For nearly a decade, Dr. Jeffrey Brenner has led the Camden Coalition of Healthcare Providers into the city's homeless shelters, public housing hallways, and emergency rooms in search of ways to improve medical care for Camden's sickest and poorest residents, while at the same time reducing wasted healthcare spending. On Tuesday, Cooper University Hospital, where Brenner heads the urban health institute, won a prestigious $2.8 million federal grant that will allow the coalition to expand -- and get the chance to prove whether it has found an antidote for the relentless rise in healthcare costs.
The Center for Medicare and Medicare Services received 2,000 applications for its Health Care Innovation Awards, announcing the first round of 26 grants yesterday. Cooper was the only New Jersey winner.
CMS will award another round of grants in June, and said it has not yet decided how many it will bestow all told.
Right now the coalition has about a dozen staff who are piloting new ways of caring for the most difficult and sickest patients in Camden, people who cycle in and out of hospitals and emergency rooms and rack up hundreds of thousands of dollars in Medicaid, Medicare, and charity care bills.
The three-year grant from CMS will let the coalition hire 14 people and "finally give us enough funding and enough staff in the field to really be able to show a change at the community level," Brenner said.
The coalition's approach is very much hands on. To figure out why some Camden residents spend several weeks or months in a hospital bed, the coalition staff gets to know them very well. Brenner explained: "We try to show up at the patient's bedside the same day they are admitted. We follow them in the hospital and take part in the discharge planning."
After the patient goes home, "We show up at their house within 24 hours and we go with them to their primary care physician within a week [of discharge]," explained Brenner. "There is a lot of handholding, patient education, making appointments, setting up transportation."
With the CMS grant, Brenner said "We will extend our outreach team, hire more nurses, more coaches, more social workers." Over the next three years, he expects to work with 1,200 of Camden's sickest and most expensive patients. The goal is to save $6.2 million in health care spending over that time.
Brenner said that since the coalition began 10 years ago, it has been able to reduce overspending on hospital and emergency room care for the patients it reached. But the coalition has been too small to make an overall dent in healthcare spending in Camden. Brenner said inpatient and emergency room care at the city's three hospitals totals about $100 million a year, and is rising about 3 percent a year.
The CMS grant, according to Brenner, will give the coalition the heft to demonstrate whether it can bend the cost curve. The stakes are very high. "If we don't reduce costs and increase quality in a demonstrable way in the next two to three years, we won't be here -- or we will be a much, much smaller, narrowly focused organization."
Joel Cantor, director of the Rutgers Center for State Health Policy, said "This grant underscores the importance of the work of the Camden Coalition of Healthcare Providers. It will allow a full-scale test of CCHP's strategy for reducing cost while making care better for some of the most poorly served people in the healthcare system."
For David Knowlton, president of the New Jersey Health Care Quality Institute, the grant is an affirmation of the Camden coalition. "They are really the pioneers here, and sometimes what happens is the pioneers aren't the ones who get the opportunities going forward. It is really rewarding after all the work [Brenner] has done." Knowlton added that "It is also brilliant on CMS's part," because expanding the work of the coalition "is going to save the taxpayers a lot of money."
If Brenner can reduce healthcare costs in Camden, he will save money for the state of New Jersey, whose taxpayers fund 50 percent of the state's Medicaid budget. The state Department of Human Services, which oversees Medicaid, said it "congratulates Cooper University Hospital and Dr. Brenner for this funding. This is a wonderful honor for him."
Brenner said the CMS grant will help support Camden's primary care practices, which he observed have become increasingly stressed.
"The city's primary care infrastructure has gotten weaker and shrunk. Some have closed down. This grant will allow us to partner with the primary care practices and help them do their job." He said over the next ten years, Camden and the nation must rebalance the health care system and build up primary care. "If we don't take care of people in the community, they end up in the hospital."
Brenner said the grant will "help us partner with the local primary care practices in Camden and bring staffing and infrastructure to ensure that every one of their patients that gets hospitalized gets connected back to their office and has a healing, long-term relationship with that office. We will be able to make sure that Camden residents who are hospitalized get pulled back into their primary care office and get that long-term, human relationship sustained, so they don't have to go back to the hospital to get their needs met."