Upload
andreacamden
View
732
Download
1
Embed Size (px)
Citation preview
Bending the Cost Curve and Improving Quality in One of America’s Poorest
Cities
Jeffrey Brenner, MD Executive Director/Medical Director
Long-term Federal Debt!
7/20/12 3
7/20/12 4
7/20/12 6
History of CCHP"!
You are cordially invited to the first
Camden City Healthcare Providers’ Breakfast
Join fellow clinicians to get acquainted, and to share strategies, resources, and ideas on providing health care to Camden City residents.
Thursday, January 24, 2002 7:30 – 9:00 am
At the Rutgers University Octagon Room, Camden Campus Center, North Third Street
Sponsored by the Center for Strategic Urban Community Leadership at Rutgers University, Division of Urban Health in the Department of Family
Medicine at Cooper Hospital, and the Camden Area Health Education Center
Please RSVP to Daria Chacón at 856-963-2432 x218 by Friday, January 11.
Camden Health Data!n 2002 – 2011 with Lourdes, Cooper, Virtua data!
n 500,000+ records with 98,000 patients!n 50 % population use ER/hospital in one year!
n Leading ED/hospital utilizers citywide!n 324 visits in 5 years!n 113 visits in 1 year!
n Total revenue to hospitals for Camden residents $100 million per year!n Most expensive patient $3.5 million!n 30% costs = 1% patients!n 80% costs = 13% patients!n 90% costs = 20% patients!
Top 10 ER Diagnosis 2002-2007 (317,791 visits)!
465.9 ACUTE UPPER RESPIRATORY INFECTION (head cold)
12,549
382.9 OTITIS MEDIA NOS (ear infx) 7,638 079.99 VIRAL INFECTION NOS 7,577 462 ACUTE PHARYNGITIS (sore throat) 6,195 493.92 ASTHMA NOS W/ EXACER 5,393 558.9 NONINF GASTROENTERI (stomach virus) 5,037 789.09 ABDOMINAL PAIN-SITE NEC 4,773 780.6 FEVER 4,219 786.59 CHEST PAIN NEC 3,711 784.0 HEADACHE 3,248
^
^ ^^
^
^
^
^^
Ewing
Trento
nRe
scue M
ission
of Tre
nton
98 Ca
rroll S
t2,3
15 ep
isode
s
Rowa
n Tow
er620
W Sta
te St
1,065
episo
des
Luthe
r Towe
rs489
W Sta
te St
1,551
episo
des
333 W
State S
t1,0
42 ep
isode
s
Trento
n Hou
sing A
uthori
ty237
Oakla
nd St
1,354
episo
des
Provid
ence
Nursi
ng &
Reha
bilita
tion C
enter
439 Be
llevue
Ave
1,174
episo
des
Trento
n Cen
ter Ap
artme
nts511
Green
wood
Ave
1,700
episo
des
Trent
Cente
r West
465 Gr
eenwo
od Av
e1,3
35 ep
isode
s
Royal
Healt
h Gate
Nursi
ng &
Reha
b131
4 Brun
swick
Ave
1,834
episo
des
Trento
n Hea
lth Te
am
Hospi
tal Ut
ilizati
on An
alysis
St Fra
ncis a
nd Ca
pital
Healt
h20
10 - 2
011
12
^
^
^̂̂̂
^
^
^̂̂̂
07114
07105
07104
07103
07112
07107
07106
07108
07102
SAIN
T BAR
NABA
SHE
ALTH
CARE
SYST
EMNe
wark
Beth I
srael M
edical
Cente
r
Newa
rk Beth
Israel
Hotsp
ot Anal
ysis (20
10)
$0 $54,23
1 - $88
,719
$1 - $1
,097
$1,098
- $4,9
55
$4,956
- $10,
700
$10,70
1 - $18
,685
$18,68
6 - $31
,353
$31,35
4 - $54
,230
Total C
osts p
erCen
sus Blo
ck (de
ciles)
$88,72
0 - $16
7,531
$167,5
32 - $1
,793,9
55
^Ho
tspot
(>$200
k in rec
eipts
and >5
0 patie
nts)
Mt Ve
rnon a
nd Ma
nor D
rHig
h Rise
s (4 Bu
ilding
s)272
Patien
ts379
ER & I
npatie
nt Visit
s$1.
11 mil
lion in
receip
ts
Elizab
eth Av
eHig
h Rise
s (6 Bu
ilding
s)774
Patien
ts1,3
90 ER
& Inpat
ient Vi
sits$2.
0 millio
n in rec
eipts
1060 B
road S
t(1 B
uilding
)87
Patien
ts198
ER & I
npatie
nt Visit
s$99
3 thou
sand in
receip
ts
^
Total R
eceipt
s by Z
ip Cod
e071
12$24
,079,8
42071
08$16
,553,5
38071
03$14
,181,3
30071
06$11
,788,4
44071
04$7,
022,27
4071
14$6,
440,65
6071
07$5,
594,55
2071
05$5,
498,10
0071
02$4,
206,92
7
13
§̈¦95
§̈¦395
§̈¦95
§̈¦95
£¤201
£¤2
£¤1
£¤202£¤202
£¤1
¤
£¤1
£¤201 £¤1
£¤201
£¤2£¤1
North Penobscot
LeeLincoln
Winn
Alton
Lakeville
Drew
Milford
Carroll
Bradley
Clinton
Lowell
Exeter
Patten
Chester
Clifton
Dexter
Corinth
Etna
Hudson
Seboeis
Carmel
Corinna
Stetson
En!eld
Bradford
Bangor
Garland
Prentiss
Old Town
Hermon
Holden
Levant
Dixmont
Newport
Webster
Woodville
BentonRome
Burlington
Lagrange
East Central PenobscotArgyle
Stacyville
Howland
Hampden
Greenbush
Edinburg
Charleston
Spring!eld
Plymouth
GlenburnOrono
Newburgh
Twombly Ridge
Orrington
Kingman
Mount Chase
Eddington
Mattawamkeag
Max!eld Whitney
Brewer
UnityOakland
Millinocket
Passadumkeag
Kenduskeag
Medway
Vienna
Penobscot Indian Island
East Millinocket
Veazie
SomersetPenobscot
Piscataquis
Washington
Aroostook
Hancock
Franklin
WaldoOxford
¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤
MaineCare Hotspot Analysis: Penobscot County7/1/2008 - 6/30/2010
A hot spot is any geography where a large number of high utilizers reside. High Utilizers are de!ned as any individual with 3 or more hospital admissions or 6 or more ER visits within 2 years. Hot spots range from blue (no hot spot) to red (intense hot spot)
What is a hot spot?
Low
High utilizer densityHigh
§̈¦495
§̈¦95
§̈¦495
§̈¦95
£¤202
£¤1
£¤2
£¤201
£¤1
£¤201
£¤201
£¤201
£¤201
£¤202
£¤
£¤201
China
Augusta
Sidney
Belgrade
Clinton
Albion
Rome
Winslow
Litch!eldPittston
Dixmont
Vassalboro
WindsorWinthrop
Fayette
Benton
Wayne
Monmouth
Vienna
Etna
Oakland
Read!eld
Mount Vernon
Plymouth
Chelsea
Unity
Gardiner
West Gardiner
Farmingdale
Manchester
Waterville
Hallowell
Randolph
Newburgh
New Gloucester
Waldo
Knox
Franklin
Lincoln
Somerset
Oxford
Androscoggin
Sagadahoc¤¤¤¤¤¤¤¤¤¤¤¤£££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££
¤¤¤££££££££££££££££££¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤£££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££
LLLLLLLLLiinccoooooooooooooooooooooooooooooooolllllllllllllln
MaineCare Hot Spot Analysis: Kennebec County7/1/2008 - 6/30/2010
A hot spot is any geography where a large number of high utilizers reside. High Utilizers are de!ned as any individual with 3 or more hospital admissions or 6 or more ER visits within 2 years. Hot spots range from blue (no hot spot) to red (intense hot spot)
What is a hot spot?
Low
High utilizer densityHigh
Overview of the Coalition!- 20 member board, incorporated non-profit!- Foundation and hospital support!- Structure of the Coalition:!
- Operations!- Health Information Exchange!- Research/Data/Evaluation!- Finance/Admin/Legal!
- Programming!- Citywide Care Management Project!- Camden Chronic Disease/Primary Care Collaborative!- Community-based Patient Engagement Strategies!
CCHP Outreach!
Hospital Admission
s Data!
• Nurse driven care transi.on • Pa.ents with history of ED visits/hospital admissions
and readmissions (2+ admits w/in 6 mos.); socially stable
• Average 6-‐8 week engagement
• Mul.disciplinary care management outreach • Pa.ents with history of ED visits/hospital admissions
and readmissions (4 admits w/in 6 mos.); social complexi.es
• Average 6-‐8 month engagement
Intermediate Risk
High Risk Care Coordina.on
Data driven care mgt.
Pa.ent Engagement
Medical Home!
Health Coaching
Inclusion!Triage!
Care Continuum Model!
ED visits, 2011
Inpatient visits, 2011
0 1 2 3 to 4 5+
0 0 1,293 57 4 1
1 26,128 2,075 117 7 0
2 to 3 13,390 1,842 373 68 3
4 to 5 3,216 666 223 118 15
6 to 7 1,020 251 106 84 24
8 to 9 386 112 39 41 11
10 + 339 96 70 65 62
Utilization typology
ED visits, 2011
Inpatient visits, 2011
0 1 2 3 to 4 5+
0
Normal Range of Utilization
Potential High Utilizers
Inpatient High Utilizers
1
2 to 3
4 to 5
Emergency Department
High Utilizers
Potential High Utilizers
6 to 7
8 to 9
10 +
Utilization typology
ED visits, 2011
Inpatient visits, 2011
0 1 2 3 to 4 5+
0 44,728 (85%) patients 5,210 Inpatient visits
63,489 ED visits
$28,000,000 (50%) IP payment $25,800,000 (59%) ED payment 985 (2%) patients
1,856 IP visits 4,129 ED visits
$10,000,000 (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
1
2 to 3
4 to 5
4,961(9%) patients 28,447 ED visits
$11,500,000 (27%) in
ED payment
1,563 (3%) patients 1,239 IP visits
6,962 ED visits
$6,700,000 (18%) in IP payment
$2,800,000 (6%) in ED payment
6 to 7
8 to 9
10 +
Utilization matrix
Es.mated 2011 Payment ED: $38,000 to $76,000 (93 visits) IP: $65,000 to $130,000 (12 visits) Total: $103,000 to $206,000 Saving Es.mates 30% reduc.on in u.liza.on : ED: -‐28; -‐$11,000 to -‐$22,000 IP: -‐ 4; -‐$19,000 to -‐$38,000
Patient A
Train local residents to participate in decision-
making over health care resources!
Promote collaboration among providers and
between providers and the community!
Emergency Department High Utilizers Top 1% 2007 Camden Patients 386 Visits 5169 Visits/Patient 13.4 % visiting more than one hospital 80.6%
Trenton Patients 504 Visits 7616 Visits/Patient 15.1 % visiting more than one hospital 78.2%
Newark Patients 928 Visits 14367 Visits/Patient 15.5 % visiting more than one hospital 71.1%
Comparing Emergency Room High Utilizers in Camden, Trenton, and Newark!
SENATE, No. 2443
STATE OF NEW JERSEY 214th LEGISLATURE
INTRODUCED DECEMBER 6, 2010
Sponsored by: Senator JOSEPH F. VITALE District 19 (Middlesex) SYNOPSIS Establishes Medicaid Accountable Care Organization Demonstration Project in DHS. CURRENT VERSION OF TEXT As introduced.
The Plan: Compe1ng ACOs
Cooper ACO
Lourdes ACO
Virtua ACO
A Different ACO Model for Camden
Camden cost savings strategies!
1. Nurse practitioner led clinics in high cost buildings!
2. More high utilizer outreach teams!3. Medical home-based nurse care
coordination!4. More same day appointments (open
access scheduling)!
Lessons from Camden!
n Strategic ability to filter, focus, and segment!n Comfort with ambiguity and willingness to
tinker!n Adaptive challenge not a technical challenge!n Passion for moving towards standardization
and efficiency when the time is right!n Meaningful solutions are local, gradual, and
require chunking!