National center of excellence set to improve outcomes for high-need patients

Center to be a 'professional home' for those trying to improve care for at-risk populations
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A national center to improve care for high-need patients who experience poor outcomes despite extensive and expensive treatment is being established in Camden, New Jersey.

AARP, the Atlantic Philanthropies and the Robert Wood Johnson Foundation are anteing up $8.7 million in funding, according to an announcement from the Camden Coalition of Healthcare Providers, which is establishing the center. The facility will include a scholar-in-residence to enhance an evidentiary database.

The Camden Coalition's approach includes addressing social determinants of health including housing, transportation, hunger and addiction, as well as mental health and emotional and educational support. It has worked to identify complex patients and use "coordinated, data-driven and patient-centered approaches" to improve their care, according to the announcement.

"By developing a professional home for those who are involved in this rapidly growing field, we hope to bring disparate efforts together to improve the research base, share emerging ideas, and inspire the next generation of healthcare providers," said Jeffrey Brenner, M.D., executive director of the Camden Coalition.

The Camden Coalition reported more than a decade ago that disorganized care resulted in 20 percent of patients accounting for 80 percent of hospital costs in Camden. The group found that identifying the patients and providing medical and social support following discharge improved outcomes and reduced hospital visits, according to the statement.

The Robert Wood Johnson Foundation provided initial funding allowing the research to continue. That research has now grown into the national center.

The national center comes as the healthcare community increasingly recognizes that external factors contribute significantly to healthcare costs and outcomes.

Just a few days earlier the Institute of Medicine released a framework for lifelong education of health professionals on social determinants of health, and a model for bringing together providers, communities and educators to address the problems.

Some communities are trying out something called "community paramedicine," using paramedics and emergency medical technicians to proactively treat patients who aren't sick enough for the emergency department, FierceHealthcare previously reported. These home visits, primarily for people with chronic conditions such as asthma or diabetes, are meant to create healthier communities by filling the gaps in healthcare services.