One doctor in Camden, New Jersey, Jeffrey Brenner, used data to map “hot spots” of health care high-utilizers—one patient had gone to the hospital 113 times in a year—and found a better, cheaper way to treat these costly patients through collaborative care. Brenner’s team was able to reduce hospital visits and costs by 40 to 50 percent.
Locating and focusing on “hot spots” of high-cost patients helped Brenner and his team learn that residents in just two buildings in Camden were high-utilizers: they accounted for nearly $30 million in medical spending. By better coordinating their health care, providing social services, and offering house calls with nurses, his team was able to reduce hospital visits and cut costs in half.
[We] spent $100 million for a city of 79,000 people...We wasted a lot of money. Good doctors at good hospitals go to work every day and deliver disorganized and fragmented care.”
The sickest 5% account for more than half of U.S. health care costs.
To help high-utilizers manage their health care better, Brenner and his collaborators created an outreach team with a nurse practitioner, a social worker, and a health outreach worker, backed up by a family medicine doctor. The team goes to the patient’s home, ER, hospital bed, or street corner—wherever the patient is.
The teams work to stabilize both the medical conditions and the social environment: they help patients apply for government assistance benefits, secure temporary shelter, enroll in medical day programs and coordinate primary and specialty care.
Part of a citywide coalition, the teams meet monthly with reps from all of Camden’s health institutions to present cases, discuss systemic issues, and develop coordinated solutions. “Community involvement underlies their entire approach,” said RWJF senior program officer Susan Mende. RWJF began supporting the work of Brenner and his team in 2005.
The Foundation announces a grant of $2.1 million to six communities in its Aligning Forces for Quality (AF4Q) initiative. Their task: to develop pilot programs to identify patients who make the most frequent hospital visits, and improve the care they receive outside of the hospital.
Learn moreFocusing on the high-utilizers in Medicaid programs—about 5 percent of Medicaid beneficiaries account for more than half of Medicaid spending—presents a significant opportunity for lowering costs, according to this report by the Partnership to Fight Chronic Disease.
On March 29, 2012, the Robert Wood Johnson Foundation held a briefing in Washington, DC to highlight the work of Dr. Brenner. At the briefing, Brenner discussed his work identifying "hot spots" in and beyond New Jersey, and colleagues from Maine and Delaware discussed their local efforts to address high-utilizers. John Lumpkin, senior vice president of the Health Care Group at the Robert Wood Johnson Foundation, moderated.
“In the spring of 2007, [Brenner] held a meeting with a few social workers and emergency-room doctors from hospitals around the city. ’Introduce me to your worst-of-the-worst patients,’ he said. The first person they found for him was a man in his mid-forties [who] had severe congestive heart failure, chronic asthma, uncontrolled diabetes, hypothyroidism, gout, and a history of smoking and alcohol abuse. He weighed five hundred and sixty pounds. In the previous three years, he had spent as much time in hospitals as out.” In January, 2011 Atul Gawande profiled Jeff Brenner in The New Yorker and in a story on Frontline.