Professors John V. Jacobi and Tara Adams Ragone

New Reports Recommend Improvements to New Jersey's Healthcare System

Professor Tara Adams Ragone: “Integration of behavioral and physical health care services is increasingly the clinical state of the art, and is a critically important component of health improvement efforts.”

Seton Hall Law's Center for Health & Pharmaceutical Law & Policy published two reports this past quarter presenting roadmaps for integrating behavioral health and primary care in New Jersey.

In the first report, titled “Integration of Behavioral and Physical Healthcare: Licensing and Reimbursement Barriers and Opportunities in New Jersey,” Professors John Jacobi, Tara Adams Ragone, and Kate Greenwood analyzed the legal, policy, regulatory, and fiscal barriers currently inhibiting integrated care, and recommend concrete steps the state can take to facilitate integration. The report was funded by The Nicholson Foundation, which conceived of the need for this project due to its experience funding care integration pilots at five clinics throughout New Jersey.

“The integration of care saves both lives and dollars. Too often, New Jersey’s regulations continue to reflect a previous era of separation, and create significant barriers to enacting current clinical norms,” said Professor Jacobi. “Our report shows that there is a clear path forward, and the open engagement of representatives of state agencies demonstrates both leadership and cooperation on the part of the state.”

To craft the report, the authors delved into both the clinical literature on behavioral health and the dense thicket of statutory and regulatory law on licensure and reimbursement. As mental health and substance use disorder treatment providers are generally regulated and funded by different departments within state government than primary care providers (the Department of Human Services (DHS) and Department of Health (DOH) respectively), the team closely consulted with officials from both departments throughout the process. They also conducted extensive conversations with primary care and behavioral health practitioners, academics, and advocates.

Subsequently, in June 2016 Professor Ragone published, Integrating Behavioral and Physical Health Care in New Jersey: Legal Requirements for the Sharing of Patient Health Information among Treatment Providers, exploring the issues related to breaking down barriers to create and improve the sharing of patient information between behavioral health and physical healthcare providers.

Professor Ragone details federal and state laws governing the sharing of patient information among healthcare providers; identifies the barriers to sharing health information among providers within those legal frameworks; and recommends opportunities to support provider exchange of information to advance integration of behavioral health and physical care.

“Integration of behavioral and physical health care services is increasingly the clinical state of the art, and is a critically important component of health improvement efforts,” wrote Professor Ragone. “The sharing of patient records by coordinating providers is central to integration...”

This report was prepared in response to a request for legal analysis as part of New Jersey’s State Innovation Model Grant and funded by the U.S. Department of Health and Human Services and the Centers for Medicare & Medicaid Services. Led by Professor Ragone, the Center for Health & Pharmaceutical Law & Policy conducted a number of interviews with providers, regulators, health information exchanges, health information organizations, trade and professional associations, consultants, privacy attorneys, advocates, and researchers, to learn more about the specific problems providers face and identify outstanding questions.

“Federal law increasingly recognizes the value for patients to permit health care providers to exchange health information so they may facilitate coordinated care,” said Professor Ragone. “New Jersey similarly is supporting a number of innovative integrated health initiatives that offer the promise of improved quality and greater efficiency. This Report clarifies the misinformation and uncertainty that exist in the provider community regarding when patient health information may be exchanged and urges harmonization of federal and State law, which should support and facilitate the State’s vital integration initiatives.”