The hubs coordinate medical and social services, especially for people with complex challenges like homelessness or addiction.
When state health officials sought to boost COVID-19 vaccination rates in Camden — one of a handful of communities lagging statewide immunization levels in July 2021 — they turned to the Camden Coalition for help.
The Coalition, a nonprofit alliance founded two decades ago to improve health outcomes in the city, distributed information about the benefits of immunization and organized vaccination clinics at popular sites. The group also identified trusted community leaders who could serve as vaccine “ambassadors” to help counter myths about the shots in the mostly Black and Hispanic communities, where trust of government and the health care system has been compromised after decades of misinformation and neglect.
The Camden Coalition is one of New Jersey’s four regional health care hubs — others are based in Trenton, Newark and Passaic County — that coordinate medical and social services in their areas with a focus on people with complex challenges, like homelessness or addiction.
New Jersey’s regional health care hub model was highlighted as an “Innovation in Action” in a White House report addressing social determinants of health, released in November. Social determinants — like food insecurity, poor housing or poverty — impact as much as 50% of county-level health outcomes, according to the report, impacting a person’s risk of chronic disease, life expectancy and more.
“The four Regional Health Hubs play a critical role in overall health and wellness in New Jersey. By using data and working with community partners, they help bridge the many gaps that people try to navigate with the health care delivery systems and social needs,” said Linda Schwimmer, president and CEO of the New Jersey Health Care Quality Institute, a nonprofit policy group that studied the model in 2019 and advocated for its implementation.
“The Hubs have been the consistent ‘go to’ partner for Departments of Health and Human Services for rolling out high priority projects such as COVID engagement and vaccination and now the Medicaid re-enrollment,” Schwimmer said, referring to the process states are now undergoing to reconfirm Medicaid eligibility after these checks were allowed to lapse during the pandemic.
Modifying a long-standing model
New Jersey’s health hubs were technically created by a law signed by Gov. Phil Murphy in January 2020. But they had previously existed as regional Medicaid Accountable Care Organizations, a model developed as part of the federal Affordable Care Act and codified in New Jersey through a separate law, signed by former Gov. Chris Christie in 2011.
The accountable care organizations offered similar community-based coordination to help patients access preventive care and other services, but the law also called for the organizations to pursue savings by reducing the need for more costly treatment. Many experts said this element hampered their ability to function effectively and became redundant after the state shifted most Medicaid members to managed care plans, where insurance companies are paid a set fee and work to control costs.
‘Each of the Hubs has different areas of strength and focus but the common elements are their close relationships within the community and the use of data to drive needed next steps to improve the lives of local residents.’ — Linda Schwimmer, New Jersey Health Care Quality Institute
Victor Murray, the senior director of community engagement and capacity building at the Camden Coalition, said the shift to the hub model has also given the regional agencies greater input with the state on how programs can be tweaked to benefit clients. In the past, “we learned things, but we didn’t always have a lever to transfer that knowledge,” he said. “We didn’t have any teeth in the ACO model.”
Under the hub model, Murray said government officials are more likely to accept input from the regional agency about which groups of patients should be prioritized for a program, for example, or where to set up a vaccination program. These recommendations are rooted in the trusted relationships coalition members have developed with neighborhood leaders over the years, he said, long before the COVID-19 pandemic. “You can’t build that connection in a crisis,” Murray said.
Coordinating organizations
The White House report identifies three critical pillars that are needed to address social determinants of health: Expand data gathering and sharing; support flexible funding to address social needs; and support backbone organizations. The report defines backbone organizations as community-based partnerships that span multiple sectors — like public health, social services and economic development — and can serve as coordinating entities. Health care hubs are one type of backbone organization.
“If we want to decisively address health equity and social determinants of health in a holistic way, all these pillars are important,” said Andrea Martinez-Mejia, executive director of the Greater Newark Health Care Coalition, which runs another regional hub, in an interview with the Quality Institute. “Many of the innovations and interventions at the local level are not quick fixes, but rather are the result of ongoing interactions and interventions across various sectors for multiple years; hence the need for multi-year, flexible spending for community health infrastructure, sustainability, and workforce development.”
For the Trenton Health Team, which runs another regional health hub, the connections it had established were critical during a maternal health pilot program that involved nurses visiting new moms at home. The state has since launched the program in five counties as Family Connects NJ, which also involves linking families with various support services — a task that depends on strong local knowledge.
“I think in all of these related areas of work, we’re starting to understand better how to identify and address the relationships amongst the different resources and organizations that provide them,” said Gregory Paulson, Trenton Health Team CEO. “And the Family Connects model implementing it now statewide is another way that we as a system are trying to do that better, trying to say, ‘how do the pieces fit together better’.”
The White House report also notes that New Jersey plans to expand its health care hub program, something Schwimmer supports, especially in underserved communities. “Each of the Hubs has different areas of strength and focus but the common elements are their close relationships within the community and the use of data to drive needed next steps to improve the lives of local residents,” she said.
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