big data webinar 8/2
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Camden Coalition of
Healthcare Providers
Improving care and reducing costs in
Camden, NJ with the help of
innovative local data systems
Kennen S. Gross, PhD, MPH
Director, Research & Evaluation
Camden Coalition of Healthcare Providers
Camden Coalition of
Healthcare Providers
www.camdenhealth.org
The mission of CCHP is to improve the
health status of all Camden residents by
increasing the capacity, quality and
access to care in the city.
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www.camdenhealth.org
"What we have before us are some
breathtaking opportunities disguised as
insolvable problems."
-John Gardner
Secretary of Health, Education and Welfare 1965-1968
Diabetes COPD Multi-CC No-CC
Diabetes COPD Multi-CC No-CC
Traditional Intervention Paradigm
Diabetes COPD Multi-CC No-CC High Utilizer
Traditional Intervention Paradigm
Diabetes COPD Multi-CC No-CC High Utilizer
Hotspotting Intervention Paradigm
Understand
the problem
Develop
interventions
to target the
problem
Evaluate the
impact of
the solutions
www.camdenhealth.org
Identify and
engage
patients
needing
intervention
10www.camdenhealth.org
Issue #1:
Getting access to local healthcare data
11www.camdenhealth.org
Issue #2:
Limitations of Existing Population Datasets
12www.camdenhealth.org
Issue #3:
Healthcare data that reflects the population
Issue #3:
Healthcare data that reflects the population
www.camdenhealth.org
CCHP Solution:
Camden Health Database
Yearly Clams Data
Data Use Agreements
IRB Agreement
Data processing/cleaning
Probabilistic matching
Geocoding
Camden Residents All-Payer Claims Longitudinal Dataset
Demographics
Inpatient and Emergency visits
Diagnosis codes
Charges/receipts
Insurance
www.camdenhealth.org
Different Strategies for Undertaking this Analysis
www.camdenhealth.org
Business Intelligence Issues
Legal Issues
Data Access IssuesSTART WITH WHY
www.camdenhealth.org
Defining the Project: QA/PI or Research
Quality Assurance
Process
Improvement
Research Project
Business Associates
Agreements (BAAs)
Institutional Review
Boards
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www.camdenhealth.org
Data Storage & Transfer Security
www.camdenhealth.org
Areas of data available through claims
www.camdenhealth.org
Data Quality Issues
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www.camdenhealth.org
Probabilistic Linkage
www.camdenhealth.org
Geocoding and GIS Analysis
www.camdenhealth.org
Camden Cost Curve, 2011
www.camdenhealth.org
ED visits, 2011
Inpatient visits, 2011
0 1 2 3 to 4 5+
044,728 (85%) patients
5,210 Inpatient visits
63,489 ED visits
$28,000,000 (50%) IP payment
$25,800,000 (59%) ED payment985 (2%) patients
1,856 IP visits
4,129 ED visits
$10,000,000 (17%) IP
payment
$1,700,000 (4%) ED
payments
503 (1%) patients
2,026 Inpatient Visits
4,144 ED Visits
$10,900,000 (20%) in IP payment
$1,700,000 (4%)in ED payment
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2 to 3
4 to 5
4,961(9%) patients
28,447 ED visits
$11,500,000 (27%) in
ED payment
1,563 (3%) patients
1,239 IP visits
6,962 ED visits
$6,700,000 (18%) in IP
payment
$2,800,000 (6%) in ED
payment
6 to 7
8 to 9
10 +
24www.camdenhealth.org
Camden Hospital Utilization Typology
Camden Hospital Utilization, 2011
www.camdenhealth.org
Camden Hospital Inpatient and Emergency Revenue, 2011
www.camdenhealth.org
“Ambulatory Care Sensitive Conditions” and
are often amenable to outpatient
management
Camden ED use by diagnosis, 2011
www.camdenhealth.org
“Ambulatory Care Sensitive Conditions” and
are often amenable to outpatient
management
Camden Inpatient use by Diagnosis, 2011
www.camdenhealth.org
Another way to look at ICD data
www.camdenhealth.org
Another way to look at ICD data
www.camdenhealth.org
Camden High Utilizers, 2011
www.camdenhealth.org
www.camdenhealth.org
Camden Spatial Analysis of Hospital Costs
CCHP Solution:
Camden Health Information Exchange
Daily Data
Share
HIE Daily Report
List of patients currently in hospital with 2+IP and/or 6+ ED
in last 6 months
CCHP care teams review cases
Enroll patients in Care Management / Care Transitions
program before discharge
HIE
VendorDaily HL-7
Feeds
Web based HIE
system
Customized data cleaning and processing
www.camdenhealth.org
www.camdenhealth.org
www.camdenhealth.org
Issue #4:
EMR’s not customizable
CCHP Solution:
Customized data collection tools
-Quantify the “dose” per client
-Understand staffing
-Continuous quality improvement
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1/3/2011 2/3/2011 3/3/2011 4/3/2011 5/3/2011 6/3/2011 7/3/2011 8/3/2011 9/3/2011 10/3/2011 11/3/2011 12/3/2011
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ED IP
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Patient utilization profile
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Len
gth
of
Stay
ED IPC
1 year pre-enrollment
Charges = $745,018; Receipts: $95,358;
Inpatient days: 55; ED visits: 1
Post-enrollment
Charges = $0; Receipts= $0
Inpatient days: 0; ED visit=0
www.camdenhealth.org
1 year pre-enrollment Charges = $112,664; Receipts: $22,365
Post-enrollment (10 months)Charges = $64,974; Receipts= $12,380
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Len
gth
of
stay
ED IP
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Len
gth
of
stay
ED IP
1 year pre-enrollment Charges = $312,525; Receipts: $59,133
Inpatient days: 24; ED visits: 2
Post-enrollmentCharges = $0; Receipts= $0
Inpatient days: 0; ED visit=0
1 year pre-enrollment Charges = $745,018; Receipts: $95,358;
Inpatient days: 55; ED visits: 1
Post-enrollmentCharges = $0; Receipts= $0
Inpatient days: 0; ED visit=0
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4
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Len
gth
of
Stay
ED IP
Data access is a necessary but not sufficient
step towards innovative delivery reforms.
Data Quality is essential
Measurement is essential
Statistical Literacy is essential
Effective Dissemination in essential
Maintaining partnerships is essential
Thank you for your time
Questions/comments please contact me at
ken@camdenhealth.org
www.camdenhealth.org
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