Camden Health Planning Conference

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Camden Health Planning Conference
Camden Coalition of Healthcare Providers Presents

• June 1st, 2006
• Rutgers University
• Camden, NJ

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Partners

• Robert Wood Johnson Foundation- New Jersey Health
  Initiatives Grant Program
• Camconnect- Linking Communities to Data
• UMDNJ- Robert Wood Johnson Medical School, Dept
  of Family Medicine in Camden

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Invitees

• Hospital executives
• Healthcare providers
• Public health practitioners
• Medical directors from the Medicaid managed care
  plans in Camden
• Researchers

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AGENDA

• Keynote Speaker- ER Utilization
• Overview Camden Demographic and Health
  Information
• Discussion time

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Goals for the Morning

• To provide an overview of the ER utilization
  literature
• To review existing health and demographic data in
  Camden
• To examine Camdens landscape of health related
  institutions and organizations
• To begin constructing a pilot health intervention

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Questions for Discussion

• What data is missing?
• What other ways could we analyze the data?
• How can we improve data collection?
• What niche does a coalition of health providers
  fill in Camden?
• What characteristics would interventions
  spearheaded by the coalition have?
• What types of interventions could the coalition
  lead?

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Conference Part II

• September 14, 2006
• Rutgers University

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Mission of the Coalition

• The Coalition seeks to improve the health status
  of Camden City residents through collaboration,
  data sharing, education, and improvements in
  service delivery.

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Goals of the Coalition

• Collaboration- to improve the level of health
  planning and coordination in the City of Camden.
• Data sharing- to maintain a city-wide health
  database for use in health planning and
  evaluation
• Practice improvements- to provide assistance to
  community-based providers to increase the
  capacity of their offices to provide outstanding
  care.

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Goals of the Coalition

• Reduce health disparities- improve the cultural
  competency of providers and health systems
  through education.
• Information resource- to maintain current
  knowledge of federal and state legislation that
  affect healthcare delivery in Camden.

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History of the Coalition

• Jan 4, 2002- first breakfast meeting, an informal
  meeting of community-based primary care providers
• 2005- wrote bylaws and formed a board
• 2006- received planning grant from the RWJ
  Foundation
• 2006- expanded board to include additional
  stakeholders

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Structure of the Coalition

• Board of 20 members
• 2 Seats for each of the hospitals (3)
• Administrator
• Health provider
• 6 Seats for the independent providers
• 1 Seat for school/childcare nurse
• 2 Seats for Camcare
• Administrator
• Health provider
• 3 Seats that are wildcard seats
• 1 Seat for fiscal agent
• 1 Seat for a public health organization

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Activities the Coalition

• Quarterly educational meetings
• Building health database
• Community-based practice management assistance
• Office manager training
• Practice management consultation
• Practice management lecture series
• Building website
• Community-based education- Ask A Health Provider
  Series

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More Information

• www.camconnect.org
• www.camdenhealth.org

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Keynote Speaker

• Kelly A. Hunt, M.P.P
• Research Officer at Robert Wood Johnson
  Foundation
• Member of the Health Disparities Team
• Work on
• Long-term Care
• Emergency Department Overcrowding
• Racial and Ethnic Disparities
• M.P.P. from Georgetown University
• B.A. from Villanova University

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Keynote Speaker

• Kelly A. Hunt, M.P.P
• Lead author of a recent paper
• Characteristics of Frequent Users of Emergency
  Rooms. Annals of Emergency Medicine. April 2006.

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Camden City Demographic Information
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Camden City Demographic Information

• Population 1990- 87,492
• Population 2000- 79,904 decrease 8.7

Source Camconnect Camden Facts
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Camden City Demographic Information
Source US Census
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Camden City Demographic Information
Source US Census
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Camden City Demographic Information
Source US Census
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Camden City Demographic Information
Source US Census
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Camden City Demographic Information
Source US Census
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Camden City Demographic Information
2000 Age Distribution
Source Camconnect Camden Facts
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Camden City Demographic Information
Source US Census
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Camden City Demographic Information
Source US Census
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Camden City Demographic Information
Source US Census
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Camden City Demographic Information
2000 Employment by Industry
Source Camconnect Camden Facts
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Camden City Demographic Information
Source US Census
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Camden City Demographic Information
Source US Census
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Camden City Demographic Information
Source US Census
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Camden City Demographic Information
Source US Census
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Camden City Demographic Information
Source US Census
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Camden City Demographic Information
Source US Census
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Camden City Demographic Information
Source US Census
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Camden City Demographic Information
Source US Census
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Camden City Health Data
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Source Camconnect Report, 2006
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Camden Health Data

• Billing data for Camden City residents only
• Cooper Health System
• Our Lady Of Lourdes Health System
• Virtua Health System
• Included in data files
• Name, DOB, address
• Diagnosis codes
• Gender, Race, Insurance status, Date of
  Admission, Date of Discharge, Type of Visit

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Camden Health Data

• HIPAA protections
• Protocol reviewed by three IRBs (Institutional
  Review Boards)
• Files isolated to a single hard drive
• Locked in filing cabinet, behind 2 locked doors,
  next to security desk
• Access only available to three researchers who
  are registered with the IRBs.

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Camden Health Data

• Overview 2003
• 68,000 Visits
• Matched 38,000 Patients across institutions
• Using DOB and part of address
• 50 of the city population 1 or more visits
• Limitations
• Gender missing from Virtua data
• Race data very poor
• Name missing from OLOL data
• Insurance data not consistent

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Camden Health Landscape

• Significance of data
• Patient level data
• Complete data set
• Includes geographic information
• No similar datasets available
• State of Utah
• State of Ontario
• Set up to be queryable

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Source Camconnect Report, 2006
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Source Camconnect Report, 2006
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Source Camconnect Report, 2006
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Source Camconnect Report, 2006
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Source Camconnect Report, 2006
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Source Camconnect Report, 2006
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Source Camconnect Report, 2006
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Source Camconnect Report, 2006
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Source Camconnect Report, 2006
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Source Camconnect Report, 2006
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Source Camconnect Report, 2006
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Source Camconnect Report, 2006
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Source Camconnect Camden Health Report, 2006
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Source Camconnect Camden Health Report, 2006
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Source Camconnect Camden Health Report, 2006
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Source Camconnect Camden Health Report, 2006
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Source Camconnect Camden Health Report, 2006
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Source Camconnect Camden Health Report, 2006
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Source Camconnect Camden Health Report, 2006
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Source Camconnect Camden Health Report, 2006
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Source Camconnect Camden Health Report, 2006
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Source Camconnect Camden Health Report, 2006
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Camden Health Data

• Conclusions
• High rate of utilization of the ER
• Many of the conditions are treatable in a primary
  care setting
• High-utilizers are more likely to be insured
• Over-utilization is occurring in every category
  of patients 1 or more visits, 3 or less visits,
  4 or more visits.

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Camden Health Data

• Causes for excess utilization
• Lack of insurance
• Primary care
• access
• quality
• Mental health care
• access
• quality
• Dangerous living conditions
• Violence
• Accidents

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Camden Health Landscape

• 2 Acute Care Hospitals
• Cooper University Hospital
• Our Lady of Lourdes Health System
• 1 Urgent Care Center
• Virtua Health System
• 1 Federally Qualified Community Health Center
• Camcare

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Camden Health Landscape

• 4 Large Outpatient Primary Care Sites
• 3 Cooper Plaza
• Virtua- Kyle Will Family Health Center
• OLOL- Osborne Family Health Center
• Planned Parenthood Offices
• 10-15 Community-based Primary Care Offices
• 3 School-based Health Centers
• Public Health Clinics
• County STD/TB clinic

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Camden Health Landscape

• Free Clinics
• Bergen Lanning Health Center
• RWJ Medical School Student-run Clinic
• UMDNJ-SOM Student-run Clinic
• Public Health Organizations
• Camden AHEC (Area Health Education Center)
• Community Outreach Vans
• Camden AHEC
• Project HOPE

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Pilot Intervention Project
Insurance companies
Hospitals
Camden Coalition of Healthcare Providers
Public health practitioners
Office-based Providers
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Pilot Intervention Project

• Local Healthcare Intermediary Organization
• Data sharing
• Health database
• Regional electronic health records
• Chronic disease registry
• Office-based practice improvements
• Implementation of office-based EHR
• Practice management improvements
• Provider and staff education

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Pilot Intervention Project

• Local Healthcare Intermediary Organization
• City-wide projects
• Improvements to coordination of care between
  systems
• Case-management of high-utilizers for ERs
• Community-wide education

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Discussion
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Discussion Questions

• What principles would guide interventions
  undertaken by the Coalition?
• Initial small pilot projects
• Guided by evidence
• Use experimental design
• Demonstrate effectiveness
• Cost-effective
• Consensus building and broadly accepted
• Patient focused, disease focused, community
  focused, provider focused?

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Discussion Questions

• How would interventions be prioritized and
  chosen?
• Low hanging fruit
• Greatest need for population
• Highest priority of stakeholders
• Funders interests

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Discussion Questions

• How would interventions be designed?
• Input from researchers/statisticians
• Input from community members
• Input from insurers
• Input from hospitals
• Input from outpatient organizations
• Input from providers

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Discussion Questions

• How would interventions measure success?
• Can measure improvement
• Can calculate cost per unit of improvement
• Widely accepted by providers, institutions, and
  patients
• Financially sustainable

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Discussion Questions

• What is missing in the Camden Health Database?
  How do we improve the database? How can the
  database be most useful to you or your
  organization?

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Discussion Questions

• What are the next steps for the health database?
• Simple EHR for use by the emergency room staff
  and community providers
• Case management/disease management of high
  utilizers of the ERs
• On-line version for use by the public

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Discussion Questions

• How would a case management/disease management
  program be run?
• Provider-driven care management committee
• Staffing of intervention
• Collaboration with health institutions
• Collaboration with insurers
• Who would be targeted?

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Next Steps

• Give us feedback
• Request and use the data
• Join the Coalition and Camconnect
• Support the health database in the evaluation
  section of your grant proposals
• Participate in the interventions
• Attend our planning conference Part II in
  September 2006
• Facilitate contacts with stakeholders

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More Information

• www.camconnect.org
• www.camdenhealth.org