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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, MPH
Director, Research & Evaluation
Camden Coalition of Healthcare Providers
Camden Coalition of
Healthcare Providers
www.camdenhealth.org
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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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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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Diabetes COPD Multi-CC No-CC
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Diabetes COPD Multi-CC No-CC
Traditional Intervention Paradigm
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Diabetes COPD Multi-CC No-CC High Utilizer
Traditional Intervention Paradigm
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Diabetes COPD Multi-CC No-CC High Utilizer
Hotspotting Intervention Paradigm
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Understand
the problem
Develop
interventions
to target the
problem
Evaluate the
impact of
the solutions
www.camdenhealth.org
Identify and
engage
patients
needing
intervention
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Issue #1:
Getting access to local healthcare data
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Issue #2:
Limitations of Existing Population Datasets
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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 Data
Data 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
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Different Strategies for Undertaking this Analysis
www.camdenhealth.org
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Business Intelligence Issues
Legal Issues
Data Access IssuesSTART WITH WHY
www.camdenhealth.org
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Defining the Project: QA/PI or Research
Quality Assurance
Process
Improvement
Research Project
Business Associates
Agreements (BAAs)
Institutional Review
Boards
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www.camdenhealth.org
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Data Storage & Transfer Security
www.camdenhealth.org
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Areas of data available through claims
www.camdenhealth.org
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Data Quality Issues
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www.camdenhealth.org
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Probabilistic Linkage
www.camdenhealth.org
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Geocoding and GIS Analysis
www.camdenhealth.org
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Camden Cost Curve, 2011
www.camdenhealth.org
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ED visits, 2011
Inpatient visits, 2011
0 1 2 3 to 4 5+
044,728 (85%) patients
5,210 Inpatient visits
63,489 ED visits
$28,000,000 (50%) IP payment
$25,800,000 (59%) ED payment985 (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 +
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Camden Hospital Utilization Typology
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Camden Hospital Utilization, 2011
www.camdenhealth.org
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Camden Hospital Inpatient and Emergency Revenue, 2011
www.camdenhealth.org
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“Ambulatory Care Sensitive Conditions” and
are often amenable to outpatient
management
Camden ED use by diagnosis, 2011
www.camdenhealth.org
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“Ambulatory Care Sensitive Conditions” and
are often amenable to outpatient
management
Camden Inpatient use by Diagnosis, 2011
www.camdenhealth.org
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Another way to look at ICD data
www.camdenhealth.org
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Another way to look at ICD data
www.camdenhealth.org
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Camden High Utilizers, 2011
www.camdenhealth.org
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www.camdenhealth.org
Camden Spatial Analysis of Hospital Costs
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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
VendorDaily HL-7
Feeds
Web based HIE
system
Customized data cleaning and processing
www.camdenhealth.org
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www.camdenhealth.org
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www.camdenhealth.org
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Issue #4:
EMR’s not customizable
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CCHP Solution:
Customized data collection tools
-Quantify the “dose” per client
-Understand staffing
-Continuous quality improvement
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0
2
4
6
8
10
12
14
1/3/2011 2/3/2011 3/3/2011 4/3/2011 5/3/2011 6/3/2011 7/3/2011 8/3/2011 9/3/2011 10/3/2011 11/3/2011 12/3/2011
Len
gth
of
Sta
y
ED IP
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Patient utilization profile
C
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0
2
4
6
8
10
12
Len
gth
of
Stay
ED IPC
1 year pre-enrollment
Charges = $745,018; Receipts: $95,358;
Inpatient days: 55; ED visits: 1
Post-enrollment
Charges = $0; Receipts= $0
Inpatient days: 0; ED visit=0
www.camdenhealth.org
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1 year pre-enrollment Charges = $112,664; Receipts: $22,365
Post-enrollment (10 months)Charges = $64,974; Receipts= $12,380
0
0.5
1
1.5
2
2.5
3
Len
gth
of
stay
ED IP
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0
1
2
3
4
5
6
7
8
9
Len
gth
of
stay
ED IP
1 year pre-enrollment Charges = $312,525; Receipts: $59,133
Inpatient days: 24; ED visits: 2
Post-enrollmentCharges = $0; Receipts= $0
Inpatient days: 0; ED visit=0
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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
0
2
4
6
8
10
12
Len
gth
of
Stay
ED IP
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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
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Thank you for your time
Questions/comments please contact me at
[email protected]
www.camdenhealth.org