By: Albert Kelly, Guest Columnist
Closing the gaps on health outcomes in the region will require our thinking outside the box.
Over the course of two terms as a mayor for the City of Bridgeton, one issue that has presented a constant challenge to me and my colleagues in both public and nonprofit sectors, is improving the health and well-being of residents. Our primary reference to check progress is the County Health Rankings & Roadmap from the Robert Wood Johnson (RWJ)Foundation. By that measure, we haven’t moved the needle very much. Cumberland and Salem counties are consistently ranked at or near the bottom statewide.
The purpose of the rankings is to help counties understand what it is that influences resident health. They look at the obvious, such as rates of smoking, obesity, teen births, and access to healthy foods. They also consider other impacts from such things as predatory lending, discriminatory prison sentencing, and school funding. Together, these all play a role in the health and well-being of people and communities.
In thinking about our area, I began to wonder if we weren’t missing other things or if there were new ways to think about issues and outcomes. With that in mind, I stumbled onto the Dartmouth Atlas of Health website, which basically measures variations in how medical resources are distributed or used across the country and in states down to the county level.
I approached this in the same spirit as the Rutgers University study from a couple of years ago that concluded that the poorest municipalities in South Jersey receive 33 percent less total state funding compared to similar communities in the rest of the state. I wanted to see if some patterns were obvious in terms of healthcare and get additional insights if possible. I don’t know that I did.
The Dartmouth project is a couple of decades old and uses Medicare data (those 65 years or older) from the Centers for Medicare and Medicaid Services (CMS) among others, to provide information and analysis about healthcare nationally and in states. My focus was on different rates statewide. The project explains rates as “the number of events or amount of resources divided by the number in the population so if an area with 100,000 Medicare enrollees has 810 hip fracture repairs, then the rate of hip fracture repair is 8.1 per 1,000 Medicare enrollees.”
In looking at 2015, the latest year I could find, Cumberland and Salem counties had the highest rate of discharge related to congestive heart failure (CHF) at 21.50 and 22.81, while Hunterdon County was lowest at 9.09 followed by Somerset at 11.22. For chronic obstructive pulmonary disease (COPD), Salem and Cumberland counties were highest at 16.67 and 14.55 while Somerset and Morris counties were lowest at 5.07 and 5.30, respectively. For kidney/urinary infections, Cumberland County led the way at 8.99, followed by Salem at 8.98, while Sussex County was at 4.89 and Union County at 5.03.
These numbers reflect the RWJ Foundation rankings. When it comes to certain other measures, healthcare feels like a revolving door or “catch as catch can.” Cumberland County had among the highest percentage of patients visiting an ER within 30 days of both a medical discharge (22.84%) and surgical discharges (20.54%). Hunterdon County was lowest at 17.53% (medical) and 13.16% (surgical). Cumberland was highest for hospital readmissions within 30 days of discharge whether for medical (16.33%) or surgical (14.24%).
Statewide, total Medicare reimbursements per enrollee were highest in Salem ($11,670) and Cumberland ($11,196), and hospital and skilled nursing facility reimbursements were also highest in the state per enrollee at $5,603 (Salem) and $5,365 (Cumberland). So there is certainly enough quality medical care being delivered, yet it doesn’t seem to be reflected in the health outcomes. The data didn’t suggest how to move the needle in a positive direction, but it did suggest some questions.
Is the higher number of ER visits and readmissions indicative of a lack of access to transportation for follow-up office or therapy visits or a need for more evening hours? If so, is it possible to improve things with mobile or pop-up clinics? Do the rates for CHF, COPD, and pneumonia reflect of people delaying treatment for various reasons so conditions worsen? Is it simply a cost issue? Is more bilingual education needed?
I’m not sure, but somewhere in the data is the gap between healthcare delivery and health outcomes. Whatever else the data may say, it suggests to me that we’ll have to think outside-the-box in trying to close it.