The New Jersey Senate confirmed Judith M. Persichilli, RN, BSN, MA, as Commissioner of the New Jersey Department of Health on January 9, 2020. Commissioner Persichilli, whose nomination was announced by Governor Phil Murphy in June 2019, has served as Acting Commissioner since August 2019. She is the first registered nurse to become the state’s Health Commissioner. Commissioner Persichilli was President Emerita of CHE Trinity Health and most recently served as the Acting CEO of University Hospital in Newark, New Jersey. She is a former MDAdvisor Editorial Board member and a 2011 recipient of the EJI Excellence in Medicine Awards in the Outstanding Healthcare Executive category. Commissioner Persichilli recently responded to questions posed by MDAdvisor staff about her goals and priorities at the Department of Health and the challenges facing New Jersey healthcare providers.
MDAdvisor: What is the significance of being the first nurse to serve as the Commissioner of Health?
Persichilli: It is surprising to me that there hasn’t been a nurse in this role already. Nurses just put their heads down and do the work. Many of them rise to significant positions within hospitals and health systems and community health services. They are able to integrate their clinical knowledge with business acumen. They are doing great things, but as with most women-dominated professions, they are not in the forefront. They are always in the background doing the work, so they often don’t get recognized and considered for positions where they could really use what they have learned and experienced to bring about better healthcare. I know many women who started their careers as nurses who could fill this role.
MDAdvisor: How has your background in the private sector as a hospital executive prepared you for your role as Commissioner?
Persichilli: The lessons that I’ve learned in the private sector really have helped me understand that we, at the Department, have to integrate all that we do within public health and public service and government with the realities of how health systems are run and how change is affected. We need to admit that the business model of healthcare has been stuck in two areas for almost a century—the doctor’s office and the hospital—where more than 50 percent of the money is spent. That’s what we need to change. We want to move toward prevention and community health, but that doesn’t happen with the stroke of a pen or legislation. It happens through sound stakeholder involvement and change management, processes that the private sector uses all the time when it introduces a new product or integrates a new hospital into a system. We’re learning internally at the Department to use those same principles, not only with other departments and the Governor’s office, but also with stakeholders outside of the Department.
MDAdvisor: What are your top priorities while serving as Commissioner of the New Jersey Department of Health?
Persichilli: I like to put my priorities into two buckets: strategic and tactical. The tactical priorities consist of tasks that have gone on for years at the Department; they’re what we confront every day. These include epidemiological studies, vital statistics and the reporting and follow up of outbreaks. These activities will continue day by day, and they have to be handled in short time frames. Then we have the longer-term strategic priorities, such as improving health and lowering healthcare costs. If we want to improve health for New Jerseyans, we have to start with improving maternal health, morbidity and mortality. A black woman in New Jersey is five times more likely to die due to pregnancy complications than a non-Hispanic white woman, regardless of socioeconomic status and education. Black infant mortality in New Jersey is also an issue. Our ultimate goal is to make New Jersey the safest place to have a baby. Another priority is combatting the opioid epidemic. In New Jersey, there are on average eight overdose deaths and 40 doses of Narcan given in the field every day. If you put those two statistics together, you realize that the epidemic is not going to be stopped overnight. Strategically, we need to use some of the same principles for maternal health and the opioid epidemic. It starts with granular data that can help identify where the hot spots are, so we can move to action in a targeted way. The Department has put together a Maternal Health Hospital Report Card (https://nj.gov/health/maternal/morbidity/mhh_reportcard/) (as shown in Figure 1), which is the only report card in the nation that calls out specific hospitals and racial and ethnic disparities. We have done the same thing with an interactive Overdose Data Dashboard (www.state.nj.us/health/populationhealth/opioid/) that is organized by county and displays opioid and other drug-related overdose indicators, including numbers of overdoses, deaths and associated emergency room visits. (See sample data in Figure 2.). That data drives the action. Lastly, I think we have to start really focusing on end-of-life issues and educating people about hospice and palliative care services, so that, along with legislative mandates, people feel empowered to make the best end-of-life decisions for their own circumstances.
MDAdvisor: Has the state seen any improvement in curtailing the opioid epidemic?
Persichilli: The Governor recently announced that preliminary 2019 year-end data indicates an approximate three percent decrease in the number of individuals lost compared to 2018, and a six percent decline in the number of opioids prescribed statewide. To some, that may not sound like a very significant improvement, but even reaching a plateau is a big improvement from the trends of the recent past. One of the areas we are focusing on is harm reduction. At the end of the day, we cannot force people into treatment if they are not ready. Our harm reduction centers offer a welcoming, non-judgmental place for people suffering from substance use disorders, where they can receive care, testing, counseling, sterile needles and strips to test their drugs for fentanyl. The stigma of substance use disorder is still very present. We need to understand that addiction is a true disease and that people need help. Some have a genetic predisposition to addiction, and some are motivated by traumatic childhood experiences. Our statistics show that of the individuals who enter our harm reduction centers, the percentage who go to follow-up care and who go into treatment is higher. We have seven centers now in New Jersey, and we would like to have more, which requires a municipal ordinance. So the challenge is trying to break down the stigma and acknowledge the fact that these people deserve the dignity and the respect that these centers give them. We have used our data to know where to focus our efforts, and I know these centers are making a difference in the lives of individuals battling addiction.
MDAdvisor: What is New Jersey’s stance on vaping, and what is the Department doing to educate and protect our citizens from the risks of vaping?
Persichilli: The lung injuries related to vaping recently reported across the nation were unusual occurrences all at once, equating to an outbreak of a non-communicable disease. We have seen a significant increase in vaping among underage individuals in just a two-year time frame. Studies have shown that nicotine is more addictive than heroin or cocaine, and some of the vape cartridges have nicotine amounts similar to what is found in a pack of cigarettes. We know that flavored vape products are enticing to underage individuals. The Electronic Smoking Device Task Force that I led made a number of recommendations, one of which was to ban flavored vapes, and Governor Murphy just signed a bill to do just that. The Task Force made additional recommendations, and the Legislature has the will to continue looking at additional precautions.
MDAdvisor: Should healthcare providers in New Jersey be aware of any recent developments with New Jersey’s Medicinal Marijuana Program?
Persichilli: The Medical Marijuana Program is going really well. The Governor has expanded the eligible diagnostic categories and we’ve seen about 40,000 additional people sign up to participate in the program. Personally, coming from a nursing background, I support individualized plans of care where people are given the knowledge to make their own choices about all the options, including medical marijuana and cannabidiol (CBD). What works for one person may not work for another.
MDAdvisor: One of the recent threats to health around the world is the coronavirus. What steps is New Jersey taking to protect its residents from the outbreak?
Persichilli: As soon as we began to get alerts from the Centers for Disease Control and Prevention (CDC) about the first outbreak of coronavirus, we immediately began to monitor the outbreak and initiate a response team. On February 3, Governor Murphy signed Executive Order No. 102, establishing the Coronavirus Task Force to coordinate all state efforts to appropriately prepare for and respond to the public health hazard posed by the novel coronavirus (2019-nCoV).The Department of Health is prepared to do
what needs to be done to protect the residents of New Jersey. We continuously work with the CDC, local authorities and local health departments. As an aside, most residents aren’t aware of the significant role of our local health departments, whether we’re talking about lead poisoning, or vaping, or outbreaks or animal shelters. I think people just assume local health officers only inspect restaurants, but that is not the case at all. The health officers are the unsung heroes of our communities.
MDAdvisor: Mandatory vaccinations is a topic the New Jersey Legislature has been taking on. What is the Department of Health’s role in the push for vaccinations, and how can physicians support these initiatives?
Persichilli: There is some real emotion surrounding this issue. Some people want to be able to make their own decisions about their children, and I get that. Then there are others who really feel that the science is saying that vaccinations cause autism, which is not the case. Of course, we know that every vaccination, or every pill you take, has side effects for some individuals. From a public health perspective, we support herd immunity. We need about 95 percent of people to be vaccinated to interrupt the spread of a disease. The measles outbreak in New York taught us a lot. Measles is one of the most contagious diseases in the world, and it can kill, particularly young children. We have an obligation to protect as many people as we can.
MDAdvisor: What are the greatest challenges facing New Jersey hospitals?
Persichilli: We are one of the most diverse and populous states in the nation, but, overall, I don’t think our challenges differ all that much from other states. We are an extremely welcoming state and have seen significant increases in undocumented residents. We are also now seeing a slight uptick in charity care for some hospitals, which is challenging them and their bottom line. We do have a percentage of hospitals that are really struggling. The transparency bills that have just been signed into law really assist the Department in being more vigilant and provide an early warning system, so the elected officials and county and municipal officials will be aware when a hospital is having difficulty. We have meetings every Friday just on that issue.
MDAdvisor: What are the most important changes coming to healthcare in the upcoming years?
Persichilli: We haven’t focused enough on artificial intelligence and then the use of technology to promote better health and better healthcare at a lower cost. I think the whole advent of wearables that will allow people to manage their own care with connectivity to central hubs that can predict when things are going good or bad will become significant. We haven’t yet harnessed the disruptive technologies that can make a real difference in how people are cared for, both in suburban and urban environments. I hope that the academic centers in our state will aim to be on the cutting edge of some of this technology, along with our large hospital systems.
MDAdvisor: The annual EJI Excellence in Medicine Awards program is coming up in the spring, and the mission of the program is to provide scholarships to medical and healthcare students in New Jersey. How important is it to be able to keep our medical talent here in New Jersey?
Persichilli: There’s a dearth of primary care physicians, particularly in challenged environments and urban centers. We train excellent students and then they leave for fellowships and don’t come back. We need as much help as we can get. Giving scholarships to students with the encouragement to see New Jersey as a great place to practice is one of the most important things you can do.
MDAdvisor: What has surprised you the most about your role as Commissioner so far?
Persichilli: I would have to say my biggest surprise is how much is accomplished with the small group of people we have at the Department of Health. They are a very efficient group, and they get things done. Sure, there are delays in certain areas, but at the end of the day when you look at all that has to get done, it’s pretty exciting. I’ll use vaping as an example. We jumped on it right away and put together the Task Force, by executive order of the Governor, and we had a report done in three weeks. I’m happy to say that the team has some of the longest tenured public employees, and I don’t want any of them to retire. Serving as Commissioner is a real privilege for me at this point in my career and I appreciate the opportunity to help the residents of New Jersey.
Catherine E. Williams is Senior Vice President, Business Development and Corporate Secretary, and Janet S. Puro, MPH, MBA, is Vice President of Business Development and Corporate Communications, at MDAdvantage Insurance Company.