‘Hardest and best job I’ve had’: Health Commissioner Elnahal talks Year One and beyond

New Jersey’s health commissioner has had a tumultuous first year — successfully expanding the medical marijuana program and then facing the Legislature in a hearing over a virus outbreak at a number of New Jersey health facilities.

Dr. Shereef Elnahal spoke with ROI-NJ about Year One in the hot seat, as well as what he anticipates for the new year.

ROI-NJ: What can you say about Year One in the administration of Gov. Phil Murphy?

Shereef Elnahal: It’s been simultaneously the hardest and the best job I’ve had. The best job, because I’ve been fortunate enough to build a full team. I come to work every day excited to meet my team, and it makes the job so much more enjoyable. The second reason is, despite what some folks told me before coming back to New Jersey, I really think the major players that are influential that we need to partner with are well-intentioned. They have strong feelings about where they want to see health care go. But they have the same goals as I do, as the governor does. There may be slight disagreements on how to get there, but all the stakeholders I’ve worked with have been a pleasure to work with. That includes the Legislature, hospital leadership and folks that run long-term care centers and smaller institutions. They’re very patient-focused and that’s been surprising and heartening to see.

ROI: Why was it surprising? What did you hear about New Jersey?

SE: When I was at the (Department of Veterans Affairs), I had the experience of working with very mission-oriented people because they weren’t there for the pay, certainly, and they were working for folks who had sacrificed so much for us. This is the first job where I’ve had to interface, meaningfully, every day with folks in the private sector and folks that run interest groups. The reputation (of New Jersey) had been that sometimes these folks take matters into their own hands, things that may be against the patient’s interest, but I really haven’t seen that. I think that playing field makes it easier to navigate the politics (that New Jersey is known for). If I had noticed a more cynical outcome, primarily motivated by self-interest, that would be more difficult, but I haven’t noticed that in the health care landscape.

ROI: Going back to the year in review, how has the job been been difficult?

SE: It is a difficult job because, if you care about being thorough, (it) consumes a large part of your life. That’s just the very nature of it. I think that’s why I’ve gotten the counsel of former commissioners regardless of who was governor, from both Democratic and Republican administrations, on advice on how to move forward in certain situations (including Fred Jacobs, Heather Howard, Mary O’Dowd and Cathleen Bennett). There have been times where I wasn’t sure about the actions I was taking, and I think a humble approach to this job makes that inevitable. But having a perspective of someone who has been in this seat is really important. The governor’s been really supportive. It’s not really the case that governors communicate with the health lead, and, in every state, I hear mixed things about that from my peers nationally, but he is very interested in health care. He counsels me and consults with me all the time on issues. His leadership has been very supportive and has made the job easier. Overall, I think it’s been a tremendous and humbling experience.

ROI: It must be interesting to be working with Cathleen Bennett, now that she is working on the other side at the New Jersey Hospital Association.

SE: I’ve gotten a lot of chances to work with her on things. She’s been a tremendous leader of NJHA and we’re partnering on a number of things, like reducing opioid prescriptions in hospitals. It’s part of the landscape of what I’m excited about next year in the opioid epidemic: exploring syringe access programs, access in health care institutions — especially in hospitals, specifically — spreading the best practice that St. Joseph’s Healthcare System has offered with reducing opioid prescriptions in the emergency room. And then thinking about ways of expanding that to areas like post-operative pain control, where patients often get a full bottle of Oxycodone when they have had a minor surgery. We are going to have a request for applications for grants that would go to hospitals to support staff time and attention to educating frontline clinicians on alternatives to opioids.

St. Joseph’s has a model that has the costs of clinician time well-accounted for, and that’s informing what the grant dollars will look like. And there will be accomplishment-based milestones for which people would be able to get a higher dollar amount and be recognized. Or, if there’s innovation, or a different method to get (to reducing opioid prescriptions), that’s also part of the project. Looking for even newer and maybe even more effective ways. So far, it’s just for hospitals.

ROI: How is the state innovating or doing things differently in a way that proves it is patient-focused?

SE: What the Housing Mortgage Financing Authority is doing with encouraging hospitals to pay for housing up front, to provide a layer of social stability that ultimately improves health, is fantastic. That has to prove itself in terms of return on investment, but you have to have institutions that are at least willing to take that risk and at least piloting those efforts. We are seeing hospitals all over the state interested in that. We have some preliminary evidence from the Camden Coalition — from which the Murphy administration has recruited fantastic staff — their Housing First program continues to show benefits in health. I think the jury is still out on the financial sustainability and business model, but I think there is room to find a solution there. 

ROI: Sounds like there are a lot of things that the government is looking at — including expanding the health care information exchange the DOH has been creating, which began under the previous administration. Is it because the private sector isn’t? 

SE: In the last 20 years, you’ve had lots of technology that has had questionable results, in terms of outcomes, and has not necessarily lead to more efficient care. I think the tragedy behind that phenomenon has been a lack of engagement of frontline clinicians in the development of that technology. Which is why you’ve had systems which are designed and optimized for billing, but have made the lives of physicians, nurses and other clinicians more difficult. For the Health Information Exchange, we now have 62 of the 72 hospitals in the state, so we only have 10 left. We are hoping to get that done by spring. We are also connecting to One Health, which is being run by the Medical Society of New Jersey. The more providers that connect to that single network, the higher the value of that network.

ROI: How do we leverage all that technology?

SE: The social determinants piece goes hand in hand with that. Can you build technology that makes it easier to access communities of color that we failed to access in the past? The shameful disparities we have in infant mortality, maternal mortality, pick a chronic disease, are in large part because we fail to find folks of color and bring them into care. That can be solved, in large part, by technology. We are talking about telehealth. Almost everyone has a smartphone now and to not leverage that to bring in people would be a mistake. This also feeds into the governor’s economic agenda (of the innovation economy). If I’m able to do an API with the full universe of a patient’s information, the value of things like health care apps that help with self-management for patients explodes. (This) can help in attracting early stage companies to the state. Health care is an industry that New Jersey has a huge competitive advantage in.

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