Greg Woods leads the Division of Medical Assistance and Health Services, which administers NJ FamilyCare, the state Medicaid program.
What are the one or two top priorities that you and the administration seek to accomplish at NJ FamilyCare over the remainder of this administration?
Over the past year plus, New Jersey, like all state Medicaid programs, was required to confirm whether all our two million-plus Medicaid members remained eligible for coverage after the COVID-19 pandemic. One important priority for me, as we come out of that very intense experience, is to take stock of our eligibility and enrollment systems and processes, build on areas where they performed well and address opportunities for improvement. This includes continuing to innovate in our outreach and communications strategy, with a focus on effectively sharing information with members who may be only loosely connected to the health care system. It also involves thinking about how to most effectively partner with stakeholders, such as community-based groups to share important information about the Medicaid program, as well as pursuing improvements to our application forms and online systems, to make them as user-friendly and painless as possible.
A second priority is that during 2025, we are planning to start providing what are known as housing-related services under Medicaid. These are new services that will assist our members with either finding housing – for instance, if they are currently in an unstable housing situation or are transitioning out of an institution. It will also help members remain in housing that is working for them. To support this benefit, we are working on partnering with organizations that may have not traditionally worked with Medicaid — such as shelters or community-based organizations that help with housing search. This is a new area for us, so we’ll need to learn as we go, but we’re very excited about innovating in this space, since we know that housing and health are closely interrelated, and having stable housing is critical for achieving strong health outcomes.
You will be bringing certain behavioral health services under the Managed Care Organizations’ contract in early 2025. What can enrollees and providers expect?
From a member perspective, our most immediate priority is that there not be any disruption to ongoing care. So if a member is seeing a behavioral health care provider, it’s critical that this transition not disrupt that care relationship. There are a range of fairly strict requirements we are putting into our MCO contracts to ensure that this is the case – including requirements around continuity of care, authorization and approval of services, and provider reimbursement.
Longer term, the goal is greater integration. Our view is that it hasn’t served members well to have behavioral health care over ‘here’ — and physical health care over ‘there’. An example is postpartum care, where care for postpartum depression will now be better integrated with the physical health care that the mother is receiving at the same time. That integration, we hope, will mean better care management for our members and better health outcomes as a result.
Another important goal is improved access to care. There are certain behavioral health provider types where demand often outstrips supply. That’s a hard problem to manage under any delivery system, but we are really hopeful that by integrating this benefit into managed care and setting clear requirements that managed care organizations build a robust network of providers, that over the long term we will build greater access to needed services.
Are there types of care provided under NJ FamilyCare where we need improvements on access, and are there steps you plan to pursue to increase access?
I think it’s important to remember that meaningful access is not just having a network of providers on paper; it’s making sure that those providers are actually accepting appointments to serve NJ FamilyCare beneficiaries and providing those beneficiaries with access to the care they need. One thing we are doing to ensure this is the case is reviewing managed care provider networks to see not only which providers are on that list, but which are actually serving our members, with historical claims to prove it. There are also additional steps we intend to take in the future, under the recently finalized CMS managed care rule, such as implementing Secret Shopper, where you call the provider in the network and check that they are accepting appointments.
In terms of specific areas where we need improvements in access — this is not an exhaustive list — but I would mention behavioral health, which we just talked about and where we hope integration into the managed care benefit will be helpful. Another area is dental care, in particular dental care for children. One thing we’ve been doing in that space is strengthening our accountability for managed care organizations. What percentage of the children who they cover are getting a preventive pediatric visit each year? If they’re not hitting our targets on that front, there are financial penalties.
Another area is doulas. That’s a new benefit, about which we are very proud and excited. But the important next step is making sure not only that we have a doula benefit, but also that there is a sufficient workforce to provide the benefit to every mother that would like a doula. One lever here may be helping more people who live in the community who are interested in becoming doulas find a pathway to get trained.
You have a background in payment reform and innovation and have worked at the Center for Medicare and Medicaid Innovation. What payment and delivery innovations would you like to pursue now?
I think a first principle is that you should not do innovation just for the sake of innovation. Some program goals can be advanced through an innovative payment or delivery model. Other goals are best advanced not through innovation, but just by making your existing payment and delivery models work better.
With that caveat, I will mention a few areas where I am excited about innovative approaches. One is housing, which I already mentioned. A second, is a new pilot we are standing up with our managed care plans to test innovative approaches to using community health workers to educate or support individuals with chronic illnesses. A third area is our perinatal episode of care pilot, which is a voluntary program in which we pay ob-gyns and midwives not just for the services they deliver, but also based on their patient outcomes and the quality and efficiency of care. This program was stood up several years ago with the assistance of the Quality Institute, and we’re now in our third year of testing this.
Finally, we like to ask a question beyond a person’s professional work. If you could choose anyone (throughout history or alive today), who would be your hero?
I think the way Abraham Lincoln combined ambition, determination, fortitude, and wisdom is an aspirational model for me, and for many Americans who work in public service. If you can epitomize those qualities even 1/100th as well as Lincoln — then as a public servant you’ve done well.