Camden health-care success
By Rebecca Alper and Mark DiFilippo
Throughout the past year's health-care reform debate, all eyes have been fixed on Washington. But examples of innovative, cost-saving health-care initiatives can be found right here in New Jersey.
The Camden Coalition of Health-Care Providers - made up of providers throughout the city - posits that a broken primary-care delivery system is responsible for the fragmented, inefficient, and often redundant care that is straining the health system and the economy.
As a result of this broken system, Camden residents use emergency rooms at twice the national rate, with all the accompanying costs. From 2002 to 2007, each of the 1,035 people in Camden's top 1 percent of health-care users visited an emergency room or hospital between 24 and 324 times. The $46 million the hospitals received for their care could fund about 50 primary-care physicians, who could help the city's patients avoid the chronic and acute conditions clogging emergency rooms.
In the same five years, 6,295 Camden residents made 48,000 visits to Camden hospitals for diabetes-related conditions, racking up more than $1.2 billion in charges.
Changing these figures will require changing how doctors and hospitals care for patients, collaborate, and share information. The Camden coalition is modernizing care by helping primary-care practices adopt electronic records systems and by creating a citywide health information exchange. Primary-care offices are adopting innovative, research-based practices such as open-access scheduling, electronic prescribing, and chronic-disease registries.
The coalition's care-management team is targeting care to Camden's most expensive and sickest patients. These patients are often homeless and suffer from chronic disease, mental illness, and substance abuse. The team provides transitional primary care to patients referred by local emergency rooms, social workers, and primary-care providers.
There have already been dramatic improvements in the patients. In the initial group studied, monthly emergency room visits were reduced by 32 percent, hospital admissions by 56 percent, and overall hospital charges by 56 percent.
Fortunately, the federal health-care reform legislation contains numerous pilot projects that will help other communities experiment with approaches similar to those being used in Camden. Some of these programs would pay providers based on successful treatment, not just the volume of care delivered. The result will be fewer emergency room visits and hospital admissions, as well as lowered costs for all of us.
To reduce care costs and improve quality across the country, we need to change the incentives of our health-care system. Doctors and hospitals are being paid to provide services - run tests, perform procedures, and prescribe drugs - rather than improve health.
Both the House and Senate bills also take aim at preventable hospital readmissions by limiting Medicare payments when patients are readmitted for a condition that a hospital could have prevented. Such efforts will help ensure that patients are effectively treated and educated before discharge.
The Camden Coalition of Health-Care Providers has created a successful health-care model for one New Jersey community. But, in our current system, it is impossible to implement on a large scale. We urge our representatives to pass health-care reform and allow the flowering of experimentation to improve the system.
Rebecca Alper is program associate for the New Jersey Public Interest Research Group. Mark DiFilippo is project manager for the Camden Citywide Diabetes Collaborative.
