In 2009, Camden, New Jersey was listed the most dangerous city in America by CQ Press survey. And despite the FBI-compiled crime data and negative perception associated, I view them as thee progressive model for improving quality of care and cutting healthcare costs. Thanks to the Camden Coalition of Healthcare Providers, you should too.
Earlier this year, PBS FRONTLINE correspondent Atul Gawande delivered the story, “Doctor Hotspot,” about Dr. Jeffrey Brenner. A local Camden physician, Dr. Brenner created a model to address the issue of high-cost patients over utilizing the emergency department. Under-insured or uninsured patients receive insufficient coordinated care that they cannot afford and society is burdened with the leftover costs, leading to a double negative.
Inspired by a traumatic neighborhood experience, Dr. Brenner soon devised a plan to statistically map out neighborhoods with high crime rates and the most costly medical patients. The results were astonishing. 1% of the city population accounted for 30% of the total healthcare costs. With this data, Dr. Brenner created colored cost data graphs and maps of the city to locate “hotspots” for high health costs. These would be the areas he would focus on.
To offer some perspective, Camden had 12,000 ER visits for non-emergent issues such as head colds, ear infections, sore throat, asthma, and stomach viruses. To start, Dr. Brenner only asked for the highest-cost patient referrals from the emergency department. Establishing relationships outside the hospital, he developed a high degree of acuity to the level of complexity of each individual. Soon thereafter, Dr. Brenner founded the Camden Coalition of Healthcare Providers. The Coalition now provides in-home organized care for 300 of the highest-cost patients within the city.
Implementing such system into a larger metropolis will be challenging. Replacing a competent and passionate advocate such as Dr. Brenner will be difficult, but we the have responsibility to at least try. At Camden, this approach has revolutionized the coordination of care to a small subset of the most frequent ED patients who cost $10 million a year. Although comprehensive and time consuming, one cannot ignore the legitimacy of hotspot mapping and statistical analysis. Various hospitals and communities have implemented programs to address the concerns of high-cost patients, including Massachusetts General Hospital and Atlantic City Special Care Center.
The current healthcare system is unsustainable. The ED is not equipped nor designed to handle patients who could be treated at a primary care clinic too. As Dr. Brenner so eloquently states, “It’s like arriving at a major construction project with nothing but a screw driver and a crane.” We must explore and expand on all options that show significant gains. And by the way, preliminary results show 40-50% decrease in hospital visits and costs for the patients served by Camden Coalition of Healthcare Providers. I would say at the very least, it is worth looking into.
Andrew G. Mychkovsky is a Healthcare Consulting Intern at Blue Cottage Consulting.
Tags: Atlantic City Special Care Center, Camden, Camden Coalition of Healthcare Providers, CQ Press, Doctor Hotspot, Dr. Jeffrey Brenner, high-cost patients, hotspots, Massachusetts General Hospital, New Jersey, PBS Frontline
