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New Jersey: Voices From the Field – Aaron Truchil

Camden, New Jersey has been recognized for decades as one of the most troubled cities in America in terms of socio-economic challenges, crime and urban blight. So it was with great interest that participants at a January 26-27th AcademyHealth event in Austin, TX, “Striving Toward a Culture of Health: How Does Care and Costs for Non-Medical Needs Get Factored into Alternative Payment Models?”, listened to Aaron Truchil of the Camden Coalition of Healthcare Providers share lessons – and triumphs – from the Camden ARISE (Administrative Records Integrated for Service Excellence) project. Now in its second year, the project, which aims to improve community wellbeing and reduce unnecessary spending through reduced hospital utilization and criminal justice involvement, is being heralded as a gleaming Bright Spot.

A little background: Camden is only 9 square miles geographically and is home to approximately 80,000 residents. In 2014, total revenue at city hospitals was a whopping $132 million. Records show that about half of that population – 42,708 patients – visited hospitals that year. A troubling percentage. What was even more striking is that 23% of those patients visited two or more hospitals that year, and 41% visited two or more hospitals in the past five years.

Stakeholders across the healthcare spectrum agreed this was a crisis that needed to be addressed … collectively. Thus the Camden Coalition of Healthcare Provider’s Camden ARISE project was born.

Analysts started out by studying hospital billing data from three local hospitals. They found high spending was concentrated in a small subset of the population and often the result of frequent, preventable hospitalizations that delivered inefficient, ineffective care for these highly vulnerable patients.

The Coalition’s Director of Strategy and Analytics, Aaron Truchil, described how they then overlaid information on those patients regarding 16 social determinants of health including housing/homelessness, behavioral health, interactions with the criminal justice system, child services, school absenteeism and graduation rates.

“We started using that data to figure out what the root causes were for why these individuals keep coming in and out of the hospital,” says Truchil. “We then built a system of bringing in as much of the data as possible in a real-time manner to be able to identify and start to engage them.”

Truchil and his team employed an approach termed “hotspotting”, which he defines as “the strategic use of data to target evidence-based services to complex patients with high utilization”. These patients are experiencing a mismatch between their needs and the services available. What analysts found was that on average, the high-cost, high utilizers were 57 years old and spent an average of 54 days a year in the hospital at a cost of $75,000.

Working in conjunction with providers, hospital staff, social workers and a variety of social and community service organizations, including the Camden County Police Department, the Coalition formulated a care coordination and navigation system to pilot.

“We built this community-based model comprised of cross-disciplinary teams that engage the person at bedside or somewhere else and start building a relationship over three or four months,” explains Truchil. “It includes going out into the home as well as helping them to navigate available social services – a whole variety of services. It starts at the hospital and expands outward.”

Over the first twelve months of the project, emergency department admissions have been significantly reduced as has mortality, utilization of benefits and criminal justice involvement. The Coalition’s program is close to completing a randomized controlled trial in collaboration with Massachusetts Institute of Technology’s Abdul Latif Jameel Poverty Action Lab (MIT J-PAL) to rigorously evaluate the program’s effect on improved wellbeing and reduced hospital utilization.

“Our organization really has been about uplifting the Camden Community as much as possible. These care teams are really predicated on an authentic healing relationship, and how we ultimately engage the community,” says Truchil.

To learn more about the Camden Coalition and their work, visit their website: https://www.camdenhealth.org/