The ROI of the Camden Coalition's Care Model

There is a growing acknowledgement that the US healthcare system fails people with complex health and social needs. The evidence lies in the fact that these individuals regularly cycle through a variety of healthcare, social service, and other support systems, without gaining long-term improvements to their health or well-being. These factors cause this population to experience higher rates of emergency department use and hospitalization, and worsening chronic diseases and co-morbidities.

Since 2007, the Camden Coalition has worked tirelessly to reduce preventable hospital readmissions for some of the city’s most vulnerable residents. According to the Coalition's founder, Dr. Jeffrey Brenner, "the full dataset told an unbelievable story of wasteful, disorganized services. Somehow good doctors were going to work every day at good hospitals and delivering a very disorganized set of services."

At the time, nearly half of the city's approximately 77,000 residents were visiting an emergency department or hospital annually — most often for head colds, viral infections, ear infections, and sore throats. Thirteen percent of the patients accounted for 80 percent of hospital costs; 20 percent of the patients accounted for 90 percent of the costs. In a study conducted during the first performance period with 3716 Camden residents, costs were highly concentrated: 0.9% of patients accounted for more than 32% of spending. As Dr. Brenner recounts: "My patients were in those data. They weren't getting their needs met." 

^{Source: Camden's article in Population Health Management Journal (Liebert)}

Camden ROI Data

Results of the Camden Core Model are significant. While Dr. Brenner's main purpose was to improve care, there is evidence that his model also reduces costs. The first 36 patients in his study averaged a total of 37 hospital and emergency room visits per month after the Coalition's intervention, compared to 62 visits per month before. 

^{Source: Camden Coalition Presentation to the National Academies}

In addition, their hospital bill total fell from a monthly average of $1.2 million to just over $500,000 — cost savings which benefit the state and federal governments in reduced Medicaid spending, and which reduce the local hospitals' charity care costs. 

The Camden Coalition is now also a Medicaid Accountable Care Organization (ACO) contracted with the state of New Jersey, in a model that is similar to the Medicare Shared Savings ACO model. Recent shared savings estimates ranged from an Annual Savings Rate of 0.4% to 5.3%, depending on two key factors:

• at which dollar amount to create the outlier ceiling (a limit at which patients with expensive utilization patterns exist),
• how to choose the appropriate statewide trend factor (or, the allowable spending factor).

^{Source: Camden's article in Population Health Management Journal (Liebert)}

Since the Coalition received an upfront shared savings payment from their Managed Care Organization (MCO) partners that was comparable with these estimates, even in the most favorable scenario, no additional savings payment came as a result of the evaluation.

How Camden's Model Works

The Camden Coalition works to reduce the number of super-utilizers that face healthcare disparities. Their main intervention is a person-centered approach to care delivery that addresses the needs of people whose combinations of medical, behavioral health, and social challenges result in extreme patterns of healthcare utilization and cost. By employing the COACH Model, the Coalition can guide patients toward sustained behavior change & track progress on their goals.

COACH stands for:

• C - connect tasks with vision and priorities
• O - observe the normal routine
• A - assume a coaching style
• C - create a backwards plan
• H - highlight progress with data 

The Camden Core Model incorporates these principles as they engage with patients around 16 different domains, many of which are primarily concerned with what happens in our daily lives outside the four walls of the hospital or doctor's office. The Coalition promotes a vision of complex care which seeks to be: 

• Person-centered: Care delivery is designed around the whole person, their needs, and their convenience.
• Equitable: Complex care addresses the consequences of systemic issues such as poverty and racism, and ensures consumers have a strong voice in developing solutions.
• Cross-sector: Complex care works at the system level to break down divisions between fields, sectors, and specialties.
• Team-based: Complex care is delivered through interprofessional, non-traditional, and inclusive teams.
• Data-driven: Timely, cross-sector data are freely shared across all care team members.