Of the 79,000 residents in Camden, N.J., 386 constitute the top 1 percent of emergency department (ED) visitors. In 2011, they made a total of 5,000 trips to one of the city's three EDs for an average of 13 visits per patient.
Nearly 80 percent of those ED patients visited more than one hospital during the year-and inpatient high-utilizers are just as transient. "They are highly mobile, and they go from ED to ED, hospital to hospital, in search of better care," says Jeffrey C. Brenner, MD, executive director and medical director of the Camden Coalition of Healthcare Providers.
To address the issue, all three Camden hospitals now send information about every ED visit and inpatient admission-patient names, addresses, insurance type, and more-to a database that Brenner created. He and his team scour the data to identify community members who had more than two inpatient stays in the last six months. Then they enroll these superusers in a citywide care management service, which works with all of the providers in Camden to ensure these patients get needed primary care, behavioral health, and social services so they are less likely to need costly inpatient care.
"One hospital and one clinic can't solve this," Brenner says. "This problem operates at the community level."
So far, the results are mixed. "We do not always hit a home run because these are very difficult patients," Brenner says. "We score with some, and some are much more challenging."
Here's what a home run looks like. Last November, a 55-year-old man with nine chronic conditions was admitted to a Camden hospital and assigned to a care manager at Camden Coalition, which runs the care management program. In the previous year, the patient visited the ED nine times and had six inpatient stays, racking up total charges of $312,000. He is a dual-eligible covered by Medicare and Medicaid, which paid a total of $59,000 for that care.
"We coordinated his home care, transport, meals, crutches, wheelchair, and dialysis. We got him to see a nephrologist, got him on the transplant list, and arranged numerous other services," says Brenner. In the six months after the 55-year-old patient "graduated" from care coordination, he had had no ED visits and no hospitalizations.
Case management for superusers is just one of several ways that the Camden Coalition carries out its mission statement: to improve the health status of Camden residents by increasing the capacity, quality, and access of health care. Other initiatives include helping establish a medical clinic in an apartment building where a high concentration of superusers live and forming a citywide diabetes collaborative to help primary care practices improve health outcomes for patients with diabetes.
Organized as a not-for-profit agency, the Coalition gathers providers, social service agencies, churches, and other constituencies to work together on some of healthcare's thorniest problems. Representatives from all of these entities serve on the Coalition's board.
Brenner refers to the Coalition as a virtual organization because it has no employees. Rather, all of its staff members are employed by Cooper University Hospital and leased to the Coalition.
The Coalition's philanthropic grant funds are administered by Cooper's foundation. "In addition, other hospitals in the region who have representatives on our board contribute money to our upkeep," Brenner says. "These are highly, highly competitive hospitals that are all working together toward the same goals."
This type of collaboration among providers is necessary to achieve the type of change required. "Entirely new models of how we deliver care are going to have to be designed-and the institutions that don't figure that out are going to be like Kodak and Blockbuster. They're going to be history," Brenner says. "The next 30 years are going to be about sucking cost out of the system, and if you don't figure out how to be a player in that, you're not going to be relevant."
Jeffrey C. Brenner is executive director and medical director, Camden Coalition of Healthcare Providers, Camden, N.J. (email@example.com).
J.P. Morgan: Managing Cybersecurity and Protecting Patient Data
Brian DiPietro, Managing Director, Commercial Bank Technology, JPMorgan Chase & Co., discusses the importance of evaluating your cybersecurity protocols to help prevent malicious data breaches.
TransUnion Healthcare: Smarter Revenue Cycle Solutions
Gerry McCarthy, President of TransUnion Healthcare, discusses industry trends contributing to higher bad debt and what to do about them. Gerry is responsible for the strategic direction of the healthcare business and expanding its footprint in the healthcare market overall. He has more than 20 years of experience in healthcare information technologies.
Deloitte: Creating Value with Effective Care Management
Scott Kolesar, principal and senior leader in Deloitte Consulting LLP's Value Based Care practice, and David Wennberg, MD, MPH, adjunct associate professor of The Dartmouth Institute and former chief executive officer, Northern New England Accountable Care Collaborative, discuss the challenges and competencies involved in creating a care management organization.
American Express: Streamlining Supplier Payments and Boosting Revenue
Andrew Jamison, vice president in the Global Corporate Payments division of American Express, discusses trends and opportunities in supplier payments.
Deloitte: Realizing the Potential of Your CDI Program
Suzanne Whitworth, director at Deloitte & Touche LLP, and LaVerne Romberger, MSN, CCM, CCDS, clinical operations manager-Seton Healthcare, share leading practices for maximizing the potential of clinical documentation programs under value-based care.
RevSpring: Customizing a Technology Platform to Drive Patient Payment
Martin Callahan, Senior Vice President, Healthcare Solutions, RevSpring, describes key industry trends affecting how patients engage with the revenue cycle and ways payment processes are changing as a result.
KPMG: Readying for Healthcare Today and Tomorrow
Dion Sheidy, a partner in KPMG's Healthcare Advisory practice, discusses healthcare's changing landscape and how having the right advisor can help organizations navigate challenges and opportunities.
Huron Healthcare: Readying Your Organization for Transformation
Gordon Mountford, executive vice president, Huron Healthcare, discusses business imperatives for undertaking transformative change.
Xtend Healthcare: A Custom Approach to Optimizing Revenue Cycle Performance
Tom O'Neill, CEO of Xtend Healthcare Advanced Revenue Solutions, discusses key areas where organizations risk revenue leakage and ways they can use outsourcing to better protect cash flow and support accurate payment.
KeyBank: Helping You to Realize Your Strategic Vision in Changing Times
Victoria Terekhova, senior strategist for Enterprise Healthcare at KeyBank, discusses key challenges when developing long-term strategy in a rapidly changing industry, and the role the right banking partner can play in helping healthcare providers navigate the opportunities before them.