The Camden Coalition of Healthcare Providers and Crozer-Keystone Health System recently launched a unique Superutilizer Fellowship. The fellowship aims to train physicians to identify and care for the complex medical needs of patients known as “superutilizers,” or patients who use a very high volume of health care resources because of repeat visits to emergency departments because of chronic health problems and more. The fellowship is supported by a two-year, $175,000 grant from the Aetna Foundation.

The Camden Coalition of Healthcare Providers is a nine-year-old strategic initiative, affiliated with Cooper University Hospital, with a mission to improve the quality, capacity, and accessibility of the health care system for vulnerable populations in the City of Camden, New Jersey. Crozer-Keystone’s Family Medicine Residency Program has been involved in the creation of the fellowship.

Leaders of both organizations have worked for years, both separately and collaboratively, to address the challenges of superutilizers. Superutilizers typically make up a small percentage of a patient population, but they can account for a relatively large percentage of costs.

Leaders of health care delivery system reform and medical education have identified several necessary elements for successful models of health care financing and delivery that will be addressed through this fellowship. These include care coordination, system-based practice, interdisciplinary teamwork, awareness of cost, familiarity with information technology and continuous quality improvement skills.

The fellowship’s first two fellows have been chosen from the Crozer-Keystone Family Medicine Residency Program and officially began seeing patients in July. The fellows split their time seeing patients at health care facilities in Camden and Delaware County – two days each week in each location, plus a day for scholarly work. The fellows will coordinate care for a small panel of high-cost patients with complex needs, develop data-driven protocols to improve their care, and complete a scholarly project in population health. The fellows will invest in community health education as well as strengthening primary care and provider collaboration to form an interdisciplinary care network.

Oversight of the program is shared by Jeff Brenner, M.D., a family physician and executive director of the Camden Coalition, and William Warning, M.D., a Crozer-Keystone family physician and director of the health system’s Family Medicine Residency Program. Both are dedicated to helping train physician who can lead their communities in making smart, effective and needed investments in population health.

“Most residencies and fellowships do not prepare physicians with the formal training necessary in order to deliver high-value care in a nation that faces increasing health care costs. In lieu of the challenging government budgets and growing healthcare costs, the fellowship will provide health care professionals with practical experience in care coordination, an understanding of health systems, and knowledge of absolute and relative costs that are necessary to play a leading role in these initiatives,” Brenner says.

Camden is a medically underserved urban community in New Jersey with special socioeconomic and demographic health care challenges. The Camden Coalition of Healthcare Providers found that over half of the city’s residents visited an emergency room or hospital in one year, and that the majority of the diagnoses were preventable conditions that could have been treated in a primary care office setting. The patients were visiting the emergency rooms because they had difficulty accessing primary care and represent the majority of the yearly health care spending.

Crozer-Keystone sees the same trends at its hospitals and outpatient facilities.

“These ‘superutilizers’ typically fall through the cracks. They usually have a complex mix of co-morbid psychiatric, social, medical, and substance abuse issues with no care coordination by the delivery system,” Warning says. “The fellows will learn to communicate with patients of various racial, language, gender, and education backgrounds while gaining an understanding of how social determinants of health impact the delivery of services.”

One of the goals of the fellowship is to create a curriculum outlining the necessary components of a superutilizer fellowship. These efforts aim to improve the care of high-cost individuals and serve as training sites for future physicians.

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