Camden Coalition of Healthcare Providers Improving care and

Camden Coalition of Healthcare Providers Improving care and reducing costs in Camden, NJ with the help of innovative local data systems Kennen S. Gross, Ph. D, MPH Director, Research & Evaluation 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 • • • www. camdenhealth. org Citywide Diabetes Collaborative EMR support Clinical Disease registries Embedded Nurses Ameri. Corps Volunteers Research & Advocacy • • • State ACO regulations RWJ Cross-Site Learning Grant Data Analysis on utilization patterns

System changes that will impact cost and improve quality of care requires: Understand the problem Develop interventions to target the problem Identify and engage patients needing intervention Evaluate the impact of the solutions Data is needed at the level of the intervention If intervention is local – you need local data 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 www. camdenhealth. org 6

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

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

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

CCHP Solution: Camden Health Database Data processing/cleaning Yearly Clams Data Use Agreements IRB Agreement 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

Camden Hospital Utilization Typology Inpatient visits, 2011 ED visits, 2011 0 1 2 3 to 4 5+ 0 1 44, 728 (85%) patients 5, 210 Inpatient visits 63, 489 ED visits $28, 000 (50%) IP payment $25, 800, 000 (59%) ED payment 2 to 3 4 to 5 6 to 7 8 to 9 4, 961(9%) patients 28, 447 ED visits 1, 563 (3%) patients 1, 239 IP visits 6, 962 ED visits 985 (2%) patients 1, 856 IP visits 4, 129 ED visits $10, 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 $6, 700, 000 (18%) in IP $11, 500, 000 (27%) in payment ED payment $2, 800, 000 (6%) in ED payment 10 + www. camdenhealth. org Understand the problem 12

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

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

Camden ED use by diagnosis, 2011 Primary ED Diagnosis, 2011 Upper respiratory infections (head cold) Sprains and strains Superficial injury; contusion Abdominal pain Skin and subcutaneous tissue infections Urinary tract infection Spondylosis; and other back problems Asthma Total Patients 4, 092 2, 980 2, 561 1, 986 1, 717 1, 892 1, 484 1, 058 Visits 4, 858 3, 295 2, 786 2, 318 2, 213 2, 182 1, 735 1, 580 65, 992 % of visits Receipts 16. 3% $1, 456, 464 11. 1% $1, 159, 452 9. 4% $837, 132 7. 8% $926, 239 7. 4% $673, 115 7. 3% $720, 050 5. 8% $517, 997 5. 3% $675, 230 $23, 106, 476 “Ambulatory Care Sensitive Conditions” and are often amenable to outpatient management www. camdenhealth. org Understand the problem

Camden Inpatient use by Diagnosis, 2011 Primary Diagnosis, 2011 Patients Visits Births (mother & child) Hypertension Fluid and electrolyte disorders Diabetes Congestive heart failure Asthma Renal failure Immunizations/Screening for infectious disease Urinary Tract Infection Mental health and substance abuse screening 1, 289 401 255 226 183 219 195 213 151 159 Total 10, 343 % of visits 609 272 269 257 246 217 214 162 6. 4% 2. 9% 2. 8% 2. 7% 2. 6% 2. 3% 2. 2% 1. 7% Receipts $1, 448, 116 $1, 558, 671 $1, 657, 347 $1, 723, 413 $2, 365, 964 $1, 216, 779 $2, 278, 805 $608, 631 $1, 180, 835 $547, 989 $73, 556, 918 “Ambulatory Care Sensitive Conditions” and are often amenable to outpatient management www. camdenhealth. org Understand the problem

Camden High Utilizers, 2011 Emergency Department, 2011 Visits Charges Receipts 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 www. camdenhealth. org Inpatient Visits 20 17 17 16 13 12 12 11 11 11 Inpatient, 2011 Days in Inpatient Hospital Charges 201 $1, 856, 465 90 $586, 833 60 $1, 046, 217 40 $337, 772 53 $918, 245 77 $1, 049, 768 44 $539, 298 66 $1, 150, 309 90 $458, 353 127 $1, 551, 739 39 $608, 486 51 $595, 660 Inpatient Receipts $203, 458 $61, 260 $216, 490 $60, 435 $86, 641 $118, 778 $76, 980 $115, 749 $103, 738 $225, 610 $73, 193 $0 Understand the problem

Camden Spatial Analysis of Hospital Costs 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 Understand the problem Identify and engage patients needing intervention

CCHP Solution: Camden Health Information Exchange Web based HIE system Daily HL-7 Feeds HIE Vendor Daily Data Share Customized data cleaning and processing 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 Identify and www. camdenhealth. org engage patients needing intervention

www. camdenhealth. org Identify and engage patients needing intervention

www. camdenhealth. org Identify and engage patients needing intervention

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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Post-enrollment Charges = $0; Receipts= $0 Inpatient days: 0; ED visit=0 1 year pre-enrollment Charges = $745, 018; Receipts: $95, 358; Inpatient days: 55; ED visits: 1 12 10 Length of Stay 8 6 4 2 -1 2 ay 23 pr -A -M -1 2 2 23 ar 23 -M b-F e 23 -1 12 12 n- 23 - Ja c 11 De 11 23 - No v- 1 t-1 Oc 11 23 - p- IP 23 23 -A u ED -S e g 11 1 l-1 -Ju 1 www. camdenhealth. org 23 n 1 23 -Ju -1 1 ay 23 pr -A 23 -M -1 1 1 -1 ar -M -1 1 23 eb 23 -F n. Ja 23 - De c 10 C 11 0 Evaluate the impact of the solutions

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 ken@camdenhealth. org www. camdenhealth. org