How Nicholson Foundation Support Has Led to Improved Community-Based Healthcare Delivery

This entry in Our Legacy Series looks at how The Nicholson Foundation has worked to improve the well-being of vulnerable populations in New Jersey by supporting community healthcare coalitions. A combination of providers, hospitals, local government and social service agencies, community healthcare coalitions pool their efforts so they can reach more people with high quality services and at lower cost.  For this summary, we focus on our 10-year investment, totaling over $3 million, that supported the Trenton Health Team’s evolution from an ad hoc coalition of municipal officials and healthcare providers into an organization that is nationally recognized for its innovative approach to engaging not only healthcare professionals but state agencies, community service organizations, and grassroots advocates.

The Need for a Community-Wide Approach to Healthcare

The Trenton Health Team (THT) was formed in 2006 through a partnership of Capital Health (CH), St. Francis Medical Center (SFMC), Henry J. Austin Health Center (HJAHC), and the City of Trenton Department of Health and Human Services.  It was created in response to the closure of Mercer Medical Center, which, up until then, had been a primary source of healthcare for many Trenton residents.  

At the time, the health status of the city’s residents lagged behind that of the rest of the state. This was reflected in poor birth outcomes, high rates of people living with HIV, as well as high incidence rates for cancer, diabetes, hypertension, and obesity.  In addition, city residents’ use of emergency rooms was 54 percent higher than the national norm.  The use of emergency rooms, instead of visiting primary care doctors, contributed to an exodus of doctors to the suburbs, further exacerbating shortages in primary care providers.

Goals and Outcomes of Nicholson’s Early Grants to the Trenton Health Team

In awarding its first grant to THT in 2011, The Nicholson Foundation sought to help it expand and increase community-wide access to affordable, high-quality primary care.  The Foundation also provided resources that would enable THT to broaden the scope of its work to include community-wide, population health level initiatives.  Examples of impressive outcomes and achievements from THT’s work from 2011 to 2015 include:

  • Shortening the time for Trenton residents to receive care.  The wait time for appointments was slashed from 74 to 2 days at SFMC and from 37 days to 2 days at HJAHC.
  • Reducing community reliance on hospital emergency room care for non-emergency health issues.  Emergency department visits dropped more than 30 percent at SFMC and more than 60 percent at CH.  At the same time, inpatient stays fell more than 70 percent at SFMC and nearly 43 percent at CH.  That resulted in decreases in hospital charges of 73 percent at SFMC and 237 percent at CH among those individuals with very high hospital-related healthcare expenses.
  • Instituting care management—an approach to coordinating care among providers to more effectively address the physical and behavioral healthcare and social needs of Trenton residents. 
  • Making better use of data to coordinate and deliver care through implementation of the Trenton Health Information Exchange (HIE).  HIEs are databases that enable doctors and other providers to share medical information about patients across departments and among facilities.  The THT’s HIE contributed to better coordinated healthcare and clinical decisions, fewer repeated services, and improved patient care throughout Greater Trenton. 

Investing in the HIE was one of the Foundation’s most significant contributions to THT.  Nicholson support enabled THT to link social determinant and health data, leading to better decisions about how to allocate care.

In supporting THT during this time period, the Foundation had a complementary goal in mind:  To help it become a Medicaid Accountable Care Organization (ACO), an ambitious payment model designed to improve outcomes while reducing costs. ACOs were made possible by the 2010 passage of the Affordable Care Act.  Helping Trenton and other coalitions become Medicaid ACOs was very much in keeping with the national health reform wave of that time.  Medicaid ACOs were expected to be a real systems game-changer.

It would take four years for THT to become one of three New Jersey applicants to receive Medicaid ACO certification in 2015 (the other two—also Foundation grantees—were Camden Coalition of Health Care Providers and the Greater Newark Health Care Coalition).

Earning Regional Health Hub Status (2015-2020)

THT's designation as a Medicaid ACO and Nicholson Foundation support over subsequent years helped it to continue to improve how it addressed the health needs of community residents.

Despite steady progress, by 2019 it became evident that aspects of the ACO model were holding back THT and the other New Jersey demonstration sites from fully achieving their hoped-for potential.  The main challenge—discussed in a Nicholson-funded 2019 report issued by the New Jersey Health Care Quality Institute’s (Quality Institute) Medicaid Policy Center—was the lack of funding to sustain the ACOs once they were established.

To overcome limitations of the ACO model, the Quality Institute, along with several of the coalitions, successfully advocated for New Jersey to enact legislation establishing the Regional Health Hub Concept.  In January 2020, New Jersey Governor Phil Murphy signed into law a bill establishing a statewide Regional Health Hub program.  The legislation named the Trenton Health Team, Camden Coalition, Greater Newark Health Care Coalition, and the Health Coalition of Passaic County as New Jersey’s first Regional Health Hubs. 

The Regional Health Hubs were set up as non-profit organizations dedicated to improving healthcare delivery and health outcomes, with an eye toward bringing communities together on important public health initiatives.  The Hubs maintained some functions from the ACO model, such as responsibility for operating or using a regional HIE, and facilitating care for patients with especially complex medical conditions.  The Hubs also took on an expanded role in convening multi-sector partnerships and serving as local experts and conduits for state health priorities.  For example, in 2020, THT played a key role in coordinating how Trenton-area healthcare providers and community organizations responded to COVID-19.   

Among its many projects that address the upstream determinants of health, THT has worked in recent years to revitalize substandard housing stock in Trenton, connect households to free healthy food options, and address adverse childhood experiences.

The transformation of THT is emblematic of how several of the coalitions the Foundation supported over the years have grown and matured to become key players in their communities on health and health-related issues.