Diagnosis: Data

Creating a healthier Camden

Dan Gorenstein Aug 1, 2013
Diagnosis: Data

Creating a healthier Camden

Dan Gorenstein Aug 1, 2013

There was a time when Camden really was on the map. The Camden County Historical Society’s Sandy Levins says you could see the city’s promise along the waterfront. The New York Shipbuilding Corporation at its peak during World War II, was the most productive shipyard in world, employing 40,000. You could hear, “the thud of the metal being laid into place, the rivets being driven in,” she says.

Campbell’s Soup was here, too. And it was such a part of Camden that at one point, the city adopted “soup” as its middle name.

Then there was the RCA-Victor empire — 31 factories manufacturing everything from phonographs, like the Victrola, to radios to records. RCA introduced the 33 1/3  RPM record to the public. Its artists included Enrico Caruso, Josephine Baker, Count Basie and Bing Crosby.

The city’s waterfront drove its economy. At its height, Camden was an economic powerhouse employing 80,000 industrial workers in a city of 120,000.

“I just think of what a proud history this city of Camden had,” says Levins.

Standing in front of one of the few remaining RCA buildings, you can’t hear that Camden anymore. What you see today is a city overrun. Camden is the poorest city in America, and the most violent.

“You are scared to bring anything from the stores, thinking someone is looking at you, taking boxes in your house,” says 35-year-old Brenda Lopez, a city native. “Back in the day, my parents used to leave their windows and doors open in Camden. And you would feel safe to just lay your head down for a couple minute nap. Now you can’t do that.”

Today, Lopez says there’s a lot of desperation. People have stolen aluminum bleachers from city parks a bulldozer from a construction site.

“In order for me to go to Disney this year, I had to leave my parents babysitting my house, because if not, I’ll come back to nothing. Holes in your walls. Graffiti. Your pipes, your basement is flooded, because they are after your copper piping. This is the real life of Camden,” says Lopez.

A life where there isn’t enough work — unemployment is more than double the national average — drugs are sold in the open, schools are failing, and the last grocery store in a city of nearly 80,000 is pulling up stakes.

That life takes a toll that Lopez sees everyday when she shows up for work at one of Cooper University Hospital’s outpatient clinics.  A waiting room of people, too worn down to take care of themselves. Patients who tell her,  “I should have come for my weekly blood work, but I haven’t come in three months because I forgot,” says Lopez. “You get these patients that have cancer. They didn’t even know.”

Like lots of things in the city — health care doesn’t work like it should. “We have a lot of people who come to the (emergency room), there is no medical complaint, no medical emergency. We just frankly ask, is it really chest pain, or do you need a turkey sandwich,” says Cooper emergency room doctor Maya Yiadom.

Recently she treated a man who was kicked out of his girlfriend’s apartment and spent several days walking around the city in nine pairs of socks. “At the end of the day, the intervention he needed was a pair of shoes,” says Yiadom.

The most common emergency in a Camden ER, colds and ear aches. Translation: not enough primary care.

Things may be desperate in Camden, but Dr. Jeff Brenner — the medical director of Cooper’s Urban Health Institute and regarded as a health reform pioneer — says it’s true across the country.

“Lots of people in America have a hard time getting access to care. Lots of middle class people call for appointments and can’t get in to be seen,” says Brenner.

He says it’s expensive enough to treat someone in the ER who just needs a Tylenol, but the real cost of poor primary care comes from health care’s failure to manage the chronically sick. “I could stick someone in a limo, drive them around the city, hire a personal doctor, bring their pills to them every day for less than what we are spending right now on a hospitalization,” he says.

In Camden, just 8 percent of patients make up nearly 40 percent of the costs. The city’s three hospitals have been awarded nearly $3 million in federal grants to help improve primary care for the sickest and most expensive patients. Brenner says the partnership among competing hospitals is just one sign that the Affordable Care Act is changing the business of health care.

“I think what it’s done is sent a really strong market signal out. And that people have to change what they are doing,” he says. A signal that the way hospitals and doctors get paid, doesn’t work. Now, they make money by testing, cutting, zapping and hospitalizing, and the more they do, the more they make. But under the ACA, doctors and hospitals will be rewarded for holding costs down and punished for patients who are readmitted over and over again. And most of those patients are the chronically ill.

Cooper Healthcare’s senior vice president of operations and ER doctor Anthony Mazzarelli says hospital’s can’t afford to keep this up.  “Patients who are under-payers, the under-insured, taking care of those patients doesn’t help us make money. And potentially takes up space of patients who would pay more would be,” says Mazzarelli.

But how do you do it? Mazzarelli says there’s no clear path. “What are the actual tactics you actually use to do it. Those are the experiments. There is no silver bullet. I would love to tell you the answer is ‘x,’” he says.

So would every other hospital executive in America.

There’s a lot of money to be made figuring how to manage this huge population of poor sick people. The CDC says three-quarters of all health care dollars are spent on chronically ill.

But for all its struggles — this is where Camden actually may be ahead of the curve. Dr. Jeff Brenner says for several years, the city’s three hospitals have shared patient data that lets them target this population.

“We know when a patient lands in the hospital and we can respond and got right up to the bedside, follow them out of the hospital, go with them to their primary care office, go with them to their specialty office,” says Brenner.

Unlocking this health care puzzle could mean a lot in this city. Some of its sickest residents get better care, and some of the city’s largest employers — the hospitals — get stronger…generating jobs and tax base for a place that needs both.

“I’m a total optimist…I want to be the most innovative, interesting health care system in the world. I want people to come to Camden and say, ‘how did you do that?’”

A few weeks back, Brenner drove me around Camden, stopping at the waterfront — the factories and shipyard long gone. And he pointed to one of the remaining buildings of the RCA-Victor kingdom; it’s been converted into luxury lofts.

Lofts that are homes to medical students.

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