The math sounds simple: If one in five patients absorbs roughly $4 out of every $5 spent on medical care, identifying these patients and giving them the treatment they need should save millions. But when Dr. Jeffrey Brenner, a primary-care physician in Camden, set out to tackle the problem, he found the solution was anything but simple.
It wasn’t long after he launched the Camden Coalition of Healthcare Providers in 2002, that Brenner realized that these high-need patients had complex medical, psychological, and social problems. And they rarely received the multifaceted treatment they needed from existing health and welfare systems.
Instead, these desperate patients cycled through hospital emergency rooms dozens, if not hundreds of times annually, driving up healthcare costs for everyone.
“I thought it was just an engagement, coordination, and navigation problem,” Brenner said last week. “But the primary-care system is utterly broken.”
In the years since founding the Camden Coalition, Brenner and his colleagues have learned that helping this population demands tireless personal attention and nonjudgmental care from an integrated network of medical and social providers.
He is not alone. In Alaska, for example, a group of Alaska Native people joined together nearly 30 years ago to reshape a traditional federal Bureau of Indian Affairs program as the Nuka System of Care, which has been far more effective in treating the local population.
And thanks to $8.7 million in funding from a trio of major foundations, the Camden Coalition will now build a national center to help spread the success of the data-driven, patient-centered model — also known as “hot-spotting” — that has worked so well here in New Jersey. The 10-year program will involve experts from around the nation, including providers from Sutter Health, an established nonprofit system in Northern California, and one of its philanthropic partners, Better Health East Bay, among others.
“It’s a vehicle to convene and collaborate and converge and to build a field,” explained Brenner, who was awarded a MacArthur Foundation “genius grant” and has received national media attention for his work. The goal is to share models that work, prioritize research needs, devise an advocacy agenda, and even decide on the words they will use to discuss it, he said, adding: “We’re going to birth a field and a movement.”
The funding is provided by AARP, Atlantic Philanthropies, and Robert Wood Johnson Foundation, which has long supported the work of the Camden Coalition, a network of two dozen hospitals, doctors, and community organizations. They not only share data in an effort to provide more coordinated, effective healthcare — and, if needed, safe housing, nutritious food, and other essential services that are required for a healthy life. The national center will begin as a virtual collaboration — not a physical site — but will involve the first professional conference dedicated to healthcare hot-spotting, planned for Philadelphia later this year, Brenner said.
The powerful potential of the Camden Coalition’s work is in part what attracted AARP to the project. Susan Reinhardt, senior vice president and director, said these highly vulnerable patients often have critical housing, transportation, and other needs that fall outside the traditional medical system. Brenner’s efforts have shown it is possible to treat them more effectively, she said, and we need to learn from his success to help people lead healthier lives.
Reinhardt said the current system, where vulnerable patients cycle in and out of emergency care, is exhausting to family and caregivers and a burden on taxpayers who must cover the cost of paying for patients without adequate insurance. The national center “will disrupt old ways of thinking about how to help people who have many chronic conditions and wind up in the emergency room all too often. We cannot just keep patching them up and sending them out again.”