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‘Genius Grant’ Winner Offers Stinging Critique of NJ Healthcare Delivery

ACOs and other new models can make the delivery of healthcare more sensible, Brenner argued, illustrating that point by not how poorer states have managed to make strides in improving health outcomes.

“Many have large, integrated delivery models where hospitals own doctors’ (practices) or you have very large doctors groups that have joined together into large integrated delivery systems -- they deliver more effective care, higher quality care and lower cost care,” Brenner said.

“In New Jersey we’re so far away from that,” he added, because the state has more small practices and more doctors who are specialists.

Brenner compared the coming changes in healthcare to those made by carmakers in the early part of the 20th century.

Car designers and engineers could do more high-level work when cars were no longer made in small shops but were built in factories, while front-line factory workers began to have more input due to the production system developed by Toyota.

In healthcare using the ACO model, primary-care doctors can delegate 95 percent of the routine work that they currently do, allowing other healthcare workers to engage in tasks like reading normal results from routine lab tests.

“An ACO really is about industrializing the healthcare system, standardizing , protocolizing, innovating, delivering more services at a lower cost and making sure that those services are available at a high quality for everyone every day,” Brenner said, adding that it will be a long and difficult transition for providers who are unwilling to apply new approaches.

Brenner said the success of these efforts depends on being able to use data effectively, redesigning each healthcare worker’s role, and engaging more with patients, the community and the various healthcare stakeholders.

Patient data – particularly records for the small percentage of patients who account for a large share of inpatient hospital admissions – should be used by nurses to coordinate targeted visits, much like marketers who mail advertising based on consumer data, Brenner said.

In the absence of this coordinated care, there are cases like one patient Brenner encountered who had received 73 CT scans of her head. This potentially dangerous exposure to radiation may have occurred because the patient wasn’t receiving coordinated care, despite having made a series of trips to hospitals in the same system.

Brenner said the patient’s problems were rooted in anxiety, and that care coordination provided by the Camden Coalition of Healthcare Providers led to more effective treatment that reduced the patient’s pattern of frequent hospital use.

Brenner said several programs are taking a similar approach – providing coordinated care to a specific “market segment” of patients.

He’s aiming to draw attention to the work of those groups through a new organization, the Good Care Collaborative.

Dr. Kevin Mange, vice president and chief medical officer for Barnabas Health Medical Group, said the data used to improve healthcare delivery must extend beyond the insurance claims for healthcare services to include other information gathered by providers both inside and outside of hospitals.

Mange said the delivery system should no longer be conceived as being based on a one patient-to-one doctor ratio, but instead on a patient having a team of healthcare professionals, including a doctor, a nurse, a nurse practitioner, a behavioral health specialist, a pharmacist, a social worker and community organizations.

Dr. Douglas Ratner, chairman of Jersey City Medical Center’s Department of Medicine, said there are many ways that providers can innovate in how they provide patient care. He cited hospital programs that reduce the number of in-person visits with doctors, as well as improving the use of palliative care, which concentrates on treating patients’ symptoms rather than curing advanced diseases.

Wardell Sanders, president and CEO of the New Jersey Association of Health Plans, said insurers also are working on innovative approaches using data to provide more efficient care.

“We’re going to see successes, we’re going to see failures – we shouldn’t be afraid to fail” in order to achieve lasting success, Sanders said.

Conaway added that healthcare providers are in a challenging position when negotiating contracts with insurers. He said that hospitals like Bayonne Medical Center – which charged Medicare the most of any hospital in the country – were in a difficult position. If insurers offer to reimburse hospitals like Bayonne at a level that is so low that they consider closing, these hospitals may sell to for-profit operators that then cancel insurance contracts, Conaway said.

Conaway cautioned that despite the promise of ACOs, there is also a risk of introducing additional bureaucracy.

“We probably ought to be wary of increasing administration in the provision of care,” he said.

Brenner took some controversial stands, saying in response to one question about safety-net hospital funding that the state “cannot let safety-net hospitals and clinics fall apart,” but then adding that a city like Newark only needs “one great hospital” rather than the three that it currently has.

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