the camden coalition of healthcare providers · the cchp targets these super-utilizers directly to...

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JENNIFER WOJTOWICZ The Camden Coalition of Healthcare Providers

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Page 1: The Camden Coalition of Healthcare Providers · The CCHP targets these super-utilizers directly to cut costs and increased their quality of care ... hospitals, and specialty care

JENNIFER WOJTOWICZ

The Camden Coalition of Healthcare

Providers

Page 2: The Camden Coalition of Healthcare Providers · The CCHP targets these super-utilizers directly to cut costs and increased their quality of care ... hospitals, and specialty care

Shepherd Internship

� 7 week immersion in an area struggling with poverty� Live alongside other interns working in the same

area from several different schools and many different backgrounds

� Many networking events throughout the summer with other professionals working in the same area

� Had an awesome experience

Page 3: The Camden Coalition of Healthcare Providers · The CCHP targets these super-utilizers directly to cut costs and increased their quality of care ... hospitals, and specialty care

Camden, NJ

� Previously known as “America’s Most Dangerous City”¡ Recorded the highest crime rate in the country in 2012 with

the number of violent crimes being 6.6X the national rate

� Across the Delaware River from Philadelphia � Population: 77,334

¡ 40% below the poverty line¡ 50% of population on Medicaid

Page 4: The Camden Coalition of Healthcare Providers · The CCHP targets these super-utilizers directly to cut costs and increased their quality of care ... hospitals, and specialty care

Where did they begin?

� Dr. Jeffrey Brenner was a primary care provider in the city of Camden for many years and began to see the inefficiencies of the system

� He began a breakfast club with other primary care providers in the area, where they discussed how they could improve the quality of care in Camden

� What began as 8 doctors that met occasionally to discuss issues in the system, is now an Accountable Care Organization that has a staff of 85

Page 5: The Camden Coalition of Healthcare Providers · The CCHP targets these super-utilizers directly to cut costs and increased their quality of care ... hospitals, and specialty care

What did they notice?

� Dr. Jeffrey Brenner began to employ a method called “Hotspotting”

� Hotspotting¡ An approach in which data is shared between different entities

in the city such as police data and hospital data in order to discover patterns in utilization of services

¡ He noticed that there were two city blocks in Camden that had the largest proportion of hospital costs in the last year- WHY?

¡ After an in depth-analysis of the city’s hospital data, he found that 1% of the 100,000 people who used Camden hospitals accounted for 30% of the cost- called super utilizers

¡ The CCHP targets these super-utilizers directly to cut costs and increased their quality of care

Page 6: The Camden Coalition of Healthcare Providers · The CCHP targets these super-utilizers directly to cut costs and increased their quality of care ... hospitals, and specialty care

Accountable Care Organization

� The Camden Coalition of Healthcare Providers is registered as an Accountable Care Organization

� They are partnered with all primary care providers, hospitals, and specialty care providers to unite them all in the goal of providing quality care to the Medicaid population of Camden at lower costs

Page 7: The Camden Coalition of Healthcare Providers · The CCHP targets these super-utilizers directly to cut costs and increased their quality of care ... hospitals, and specialty care

Organization

� The organization is now broken down into several teams:¡ Care Management Initiative¡ Clinical Redesign Initiative¡ Cross-site Learning and Workforce Development¡ Finance and Administration¡ Legal and External Affairs¡ Strategy and Information

Page 8: The Camden Coalition of Healthcare Providers · The CCHP targets these super-utilizers directly to cut costs and increased their quality of care ... hospitals, and specialty care

Care Management Initiative

� A program of accompaniment� At any given time, the CMI team is working directly

with about 50 patients in the Camden area� The team identifies high utilizers with at least 3

physical illnesses and several social barriers to care (lack of family support, homelessness, etc.)

� The patient is identified in the hospital through the Health Information Exchange (HIE), and a team member begins their intervention that lasts about 90 days before graduation

Page 9: The Camden Coalition of Healthcare Providers · The CCHP targets these super-utilizers directly to cut costs and increased their quality of care ... hospitals, and specialty care

Clinical Redesign Initiative

� The team I worked for this summer� Work directly with the doctor’s office in Camden, NJ

to improve the number of patients utilizing their primary care physicians and increase the quality of care they receive from them

� 7- Day Pledge: The CCHP found that if doctors are able to get patients into their office within 7 days of their last hospital visit, it lowers the rate of readmission significantly

� Partnered with Horizon and United so that doctors receive reimbursements for getting their patients in within 7 days

Page 10: The Camden Coalition of Healthcare Providers · The CCHP targets these super-utilizers directly to cut costs and increased their quality of care ... hospitals, and specialty care

My Position- Camden Medicaid ACO Summer Associate

� I worked with the CRI Team along with 6 other interns outside of the Shepherd Program and 1 other within the program

� 4 interns were second year students from the medical school nearby

� We were trained the first week in trauma-informed care and interviewing

� Then spent the rest of the summer collecting about 900 surveys from patients in the 11 different primary care providers’ offices in Camden

Page 11: The Camden Coalition of Healthcare Providers · The CCHP targets these super-utilizers directly to cut costs and increased their quality of care ... hospitals, and specialty care

I was able to interact directly with hundreds of patients this summer- I was

lucky enough to receive the trust from many patients that allowed them to

share their stories with me.

Page 12: The Camden Coalition of Healthcare Providers · The CCHP targets these super-utilizers directly to cut costs and increased their quality of care ... hospitals, and specialty care

Important Experience 1

� 85 Year Old Woman Patient¡ Raised 10 children on her own¡ Neither her nor her children finished past the 8th grade¡ Lost one child in infancy due to a preventable illness¡ Two children in jail, one for homicide¡ Manages several chronic illnesses¡ Resilient and positive attitude

Page 13: The Camden Coalition of Healthcare Providers · The CCHP targets these super-utilizers directly to cut costs and increased their quality of care ... hospitals, and specialty care

Important Experience 2

� Project HOPE is a clinic that primarily serves the homeless population

� 45 Year Old Woman Immigrant from Central America¡ Spoke only Spanish¡ Used to receive special aid in the clinic from an advisor

who allowed her to receive reductions in care and medication costs- this person has since left and she no longer has the resources to help pay for her care

¡ Her doctor does not speak Spanish and she is unable to communicate about her current illnesses and does not believe that they are providing her with the correct medication and overall care

¡ Lack of cultural competency in doctors

Page 14: The Camden Coalition of Healthcare Providers · The CCHP targets these super-utilizers directly to cut costs and increased their quality of care ... hospitals, and specialty care

How has the CCHP Impacted Camden?

� The Clinical Management Initiative’s High Utilizer program is currently being analyzed in an MIT randomized control trial for effectiveness

� Reports on quality of care from most primary care providers have increased while cost has been steadily decreasing for the city

� Recently started a Housing First pilot in Camden, which provides housing for the homeless without the usual many requirements, which they have found dramatically cuts the amount of hospital admissions for previous super utilizers

� There are many personal reports from patients that the CCHP has reached that the accompaniment process has significantly impacted their lives positively

� Stay tuned for the data collected this summer!

Page 15: The Camden Coalition of Healthcare Providers · The CCHP targets these super-utilizers directly to cut costs and increased their quality of care ... hospitals, and specialty care

AWESOME (unrelated) Experience

� My job was very invested in each of us being able to pursue our many interests available in the area also outside of our own jobs

� I was able to shadow a cardiologist in the catheterization lab at UPenn Hospital for a day

� Connected with many physicians in the hospital and was allowed to stand in the operating room next to the doctor

Page 16: The Camden Coalition of Healthcare Providers · The CCHP targets these super-utilizers directly to cut costs and increased their quality of care ... hospitals, and specialty care

Future Plans

� MD/MPH to work with patients from a low SES¡ After seeing how some doctors interacted with their

patients¡ Would love to go back to an organization like the Camden

Coalition of Healthcare Providers, who work not only directly with patients but in policy work to help increase quality of and access to care overall