Bending the Cost Curve and ImprovingQuality in One of America’s Poorest Cities            Jeffrey Brenner, MD     Executiv...
You are cordially invited to the first  Camden City Healthcare Providers’             Breakfast                           ...
Long-term Federal Debt
Camden Health Data   2002 – 2011 with Lourdes, Cooper, Virtua data       500,000+ records with 98,000 patients       50...
Top 10 ER Diagnosis 2002-2007 (317,791 visits)465.9    ACUTE UPPER RESPIRATORY               12,549         INFECTION (hea...
8
9
Overview of the Coalition-   20 member board, incorporated non-profit-   Foundation and hospital support-   Structure of t...
Care Continuum Model Hospital            •   Multidisciplinary care management outreachAdmission            •   Patients w...
A Typical Month of Healthcare in the US   (New England J Med 2001; 344:2021-25)
Utilization typology                                    Inpatient visits, 2011 ED visits, 2011     0       1              ...
Utilization typology                                                       Inpatient visits, 2011 ED visits, 2011         ...
Utilization matrix                                                                   Inpatient visits, 2011 ED visits, 201...
Patient A            Estimated 2011 Payment            ED: $38,000 to $76,000 (93 visits)            IP: $65,000 to $130,0...
Train local residents toparticipate in decision-making over health care       resources
Promote collaboration among providers andbetween providers and   the community
Comparing Emergency Room High Utilizers in      Camden, Trenton, and NewarkEmergency Department High Utilizers   Top 1% 20...
SENATE, No. 2443STATE OF NEW JERSEY              214th LEGISLATURE                    INTRODUCED DECEMBER 6, 2010Sponsored...
The Plan: Competing ACOs                Lourdes ACOCooper ACO                              Virtua ACO
A Different ACO Model for         Camden
Camden cost savings strategies1.   Nurse practitioner led clinics in high cost     buildings2.   More high utilizer outrea...
Lessons from Camden   Strategic ability to filter, focus, and segment   Comfort with ambiguity and willingness to    tin...
LDI Health Policy Seminar with Jeffrey Brenner_ Bending the Cost Curve and Improving Quality in One of America’s Poorest C...
LDI Health Policy Seminar with Jeffrey Brenner_ Bending the Cost Curve and Improving Quality in One of America’s Poorest C...
LDI Health Policy Seminar with Jeffrey Brenner_ Bending the Cost Curve and Improving Quality in One of America’s Poorest C...
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LDI Health Policy Seminar with Jeffrey Brenner_ Bending the Cost Curve and Improving Quality in One of America’s Poorest Cities 4_20_12

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  • Primary care practice opened in January 2003.
  • LDI Health Policy Seminar with Jeffrey Brenner_ Bending the Cost Curve and Improving Quality in One of America’s Poorest Cities 4_20_12

    1. 1. Bending the Cost Curve and ImprovingQuality in One of America’s Poorest Cities Jeffrey Brenner, MD Executive Director/Medical Director
    2. 2. You are cordially invited to the first Camden City Healthcare Providers’ Breakfast History of CCHPJoin 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 FamilyMedicine at Cooper Hospital, and the Camden Area Health Education Center Please RSVP to Daria Chacón at 856-963-2432 x218 by Friday, January 11.
    3. 3. Long-term Federal Debt
    4. 4. Camden Health Data 2002 – 2011 with Lourdes, Cooper, Virtua data  500,000+ records with 98,000 patients  50 % population use ER/hospital in one year Leading ED/hospital utilizers citywide  324 visits in 5 years  113 visits in 1 year Total revenue to hospitals for Camden residents $100 million per year  Most expensive patient $3.5 million  30% costs = 1% patients  80% costs = 13% patients  90% costs = 20% patients
    5. 5. Top 10 ER Diagnosis 2002-2007 (317,791 visits)465.9 ACUTE UPPER RESPIRATORY 12,549 INFECTION (head cold)382.9 OTITIS MEDIA NOS (ear infx) 7,638079.99 VIRAL INFECTION NOS 7,577462 ACUTE PHARYNGITIS (sore throat) 6,195493.92 ASTHMA NOS W/ EXACER 5,393558.9 NONINF GASTROENTERI (stomach virus) 5,037789.09 ABDOMINAL PAIN-SITE NEC 4,773780.6 FEVER 4,219786.59 CHEST PAIN NEC 3,711784.0 HEADACHE 3,248
    6. 6. 8
    7. 7. 9
    8. 8. 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
    9. 9. Care Continuum Model Hospital • Multidisciplinary care management outreachAdmission • Patients with history of ED visits/hospital admissions and readmissions (4 admits w/in 6 mos.); social s Data complexities • Average 6-8 month engagement Inclusion CCHP Outreach Medical Home Triage High Risk Care Coordination Health Coaching Intermediate Risk Data driven care mgt. Patient Engagement • Nurse driven care transition • Patients with history of ED visits/hospital admissions and readmissions (2+ admits w/in 6 mos.); socially stable • Average 6-8 week engagement
    10. 10. A Typical Month of Healthcare in the US (New England J Med 2001; 344:2021-25)
    11. 11. Utilization typology Inpatient visits, 2011 ED 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
    12. 12. Utilization typology Inpatient visits, 2011 ED visits, 2011 0 1 2 3 to 4 5+ 0 1 Normal Range of Utilization 2 to 3 Potential High Inpatient 4 to 5 Utilizers High Utilizers 6 to 7 Emergency Potential High Department Utilizers High Utilizers 8 to 9 10 +
    13. 13. Utilization matrix Inpatient visits, 2011 ED visits, 2011 0 1 2 3 to 4 5+ 0 44,728 (85%) patients 5,210 Inpatient visits 63,489 ED visits 1 $28,000,000 (50%) IP payment $25,800,000 (59%) ED payment 2 to 3 985 (2%) patients 1,856 IP visits 503 (1%) patients 4,129 ED visits 2,026 Inpatient Visits 4,144 ED Visits 4 to 5 1,563 (3%) patients $10,000,000 (17%) IP 1,239 IP visits payment $10,900,000 (20%) in IP payment 4,961(9%) patients 6,962 ED visits $1,700,000 (4%) ED $1,700,000 (4%)in ED payment 6 to 7 payments 28,447 ED visits $6,700,000 (18%) in IP $11,500,000 (27%) in payment 8 to 9 ED payment $2,800,000 (6%) in ED payment 10 +
    14. 14. Patient A Estimated 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 Estimates 30% reduction in utilization : ED: -28; -$11,000 to -$22,000 IP: - 4; -$19,000 to -$38,000
    15. 15. Train local residents toparticipate in decision-making over health care resources
    16. 16. Promote collaboration among providers andbetween providers and the community
    17. 17. Comparing Emergency Room High Utilizers in Camden, Trenton, and NewarkEmergency Department High Utilizers Top 1% 2007CamdenPatients 386Visits 5169Visits/Patient 13.4% visiting more than one hospital 80.6%TrentonPatients 504Visits 7616Visits/Patient 15.1% visiting more than one hospital 78.2%NewarkPatients 928Visits 14367Visits/Patient 15.5% visiting more than one hospital 71.1%
    18. 18. SENATE, No. 2443STATE OF NEW JERSEY 214th LEGISLATURE INTRODUCED DECEMBER 6, 2010Sponsored by:Senator JOSEPH F. VITALEDistrict 19 (Middlesex)SYNOPSIS Establishes Medicaid Accountable Care Organization Demonstration Projectin DHS.CURRENT VERSION OF TEXT As introduced.
    19. 19. The Plan: Competing ACOs Lourdes ACOCooper ACO Virtua ACO
    20. 20. A Different ACO Model for Camden
    21. 21. Camden cost savings strategies1. Nurse practitioner led clinics in high cost buildings2. More high utilizer outreach teams3. Medical home-based nurse care coordination4. More same day appointments (open access scheduling)
    22. 22. Lessons from Camden Strategic ability to filter, focus, and segment Comfort with ambiguity and willingness to tinker Adaptive challenge not a technical challenge Passion for moving towards standardization and efficiency when the time is right Meaningful solutions are local, gradual, and require chunking

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