By Sara Brenner
This week I rushed out of yet another appointment with my specialty doctor realizing that yet again we only had time to discuss one major aspect of my health, and I found myself coming to the same conclusion: there has to be a better way. We need new approaches to a health care system that currently focuses more on the delivery of health care than on the health of individuals. Thankfully, there are a host of change agents engineering new and better ways to approach health care.
For example, I am moved by the work of Dr. Jeffrey Brenner and the Camden Coalition of Healthcare Providers showcased at the Social Impact Exchange Conference last month. Dr. Brenner and the Coalition are proving that it is possible to improve health and health care quality while reducing costs in one of the poorest cities in America: Camden, NJ. We can learn a great deal from their approach – which combines personal connections and empathy with data and discipline – and has transformed health care in Camden.
In Camden, 13% of hospital patients account for 80% of hospital costs and 20% of the patients account for 90% of the costs. Dr. Brenner and the Coalition have built a model that targets these so-called “super-utilizers” (i.e., individuals who incur disproportionate healthcare costs) and provides them with wrap-around assistance that can help reduce their need for high-cost services, like emergency room visits. Dr. Brenner and his team reduced hospital visits by 40% and reduced aggregate monthly hospital bills from $1.2 million to $500,000 among the first set of super-utilizers with whom they worked.
Dr. Brenner’s work reflects the practices Community Wealth Partners has identified as common among other efforts that have achieved transformative change (i.e., solving a problem at the magnitude it exists). Two particular transformation insights stand out.
Upon aggregating data from insurers, hospitals, clinics and other healthcare providers, Dr. Brenner and his team found that super-utilizers responsible for outsized health care costs often (1) do not receive adequate primary care, (2) face barriers preventing them from following their doctor’s instructions or (3) simply do not understand how to properly navigate the healthcare system. In some cases, individuals are visiting emergency rooms hundreds of times each year, resulting in millions of dollars in cost. By exercising relentless, disciplined focus on altering the behavior and circumstances of the small number of super-utilizers, Dr. Brenner and his team have generated an outsized decrease in overall costs across the full population of patients.
This use of data to identify “hot spots” representing a disproportionate contribution to a given problem is similar to the approach to proactive policing Bill Bratton brought to New York City in the early 1990s. Bratton commissioned the development of a system – Compstat – to aggregate crime statistics and evaluate the success of different policing tactics. The system allowed the force to concentrate their resources on neighborhoods that appeared as “hot spots” of criminal activity and to understand which techniques were working and which were not in quelling crime. Under Bratton’s watch (1994-1996), murders in NYC fell by 47%, felonies by 39% and theft by 35%.
Both of these efforts demonstrate the power of using data to focus resources and effort in order to maximize progress on a significant problem. But data alone does not solve the problem. There is an important human element.
In addition to conducting rigorous data aggregation and analysis, Dr. Brenner and his team had a deep desire to understand the people behind the data. Upon being introduced to his first super-utilizer, Dr. Brenner spent a number of months meeting with and observing this individual on a daily basis. Brenner sought to understand the unique circumstances in this man’s life and to ensure that the treatment he received, his doctor’s instructions and the prescriptions he was given all fit appropriately into his reality. Brenner and his team also helped the man make changes to improve his general circumstances, predicting that these changes could alleviate some of the contributors to the man’s high health care usage. They helped him find stable housing, encouraged him to re-enroll in Alcoholics Anonymous and return to church, and persuaded him to cook his own meals, among other things.
The results? Two years later the man’s core chronic illnesses were under control, he was abstaining from alcohol, smoking and cocaine, he had lost 220 pounds and was living in a stable home. As Brenner explains about these and other results, “There is a bias in medicine against talking to people and for cutting, scanning and chopping into them. If this was a pill or a machine with these results it would be front-page news in the Wall Street Journal.” The genuine interest in the man’s life and circumstances – not a pill – was necessary for dramatically enhancing his health.
Through combining data, discipline and deep empathy, Dr. Brenner has demonstrated – in one of our country’s poorest cities – that it is possible to transform the health care equation. In next week’s post I’ll explore two other practices – building public support and developing unusual partnerships – Dr. Brenner and the Camden Coalition have used to deepen and expand their impact.