An unprecedented level of data sharing between Newark hospitals is giving healthcare providers a good idea about where to focus their efforts to improve residents’ health.
The data, released this week by the Greater Newark Healthcare Coalition, gives city hospitals a set “hotspots” — the addresses of residents with the greatest number of hospital visits.
This roadmap will allow community health centers and other providers to target their care close to those in greatest need, potentially treating problems before they lead to emergency room visits.
Dr. John Brennan, coalition chairman and the president and CEO of Newark Beth Israel Medical Center, said the group has successfully brought together a wide spectrum of healthcare and social-service providers to coordinate their efforts.
“The data is clear that healthcare is not being coordinated well and some of the areas that really stick out are in behavioral health and drug and alcohol abuse treatment,” said Brennan, adding that patients frequently receive treatment at different facilities.
Staff members from the organization’s counterpart in southern New Jersey, the Camden Coalition of Healthcare Providers, compiled the hotspot data. It was released at a symposium in Newark on Tuesday.
The Camden group, under the leadership of Dr. Jeffrey Brenner, has been using hotspot data for several years to target care. This includes opening a clinic on the ground floor of a high-rise where the largest number of Camden hospital patients live.
Newark healthcare leaders plan to use the data when they apply for federal and private foundation funding to improve primary care.
“One of the focuses that we’re really looking to do is what can we do to get better coordination of care out there,” Brennan said. “Many of these people are focused in geographical areas. We have a pretty strong understanding of what the medical issues are.”
Brennan said that while Newark is learning from Camden’s experience, it also has an additional challenge due to its rapidly changing healthcare landscape. These changes include the closure of St. James and Columbus hospitals in 2008, as well as anticipated changes at St. Michael’s Medical Center and the reorganization of University Hospital.
“We’re waiting to see what takes place,” Brennan said, noting that a for-profit operator may purchase St. Michael’s. “We have a lot of moving parts in Newark and the [coalition] is really trying to focus on the patient.”
Learning from the Community
That focus may be sharpened by events like the symposium, which gives hospital and city officials a chance to get feedback from community-health and primary-care providers about what their priorities are. Behavioral health is an example in which additional funding could make a difference, Brennan said.
Social workers and others who have frequent contact with residents “can do better care coordination in those areas, so that patients can get into the appropriate outpatient setting before they go to the ER,” Brennan said. “There’s a lot of simple reasons for overutilization of the ER.”
These reasons include some that are not strictly medical, such as mitigating environmental health hazards to lower the need for acute care. For example, legal action may be needed to force a landlord to patch a leaky roof in an apartment where a teenager with asthma lives, Brennan said.
“Where there’s a lot of healthcare components, social service components are really important” as well, he said.
The data was collected from three hospitals in the city (Newark Beth Israel, St. Michael’s, and University), as well as three nearby facilities (St. Barnabas, East Orange General, and Clara Maass). It found that 88,244 emergency department patients in 2011 visited the ER an average of 1.53 times. One percent of patients accounted for 29 percent of the dollar amounts charged by hospitals.
Some of the most frequent causes for emergency visits could be reduced by treatment outside of the hospital, including respiratory infections, asthma, headaches, and urinary tract infections.
A hotspot map generated with the data found many of the addresses were in the central part of the city, but others were located far from a conveniently located health center.
The Coalition’s Contribution
John V. Jacobi, a Seton Hall University health law professor, said that while it may be common sense for healthcare providers in a city to want to work together, it’s taken the coalition to make it happen.
“It’s not just Newark,” Jacobi said, adding that cities across the country have fragmented healthcare systems. “With the best of intentions they don’t connect and they’re connecting” due to the coalition.
Jacobi said the newly compiled data made concrete some of the shortfalls in the city’s healthcare delivery.
“It’s absolutely true that we’re seeing many of the same problems that people in Camden and Trenton are seeing,” he said.
Jacobi said that while the 2010 Affordable Care Act gives new tools to healthcare providers, they could be easier to implement in areas where care delivery is less fragmented. The ACA emphasized greater coordination of care through new payment delivery systems like accountable care organizations.
“When we engage in broad-based health care reform like the Affordable Care Act, it sometimes works least well in areas that need it the most,” Jacobi said. While cities may start at a disadvantage, organizing healthcare coalitions can help, he said.
Jacobi said the next step for the coalition is to talk to residents in the areas where the data revealed the greatest need.
The hotspot data is particularly helpful for community-health providers, according to Pamela Clark, president and CEO of Newark Community Health Centers Inc., the umbrella organization for the city’s federally qualified health centers.
The old model of establishing health centers in central locations and expecting patients to find a way to get to the centers is outdated, Clark said.
“We are trying to integrate the hotspot data in our planning in how we can deliver healthcare services in the community we serve,” she said. “The city is not a small area, it’s vast. The old model that FQHCs [Federally Qualified Health Centers] used to establish brick and mortar in a location and expect people to come — that has to change. Some of them may not have the means to actually get to the health centers.”
Clark said the data collection is just the start of a process.
“After we finish mapping this, we’ll see where the deficiencies are,” she said. “It’s a new way of thinking and it’s a new way for the FQHCs. I’m excited to be a part of it.”
Talking with patients will be central to making the data useful, she said. Providers shouldn’t try to “push” a healthcare model onto residents, but should instead solicit or “pull in” the patients’ perspectives on the best way to deliver care, she said.
“Things are different now in healthcare,” Clark said. “We can’t push anymore, we have to pull.”
Once this communication has been established, then the health centers can provide necessary information, Clark added.
What Primary-Care Physicians Know
Dr. Thomas Ortiz, a family physician with Forest Hill Family Health Association, said the data confirms what primary-care doctors have long recognized.
“It’s an eye-opener for some people. For me, it’s a call to action,” Ortiz said.
Ortiz noted that it would be useful to compile data annually in a consistent fashion.
With many of the problems related to substance-abuse treatment, as well as behavioral health, it’s important to increase coordination treatment of those conditions with other healthcare, Ortiz said.
“People do not have access to community-based physicians and primary-care providers,” before they reach the emergency room, Ortiz said.
The high level of hospital admissions for treatable conditions demonstrated in the data provides “a historical review of how much we’ve ignored primary care and prevention to try to keep people healthier.”
Now that there is a new focus on measuring outcomes in determining how doctors are paid, Ortiz said, Newark should focus on using data to “create an environment that attracts young primary-care practitioners.”
Ken Gross, the Camden coalition’s director of research and evaluation, said the data should prove useful to Newark.
“A lot of organizations will jump into a problem without quantifying it,” Gross said. “Every community’s hospital is sitting on data that could be very valuable.”
The project to collect data, which was funded by the Nicholson Foundation, will also help Newark collect its data on its own in the future.
The Newark data showed something that Camden has also seen — a high level of emergency department use.
“That’s where we get to use the hotspotting — getting a better sense of where the problem is, or who is experiencing the problem, and it allows us to get to the intervention a lot faster,” Gross said.