A Coalition Approachto Data:

If people are at the heart,then data is the blood,restless questions are the beat,and if it stops, the work is dead.

Data?1. How we think about it2. The 2 roles it serves:

Convening & Insight3. From claims data…4. …to segmentation…5. …to integration

Data?1. How we think about it2. The 2 roles it serves:

Convening & Insight3. From billing data…4. …to segmentation…5. …to integration

5

A core value of the Coalition is to be data-drivenA core value of the Coalition is to be data-driven

The mission of the Coalitionis to improve the health of all Camden residents

by increasing the capacity, quality, and accessibility

of the city’s healthcare delivery system.

The mission of the Coalitionis to improve the health of all Camden residents

by increasing the capacity, quality, and accessibility

of the city’s healthcare delivery system.

Where’s the data in the mission?

Data?1. How we think about it2. The 2 roles it serves:

Convening & Insight3. From billing data…4. …to segmentation…5. …to integration

Camden City Hospital All-Payer Claims• 2002 – 2011 with Lourdes, Cooper, Virtua data

• 500,000+ records with 98,000 patients• 50 % population use ER/hospital in one year

of residents use the

hospital in one year

/ 12

Spatial Analysis of Camden Hospital

Costs

Several buildings(e.g.) annually generate $1-$3 million in hospital costs.

6% of city blocks account for 18% of patients and 37% of receipts.

January 2002 – June 2008

Identifying, locating, and treating the sickest, most expensive patients

Hotspotting:

top diagnosesRespiratory AbnormalityChest PainAbdominal PainSepticemiaAcute Renal FailureUrinary Tract InfectionPneumoniaChronic Systolic Heart Failure

≈1% of population >5 chronic conditions

averages: 57 years old4.5 ED visits

5.3 inpatient hospitalized 54 days____

$673,000 charges$73,143 receipts

Who uses Camden’s

hospitals most?

Switzerland

Providers

Social Services

Government

Residents /Community

Data?1. How we think about it2. The 2 roles it serves:

Convening & Insight3. From claims data…4. …to segmentation…5. …to integration

continuousstandardized

high-stakes

temporaldiagnostic

financial spatial

≈ behavioral

oper

ation

al

ClaimsClaims

Data?1. How we think about it2. The 2 roles it serves:

Convening & Insight3. From billing data…4. …to segmentation…5. …to integration

a data driven process for the timely identification of extreme patterns in a defined region of the healthcare systemused to guide targeted intervention and follow up to better address patient needs, reshape ineffective utilization, and reduce cost.…Segmentation!

Hotspotting:

Healthcare Does Segment

Inte

rven

tion

Para

digm

s

Trad

ition

al M

edica

l Diabetes Heart Failure COPD ESRD

Complex People… in complex systems

Hots

potti

ng

Hierarchical Clustering Explained

1

most diversity within groups

clustersmost diversity between groups

23456“12”

High Cost

High Utilization

4-clustersolution withper-patient averages

1 ED0 INP<$10k0 chronicage 40

4 ED0 INP

$33k 1 chronic

age 40

4 ED3 INP

$400k3 chronic

age 55

13 ED1 INP$58k

1 chronicage 40

Data?1. How we think about it2. The 2 roles it serves:

Convening & Insight3. From billing data…4. …to segmentation…5. …to integration

Education & Employment

Official ID & Vital Records

Food & Nutrition

Reproductive Health

$

MentalHealth

Medication & Medical

SuppliesProvider

Relationships

Health Maintenance

Substance Use Disorder

Other

Benefits & Entitlements

Shelter

Legal

Transport

Advocacy & Activism

Family, Personal & Peer Relationships

Health Data

IntegratedDataWarehouse the observed world

ClaimsClaims

Health Data

Claims

Other Data

?

Health PlanIntegratedDataWarehouse

EMR

Social Service Data

Housing School

Justice Child Services

Public Data

Property

Census

the observed world

Existing Data Sharing:1) hospital claims from 5 regional health systems

2) Camden County Police Department (arrest, call-for-service, & overdose)

3) Camden City School District (enrollment, truancy, absenteeism, & suspension data)

4) Camden County Jail data, NJ State Prison

5) Property Data (citywide vacancy survey)

In Discussion:6) Homelessness Management Information Systems7) Mortality Data

ARISE so far:(Administrative Records Integrated for Service Excellence)

Why? Qualitative Evaluation at the Coalition• Describe complex phenomena• Beyond “Is there an effect?” How? Why? • Give more recognition to the patient and staff experience• Helps us understand what the work means to participants• Challenges the preconceptions of our metrics

Does Integrated Data Matter?

An example using administrative data from both policing and health.

70%

no police in-volvement

44%

policeinvolvement

Does Integrated Data Matter? Yes!Care Management Patient Graduation rate!

18,755 people with police encounters

93,344 people with

hospital claims12,541

peopleoverlap

5 years, ever having a Camden address

226 people with “dual sector high utilization”

12,541 dual system patients

16+ emergency department visits

12,541 dual system patients

arrests

7+ police encounters

226 people with dual sector high utilization

226 people with dual sector high utilization

Thank You!