big data webinar 8/2

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

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.

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"What we have before us are some

breathtaking opportunities disguised as

insolvable problems."

-John Gardner

Secretary of Health, Education and Welfare 1965-1968

Diabetes COPD Multi-CC No-CC

Diabetes COPD Multi-CC No-CC

Traditional Intervention Paradigm

Diabetes COPD Multi-CC No-CC High Utilizer

Traditional Intervention Paradigm

Diabetes COPD Multi-CC No-CC High Utilizer

Hotspotting Intervention Paradigm

Understand

the problem

Develop

interventions

to target the

problem

Evaluate the

impact of

the solutions


Identify and

engage

patients

needing

intervention

10www.camdenhealth.org

Issue #1:

Getting access to local healthcare data


Issue #2:

Limitations of Existing Population Datasets


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


Different Strategies for Undertaking this Analysis


Business Intelligence Issues

Legal Issues

Data Access IssuesSTART WITH WHY


Defining the Project: QA/PI or Research

Quality Assurance

Process

Improvement

Research Project

Business Associates

Agreements (BAAs)

Institutional Review

Boards

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Data Storage & Transfer Security


Areas of data available through claims


Data Quality Issues

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Probabilistic Linkage


Geocoding and GIS Analysis


Camden Cost Curve, 2011


ED visits, 2011

Inpatient visits, 2011

0 1 2 3 to 4 5+

044,728 (85%) patients

5,210 Inpatient visits

63,489 ED visits

$28,000,000 (50%) IP payment

$25,800,000 (59%) ED payment985 (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 +


Camden Hospital Utilization Typology

Camden Hospital Utilization, 2011


Camden Hospital Inpatient and Emergency Revenue, 2011


“Ambulatory Care Sensitive Conditions” and

are often amenable to outpatient

management

Camden ED use by diagnosis, 2011


“Ambulatory Care Sensitive Conditions” and

are often amenable to outpatient

management

Camden Inpatient use by Diagnosis, 2011


Another way to look at ICD data


Camden High Utilizers, 2011



Camden Spatial Analysis of Hospital Costs

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

VendorDaily HL-7

Feeds

Web based HIE

system

Customized data cleaning and processing


Issue #4:

EMR’s not customizable

CCHP Solution:

Customized data collection tools

-Quantify the “dose” per client

-Understand staffing

-Continuous quality improvement

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2

4

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1/3/2011 2/3/2011 3/3/2011 4/3/2011 5/3/2011 6/3/2011 7/3/2011 8/3/2011 9/3/2011 10/3/2011 11/3/2011 12/3/2011

Len

gth

of

Sta

y

ED IP


Patient utilization profile

C

0

2

4

6

8

10

12

Len

gth

of

Stay

ED IPC

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


1 year pre-enrollment Charges = $112,664; Receipts: $22,365

Post-enrollment (10 months)Charges = $64,974; Receipts= $12,380

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0.5

1

1.5

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2.5

3

Len

gth

of

stay

ED IP

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1

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8

9

Len

gth

of

stay

ED IP

1 year pre-enrollment Charges = $312,525; Receipts: $59,133


Post-enrollmentCharges = $0; Receipts= $0


1 year pre-enrollment Charges = $745,018; Receipts: $95,358;


Post-enrollmentCharges = $0; Receipts= $0


0

2

4

6

8

10

12

Len

gth

of

Stay

ED IP

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

Thank you for your time

Questions/comments please contact me at

[email protected]
