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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
24
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2011
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4
6
8
10
12
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ED IP
Length
of
Sta
y
www.camdenhealth.org
Patient utilization profile
C
Evaluate the
impact of the
solutions
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0
2
4
6
8
10
12
ED IP
Leng
th o
f Sta
y
C
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 [email protected]
www.camdenhealth.org