Tag Archives: Active Choice

Curing Camden: Book Review

Curing Camden is a quick read on how different groups collaborated to change the healthcare cost curve in Camden, NJ.  Here’s the official language from the Amazon site, but after reading it, I thought I’d highlight a few things that caught my attention.

As the federal health reform debate played out in the national media spotlight, author Christina Hernandez Sherwood was reporting on the American medical system from the street level. From 2010 to 2012, she wrote a half-dozen stories for thePhiladelphia Inquirer that focused on an innovative healthcare nonprofit: the Camden Coalition of Healthcare Providers. These stories centered on the nonprofit’s role in combating falls, violence, diabetes, and other issues in Camden, New Jersey, a city known nationally as one of the country’s poorest and most violent, but that is now making a name for itself as an innovation leader in the public health sector.

In Curing Camden, all of Sherwood’s articles have been collected into a single book, including the unpublished final installment profiling the nonprofit’s founder. This book takes readers from the living rooms of Camden residents to the halls of the New Jersey State House in Trenton and beyond. Sherwood highlights how Camden could be the first US city to bend the cost curve by lowering healthcare costs while improving care. The ideas revealed in this book could be translated into practice across the country, and Camden could become a national model of 21st century medicine and public health.

The book goes through several core chapters.  The first one is on creating a citywide health record by working with the 3 primary health systems in the city.  The core part of the success here is that they used the framework of opt-out not opt-in which would drive more participation at the consumer level.  This behavioral economics framework called “active choice” has been used by several companies that I’ve worked with in the healthcare space to shift behavior patterns.  This obviously has the opportunity to reduce duplicate testing and improve care coordination.

The second chapter is about create an ACO for Camden with a 3-year Medicare demonstration project.  It’s an interesting discussion about how Dr. Jeffrey Brenner began using data to learn things about the Camden population.  For example he found out that most of the population will vista a hospital at least once in a 2-year period (which is 2x the national rate).  He also found that most of the top reasons for going to the emergency room were all primary care issues.  He makes a great point in the book that while people think that complicated patients simply like going to emergency rooms the reality is that they don’t have better choices.

The third chapter was about protecting against the risk of falling.  From 2002-2009, Camden residents made more than 17,000 trips to the hospital (the number one cause of hospital visits in Camden).  This isn’t a localized issue either.  Falls affect 1 in 3 seniors every year and drive $19B in costs according to the CDC.  In the book, they make an interesting point about the “vicious cycle” of falling which leads to less activity which leads to weaker patients increasing the likelihood of another fall.

The fourth and fifth chapters are about diabetes.  In Camden, almost 13% of adults have diabetes.  These patients can be high utilizers which is something they talk about along with their focus on the 13% of patients that drive more than 80% of the costs in Camden with one patient having over $5M in charges over 5 years.  Of course, people in dangerous communities are at higher risk of obesity due to lack of access to food and safe places to exercise which contributes to the diabetes issues.

The sixth chapter is about violence and helping victims.  Camden’s 77,000 residents experience more than 13 aggravated assaults per 1,000 residents (which is 5x the national rate).  This lead to 9,361 trips to the hospital from 2002-2009.

It’s an interesting read.  They had a lot of grant money, but at the end of the day, it was about several things:

  • Coordination and collaboration across the different systems
  • Localized care – being in the apartment building with a clinic or going into people’s homes
  • Using data to target the areas where they could make a difference
  • Caring to make a change
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