A Data Set with a Story to Tell themselves by choice or necessity, so they weren’t using the on-site services. Because super-users often live alone and have complex, unmanaged illnesses, no one knows when a real or perceived health crisis is brewing, and they continue to check into the hospitals for emergency care. The Coalition Today story “of wasteful, disorganized services, delivered by good doctors working at good hospitals every day,” says Dr. Brenner. But gradually, data analysis revealed that a very small number of patients, or “super-users,” were consuming a large share of the overall costs of health care and social supports. In a single year, coalition analysts would find, nearly half the city’s residents visited a city emergency department or hospital, most often for primary care issues such as head colds, viral infections, ear infections, and sore throats. The coalition used a business technique to profile and target the scattershot use of the health care system by its super-users. “‘Hot spotting’ is not mapmaking,” says Dr. Brenner. “It’s tearing a data set apart and looking for outliers and doing root cause assessment,” to find why those locations had the health care system’s highest numbers of super-users. Why would one patient, in a single year, have visited every emergency room or hospital in the city, for a total of 113 visits? And what services would have prevented it and made the patient healthier? “In Camden, the super-utilizers are about 1 percent of the population, which is fewer than 1,000 people,” says Dr. Brenner. “Yet they account for about 30 percent of the total payment for hospitalization and emergency department care in Camden.” Over a five-year period, the total cost for hospital and emergency department care in Camden was $650 million, mostly public funds. Some 80 percent of the costs were spent on 13 percent of the patients, and 90 percent of the costs were spent on 20 percent of the patients. The coalition’s analysis identified two of the hottest of the city’s health care hot spots: an apartment building and a nursing home. Next, it focused on understanding why so many residents at these locations were continually visiting the emergency rooms for care. Most important, by organizing the data around business principles not previously used by health care providers, the coalition was able to start implementing new strategies to help provide appropriate care to the city’s sickest people. Not all its attempts were successful. It focused an extensive effort on the apartment building that housed the highest number of super-users, providing a center for preventive care and support services that proved popular with most residents. But not all, they learned. Many super-users isolate 40 Robert Wood Johnson I MEDICINE t he initial data gleaned from discharge and claims information were episodic, uncoordinated, and extremely inefficient, telling their own incredible (HIE). The system shares real-time information among the local hospitals, notifying physicians when their patients enter the hospital and providing access to their full medical records. Much of the coalition’s work focuses on improving care of super-users through a large, community-wide care coordination program. Hospitalized patients are identified through the coalition’s HIE each morning, the patients are enrolled at the hospital bedside, and then an outreach team visits them at home, checks on their health, reviews medications, accompanies them to medical appointments, and helps them to navigate the health care system for 90 days. Another coalition team works on improving the primary care capacity to “catch”’ these recently hospitalized patients. In 2012, Dr. Brenner founded the Urban Health Institute, a new business unit within Cooper University Health Care that runs the Cooper Advanced Care Center. The center uses modern business tools to provide better care to urban, high-risk, medically underserved patients at a lower cost. The redesigned work flow seeks to contain costs and teach patients self-management. “Smart booking” uses predictive modeling to schedule appointments. Patients with similar health concerns share group visits and learn self-management from a health care team of physicians, nurses, social workers, and a behaviorist. Common topics include diabetes, hand pain, heart failure, headache, and seizure disorder. “Good service delivery has a heart,” says Dr. Brenner. “It empowers the client.” Dr. Brenner seeks to build super-user programs that can be easily adapted in other areas, and replication is already happening: more than 50 communities across the country have programs focused on high-cost, complex patients. “My goal is to continue bending the cost curve, to make Camden first in the nation in health care,” says Dr. Brenner. “The MacArthur Award has attracted new funding and provided a huge boost for that effort.” M W ith the stakeholders on board, the coalition was able, in 2010, to create and run the Camden Health Information Exchange