1. Bending the Cost Curve and Improving
Quality in One of America’s Poorest Cities
Jeffrey Brenner, MD
Executive Director/Medical Director

3. You are cordially invited to the first
Camden City Healthcare Providers’
Breakfast
History of
CCHP
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.

4. Long-term Federal Debt

5. 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

6. 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) 7,638
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

8. 8

9. 9

10. 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

11. Care Continuum Model
Hospital • Multidisciplinary care management outreach
Admission • 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

12. A Typical Month of Healthcare in the US (New England J Med 2001; 344:2021-25)

13. 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

14. 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 +

15. 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 +

16. 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

17. Train local residents to
participate in decision-
making over health care
resources

18. Promote collaboration
among providers and
between providers and
the community

20. Comparing Emergency Room High Utilizers in
Camden, Trenton, and Newark
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%

21. 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.

22. The Plan: Competing ACOs
Lourdes ACO
Cooper ACO
Virtua ACO

23. A Different ACO Model for
Camden

24. 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)

25. 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