Hope for New Jersey's city hospitals: the Camden Initiative.

Abstract

A tiny fraction of patients that consumes a disproportionately large share of medical resources in cities like Camden, NJ, threatens to overwhelm the state's healthcare delivery system. Pursuant to federal law, hospitals and emergency departments (EDs) are required to provide life-sustaining medical care to anyone seeking treatment, regardless of the patient's ability to pay. This situation is untenable in every respect. Local coalitions of hospitals, clinics, medical practices, payers, housing advocates, mental health providers, state agencies, and other entities offer the best opportunity to address the issue of excess utilization. None of these actors, individually, is equipped to respond to the demands of a highly mobile group of patients with incredibly diverse medical and social needs. Many of these entities focus on the episodic needs of a single patient for a discrete complaint, rather than addressing needs at a higher public health or systemic level. Building local coalitions of providers and advocates creates relationships that permit the entire system to respond in flexible ways to the complex and changing needs of the patients who place the greatest demands on the system. These health and social needs can be defined in tangible ways, and clear metrics can be used to measure and quantify program outcomes. Furthermore, the building of local coalitions facilitates the development of additional and expanded partnerships to address issues beyond the local setting. The Citywide Care Management System, a novel approach implemented by the Camden Coalition of Healthcare Providers (Camden Coalition), an incorporated nonprofit entity, has demonstrated significant results in improving the quality of services provided to so-called super users, while meaningfully reducing the cost of providing that care. The early findings suggest that expanding this new model for the delivery of care to super users in other areas of the state has the potential to save millions of dollars in medical care resources, while improving health outcomes for the patients it would serve. The Camden Coalition has effectively identified a group of patients that was making a disproportionately large contribution to the problem of healthcare costs and designed an effective intervention to address the problem. Using readily available electronic claims data (UB-92 data), the Camden Coalition identified a small group of people to target, designed a case management intervention to address their needs outside of the ED setting, and realized significant cost savings while providing higher-quality care. Fortunately, statewide UB-92 data, which are currently being collected by the New Jersey Department of Health and Senior Services (NJDHSS), could be used to identify similar cohorts of super users in other New Jersey cities.1 If programs similar to the one implemented in Camden can be designed and implemented for these cities, they will offer bold solutions to address these potentially devastating problems.