The “Camden Coalition of Healthcare Providers” www.camdenhealth.org formed in 2007, started to implement a citywide Care Management project, to direct outreach attention to Camden’s most frequent utilizers of the city’s emergency departments and hospitals. So many in the population suffer from chronic illness, mental illness, and substance abuse, but lack consistent primary care.
Jeffrey Brenner MD, Executive Director of the Camden Coalition, spoke at the Aspen Institute’s www.aspeninstitute.org “Public Health Grand Rounds” event held in Washington D.C. on September 16th to discuss what is referred to as healthcare hot spotting.
Healthcare hot spotting uses data sets to find failures in the system and to gain insights into the root causes that lead to repeat visits to emergency rooms or hospitals. As Dr. Brenner pointed out, “A small sliver of patients are responsible for most of the costs entailed from frequent visits. As it turns out, most of the patients frequent emergency rooms because of head colds and minor complaints.”
He added, “The reason that the people in the vulnerable population use the emergency room for non-emergencies is that they simply can’t get appointments with doctors due to our broken delivery system. An example of how healthcare costs are spiraling out of control, a woman made 102 emergency room visits and ended up having 147 CT scans. It turned out that the cause of her problem was extreme anxiety.”
An example where hot spotting was successful focused on residents living in two buildings in Camden that were high utilizers of emergency rooms. By better coordinating their healthcare, Dr. Brenner and his team provided social services and offered house calls with a nurse practitioner, a social worker, and a health outreach worker backed by a family medical doctor. The team was able to reduce hospital visits and cut costs by one-half.
As Dr. Brenner explained, “Today, the role of the primary care physician is shifting toward coordinated care and preventative services. However, one of the main principles of coordinated care is to work as a team. The problem is that doctors aren’t trained in medical schools to work in teams, medical schools aren’t providing the curriculum to meet the needs of today’s communities, plus there are legal restrictions to moving data around.”
To help to provide coordinated care, the Camden Health Information Exchange www.camdenhealth.org/programs/health-information-exchange was established and is used today by over 400 healthcare providers in Camden County and the surrounding areas.
Today, nursing teams are able to use EHRs embedded in the HIE to record and manage notes to provide healthcare providers and social workers with information and to send encrypted messages for care coordination purposes. Aggregate clinical and utilization data is also exportable to identify additional care coordination opportunities.