New Brunswick Area Hotspotting Report Highlights Opportunities for Improving Patient Care
Study by Robert Wood Johnson Medical School could lead to better coordination among all health care providers
A study by Rutgers Robert Wood Johnson Medical School found that Medicaid patients who most frequently visit New Brunswick hospitals are concentrated in nearby “hotspots,” a critical first step to determine how to improve care and lower costs for some of the area’s neediest residents.
From a total number of 45,316 patients who visited Robert Wood Johnson University Hospital and Saint Peter’s University Hospital from New Brunswick and Franklin Township – the areas targeted in the study – researchers identified 1,370 who visited the emergency rooms five or more times in a two-year period, or had three or more hospital stays. Hospital bills for those patients totaled more than $14 million – about one-fifth of the $44.2 million in Medicaid costs for hospital visits in the area. Individual patients in the eight hotspots had hospital bills as high as about $38,000 over the two years, with an average bill of about $17,000, according to the study.
These patients, referred to as “high utilizers’’ of the Medicaid system, many of whom are concentrated in 10 percent of the census blocks and eight buildings and apartments complexes in New Brunswick and neighboring Franklin Township, which are designated “hotspots.”
“By using emergency departments and winding up in the hospital these are a very expensive group of folks to care for, and this study opens up the possibility that maybe we should do something differently,’’ said Alfred Tallia, chair of the Department of Family Medicine and Community Health at Rutgers Robert Wood Johnson Medical School.
Patients identified as “high utilizers” often do not have access to adequate primary care that would help avoid expensive hospital visits, or have challenges managing chronic health conditions. The goal of studies that identify hotspots of people who require the most medical services is to develop targeted programs to keep them healthy and out of the hospital.
“We need to try something different because clearly this is not the best use of resources to meet the needs of these patients,’’ Tallia said. “Maybe we need to bring services to them or modify existing services. This could potentially save millions of dollars in health care costs in our community alone over the long term.’’
The study, funded by The Nicholson Foundation, followed a groundbreaking model developed by the Camden Coalition of Healthcare Providers, which was a partner in the study. Others on the team that oversaw the work included Tallia, Maria Pellerano, assistant professor of family medicine and community health, Eric Jahn, senior associate dean for community health, and researchers from Robert Wood Johnson University Hospital and Saint Peter’s University Hospital.
The Camden Coalition conducted an analysis of the billing data of patients from New Brunswick and Franklin Township who visited both area hospitals in 2012 and 2013.
The findings from the Camden Coalition provided insight into the profile of patients who visited both hospitals the most. Many patients were dealing with a combination of challenges including mental health, substance abuse and multiple chronic conditions. Researchers also discovered that about half of high utilizers were visiting both Saint Peter’s and Robert Wood Johnson, an added challenge because the hospitals have historically not shared information to coordinate care.
“If a patient comes to Robert Wood Johnson and has previously been to Saint Peter’s, there is no record in the system so the doctor doesn’t know what medications were given or what test the patient went through,’’ Pellerano said. “This points to the need to coordinate across numerous systems.’’
Researchers say the study also called attention to the need to provide better access to mental health services, including investigating ways to combine access to both behavioral health and primary care in the same location.
“I think the reason people use the emergency department as they do is complex, and there is not one button to push to fix this,’’ Jahn said. “We need to reflect on what resources are here and how we are going to work to address the issues.’’
Tallia added, “This hotspotting report is just the first step in figuring out how to better work together to structure services for this population in need of quality health care.’’
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