Special thanks to Maureen Deevey and Michelle Fouks of The Nicholson Foundation for their encouragement and guidance during this Project. ii Project Team Co-Directors Phyllis Arn Zimmer, MN, FNP, FAANP, FAAN President Nurse Practitioner Healthcare Foundation David L. Knowlton, BA, MA President, Knowlton and Associates Past President and CEO New Jersey Health Care Quality Institute Team Members Patricia Kappas-Larson, DNP, ANP, FAAN President Transformative Solutions, LLC Jeffrey A. Warren, MPA Principal JR Market Strategies, LLC Kevin J. O’Brien, BA, MBA Founder and CEO Strategic Business Alternatives, LLC Christina Strong, J.D. Law Office of Christina Strong, Esq. Patricia Kelmar, J.D. PDKelmar Associates, LLC Judith L. Formalarie JL Formalarie Consulting, LLC iii Special Thanks Special thanks to the New Jersey Collaborating Center for Nursing for its support and collaboration on this Project. Gratitude is also expressed to: The APN Network of NJ, LLC Forum of Nurses in Advanced Practice-New Jersey Society of Psychiatric Advanced Practice Nurses The New Jersey Nurses Association New Jersey Board of Nursing iv Acknowledgements The Project Team wishes to thank the many individuals who supported this Project by participating in interviews, surveys, focus groups, or reviewing content. We appreciate their thoughtful comments, suggestions, and insights. We recognize and value their passion for moving healthcare forward in the State of New Jersey. Mary Aikins, RN, BA, CCM, Manager of Care Management Operations, Horizon Healthcare Innovations, Horizon Blue Cross Blue Shield of New Jersey Robert Atkins, PhD, RN, FAAN, National Program Director, New Jersey Health Initiatives Carolyn Beauchamp, ACSW, MSW, President/CEO, Mental Health Association in New Jersey, Inc. Adity Bhattacharya, MD, Program Director, Capital Health The Honorable Cathleen Bennett, MGA, JD, BA, Commissioner, New Jersey Department of Health Debra S. Birkenstamm, MBA, RN, DSRIP Director of Clinical Transformation, St. Francis Medical Center Dorothy Borresen, PhD, MSN, APN, Asst. Clinical Professor, Director of Behavioral Science & Community Medicine, Family Medicine and Community Health at Capital Health Jeffrey Brenner, MD, Executive Director, Camden Coalition of Healthcare Providers Jeff Brown, Former Executive Director, QI Collaborative, New Jersey Health Care Quality Institute James A. Brownlee, MPH, Health and Human Services Director, City of Trenton Edna Cadmus, PhD, RN, NEA-BC, FAAN, Executive Director, New Jersey Collaborating Center for Nursing Karen L. Clark, Vice President, Medicaid, Horizon Blue Cross Blue Shield of New Jersey Vincent M. Costantino, MBA, Chief Administrative Officer, St. Francis Medical Center Pat Dennehy, DNP, RN, FNP-BC, FAAN, Principal, Health Management Associates Judy Donlen, DNSc, RN, JD, Executive Director, Southern NJ Perinatal Cooperative and President/CEO of Family Health Initiatives AleX Durlacher, Dectective, Trenton Police Department Rev. Daniel Eisenberg, Pastor, St. Bartholomew Lutheran Church, Trenton, NJ Ilsa Ford, Assistant Manager, Homefront Doug Forrester, Chairman & CEO, Integrity Health Gloria Frederick, Executive Director, Institute of Wonderful Women Working for Empowerment Kathleen M. Gialanella, Esq., P.C. Brendan Gill, Essex County Freeholder Rabbi Yitzchock Halberstam - Principal, Seton Services Valerie Harr, Chief of Operations, NJ Medicaid Program AleXander J. Hatala, President and CEO, Lourdes Health System, New Jersey The Honorable Heather Howard, JD, BA, Lecturer in Public Affairs, Princeton University; Faculty Affiliate of the Center for Health and Wellbeing; Director of Robert Wood Johnson programs: State Health Reform Assistance Network and State Health & Value Strategies Program. Former New Jersey Commissioner of Health and Senior Services (2008-2010) Jillian Hudspeth, President and CEO, New Jersey Primary Care Association v Theresa Jacks, Deputy Director, Council of New Jersey Grantsmakers Mary L. Johansen, PhD, NE-BC, RN, Associate Director, New Jersey Collaborating Center for Nursing Barbara George Johnson, MPH, JD, Executive Director, The John S. Watson Institute for Public Policy, Thomas Edison State College Ellen Lambert, Chief Development Officer & Corporate Citizenship, PSE&G Beverly Mills, Director, Mercer County Workforce Investment Board Catherine Milone, President, New Jersey Junior Achievement Filomena Machleder, Program Officer, Corporate Social Responsibility Department, Horizon Foundation for New Jersey Cynthia Oberkofler, Executive Director, Mill Hill Child and Family Development The Honorable Mary O’Dowd, MPH, Board of Directors, Horizon Blue Cross/Blue Shield; former Commissioner, New Jersey Department of Health Melissa Parker, Chief Operating Officer, United Family Medicine, St. Paul, Minnesota Tray Parris-Benjamin, LMSW, Transformation Coach, Horizon Healthcare Innovations, Horizon Blue Cross Blue Shield of New Jersey Gregory Paulson, MS, MICP, Executive Director, Trenton Health Team Steven Peskin, MD, Senior Medical Director, Clinical Innovations, Horizon Blue Cross Blue Shield of New Jersey Bonita A. Pilon, PhD, NE-A, FAAN, Professor, Vanderbilt University School of Nursing Elyse Pivnick, Director, ISLES, Inc. Erhardt H.L. Preitauer, President, Horizon New Jersey Health & Sr. Vice President Government Programs, Horizon Blue Cross Blue Shield of New Jersey Joanne M. Pohl, PhD, ANP-BC, FAAN, FAANP, Professor Emerita, University of Michigan School of Nursing Robert. J. Remstein, DO, MBA, FACP, Vice President for Accountable Care- Capital Health, and Medical Director, Capital Health Primary Care Lower Makefield Nils Richardson, President and CEO, ACCSES NJ Diana Rogers, Acting Director of Housing & Economic Development, City of Trenton John Sarno, President, Employers Association of New Jersey Donna Scheel, Director of Veterans Services, US Department of Labor June Stanley, MSN, FNP, Senior Director of Clinical Operations, Government Programs, Horizon Blue Cross Blue Shield of New Jersey Christy Stephenson, MBA, RN, Board Member, Trenton Health Team, and Chair, Trenton Health Team ACO Board Peter G. Stewart, Partner (retired), Carella, Byrne, Cecchi, Olstein, Brody & Agnello, P.C. John Tedeschi, MD, Advocare LLC, Continuum Health Alliance Rick Thigpen, Vice President State Government Affairs, PSE&G Jennifer Valverde, Clinical Professor of Law and Clinical Director of H.E.A.L., Rutgers School of Law-Newark Patricia M. Vanhook, Ph.D, RN, FNP-BC, FAAN, Professor and Associate Dean of Practice, East Tennessee State University Erol Veznedaroglu, MD, FACS, FAANS, FAHA, Director of Drexel Neuroscience Institute, Philadelphia, PA Susan VonNessen-Scanlin, MSN, CPNP, MBA, Chief Transformation Officer, Robert Wood Johnson Medical School vi Gregory K. Williams, D. Min., Director of Community Engagement, Trenton Health Team Malvina Williams, Director of Nursing, Holy Redeemer Healthcare and Hospice Joseph Youngblood, II, JD, PHD, Chair, Board of Trustees, St. Francis Medical Center, Trenton, New Jersey vii Executive Summary The City of Trenton is both culturally and racially diverse with the significant challenges of high poverty rates, under and unemployment, and a crime rate that is out of control. Trenton has been actively engaged for a number of years in attempting to put in place a solution to the under treatment of its neediest citizens with respect to their healthcare. Community services for these underprivileged citizens are centered around community agencies; healthcare services are centered in one Federally Qualified Health Center and, at present, two safety net hospitals. Although attempts have been made to integrate these services and coordinate them, the local marketplace lacks sufficient financial resources to support all the necessary services required by Trenton’s very needy population at anywhere near sustainable levels. As a result, community/healthcare services are forced to aggressively compete for insufficient resources setting up an environment where cooperation and team effort are very difficult to achieve. The resolution of this competitive environment is an essential factor to improving the health status of Trenton residents. One of the earliest organized attempts at integration of healthcare services in the state was the Trenton Health Team. It brought all of the parties involved in healthcare to the table with the objective of improving care, lowering cost and increasing access for the Trenton population. The primary focus was to have non-emergent/primary care use of emergency rooms in the City reduced or eliminated. The miXed results of these efforts seems to be centered upon the competitive environment rather than a lack of will of the participants. Enhancing primary care while improving access to behavioral health services in Trenton needs to be the focus of any healthcare improvement strategy for the City. Abundant literature demonstrates the effectiveness and quality of Nurse Practitioner care. To meet the primary care needs, the patient centric care provided by nurse practitioners would be essential to serving the compleX populations found in Trenton’s underserved, low income neighborhoods. This feasibility study was undertaken