I mproving care and reducing costs in Camden, NJ with the help of innovative local data systems

1. 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 www.camdenhealth.org

2. "What we have before us are some breathtaking opportunities disguised as insolvable problems." -John Gardner Secretary of Health, Education and Welfare 1965-1968

3. 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.

4. Clinical • Care Management Team • Care Transitions Team • Diabetes Self-Management Education • Group Pregnancy Program • Violence Intervention • Medication Access • Research & Advocacy • State ACO regulations • RWJ Cross-Site Learning Grant • Data Analysis on utilization patterns • Practice-Level • Citywide Diabetes Collaborative • EMR support • Clinical Disease registries • Embedded Nurses • AmeriCorps Volunteers www.camdenhealth.org

5. System changes that will impact cost and improve quality of care requires: Identify and engage patients needing intervention Understand the problem Develop interventions to target the problem 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

6. 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

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

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

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

10. CCHP Solution: Camden Health Database Data processing/cleaning Probabilistic matching Geocoding Yearly Clams Data Data Use Agreements IRB Agreement • Camden Residents All-Payer Claims Longitudinal Dataset • Demographics • Inpatient and Emergency visits • Diagnosis codes • Charges/receipts • Insurance Understand the problem www.camdenhealth.org

11. Camden Cost Curve, 2011 Understand the problem www.camdenhealth.org

12. Camden Hospital Utilization Typology Understand the problem www.camdenhealth.org

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

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

15. Camden ED use by diagnosis, 2011 “Ambulatory Care Sensitive Conditions” and are often amenable to outpatient management Understand the problem www.camdenhealth.org

16. Camden Inpatient use by Diagnosis, 2011 “Ambulatory Care Sensitive Conditions” and are often amenable to outpatient management Understand the problem www.camdenhealth.org

17. Camden High Utilizers, 2011 Understand the problem www.camdenhealth.org

18. 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. Understand the problem Identify and engage patients needing intervention www.camdenhealth.org

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

20. Identify and engage patients needing intervention www.camdenhealth.org

21. Identify and engage patients needing intervention www.camdenhealth.org

22. Issue #4: EMR’s not customizable Evaluate the impact of the solutions

23. CCHP Solution: Customized data collection tools Evaluate the impact of the solutions

24. Patient utilization profile C Evaluate the impact of the solutions www.camdenhealth.org

25. 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 Evaluate the impact of the solutions www.camdenhealth.org

26. Dataaccessis 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

27. Thank you for your time Questions/comments please contact me at ken@camdenhealth.org www.camdenhealth.org