Health care costs are straining insurers, pushing health systems to the brink and — most importantly — squeezing family budgets. Affordability is becoming a greater obstacle than access.
Hackensack Meridian Health CEO Bob Garrett said it’s easy to pinpoint the reasons why. The health care system, he said, is fundamentally misaligned around the wrong incentives. The balance between prevention and treatment is not where it needs to be, he said.
Solving the problem isn’t so simple.
That’s why Garrett, following the affordability push of new Gov. Mikie Sherrill, is proposing a statewide health care summit of top industry leaders, one that not only could identify the problems, but also offers solutions. He envisions hospital CEOs, community providers, frontline physicians and nurses, insurers, regulators and lawmakers sitting together in one room with a single mission — agreeing on a handful of actionable items that could immediately begin to bend the cost curve.
“I’m encouraged to hear that the governor has made affordability a top priority,” Garrett told BINJE in an hour-long interview on the state of health care in New Jersey. “I’m willing to come as part of a group to start talking about solutions.
“Let’s get everybody in a room.”
Garrett pinpointed three reasons why health care is so expensive in New Jersey and around the country:
- Higher utilization: Which is driving up costs across the system.
- Loss of certain federal subsidies: Thanks to a revamping of the Affordable Care Act.
- Medicaid redeterminations: Which have pushed vulnerable families off coverage.
But that’s only the here and now. Garrett said the way the state and the country deliver health care needs to change, to have real impact.
Reimagining health care in N.J.
Hackensack Meridian Health CEO Bob Garrett wants to convene a meaning of the top health care thought-leaders in the state in an effort to reform the system – with a goal of making it more affordable.
Garrett will even offer the first five discussion points:
- Aligning incentives so prevention matters as much as treatment;
- Expanding primary care and ambulatory access;
- Scaling social‑needs screening statewide;
- Bringing in federal partners;
- Building a cohesive strategy — not a fragmented one.
“In the U.S., the focus on treatment versus a balance between prevention and treatment is really driving health care costs up,” he said. “It’s not helping hospitals, because 50%-60% of our patients are insured under governmental programs, where hospitals and health systems are losing money. And some of that gets passed onto the insurers, so they’re also in significant financial stress.”
All of this leads to a disconnect:
Premiums go up, and patients pay more, but insurers, like Horizon Blue Cross Blue Shield, are struggling. (The insurer recently announced layoffs due to financial issues.)
“I understand why the consumer is confused,” Garrett said.
Garrett, the leader of the Hackensack Meridian Health team that was a co-No. 1 last fall in the BINJE’s Best Health care leaders, is an acknowledged thought-leader around the world. He said the state could benefit from best practices elsewhere.
Garrett points to European countries that have succeeded in slowing cost growth by making prevention the backbone of primary care.
HMH is trying to do that internally, especially through its medical school, where future doctors are being incentivized to enter primary care and focus heavily on preventive health and social needs. But he argues that a statewide coalition could accelerate the shift dramatically, one that would help get incentives pointed in the right direction.
“If we don’t address preventing chronic disease, preventing illnesses and focusing on the social determinants of health, we’re not going to be able to bend that cost curve,” he said. “We need to change the incentives around so that we really do focus on prevention.”
Is it possible? Is this something that can be solved by a meeting of the minds of the best and brightest in New Jersey?
Even Garrett acknowledges that even a well‑orchestrated New Jersey summit can’t solve the problem alone. Federal policy is tightly interwoven with the economics of Medicare, Medicaid, and ACA coverage.
But there is hope, Garrett said.
Garrett and other HMH leaders recently met with senior officials at the Centers for Medicare & Medicaid Services during the JP Morgan Healthcare Conference in January. He came away optimistic.
“There is an openness to innovation,” he said.
And while CMS has to be at the table, that doesn’t mean New Jersey can’t lead the conversation, Garrett said. He points to HMH’s own prevention initiatives, ones built around social determinants of health, as proof that progress is possible even within the current system.
HMH already has screened 3.4 million people — approximately one‑third of New Jersey’s entire population. Those screenings have produced 7.8 million referrals for help with rent, food, transportation, utilities, and other non‑medical needs that directly affect health outcomes.
“That’s just one health system,” Garrett said. “If everybody were to do the same kind of screenings, it would be incredible.”
HMH, he said, also is investing heavily in new access points:
- Push for primary care: HMH is creating a network of Amazon/One Medical primary care centers aimed at giving those without a primary care physician access to such care. Two are already open, a third is coming in months, and there are plans for up to 20 statewide, Garrett said.
- Metropark’s moment: HMH is nearly finished with a first‑of‑its‑kind ambulatory health and wellness hub on a major transit line. It is set to begin occupancy in March and be fully operational by the summer, Garrett said.
- Hospital‑at‑home and other technological advancements: Garrett noted HMH’s AI partnerships with Google, and patient‑experience tools such as Clear and Uber. It’s all part of creating technology‑enabled primary care.
Garrett sees these innovations as long-term affordability levers. Earlier interventions, he argues, lead to fewer emergencies, fewer admissions and fewer costly complications.
“Ultimately,” he said, “that’s how you make care more affordable.”
Worth talking about? Garrett says yes. The only question remaining is who sends the invitations.
Garrett says the governor is best positioned to call the meeting, given the mix of private, nonprofit, and government stakeholders needed. But he’s willing to help lead the effort — and he believes others will join.
“I’d certainly partner with the governor’s office,” he said. “And I think the regulators and the legislators would welcome that, too.”
There are great possibilities.
“In all these challenges, there are solutions and opportunities,” he said. “So, let’s go at it.”
