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

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

3. Who we are c h a p t e r 1

4. 13 year old membership non-profit 20 member board Incorporated non-profit Approximately 80 full time staff Our Basics

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

6. Why Disrupt? c h a p t e r 2

7. 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

8. 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

9. 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

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

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

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

15. 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= $60.000 Total costs= $64,500

16. 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= $60.000 Total costs= $64,500

17. 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= $60.000 Total costs= $64,500

18. 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= $60.000 Total costs= $64,500

19. 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= $60.000 Total costs= $64,500

20. 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= $60.000 Total costs= $64,500

21. 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= $60.000 Total costs= $64,500

22. 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= $60.000 Total costs= $64,500

23. 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= $60.000 Total costs= $64,500

24. 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= $60.000 Total costs= $64,500

26. 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

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

29. The Beginning

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

32. How we embrace change: Our Theory of Change

33. How we embrace change: Collaboration

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

35. 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

36. Current Model

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

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

39. 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.

40. Well-coordinated, Patient-centered care

41. TRIAGE

42. BEDSIDE ENGAGEMENT

43. INITIAL CARE PLANNING

44. HOME VISIT

45. ACCOMPANIMENT

46. 562 Our care management team has worked with 562 patients

47. 6,911 home visits

48. 1,925 bedside engagements

49. 29,364 staff hours spent with and on behalf of patients

50. 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

51. 337 graduated patients

52. Practice and Community Engagement

53. Practice Engagement Citywide Care Management Meetings

54. Practice Engagement Community Partners

55. Over 35,000 capitated patients monthly

56. 3,985 individual patients triaged since beginning of ACO

57. 3,768 provider visits scheduled

58. 7,038 Follow up phone calls

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

60. CITYWIDE INVESTMENTS

61. Percentage of patients reconnecting with primary care within 7 days of discharge NOV 2014 AUG 2015 26% 42%

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

63. Building the field & the movement

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

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

67. 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 care @ Lower costs Encourages a group of docs and hospitals in a community

68. 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. &

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

70. Was$ What do we mean by lower costs? $

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

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

73. 3) National C e n t e r

75. The future