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, MPHDirector, Research & Evaluation

Camden Coalition of Healthcare Providers

Camden Coalition of Healthcare Providers

www.camdenhealth.org

"What we have before us are some breathtaking opportunities disguised as insolvable problems."

-John Gardner Secretary of Health, Education and Welfare 1965-1968

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

www.camdenhealth.org

System changes that will impact cost and improve quality of care requires:

Understand the

problem

Develop interventi

ons to target the problem

Evaluate the

impact of the

solutions

www.camdenhealth.org

Data is needed at the level of the interventionIf intervention is local – you need local data

Identify and

engage patients needing

intervention

6www.camdenhealth.org

Issue #1: Getting access to local healthcare data

Camden CityMedian Family Income: $29,11836% below Federal Poverty Level48% Black, 47% Hispanic

Camden CountyMedian Family Income: $57,42911% below the Federal Poverty Level21% Black, 14% Hispanic

7www.camdenhealth.org

Issue #2: Limitations of Existing Population Datasets

8www.camdenhealth.org

Issue #3: Healthcare data that reflects the population

Issue #3: Healthcare data that reflects the population

www.camdenhealth.org

CCHP Solution: Camden Health Database

Yearly Clams DataData 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

Camden Cost Curve, 2011

www.camdenhealth.org

Understand the

problem

12

ED visits, 2011

Inpatient visits, 2011

0 1 2 3 to 4 5+

044,728 (85%) patients5,210 Inpatient visits

63,489 ED visits

$28,000,000 (50%) IP payment$25,800,000 (59%) ED payment

985 (2%) patients1,856 IP visits

4,129 ED visits

$10,000,000 (17%) IP payment

$1,700,000 (4%) ED payments

503 (1%) patients2,026 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%) patients28,447 ED visits

$11,500,000 (27%) in ED

payment

1,563 (3%) patients

1,239 IP visits6,962 ED visits

$6,700,000 (18%) in IP payment

$2,800,000 (6%) in ED payment

6 to 7

8 to 9

10 +

www.camdenhealth.org

Camden Hospital Utilization Typology

Understand the

problem

Camden Hospital Utilization, 2011

www.camdenhealth.org

Understand the

problem

Camden Hospital Inpatient and Emergency Revenue, 2011

www.camdenhealth.org

Understand the

problem

Primary ED Diagnosis, 2011 Patients Visits% of visits Receipts

Upper respiratory infections (head cold) 4,092 4,858 16.3%$1,456,464Sprains and strains 2,980 3,295 11.1%$1,159,452Superficial injury; contusion 2,561 2,786 9.4% $837,132Abdominal pain 1,986 2,318 7.8% $926,239Skin and subcutaneous tissue infections 1,717 2,213 7.4% $673,115Urinary tract infection 1,892 2,182 7.3% $720,050Spondylosis; and other back problems 1,484 1,735 5.8% $517,997Asthma 1,058 1,580 5.3% $675,230

Total65,99

2$23,106,47

6“Ambulatory Care Sensitive Conditions” and are often amenable to outpatient management

Camden ED use by diagnosis, 2011

www.camdenhealth.org

Understand the

problem

Primary Diagnosis, 2011Patient

sVisit

s% of visits Receipts

Births (mother & child) 1,289 609 6.4% $1,448,116Hypertension 401 272 2.9% $1,558,671Fluid and electrolyte disorders 255 269 2.8% $1,657,347Diabetes 226 257 2.7% $1,723,413Congestive heart failure 183 247 2.6% $2,365,964Asthma 219 246 2.6% $1,216,779Renal failure 195 217 2.3% $2,278,805Immunizations/Screening for infectious disease 213 214 2.2% $608,631Urinary Tract Infection 151 164 1.7% $1,180,835Mental health and substance abuse screening 159 162 1.7% $547,989

Total 10,343$73,556,91

8“Ambulatory Care Sensitive Conditions” and are often amenable to outpatient management

Camden Inpatient use by Diagnosis, 2011

www.camdenhealth.org

Understand the

problem

Emergency Department, 2011Visits Charges Receipts

106 $233,061 $43,69277 $231,047 $074 $67,474 $068 $240,823 $066 $107,396 $14,56765 $74,289 $11,97464 $30,705 $4,96257 $493,585 $056 $193,317 $18,40150 $196,808 $29,08750 $133,387 $21,700

Inpatient, 2011Inpatient

VisitsDays in Hospital

Inpatient Charges

Inpatient Receipts

20 201$1,856,46

5 $203,45817 90 $586,833 $61,260

17 60$1,046,21

7 $216,49016 40 $337,772 $60,43513 53 $918,245 $86,641

12 77$1,049,76

8 $118,77812 44 $539,298 $76,980

12 66$1,150,30

9 $115,74912 90 $458,353 $103,738

11 127$1,551,73

9 $225,61011 39 $608,486 $73,19311 51 $595,660 $0

Camden High Utilizers, 2011

www.camdenhealth.org

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.

www.camdenhealth.org

Camden Spatial Analysis of Hospital Costs

Identify and

engage patients needing intervent

ion

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

www.camdenhealth.org

Identify and

engage patients needing intervent

ion

www.camdenhealth.org

Identify and

engage patients needing intervent

ion

Identify and

engage patients needing intervent

ionwww.camdenhealth.org

Issue #4: EMR’s not customizable

Evaluate the

impact of the

solutions

CCHP Solution: Customized data collection tools

Evaluate the

impact of the

solutions

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Patient utilization profile

CEvaluate

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

Inpatient days: 55; ED visits: 1

Post-enrollmentCharges = $0; Receipts= $0

Inpatient days: 0; ED visit=0

www.camdenhealth.org

Evaluate the

impact of the

solutions

Data access is a necessary but not sufficient step towards innovative delivery reforms.

Data Quality is essentialMeasurement is essentialStatistical Literacy is essentialEffective Dissemination in essentialMaintaining partnerships is essential

Thank you for your timeQuestions/comments please contact me at ken@camdenhealth.org

www.camdenhealth.org