i mproving care and reducing costs in camden, nj with the help of innovative local data systems
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Camden Coalition of Healthcare Providers. I mproving 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. - PowerPoint PPT PresentationTRANSCRIPT
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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
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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
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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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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
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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
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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
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7www.camdenhealth.org
Issue #2: Limitations of Existing Population Datasets
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8www.camdenhealth.org
Issue #3: Healthcare data that reflects the population
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Issue #3: Healthcare data that reflects the population
www.camdenhealth.org
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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
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Camden Cost Curve, 2011
www.camdenhealth.org
Understand the
problem
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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
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Camden Hospital Utilization, 2011
www.camdenhealth.org
Understand the
problem
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Camden Hospital Inpatient and Emergency Revenue, 2011
www.camdenhealth.org
Understand the
problem
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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
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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
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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
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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
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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
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www.camdenhealth.org
Identify and
engage patients needing intervent
ion
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Identify and
engage patients needing intervent
ionwww.camdenhealth.org
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Issue #4: EMR’s not customizable
Evaluate the
impact of the
solutions
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CCHP Solution: Customized data collection tools
Evaluate the
impact of the
solutions
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www.camdenhealth.org
Patient utilization profile
CEvaluate
the impact of
the solutions
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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
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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
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Thank you for your timeQuestions/comments please contact me at [email protected]
www.camdenhealth.org