In 2007, Dan Derksen, MD, arrived in Washington to begin his term as a Robert Wood Johnson Foundation (RWJF) Health Policy Fellow. At the time, he would never have guessed that the legislative baptism by fire that he received working for Sen. Jeff Bingaman, (D-NM, Senate Finance and Health & Education Committees), was perfect training for the next big step in his career. "I worked on legislative provisions addressing health workforce shortages and the distribution of health professionals in rural and underserved areas that were eventually signed into law," Derksen says of his year spent in Washington, D. C. "It was a total immersion in researching, drafting and going through the federal legislative process that will now help me carry out my work at the state level."
Derksen is referring to his appointment, by Governor Susana Martinez, as the director of the New Mexico Office of Health Care Reform in August of 2011. Having just secured the state's first grant—$34.2 million to establish a health insurance exchange—Derksen says he is "excited," but he acknowledges that he faces a complex range of duties. "In addition to establishing an exchange, the priorities of the office include: modernizing New Mexico's Medicaid system and addressing an extreme shortage of health workers across the state, while controlling state health costs."
Taking on these issues would be challenging under any circumstances, but Derksen explains that New Mexico faces many unique problems. "We have the second highest percentage of uninsured of any state in the country. Approximately 450,000 of our residents are uninsured and 550,000 are on Medicaid. We expect 175,000 to eventually join the Medicaid plan and as many as 250,000 people to gain insurance through the exchanges, starting in 2014, as a result of reform," Derksen says.
"We also have the fifth largest land mass in the country, but our population is just over 2 million people. We are short 400, full-time primary care providers needed for our state—physicians, nurses, dentists and health care workers across the board. For these reasons, 32 of our 33 counties are full or partial federally-designated health professions shortage areas," Derksen explains.
An Experienced Leader
To solve problems of this magnitude, Derksen is also drawing on the lessons learned as former president of New Mexico's Medical Society and a current senior fellow at the Robert Wood Johnson Foundation Center for Health Policy at the University of New Mexico (UNM).
"Working for the Medical Society gave me an opportunity to travel around the state and hear physician and patient concerns, needs and interests," Derksen says. In addition, says Robert Valdez, PhD, executive director of the RWJF Health Policy Center at UNM, "Dan has led the Center's work on the RWJF Aligning Forces for Quality initiative in Albuquerque." Aligning Forces for Quality efforts are designed to increase access, improve the quality of health care received in targeted areas and conduct meaningful performance measurement and public reporting.
"Dan also worked on the Center's recent summit for the state's legislators and executive branch staff," Valdez adds. "The Center hosted the meeting to provide a neutral, non-partisan space for a discussion on establishing the New Mexico Health Insurance Exchange. Other activities at the Center include working with New Mexico's 22 Native American tribes whose Indian Health Service benefits and other health care services will be impacted by the ACA and our national and state-level opinion research work on Latino perspectives on health care reform," Valdez says.
Toward a Healthier New Mexico
Even with all of these issues on his plate, Derksen says, "I'm very enthusiastic about this work." His approach includes testing models that may be replicated in other states. "The integrated care provided in our patient-centered medical homes, for example, is based on a payment structure that would reward the medical home with additional pay per member for the successful coordination and integration of a member's care. This type of care is especially important in states like ours with very high rates of chronic diseases such as diabetes. We're drawing on experiences from our state Health Commons program where integrated care has reduced hospitalizations."
"Overall, we're very eager to get more New Mexicans covered by insurance, so we're moving forward despite the unique challenges we may face," Derksen says. "This is a time for us to innovate, expand coverage, improve health outcomes and assure access to quality health care for our uninsured."
The Robert Wood Johnson Foundation Health Policy Fellows program provides the nation's most comprehensive fellowship experience at the nexus of health science, policy and politics in Washington, D.C. It is an outstanding opportunity for exceptional midcareer health professionals and behavioral and social scientists with an interest in health and health care policy. Fellows participate in the policy process at the federal level and use that leadership experience to improve health, health care, and health policy.