2014-11-17T12:40:17-06:00 2013-12-31 223271712 MERCADIEN PC PO BOX 7648 PRINCETON NJ 085437648 990 2013-01-01 451257757 TRENTON HEALTH TEAM INC TREN 6092564555 218 NORTH BROAD STREET TRENTON NJ 08608 RUTH PERRY MD EXECUTIVE DIRECTOR 6092564555 2014-11-17 1 SHERISE D RITTER CPA P00039222 6096899700 2013 2015-11-30 17:44:51Z RUTH PERRY MD 218 NORTH BROAD STREET TRENTON NJ 08608 1467195 0 X WWW.TRENTONHEALTHTEAM.ORG X 2010 NJ MEASURE HEALTH CARE GAPS IN THE CITY OF TRENTON AND DEVELOP INNOVATIVE SOLUTIONS TO FIX THEM. 13 12 12 0 0 0 524305 1465785 0 0 3039 1410 0 0 527344 1467195 0 0 0 0 290919 759684 0 0 150427 535294 736365 826213 1496049 -298869 -28854 1379707 1043992 573335 266474 806372 777518 X TO TRANSFORM HEALTHCARE FOR THE CITY OF TRENTON BY FORMING A COMMITTED PARTNERSHIP WITH THE COMMUNITY TO EXPAND ACCESS TO HIGH QUALITY COORDINATED CARE, THEREBY, MAKING TRENTON THE HEALTHIEST CITY IN THE STATE OF NEW JERSEY. 0 0 504715 STRENGTHENING THE TRENTON HEALTH TEAM TO BECOME A SAFETY-NET ACCOUNTABLE CARE ORGANIZATION - THE NICHOLSON FOUNDATION AWARDED THT AN 18-MONTH GRANT FROM SEPTEMBER 1, 2012 - FEBRUARY 28, 2014, TO ESTABLISH A CARE MANAGEMENT TEAM TO SUPPORT MEDICAID HIGH UTILIZING PATIENTS AND TO BUILD THE ORGANIZATIONAL INFRASTRUCTURE TO BECOME AN EFFECTIVE ACCOUNTABLE CARE ORGANIZATION. THIS GRANT WAS EXTENDED FOR THREE MONTHS, TO COVER MARCH-MAY, 2014. TAKEN TOGETHER, THE GRANT ACTIVITIES GREATLY ENHANCED THT'S ABILITY TO BE READY FOR CERTIFICATION AS A MEDICAID ACO. PROGRAM ACTIVITIES INCLUDED: 1. ESTABLISHMENT OF A CARE MANAGEMENT TEAM (CMT): THT ESTABLISHED A CARE MANAGEMENT TEAM, CONSISTING OF A REGISTERED NURSE, LICENSED SOCIAL WORKER, AND TWO COMMUNITY HEALTH WORKERS. THE CMT PROVIDED COMPREHENSIVE CARE MANAGEMENT INTERVENTIONS FOR A PILOT GROUP OF 45 MEDICAID AND CHARITY CARE RECIPIENTS WHO WERE HIGH-UTILIZERS OF EMERGENCY DEPARTMENT (ED) SERVICES (DEFINED AS MORE THAN 10 ED VISITS IN A YEAR) OR WHO WERE CONSIDERED HIGH-RISK BASED ON ONE OR MORE OF THE FOLLOWING PARAMETERS: DIAGNOSIS OF DIABETES, MYOCARDIAL INFARCTION, PNEUMONIA, COPD, OR SICKLE CELL MORE THAN TWO (2) HOSPITALIZATIONS IN A 12-MONTH PERIOD A PREVIOUS 30-DAY HOSPITAL READMISSION FOUR (4) OR MORE MEDICATIONS. A SUMMARY OF THE FINDINGS FROM THE CMT INTERVENTION INCLUDES THE FOLLOWING: THT DID NOT HAVE ACCESS TO MEDICAID COST DATA, BUT FINANCE PERSONNEL AT THT'S HOSPITAL PARTNERS ADVISED US THAT MEDICAID REIMBURSEMENT LEVELS WERE ROUGHLY 20% OF HOSPITAL CHARGES. USING THAT RATIO TO COMPARE THE COST OF DELIVERING THE INTERVENTION WITH THE PREDICTED REDUCTION IN TOTAL COST TO MEDICAID, THE CARE MANAGEMENT PROGRAM DEMONSTRATED A RETURN ON INVESTMENT OF 196%. THE MEAN LENGTH OF INTERVENTION WAS 4.7 MONTHS WITH A STANDARD DEVIATION OF 1.6 MONTHS. THE MEDIAN LENGTH OF INTERVENTION WAS FOUR (4) MONTHS, THE MAXIMUM LENGTH EIGHT (8) MONTHS AND THE MINIMUM LENGTH WAS TWO (2) MONTHS. ED UTILIZATION DECREASED BY 4.6% FOR THE TOTAL COHORT, EMERGENCY DEPARTMENT CHARGES WERE REDUCED BY 24.2%, AND TOTAL HOSPITAL CHARGES WERE REDUCED BY 24.4%. THE ANALYSIS IDENTIFIED THAT FOUR PATIENTS WHO WERE HIGH UTILIZERS SERVED IN THE COHORT HAD SICKLE CELL ANEMIA. THESE INDIVIDUALS HAD SIGNIFICANTLY DIFFERENT UTILIZATION AND COST OUTCOMES FROM THE REST OF THE HIGH-UTILIZER COHORT. EXCLUDING THE RESULTS FROM THOSE FOUR PARTICIPANTS, ED UTILIZATION FOR THE REST OF THE COHORT DECREASED BY 56.4%, ED CHARGES DECREASED BY 53.0%, AND TOTAL HOSPITAL CHARGES DECREASED BY 38.6%. A NUMBER OF VARIABLES AFFECTED THE FINAL RESULTS. THE LENGTH OF THE STUDY WAS SHORTER THAN EXPECTED BECAUSE OF DIFFICULTIES IN RECEIVING INITIAL REFERRALS FROM THE HOSPITALS. THE HIGH PREVALENCE (98%) OF MENTAL HEALTH AND SUBSTANCE ABUSE CO-MORBIDITIES, AS DETERMINED FROM MEDICAL HISTORY AND ASSESSMENTS, ALSO LIMITED THE EFFECTIVENESS OF CMT INTERVENTIONS AS IT WAS OFTEN DIFFICULT TO CONNECT PATIENTS TO BEHAVIORAL RESOURCES IN THE COMMUNITY. THE CMT HAD SIGNIFICANT DIFFICULTY OBTAINING SUBSTANCE ABUSE AND MENTAL HEALTH PLACEMENTS BECAUSE OF INSUFFICIENT OUTPATIENT AND/OR RESIDENTIAL DETOXIFICATION PROGRAMS IN THE CITY OR SUFFICIENT PROVIDERS WITH REQUISITE BEHAVIORAL HEALTH CREDENTIALS. AS MENTIONED ABOVE, THT PROVIDED CARE MANAGEMENT SERVICES UNDER THIS GRANT BOTH FOR HIGH-UTILIZERS OF AVOIDABLE HOSPITAL SERVICES AND FOR PATIENTS WHO WERE MEDICALLY AT HIGH RISK FOR BECOMING HIGH-UTILIZERS IN THE FUTURE (SELECTED BY THE CLINICAL CRITERIA SPECIFIED IN THE GRANT AGREEMENT AND LISTED ABOVE). SUBSEQUENT COMMUNICATION BETWEEN THE NICHOLSON FOUNDATION AND THT DURING THE GRANT PERIOD REVEALED CONFUSION REGARDING THE INTENDED TARGET POPULATION FOR THE CARE MANAGEMENT INTERVENTION. MOVING FORWARD UNDER THIS GRANT, THT'S CARE MANAGEMENT PROGRAM WILL SERVE ONLY MEDICAID BENEFICIARIES WHO ARE THE HIGHEST UTILIZERS OF AVOIDABLE HOSPITAL SERVICES. KEY LEARNINGS TO INFORM FUTURE WORK INCLUDE THE FOLLOWING: INITIAL OUTREACH AND ENROLLMENT EFFORTS TEND TO BE MORE SUCCESSFUL WHEN THEY OCCUR DURING OR IMMEDIATELY AFTER A HOSPITAL VISIT. SUCCESSFUL REFERRAL PATTERNS ARE ESSENTIAL AND TAKE TIME TO BUILD. CONNECTING PATIENTS TO PRIMARY CARE IS NOT IN ITSELF SUFFICIENT TO CHANGE UTILIZATION PATTERNS. A PARTICIPANT'S INITIAL COMPLIANCE WITH CARE PLAN GOALS FREQUENTLY PREDICTS FUTURE SUCCESS IN THE PROGRAM. THE CARE MANAGEMENT TEAM'S APPROACH NEEDS STANDARDIZATION. SEGMENTATION OF CMT PARTICIPANTS ALLOWS FOR MORE TARGETED INTERVENTION DESIGN. IMMEDIATE ACCESS TO UNIFIED CLINICAL INFORMATION (VIA A MECHANISM SUCH AS A HEALTH INFORMATION EXCHANGE (HIE)) IS ESSENTIAL TO DELIVERING AN EFFECTIVE CARE MANAGEMENT INTERVENTION. DEPTH OF NEED AROUND MENTAL HEALTH AND SUBSTANCE ABUSE IS NOT MATCHED BY AVAILABLE RESOURCES. SICKLE CELL ANEMIA PRESENTS PARTICULAR CHALLENGES. 2. BUILDING THE ORGANIZATIONAL CAPACITY OF THT: FUNDING FROM THIS GRANT ALSO ALLOWED THT TO BUILD THE CAPACITY OF THE ORGANIZATION TO BECOME A SUCCESSFUL MEDICAID ACO BY HIRING ADDITIONAL STAFF AND EXPANDING OUR ORGANIZATIONAL INFRASTRUCTURE. IN ADDITION TO FUNDING THE CURRENT EXECUTIVE DIRECTOR POSITION PLUS FOUR NEW POSITIONS FOR THE CMT, FOUR NEW ADMINISTRATIVE POSITIONS WERE FILLED, INCLUDING A DEPUTY DIRECTOR, DIRECTOR OF DEVELOPMENT, ADMINISTRATIVE ASSISTANT, AND DATA ANALYST. 160700 IMPLEMENTATION OF THE TRENTON HEALTH INFORMATION EXCHANGE - THT ALSO LAUNCHED THE TRENTON HEALTH INFORMATION EXCHANGE (HIE), AN EFFORT THAT WAS LED BY THE DEPUTY DIRECTOR, TO CONNECT THE CLINICAL DATA SYSTEMS OF THT'S PARTNERS. THE TRENTON HIE CREATED A SINGLE UNIFIED ELECTRONIC HEALTH RECORD FOR EACH PATIENT BY COMBINING DATA FROM CAPITAL HEALTH, ST. FRANCIS MEDICAL CENTER, HENRY J. AUSTIN HEALTH CENTER, AND THE CITY OF TRENTON CLINICS. DATA BEGAN TO FLOW INTO THE SYSTEM IN THE FOURTH QUARTER OF 2013. THOSE DATA INCLUDE ALL INPATIENT, OUTPATIENT, AND EMERGENCY DEPARTMENT VISITS FROM CAPITAL HEALTH AND ST. FRANCIS MEDICAL CENTERS (INCLUDING ALL CAMPUSES) AND ALL DATA FROM HENRY J. AUSTIN'S AND THE CITY OF TRENTON'S CLINICAL SITES. A KEY COMPONENT OF THIS SYSTEM IS THE PROBABILISTIC MASTER PATIENT INDEX, WHICH USES MULTIPLE POINTS OF DEMOGRAPHIC INFORMATION TO LINK RECORDS FOR THE SAME PATIENT ACROSS SEPARATE DATA SYSTEMS. PRIOR TO THE EXISTENCE OF THE TRENTON HIE, THAT TYPE OF PATIENT RECORD LINKING HAD TO BE PERFORMED MANUALLY FOR EACH INDIVIDUAL PATIENT. THE ABILITY TO ACCESS AND ANALYZE COMMUNITY-WIDE DATA THROUGH THE HIE WILL BE CRITICAL TO THT'S SUCCESS AS A MEDICAID ACO. CARE EVOLUTION IS CONTRACTED AS OUR HIE VENDOR AND BLUEPRINT HEALTHIT WAS CONTRACTED TO SERVE AS THE HIE IMPLEMENTATION PROJECT MANAGEMENT ORGANIZATION. 106761 TUBERCULOSIS CLINIC - THT PROVIDED COMPREHENSIVE TUBERCULOSIS (TB) SERVICES TO UNINSURED, ELIGIBLE MERCER COUNTY RESIDENTS. THE PROGRAM PROVIDED A TB NURSE CASE MANAGER WHO DELIVERED OUTPATIENT DIAGNOSIS AND TREATMENT FOR LATENT TUBERCULOSIS IN THE CITY OF TRENTON TB CLINIC, PROVIDED ACTIVE CASE MANAGEMENT SERVICES FOR PATIENTS AND THEIR FAMILIES DIAGNOSED WITH TB, PROVIDED COUNTYWIDE COORDINATION OF CLINICAL TREATMENT WITH LOCAL PUBLIC HEALTH OFFICERS, SCHOOL NURSES AND PUBLIC HEALTH NURSES, AND PROVIDED WORKSHOPS TO APPROPRIATE MERCER COUNTY AUDIENCES DURING THE PERIOD OF JANUARY 1, 2013 THROUGH DECEMBER 31, 2013. 292730 OTHER PROGRAMS INCLUDED THE NJ SBIRT (SCREENING, BRIEF INTERVENTION, AND REFERRAL TO TREATMENT) PROGRAM PROVIDING SCREENING FOR SUBSTANCE USE IN PRIMARY CARE SETTINGS AN IN THE EMERGENCY DEPARTMENTS, A TEXT-MESSAGING BASED PROGRAM PROMOTING HEALTH LITERACY FOR DIABETES FUNDED BY THE HORIZON FOUNDATION FOR NEW JERSEY, AND OTHER COMMUNITY ENGAGEMENT PROGRAMS PROMOTING HEALTH LITERACY. 292730 1064906 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 6 0 12 1 0 0 0 0 0 0 0 0 0 0 X 13 12 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 NJ X GREGORY PAULSON 6099893262 218 NORTH BROAD STREET TRENTON NJ 08608 ROBERT REMSTEIN DO PRESIDENT 0.50 X X 0 0 0 JAMES BROWNLEE VICE PRESIDENT 0.50 X X 0 0 0 KEMI ALLI MD SECRETARY 0.50 X X 0 0 0 CHRISTINE STEPHENSON TREASURER 0.50 X X 0 0 0 CATHLEEN BENNETT MEMBER 0.50 X 0 0 0 JUDY DIBARTOLO MEMBER 0.50 X 0 0 0 DENNIS DOOLEY MEMBER 0.50 X 0 0 0 CORINNE HIGGINS MEMBER 0.50 X 0 0 0 MARIA JUEGA MEMBER 0.50 X 0 0 0 JOHN MONAHAN MEMBER 0.50 X 0 0 0 GEORGE MUSCHAL MEMBER 0.50 X 0 0 0 HARRY POSTAL MEMBER 0.50 X 0 0 0 RUTH PERRY MD EXECUTIVE DIRECTOR 40.00 X 164947 0 0 164947 0 0 1 0 1 0 CAREEVOLUTION INC 521 HILLSPUR ROAD ANN ARBOR MI 48105 SOFTWARE DEVELOPMENT 235000 BTAYLOR 243 N UNION ST SUITE 116 LAMBERTVILLE NJ 08530 PUBLIC RELATIONS 105247 2 476602 989183 10263 1465785 1410 1410 1467195 0 0 1410 X 166800 33360 66720 66720 485951 361852 72045 52054 36555 22360 7666 6529 70378 42634 14951 12793 14316 14316 54969 54969 160149 121150 27750 11249 21018 21018 430746 422241 8017 488 11096 11096 19987 18726 1261 15172 10768 3810 594 MISCELLANEOUS EXPENSES 4987 2478 2509 STAFF EDUCATION AND EXP 3925 3925 1496049 1064906 280716 150427 280492 26206 759383 276106 252736 542877 6689 117193 110531 28921 80407 81610 1379707 1043992 50225 66015 523110 200459 573335 266474 X -193148 329760 999520 447758 806372 777518 1379707 1043992 -28854 0 X X 0 1 X 1 0 X 1000000 571309 524305 1446398 3542012 1000000 571309 524305 1446398 3542012 1266165 2275847 7491 5132 3039 1410 17072 3559084 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3292 988 2304 107239 27933 79306 81610 X 1557552 90357 90357 1467195 0 1467195 1586406 90357 90357 1496049 0 1496049 PART X, LINE 2: THE ORGANIZATION ACCOUNTS FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN THE FINANCIAL STATEMENTS USING A RECOGNITION THRESHOLD OF MORE LIKELY THAN NOT AS TO WHETHER THE UNCERTAINTY WILL BE SUSTAINED UPON EXAMINATION BY THE APPROPRIATE TAXING AUTHORITY. MEASUREMENT OF THE TAX UNCERTAINTY OCCURS IF THE RECOGNITION THRESHOLD HAS BEEN MET. MANAGEMENT DETERMINED THERE WERE NO TAX UNCERTAINTIES THAT MET THE RECOGNITION THRESHOLD. DUE TO ITS RECENT INCORPORATION, ALL TAX YEARS ARE OPEN AND SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. X X 0 0 0 0 0 0 0 0 0 RUTH PERRY MD EXECUTIVE DIRECTOR 164947 0 0 0 0 0 0 0 0 0 164947 0 0 0 FORM 990, PART VI, SECTION A, LINE 2 ROBERT REMSTEIN, DO, THT PRESIDENT, AND DENNIS DOOLEY, MEMBER, ARE OFFICERS OF CAPITAL HEALTH SYSTEM, INC. JAMES BROWNLEE, THT VICE PRESIDENT, IS THE DIRECTOR OF HEALTH & HUMAN SERVICES AND THE HEALTH OFFICER FOR THE CITY OF TRENTON. GEORGE MUSCHAL, PRESIDENT OF CITY COUNCIL IS A MEMBER, FOR THE CITY OF TRENTON. KEMI ALLI, MD, THT SECRETARY, AND CORRINE HIGGINS, MEMBER, ARE OFFICERS OF HENRY J. AUSTIN HEALTH CENTER, INC. CHRISTINE STEPHENSON, THT TREASURER, AND JERRY JABLONOWSKI MEMBER FROM 1/1/2013-8/31/2013. FROM 9/1/2013 JUDY DIBARTOLO, TREASURER, AND CHRISTY STEPHENSON, MEMBER, ARE OFFICERS OF SAINT FRANCIS MEDICAL CENTER. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS FOUR CORPORATE MEMBERS: CAPITAL HEALTH SYSTEM, INC., SAINT FRANCIS MEDICAL CENTER, TRENTON, NJ, HENRY J. AUSTIN HEALTH CENTER, INC. AND THE CITY OF TRENTON, NEW JERSEY. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION'S CORPORATE MEMBERS HOLD AN ANNUAL MEETING WHERE THEY APPOINT TRUSTEES AND ELECT CORPORATE OFFICERS. FORM 990, PART VI, SECTION A, LINE 7B THE CORPORATE MEMBERS HOLD CERTAIN RESERVED POWERS INCLUDING APPROVING AN AMENDMENT OR RESTATEMENT OF THE CERTIFICATE OF INCORPORATION OR KEY BYLAWS PROVISIONS OF THE CORPORATION, APPROVING THE ANNUAL OPERATING PLAN AND BUDGET OF THE CORPORATION, APPROVING SIGNIFICANT FINANCIAL TRANSACTIONS AND SIGNIFICANT BUDGET VARIANCES OF THE CORPORATION, APPROVING GRANTS AND OTHER OPPORTUNITIES FOR FUNDING, APPROVING THE ESTABLISHMENT OR DISSOLUTION OF ORGANIZATIONAL RELATIONSHIPS BY THE CORPORATION, APPROVING ANY CHANGES IN THE PURPOSE AND MISSION OF THE CORPORATION AND APPROVING THE DISSOLUTION OF THE CORPORATION. FORM 990, PART VI, SECTION B, LINE 11 THE EXECUTIVE TEAM WILL REVIEW THE 990 AND THEN PRESENT IT TO THE BOARD OF TRUSTEES BEFORE IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF TRUSTEES REQUIRES ANNUAL STATEMENTS FROM TRUSTEES, OFFICERS AND KEY EMPLOYEES THAT DISCLOSE EXISTING AND POTENTIAL DUALITIES OF INTEREST, AND CORRECTIVE AND DISCIPLINARY ACTION WITH RESPECT TO TRANSGRESSIONS OF SUCH POLICIES. FORM 990, PART VI, SECTION B, LINE 15A THE COMPENSATION OF THE EXECUTIVE DIRECTOR INCLUDES THE REVIEW AND APPROVAL OF THE EXECUTIVE TEAM AND THE ASSESSMENT OF COMPENSATION PAID TO SIMILARLY SITUATED TAX-EXEMPT ORGANIZATIONS FOR THE EQUIVALENT POSITION AND CURRENT COMPENSATION SURVEYS. THERE ARE NO OTHER OFFICERS OR KEY EMPLOYEES OF THE ORGANIZATION. FORM 990, PART VI, SECTION C, LINE 18 THE ORGANIZATION'S FORM 1023 AND 990 ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION CURRENTLY DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY OR FINANCIAL STATEMENTS AVAILABLE TO THE GENERAL PUBLIC. FORM 990, PART IX, LINE 11G CONSULTING SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 500. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 500. RADIOLOGY SERVICES: PROGRAM SERVICE EXPENSES 1,770. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,770. PUBLIC AFFAIR SERVICES: PROGRAM SERVICE EXPENSES 117,385. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 117,385. GRANT WRITING: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 10,650. TOTAL EXPENSES 10,650. PAYROLL SERVICES: PROGRAM SERVICE EXPENSES 1,995. MANAGEMENT AND GENERAL EXPENSES 700. FUNDRAISING EXPENSES 599. TOTAL EXPENSES 3,294. HUMAN RESOURCES CONSULTING: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 26,550. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 26,550. FORM 990, PART XII, LINE 2C: THE FINANCIAL STATEMENTS ARE AUDITED BY AN INDEPENDENT CPA FIRM AS SELECTED BY THE BOARD OF TRUSTEES. THE BOARD REVIEWS THE FINANCIAL STATEMENTS AND AUDITOR'S REPORT IN DETAIL AND APPROVES THEM. THIS PROCESS HAS NOT CHANGED DURING THE TAX YEAR.