Embracing Disruptive Innovation: Camden Coalition of Healthcare Providers Natassia Rozario, JD, MPH Associate Counsel & Associate Director of Policy & Engagement Camden Coalition of Healthcare Providers

Contents: 1)Who we are 2)Why disrupt 3)Our story 4)How we embrace innovation 5)Beyond Camden: Spreading & supporting innovation

Who we are c h a p t e r 1

13 year old membership non-profit 20 member board Incorporated non-profit Approximately 80 full time staff Our Basics

To improve the health of Camden residents by enhancing the quality, capacity, coordination, efficiency, and accessibility of the health care system. Our Mission

Why Disrupt? c h a p t e r 2

FRANCESWEEDENAUSTRIA SWITZERLAND DENMARKGERMANYBELGIUMITALYFINLAND NETHERLANDS PORTUGALHUNGARY UNITED STATES NORWAYGREECESPAINSLOVENIA UNITED KINGDOM POLAND LUXEMBOURG JAPAN NEW ZEALAND CANADA CZECH REPUBLIC AUSTRALIAIRELAND Countries ranked by amount spent on health expenditures 2009 United States falls in the middle (out of top 26 countries) Source: American Healthcare Paradox Social Expenditures Health Expenditures

FRANCESWEEDENAUSTRIA SWITZERLAND DENMARKGERMANYBELGIUMITALYFINLAND NETHERLANDS PORTUGALHUNGARY UNITED STATES NORWAYGREECESPAINSLOVENIA UNITED KINGDOM POLAND LUXEMBOURG JAPAN NEW ZEALAND CANADA CZECH REPUBLIC AUSTRALIAIRELAND Countries ranked by amount spent on health expenditures 2009 United States spends the most (out of top 26 countries) Source: American Healthcare Paradox Social Expenditures Health Expenditures

FRANCESWEEDENAUSTRIA SWITZERLAND DENMARKGERMANYBELGIUMITALYFINLAND NETHERLANDS PORTUGALHUNGARY UNITED STATES NORWAYGREECESPAINSLOVENIA UNITED KINGDOM POLAND LUXEMBOURG JAPAN NEW ZEALAND CANADA CZECH REPUBLIC AUSTRALIAIRELAND Countries ranked by amount spent on social expenditures 2009 United States spends the least (out of top 26 countries) Source: American Healthcare Paradox Social Expenditures Health Expenditures

Total US Spend: $2.3 trillion (2012) World ranking: Average at best

Total US Spend: $2.3 trillion (2012) World ranking: Average at best

Total US Spend: $2.3 trillion (2012) World ranking: Average at best What can be learned from Camden?

Who has been hurt the most by the system? Meet Joe. 6 months ESRD Renal carcinoma HEP B Hypertension Hyperlipidemia Peripheral vascular dx Glaucoma Asthma Sleep anemia 1 Inpt2 Inpt3 Inpt 4 Inpt 5 Inpt6 Inpt $10k $10k $10k 9 EDs= $4,500 6 Inpts= $ Total costs= $64,500

Who has been hurt the most by the system? Meet Joe. 6 months ESRD Renal carcinoma HEP B Hypertension Hyperlipidemia Peripheral vascular dx Glaucoma Asthma Sleep anemia 1 Inpt2 Inpt3 Inpt 4 Inpt 5 Inpt6 Inpt $10k $10k $10k 9 EDs= $4,500 6 Inpts= $ Total costs= $64,500

Who has been hurt the most by the system? Meet Joe. 6 months ESRD Renal carcinoma HEP B Hypertension Hyperlipidemia Peripheral vascular dx Glaucoma Asthma Sleep anemia 1 Inpt2 Inpt3 Inpt 4 Inpt 5 Inpt6 Inpt $10k $10k $10k 9 EDs= $4,500 6 Inpts= $ Total costs= $64,500

Who has been hurt the most by the system? Meet Joe. 6 months ESRD Renal carcinoma HEP B Hypertension Hyperlipidemia Peripheral vascular dx Glaucoma Asthma Sleep anemia 1 Inpt2 Inpt3 Inpt 4 Inpt 5 Inpt6 Inpt $10k $10k $10k 9 EDs= $4,500 6 Inpts= $ Total costs= $64,500

Who has been hurt the most by the system? Meet Joe. 6 months ESRD Renal carcinoma HEP B Hypertension Hyperlipidemia Peripheral vascular dx Glaucoma Asthma Sleep anemia 1 ER 2ER3ER4ER5ER 6ER 7ER 8ER 9ER $500 $500 $500 $500 $500 $500 $500 $500 $500 1 Inpt2 Inpt3 Inpt 4 Inpt 5 Inpt6 Inpt $10k $10k $10k 9 EDs= $4,500 6 Inpts= $ Total costs= $64,500

Who has been hurt the most by the system? Meet Joe. 6 months ESRD Renal carcinoma HEP B Hypertension Hyperlipidemia Peripheral vascular dx Glaucoma Asthma Sleep anemia 1 ER 2ER3ER4ER5ER 6ER 7ER 8ER 9ER $500 $500 $500 $500 $500 $500 $500 $500 $500 1 Inpt2 Inpt3 Inpt 4 Inpt 5 Inpt6 Inpt $10k $10k $10k 9 EDs= $4,500 6 Inpts= $ Total costs= $64,500

Who has been hurt the most by the system? Meet Joe. 6 months ESRD Renal carcinoma HEP B Hypertension Hyperlipidemia Peripheral vascular dx Glaucoma Asthma Sleep anemia 1 ER 2ER3ER4ER5ER 6ER 7ER 8ER 9ER $500 $500 $500 $500 $500 $500 $500 $500 $500 1 Inpt2 Inpt3 Inpt 4 Inpt 5 Inpt6 Inpt $10k $10k $10k 9 EDs= $4,500 6 Inpts= $ Total costs= $64,500

Who has been hurt the most by the system? Meet Joe. 6 months ESRD Renal carcinoma HEP B Hypertension Hyperlipidemia Peripheral vascular dx Glaucoma Asthma Sleep anemia 1 ER 2ER3ER4ER5ER 6ER 7ER 8ER 9ER $500 $500 $500 $500 $500 $500 $500 $500 $500 1 Inpt2 Inpt3 Inpt 4 Inpt 5 Inpt6 Inpt $10k $10k $10k 9 EDs= $4,500 6 Inpts= $ Total costs= $64,500

Who has been hurt the most by the system? Meet Joe. 6 months ESRD Renal carcinoma HEP B Hypertension Hyperlipidemia Peripheral vascular dx Glaucoma Asthma Sleep anemia 1 ER 2ER3ER4ER5ER 6ER 7ER 8ER 9ER $500 $500 $500 $500 $500 $500 $500 $500 $500 1 Inpt2 Inpt3 Inpt 4 Inpt 5 Inpt6 Inpt $10k $10k $10k 9 EDs= $4,500 6 Inpts= $ Total costs= $64,500

Who has been hurt the most by the system? Meet Joe. 6 months ESRD Renal carcinoma HEP B Hypertension Hyperlipidemia Peripheral vascular dx Glaucoma Asthma Sleep anemia 1 ER 2ER3ER4ER5ER 6ER 7ER 8ER 9ER $500 $500 $500 $500 $500 $500 $500 $500 $500 1 Inpt2 Inpt3 Inpt 4 Inpt 5 Inpt6 Inpt $10k $10k $10k 9 EDs= $4,500 6 Inpts= $ Total costs= $64,500

Cost Breakdown in Camden Total revenue to hospitals for Camden residents $108 million per year Most expensive patient $3.5 million 30% hospital receipts = 1% patients 80% hospital receipts = 13% patients 90% hospital receipts = 20% patients

Embracing Innovation our story c h a p t e r 3

The Beginning

Embracing Innovation how we do it c h a p t e r 4

How we embrace change: Our Theory of Change

How we embrace change: Collaboration

Board of Directors Executive Committee Quality Committee Finance Committee HIE Committee CEO Roundtable Care Coordination Meetings Community Advisory Council Governance

Our Board Hospitals PCPs Social Service Behavioral Health Consumer & Community Organizations Fairview Village Dr. Roman Acosta Reliance St. Luke’s Catholic Medical Services Home Health

Current Model

1) We focus on the sickest, most frequently hospitalized patients.

2) City’s hospitals and practices share information to create a data-rich environment.

1) We focus on the sickest, most frequently hospitalized patients. 2) City’s hospitals and practices share information to create a data-rich environment. 3) We use that data to understand the right problems at the right time in the right settings all across the city. We focus on the sickest, most frequently hospitalized patients. City’s hospitals and practices share information to create a data-rich environment. We use that data to understand the right problems at the right time in the right settings all across the city.

Well-coordinated, Patient-centered care

TRIAGE

BEDSIDE ENGAGEMENT

INITIAL CARE PLANNING

HOME VISIT

ACCOMPANIMENT

562 Our care management team has worked with 562 patients

6,911 home visits

1,925 bedside engagements

29,364 staff hours spent with and on behalf of patients

93% of our enrolled clients are taking 5+ medications 90% have 4 or more chronic conditions 30% have self-reported depression and/or anxiety 26% are homeless during enrollment

337 graduated patients

Practice and Community Engagement

Practice Engagement Citywide Care Management Meetings

Practice Engagement Community Partners

Over 35,000 capitated patients monthly

3,985 individual patients triaged since beginning of ACO

3,768 provider visits scheduled

7,038 Follow up phone calls

Goal: All patients hospitalized in Camden will be reconnected with primary care within 7 days of discharge.

CITYWIDE INVESTMENTS

Percentage of patients reconnecting with primary care within 7 days of discharge NOV 2014 AUG % 42%

Spreading & Supporting Innovation Beyond Camden… c h a p t e r 5

Building the field & the movement

1)Medicaid ACO Demonstration Project 2)Statewide Coalition 3)National Center

1) Medicaid ACO D e m o n s t r a t i o n Project

sdas The Medicaid ACO is special Because it’s a community based model of healthcare delivery that... T To work together with shared data & public input Deliver Better Lower costs Encourages a group of docs and hospitals in a community

sdas T Under the model, if we can improve quality and reduce costs, then… It’s possible that the community... Can share in the cost savings Re-allocate funds to initiatives that matter to the community. &

was What do we mean by better care? We’re focusing on Patient Satisfaction Maternal & Child Health Access to Primary Care

Was$ What do we mean by lower costs? $

2) Statewide C o a i I t i o n

POLICY AGENDA Housing First Transportation Community-based (not telephonic) care coordination Integrated behavioral health Integrated data systems Medicaid ACO

3) National C e n t e r

The future