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Trenton Health Team actively engages, empowers residents to improve their health, dramatically reduces wait times to see a doctor

1st Community Report outlines progress to provide effective services while containing costs

Trenton, NJ)– The Trenton Health Team today issued its first report to the community outlining progress in its efforts to improve the health of the city’s most vulnerable residents. The THT is a collaboration of all the city’s major healthcare providers. It has forged partnerships to create new educational pathways and engaged city residents in creative ways over the past 18 months. Its goal is to expand access to high-quality, coordinated care and make Trenton the healthiest city in the state.

“The Trenton Health Team has been working since 2006 to address Trenton’s fragmented primary care system, underutilization of clinics, and higher rates of illness compared with other areas across the state,” said Dr. Ruth Perry, executive director of the Trenton Health Team. “We are taking very deliberate, concrete steps to overhaul a system that has failed Trenton’s vulnerable population while costing hundreds of millions of dollars each year.”

“We are especially encouraged with our progress,” said Christy Stephenson, president of the Trenton Health Team over the past year and executive vice president at St. Francis Medical Center. “We’re connecting with residents and community partners at a much deeper level. We are working to solve healthcare problems and help our residents improve their health.”

The THT’s lead partners are of all the city’s major healthcare providers including Capital Health, Henry J. Austin Health Center, St. Francis, and the City of Trenton Division of Health and Human Services.

In a 24-page document posted on its website,, the THT reports on five strategic initiatives for carrying out programs to transform healthcare.

“The Trenton Health Team’s data-driven approach to improving care while reducing costs is consciously being designed for replication throughout the city and beyond,” said Dr. Robert Remstein, incoming president of the THT and vice president of medical affairs at Capital Health. The Trenton Health Team’s efforts have led to significant progress in increasing access to care, he said.

The first Trenton Health Team initiative is to expand access to primary care. In the past, patients have had to wait up to a month or more to see a doctor, and as a result, they often turned to the city’s emergency rooms for hospital care, costing taxpayers millions each year. By developing a model of care that analyzes data, the THT determined the optimal number of patients each physician in the city can handle while still having time for patients who needed same-day visits. As a result, Henry J. Austin reduced wait times from 37 days to 2 days.

A second initiative has been to coordinate clinical care community wide. Robert Remstein, vice president of Medical Affairs at Capital Health, D.O., M.B.A, leads this effort, which brings together the case managers and the clinical staff from the hospitals, Henry J. Austin, and some 40 community partners to coordinate care for these individuals. Working together, partners in this initiative have identified the highest utilizers of emergency care and, the collaborative teams have improved provisions of healthcare and social services for those patients.

The third initiative is the engagement of residents. Over the past several months, the residents at Kingsbury Towers have gained knowledge about diabetes, learning not only how to use a glucose monitor to measure glucose levels but also why. Members of the core group recently began attending train-the-trainer sessions run by nurse practitioner Peg Nucero of St. Francis Medical Center and others so they can begin helping themselves and neighbors to learn about health.

Exchanging information is the fourth strategic initiative of the THT. Pulling together data from various healthcare agencies and making it accessible to all is a critical goal in the effort to provide appropriate, cost effective care, Dr. Perry said. The Trenton Health Team is building a shared, computerized database of patient records. The information hub is expected to result in improved care of the chronically ill while controlling costs by avoiding costly duplication of services.

The final strategic initiative of THT is to become a Medicaid ACO. An ACO is a government-approved organization that aims to change funding so that care providers treat people, not ailments. “This allows for urban health care programs to cut costs by implementing innovative health models which increase care coordination, improve access to primary care, and utilize data to monitor the achievement of the Triple Aim of better health in the city’s population,” said Dr. Perry.

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