Camden-area patients struggling to avoid heart attack or stroke could benefit from a new suite of services that will be designed to help address the underlying factors associated with cardiovascular disease, thanks to an effort associated with Cooper University Hospital.
The Bristol-Myers Squibb Foundation provided nearly $1 million to enable Cooper’s Urban Health Institute to develop a program to recruit the most vulnerable and challenging cardiovascular patients, provide them with specialized care and additional clinical and social supports, and identify the elements that could also be effective with other conditions or with patients in cities elsewhere. If done right, the process could also reduce healthcare costs over time.
The program is particularly focused on addressing the disparities that exist with cardiovascular health and its risk factors, including high blood pressure, depression, and stress. But it seeks to go beyond a clinical review to assess both underlying causes and barriers to success like transportation challenges, limited health literacy, and food insecurity — factors now considered “social determinants of health.”
“We know we need to address these social determinants of health early and often in a way we are not doing,” said Dr. Steven Kaufman, an endocrinologist who is medical director at the Urban Health Institute. “All these things get bundled in and can lead to worse clinical outcomes.”
Leading cause of death in NJ
Heart disease is the leading cause of death among men and women in New Jersey — killing more than 18,600 people in 2015, according to state statistics — but individuals who are poor, urban, and non-white tend to suffer at higher rates. Experts have found the differences result from immediate concerns, like limited access to healthy foods or safe exercise space, but also community violence, economic insecurity and other stress, and childhood traumas.
Even cardiovascular risk factors, like high blood pressure, impact urban residents and minorities at higher rates; while 31.7 percent of white residents suffered from hypertension, the rate was 40.7 percent among urban dwellers, 41.7 percent among black residents, and 42 percent among those earning less than $25,000, according to a 2015 report from America’s Health Rankings.
Nearly 40 percent of Camden’s residents live in poverty, with a median household income of just over $25,000, and less than 5 percent are white, according to Data USA.
“When we talk about social determinants of health, it is something very real,” explained Susan Bass Levin, president and CEO of the Cooper Foundation, the health system’s philanthropic arm, which accepted the grant on behalf of the urban institute. The foundation supports the work of Cooper University Health Care which operates the hospital and more than 100 outpatient offices and facilities in South Jersey— by working to expand affordable housing, education opportunities, park space and more.
Part of a pattern
The cardiovascular project joins a growing number of efforts, many funded through philanthropy, designed to help healthcare providers become more effective in addressing chronic conditions and diseases. Virtua, another South Jersey network, has partnered with community groups in Camden to improve access to healthy food; RWJ/Barnabas Health has created urban gardens and a greenhouse in Newark; and the Trenton Health Team is looking to improve diabetes outcomes with assistance from a number of community partners.
Camden, one of the nation’s poorest communities, has become a hub for healthcare innovation in recent years, thanks in part to the work of Dr. Jeffrey Brenner, who founded the Camden Coalition of Healthcare Providers — and preceded Kaufman at the urban institute — before moving on to UnitedHealthcare last year. Brenner’s focus was on providing effective, sustainable care for some of the most vulnerable patients, work that involved detailed data analysis to zero in on high-risk patients who were frequent users of medical services, often with poor outcomes.
Cooper’s urban institute, founded in 2013, has pursued similar goals, expanding access to primary care and 22 specialty practices in an effort to help low-income Camden-area residents facing a range of health challenges. The approach involves the use of nurses to provide additional care, in addition to physician visits, shared or group medical appointments for patients with similar conditions, and health coaches who can help patients manage their disease, address risk factors and connect with social services.
The dollars from the Bristol-Meyers Squibb Foundation, which funds projects around the world and seeks to reduce barriers to care in the U.S., enabled the institute to expand its reach further by partnering with cardiovascular specialists, who happen to be located one flight up from the institute at Cooper’s headquarters in Camden.
‘…biggest bang for the buck’
The three-year, $982,000 grant allows the institute to recruit around 500 patients, build the program — with extra nursing support, shared appointments, health coaches, and other elements that have proved successful with other conditions — and analyze its impact, Kaufman said. The grant pays for health coaches, staff coordination, and administrative costs; Medicaid or Medicare will be billed for patients’ clinical treatments.
While the goal is to improve care and general health for those involved, the project also aims to develop a sustainable model that could be applied elsewhere, or work with other diseases and conditions. The keys to success may not be specific to cardiovascular care, Kaufman said, and as an endocrinologist — focused on glands and secretions that impact multiple organs — he is eager to break down the barriers between various diseases.
“We want to develop something that is definitely not unique to Camden,” Kaufman added, stressing that the model could also be useful for rural health systems. “We’re going to try and figure out what is the biggest bang for the buck.”