Trenton medical officials ask the same question and seek solutions for the people who live there — especially for those who can’t afford a doctor and use hospital emergency rooms as the first resort for care and treatment.
That option also happens to be the most expensive option and is usually paid for by the federal government.
The U.S. Department of Health and Human Services Agency for Healthcare Research and Quality reported treating repeat visitors at hospital emergency rooms uses about 21 percent of the nearly $1.3 trillion spent each year on health care in the United States.
In Trenton the issue of treating repeat emergency room visitors came into focus in 2005, when Doug Palmer was entering his final term as mayor and Capital Health Systems was proposing closing one of its two hospitals in the city to open a new hospital in Hopewell Township.
Palmer asked what would happen to the people in Trenton who depended most on hospital services — especially the homeless and those with difficult-to-manage chronic medical issues, the most likely to go to emergency rooms for treatment.
The answer was the Trenton Health Team, a collaboration of St. Francis Medical Center, Capital Health Systems, the Henry J. Austin Health Center, and the city Health Department.
The Trenton Health Team is a nonprofit organization funded by the Newark-based Nicholson Foundation.
To maximize existing medical services in the capital city THT launched a 2011 strategic initiative to improve patient experience, improve the health of the Trenton’s population, and lower costs. To do so the team developed five goals:
Lay the groundwork to become a Medicaid Accountable Care Organization (ACO), defined by the Center for Medicare and Medicaid Services as groups of doctors, hospitals, and other health care providers who come together voluntarily to give coordinated high-quality care to the Medicare patients they serve and provide better population health and containment of costs.
Expand access to primary care by reducing wait times at the city’s health centers and providing new patient-centered, personalized approaches to care.
Coordinate community-wide clinical care for those seeking primary care in the emergency room by targeting high users of hospital services.
Share information among health care providers to improve care coordination, avoid duplication of services, and reduce medical errors.
Engage residents in a concerted effort to understand and overcome obstacles to quality health care.
The early initiatives were led by Dr. Ruthanne Perry, who wrote in a 2012 editorial: “One-quarter of Trenton’s underprivileged have no health care coverage and suffer from higher-than-average rates of diabetes, hypertension, and obesity. Residents have little access to primary care, and until recently it could take weeks to get a clinic appointment. Instead, patients often visit emergency rooms for problems that are not emergencies. Using the ER this way is more expensive than using primary care services, and without follow-up care, the patient will probably end up in the ER again soon.”
Several years later the organization has a staff of 21 and a $3 million operating budget, mostly derived from grants and philanthropy.
But most importantly it is known for its Health Information Exchange (HIE), an approach that provides practitioners access to patient records in real time to support treatment decisions and strategies.
“Our work is really strongly engaged in expanding community health and well-being,” says current executive director Gregory Paulson, 43. “We’re very fortunate to be in a very positive position at a time when Trenton has a lot of very positive things on the horizon.”
Paulson has been with THT since 2013 and became director in 2015. He says much of THT’s work involves high-tech number crunching to identify health care needs as they take shape. For example, if a group of residents is identified as having high costs associated with care for diabetes, it will show up in the THT database and treatment can be tailored to meet that need.
He also led THT through an updated to its strategic plan. While the former plan set a goal to make Trenton the healthiest city in New Jersey, the new plan contains more specific goals and strategies for a healthy environment and housing; clean, green, and accessible spaces for recreation; a growing economy; effective education; healthy food; improved safety, equity and social cohesion; and quality healthcare.
Also new is THT’s decision to offer NowPow, which, Paulson says will match the database of electronic medical records operated by THT with practitioners providing social services.
“If someone needs a primary care provider we can help them that way,” Paulson says. “It will also keep track of whether they received the care they needed.”
“We’ve been doing research into these kinds of services for a while,” Paulson says of the database that originated in Chicago and recently became available on the East Coast.
Paulson is a native of of Los Angeles. His mother, who still lives there, is a consultant for a high-end women’s clothing line. His father lives in Wyoming and is a retired management consultant and investor. Paulson came east to attend Princeton University (Class of 1998).
One day the psychology major watched as an EMT unit responded to a call on campus. He had some experience as a paramedic in Los Angeles and noticed that many of the rescue squad members looked like students. That led him to pursue additional training.
“I was fulfilling my premedical requirements at Princeton,” he says, “and I even did a post-baccalaureate year at University of Pennsylvania in their premed program to finish. It was during that program that I decided to pivot and go get my master’s at Drexel University in emergency management and become a paramedic. I had been an EMT since 1993.”
“In New Jersey all paramedics work for hospitals,” he says, “so that gave me broader exposure to the administration of hospitals in New Jersey. As I was promoted in positions at Somerset Medical Center, I took on more and more administrative responsibility.”
Before joining THT Paulson served as the manager of Emergency Medical Services at Somerset Medical Center, Somerville, where he oversaw all operations, policy development, new program development and implementation, staff management, strategic planning, and community outreach. He lives in Hopewell with his wife and their three daughters.
Today the Trenton Health Team occupies spacious offices on the fourth floor of One West State Street, at the corner of West State and South Warren streets. It is among a group of six regional health-care organizations — in the Finger Lakes, New York; Albuquerque, New Mexico; Seattle Washington; Central Oregon; and Sonoma County, California — that use data-driven strategies for improving care and reducing costs.
“We have a lot of other involvement with non-traditional partners,” Paulson says. One of these will include a “Tactical Urbanism” project along the Brunswick Avenue corridor, similar to the Street Plans project in Jersey City that brightened pedestrian areas.
Other recent developments include THT welcoming Julia Taylor, the former Isles deputy operations office, as the senior director of programs and partnerships. The group is also participating in a New Jersey Health Initiative program to identify high concentrations of irritants and lead exposure in Trenton homes and in Robert Wood Johnson Foundation’s national program DASH CIC-START. Along with a $24,915 grant, the program will help provide data for public health initiatives and support the NowPow system.
As we know, any doctor will recommend improving a patient’s immediate environment as key to overall well-being. The Trenton Health Team is no different. Outside the conference room in its downtown Trenton office is a large mural by the noted area artist Leon Rainbow.
Trenton Health Team, 1 West State Street, Fourth Floor. 609-256-4555. www.trentonhealthteam.org
This article was originally published in the April 2019 Trenton Downtowner.