The overhaul at Cooper University Hospital begins in the waiting room.
As recently as last summer, this office was in rough shape. Carpet was patched with mismatched swatches; there were walls that time forgot.
"That a wall could be stained with marks of people’s heads, it appeared as if people were sitting there, shadows of them," says Sophia Kolosowsky, who has worked here since 1995. Look around now and you see modern wood furniture, bright colors, tasteful photos of long ago Camden on the walls instead of shadows.
When you strip away all the bells and whistles at the Cooper Advanced Care Center, you see a massive effort to make primary and specialty care for the poorest and sickest patients – who for years have cost hospitals money – as easy to get as just showing up at the ER, says the clinic's executive director, Kathy Stillo.
"I think we are figuring out how to redo this whole thing, how to deliver this care in a much smarter and more efficient way," she says.
Transforming the whole practice has taken a financial investment and a leap of faith. This office was designed exclusively for the hospital’s nearly 10,000 Medicaid patients – patients who often are unemployed, homeless, mentally ill and sick. Armed with a mandate from Cooper – and several million dollars from a New Jersey philanthropic group, the Nicholson Foundation – Stillo hopes to stem those losses by figuring out how to fuse patients to their healthcare providers.
"Our feeling is to make sure these aren’t just doctors and patients seeing each other in short clips," she says. "There are more comprehensive teams wrapped around those patients."
Stillo, who came from the pharmaceutical industry, was brought in to look at this as a business problem to solve. Cooper lost $3 million providing care to this population last year, and under the Affordable Care Act, Medicaid is going to grow, perhaps covering up to nearly a quarter of the population.
That’s just one reason why hospitals around the country are looking at their Medicaid patients, some for the first time in decades. At Cooper, the office has started these group visits, with up to 12 patients a doctor and other staff to learn ways to better manage their condition. If a patient ends up in the ER or hospital, someone from the office goes to the patient's bed-side to schedule a follow-up primary care visit within seven days.
The office is also reconfiguring basic functions, like how its phone calls get answered.
The other thing that's already paying off – and it doesn’t sound sexy: Reconfiguring basic office functions.
Evan Gaston, who handles that work, says that when he first arrived, he found a chaotic Grand Central-type scene phones ringing constantly. Imagine, Gaston says, patients lining up waiting to check in, others waiting to check out, workers overwhelmed.
"While at the same time have a phone balanced on their neck," he recalls. "Saying, ‘oh please can I have you hold one moment?’ They would put the phone down and it would ring again. We’re talking 700 calls a day."
The answer seemed obvious: build some kind of call center.
But even a straight-forward-sounding idea like that – what sometimes is called organizational spaghetti – took Gaston two solid months. Norma Martinez, who has worked the front desk for 11 years, says whatever it took was worth it. Patients, she says, often got angry, like the time a woman went off after she had to be rescheduled because her doctor was called away suddenly. The woman threatened workers and police came.
"That kind of thing happened maybe three times a month," Martinez says. "And now, we’ve only had maybe out of the whole time, maybe twice."
Having fewer frustrated patients is good, but it’s not the same as reducing ER visits and hospital admissions. Columbia Health Policy Professor Michael Sparer says what the new office is trying to do – getting buy-in from patients - is incredibly tough.
"Now you are asking patients to change their behavior in significant ways. And... they’ve got to trust the people who are asking them to do that," he says. "You are talking about changing the delivery system for the high cost, low-income population in the United States. And changing delivery systems is not easy to do."
Sparer says no one has yet figured out a model that can be franchised like McDonald’s, but the demand for solutions is growing. Bloomberg Industries estimates that at least $50 billion was spent last year managing Medicaid patients.
The team at Cooper hasn’t cracked a code yet, but costs have come down 10 percent after the first several months, partly because patients like 60-year-old Nick Panaro, who had a pain come out of nowhere, could get right into the clinic.
"Sometimes I didn’t get an appointment here for two weeks," Panaro says. "That has changed. It seems like they take you right in if they have to."
The way Stillo drew it up -- seeing patients quickly so they don’t have to go to the ER and tinkering with how healthcare is delivered -- so far, people are healthier and we all end up paying less money.