Camden Coalition of Healthcare Providers Improving care and reducing costs in Camden, NJ with the help of innovative local data systems Kennen S. Gross, PhD, MPH Director, Research & Evaluation Camden Coalition of Healthcare Providers Camden Coalition of Healthcare Providers

"What we have before us are some breathtaking opportunities disguised as insolvable problems." -John Gardner Secretary of Health, Education and Welfare

The mission of CCHP is to improve the health status of all Camden residents by increasing the capacity, quality and access to care in the city.

Clinical Care Management Team Care Transitions Team Diabetes Self- Management Education Group Pregnancy Program Violence Intervention Medication Access Practice-Level Citywide Diabetes Collaborative EMR support Clinical Disease registries Embedded Nurses AmeriCorps Volunteers Research & Advocacy State ACO regulations RWJ Cross-Site Learning Grant Data Analysis on utilization patterns

System changes that will impact cost and improve quality of care requires: Understand the problem Develop interventions to target the problem Evaluate the impact of the solutions Data is needed at the level of the intervention If intervention is local – you need local data Identify and engage patients needing intervention

6 Issue #1 : Getting access to local healthcare data Camden City Median Family Income: $29,118 36% below Federal Poverty Level 48% Black, 47% Hispanic Camden County Median Family Income: $57,429 11% below the Federal Poverty Level 21% Black, 14% Hispanic

7 Issue #2 : Limitations of Existing Population Datasets

8 Issue #3 : Healthcare data that reflects the population

CCHP Solution : Camden Health Database Yearly Clams Data Data Use Agreements IRB Agreement Data processing/cleaning Probabilistic matching Geocoding Camden Residents All-Payer Claims Longitudinal Dataset  Demographics  Inpatient and Emergency visits  Diagnosis codes  Charges/receipts  Insurance Understand the problem

Camden Cost Curve, Understand the problem

ED visits, 2011 Inpatient visits, to ,728 (85%) patients 5,210 Inpatient visits 63,489 ED visits $28,000,000 (50%) IP payment $25,800,000 (59%) ED payment 985 (2%) patients 1,856 IP visits 4,129 ED visits $10,000,000 (17%) IP payment $1,700,000 (4%) ED payments 503 (1%) patients 2,026 Inpatient Visits 4,144 ED Visits $10,900,000 (20%) in IP payment $1,700,000 (4%)in ED payment 1 2 to 3 4 to 5 4,961(9%) patients 28,447 ED visits $11,500,000 (27%) in ED payment 1,563 (3%) patients 1,239 IP visits 6,962 ED visits $6,700,000 (18%) in IP payment $2,800,000 (6%) in ED payment 6 to 7 8 to Camden Hospital Utilization Typology Understand the problem

Camden Hospital Utilization, Understand the problem

Camden Hospital Inpatient and Emergency Revenue, Understand the problem

Primary ED Diagnosis, 2011PatientsVisits % of visitsReceipts Upper respiratory infections (head cold)4,0924, %$1,456,464 Sprains and strains2,9803, %$1,159,452 Superficial injury; contusion2,5612,7869.4%$837,132 Abdominal pain1,9862,3187.8%$926,239 Skin and subcutaneous tissue infections1,7172,2137.4%$673,115 Urinary tract infection1,8922,1827.3%$720,050 Spondylosis; and other back problems1,4841,7355.8%$517,997 Asthma1,0581,5805.3%$675,230 Total65,992$23,106,476 “Ambulatory Care Sensitive Conditions” and are often amenable to outpatient management Camden ED use by diagnosis, Understand the problem

Primary Diagnosis, 2011PatientsVisits % of visitsReceipts Births (mother & child)1, %$1,448,116 Hypertension %$1,558,671 Fluid and electrolyte disorders %$1,657,347 Diabetes %$1,723,413 Congestive heart failure %$2,365,964 Asthma %$1,216,779 Renal failure %$2,278,805 Immunizations/Screening for infectious disease %$608,631 Urinary Tract Infection %$1,180,835 Mental health and substance abuse screening %$547,989 Total10,343$73,556,918 “Ambulatory Care Sensitive Conditions” and are often amenable to outpatient management Camden Inpatient use by Diagnosis, Understand the problem

Emergency Department, 2011 VisitsChargesReceipts 106$233,061$43,692 77$231,047$0 74$67,474$0 68$240,823$0 66$107,396$14,567 65$74,289$11,974 64$30,705$4,962 57$493,585$0 56$193,317$18,401 50$196,808$29,087 50$133,387$21,700 Inpatient, 2011 Inpatient Visits Days in Hospital Inpatient Charges Inpatient Receipts 20201$1,856,465$203, $586,833$61, $1,046,217$216, $337,772$60, $918,245$86, $1,049,768$118, $539,298$76, $1,150,309$115, $458,353$103, $1,551,739$225, $608,486$73, $595,660$0 Camden High Utilizers, Understand the problem

Several buildings, each year, are responsible for between $1 and $3 million in hospital costs. 6% of city blocks account for 18% of patients and 37% of patients. Camden Spatial Analysis of Hospital Costs Identify and engage patients needing intervention Understand the problem

CCHP Solution : Camden Health Information Exchange Daily Data Share HIE Daily Report  List of patients currently in hospital with 2+IP and/or 6+ ED in last 6 months  CCHP care teams review cases  Enroll patients in Care Management / Care Transitions program before discharge HIE Vendor Daily HL-7 Feeds Web based HIE system Customized data cleaning and processing Identify and engage patients needing intervention

Identify and engage patients needing intervention

Issue #4 : EMR’s not customizable Evaluate the impact of the solutions

CCHP Solution : Customized data collection tools Evaluate the impact of the solutions

24 Patient utilization profile C Evaluate the impact of the solutions

1 year pre-enrollment Charges = $745,018; Receipts: $95,358; Inpatient days: 55; ED visits: 1 Post-enrollment Charges = $0; Receipts= $0 Inpatient days: 0; ED visit=0 Evaluate the impact of the solutions

Data access is a necessary but not sufficient step towards innovative delivery reforms. Data Quality is essential Measurement is essential Statistical Literacy is essential Effective Dissemination in essential Maintaining partnerships is essential

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