1. 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 www.camdenhealth.org

2. "What we have before us are some breathtaking opportunities disguised as insolvable problems." -John Gardner Secretary of Health, Education and Welfare 1965-1968

3. 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.

4. 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 www.camdenhealth.org

5. 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 www.camdenhealth.org Data is needed at the level of the intervention If intervention is local – you need local data Identify and engage patients needing intervention

6. 6 www.camdenhealth.org 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. 7 www.camdenhealth.org Issue #2 : Limitations of Existing Population Datasets

8. 8 www.camdenhealth.org Issue #3 : Healthcare data that reflects the population

9. www.camdenhealth.org

10. 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 www.camdenhealth.org Understand the problem

11. Camden Cost Curve, 2011 www.camdenhealth.org Understand the problem

12. ED visits, 2011 Inpatient visits, 2011 0123 to 45+ 0 44,728 (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 9 10 + 12 www.camdenhealth.org Camden Hospital Utilization Typology Understand the problem

13. Camden Hospital Utilization, 2011 www.camdenhealth.org Understand the problem

14. Camden Hospital Inpatient and Emergency Revenue, 2011 www.camdenhealth.org Understand the problem

15. Primary ED Diagnosis, 2011PatientsVisits % of visitsReceipts Upper respiratory infections (head cold)4,0924,85816.3%$1,456,464 Sprains and strains2,9803,29511.1%$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, 2011 www.camdenhealth.org Understand the problem

16. Primary Diagnosis, 2011PatientsVisits % of visitsReceipts Births (mother & child)1,2896096.4%$1,448,116 Hypertension4012722.9%$1,558,671 Fluid and electrolyte disorders2552692.8%$1,657,347 Diabetes2262572.7%$1,723,413 Congestive heart failure1832472.6%$2,365,964 Asthma2192462.6%$1,216,779 Renal failure1952172.3%$2,278,805 Immunizations/Screening for infectious disease2132142.2%$608,631 Urinary Tract Infection1511641.7%$1,180,835 Mental health and substance abuse screening1591621.7%$547,989 Total10,343$73,556,918 “Ambulatory Care Sensitive Conditions” and are often amenable to outpatient management Camden Inpatient use by Diagnosis, 2011 www.camdenhealth.org Understand the problem

17. 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$203,458 1790$586,833$61,260 1760$1,046,217$216,490 1640$337,772$60,435 1353$918,245$86,641 1277$1,049,768$118,778 1244$539,298$76,980 1266$1,150,309$115,749 1290$458,353$103,738 11127$1,551,739$225,610 1139$608,486$73,193 1151$595,660$0 Camden High Utilizers, 2011 www.camdenhealth.org Understand the problem

18. 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. www.camdenhealth.org Camden Spatial Analysis of Hospital Costs Identify and engage patients needing intervention Understand the problem

19. 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 www.camdenhealth.org Identify and engage patients needing intervention

20. www.camdenhealth.org Identify and engage patients needing intervention

21. www.camdenhealth.org

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

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

24. 24 www.camdenhealth.org Patient utilization profile C Evaluate the impact of the solutions

25. 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 www.camdenhealth.org Evaluate the impact of the solutions

26. 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

27. Thank you for your time Questions/comments please contact me at ken@camdenhealth.org www.camdenhealth.org