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Report from Rutgers Center for State Health Policy Reinforces Importance of Trenton Health Team’s Work

TRENTON, N.J. — The fruits of the analysis described today by Rutgers Center for State Health Policy provide potentially valuable snapshots of Trenton`s healthcare system prior to Trenton Health Team`s (THT) launch of five strategic initiatives to improve the health of the city. THT is a health improvement collaborative made up of the city`s hospitals, its federally qualified health center and the city`s health department.

In addition to highlighting opportunities for better care and lower costs, the Rutgers analysis of uniform billing data from 2008-2010 further illuminates the dire circumstances in Trenton-the same circumstances that drove Trenton Health Team`s planning process.

“The Trenton Health Team has been aware of the socioeconomic and health disparities for a number of years. The four partners of the THT, Capital Health, St. Francis Medical Center, Henry J. Austin Health Center and the city`s Department of Health & Human Services, have been working collaboratively to address those difficult issues,” said Dr. Ruth Perry, executive director of the THT.

THT is now using a Medicaid ACO approach that is improving the numbers described today. Since 2011, THT has launched five strategic initiatives to improve health care delivery in Trenton and the health of the city`s residents. The initiatives will help THT achieve the “Triple Aim” of healthcare outcomes: improved patient experience, improved health of the Trenton`s population and lower costs, Dr. Perry said. Those initiatives are:

  1. Laying the groundwork to become a Medicaid Accountable Care Organization (ACO), identified in today`s report as an opportunity to provide “better population health and containment of health care costs.” As one of New Jersey`s lowest performing regions across the report`s utilization measures from 2008-2010, Trenton is arguably a setting for some of the most important Medicaid ACO work in the state.
  2. Expansion of access to primary care by drastically reducing wait times at the city`s health centers and providing new patient-centered, personalized approaches to care. Expanded access to care directly addresses two of the measures described in the report-avoidable inpatient stays at hospitals, and avoidable Emergency Department visits.
  3. Coordination of community-wide clinical care for those seeking primary care in the emergency room by targeting high utilizers of hospital services, potentially addressing all five measures in the report.
  4. Sharing information among health care providers across settings to improve care coordination, avoid duplication of services and reduce medical errors.
  5. Engagement of residents in a concerted effort to understand and overcome obstacles to quality health care. Improving collaboration and coordination across health care settings is only one side of the equation. We are also empowering patients to become partners in their own care.

“The Trenton community is faced with incredible barriers to improved healthcare based on recent Claritas data and the THT unified Community Health Needs Assessment,” Dr. Perry noted. Despite the potential savings identified by the Rutgers report, research has demonstrated that in communities with significant socioeconomic and health disparities, it can take 18 to 41 years for health outcomes to reach an improved baseline state.

“An improved Triple Aim for the city of Trenton will not occur until collaborative work is undertaken by all community stakeholders to alleviate lack of economic opportunity, education, housing, because all of these factors are intimately tied to improved health and quality of life,” she said.

She pointed to preliminary results of the strategic initiatives as follows:

  • The Trenton Health Team`s care coordination efforts helped reduce 30-day hospital readmissions in Mercer County by 6.8% between 2011 and mid-2012.
  • THT`s efforts have reduced patient wait times across the board, most notably at Henry J. Austin, from 37 days to 2.
  • St. Francis Medical Center has improved patient provider continuity from 0% to more than 95%, building trust and reinforcing use of primary care services for non-emergent care.
  • A Capital Health pilot program to bring sickle cell patients from the emergency room into a dedicated primary care practice has reduced emergency room visits by 33% in an initial group of five patients.

About the Trenton Health Team
Trenton Health Team (THT) is an alliance of the city’s major providers of healthcare services including Capital Health, St. Francis Medical Center, Henry J. Austin Health Center and the city’s Health Department. In collaboration with residents and the city’s active social services network, THT is developing an integrated healthcare delivery system to transform the city’s fragmented primary care system and restore health to the city. THT aims to make Trenton the healthiest city in the state. The THT receives generous support from The Nicholson Foundation, corporate partners and other foundations. For more information, visit