Recently I attended the 2011 Collaborative Family Health Association conference in Philadelphia with my colleague Dr. Lynda Frost. The annual conference focuses on integrated health care, an area of particular interest to the foundation. At the conference, we learned about exciting innovations in clinical practice, operations and financing from organizations implementing integration in their communities.
I was particularly inspired by Thursday evening’s keynote speaker, Dr. Jeffrey Brenner, the physician whose work was profiled in the New Yorker’s January 2011 provocative article “The Hot Spotters” by Atul Gawande. Dr. Brenner studied utilization patterns of hospital care in Camden, N.J. He created color-coded block-by-block city maps and gained access to medical billing records to help him identify the city’s “hot spots” – areas defined by disproportionate ambulance calls and health costs per resident.
Dr. Brenner found that between January 2002 and June 2008, approximately 900 people in two buildings in north Camden accounted for more than 4,000 hospital visits and about $200 million in health care bills. He discovered that one percent of patients account for a third of the city’s medical costs. One resident had 324 hospital admissions in five years. Another resident cost insurers a total of $3.5 million during that time.
This was astounding! Dr. Brenner decided to take action, beginning with the residents whose conditions were the longest-lasting and most difficult to treat. He implemented an integrated health care team approach to intervene and improve their health conditions. He worked with local stakeholders to establish a community coalition that would collaborate with and provide support to the team and the residents they serve. Overall, through Dr. Brenner’s leadership, his team has been incredibly successful. The net savings are undoubtedly an improvement over the $200 million previously expended and are almost certainly revolutionary in the health care industry.
Dr. Brenner has shown that one person can make a difference. He and his team are out there on the streets of Camden, doing innovative outreach and engagement. They are demonstrating the possibilities of a new approach to health care: to look for the most expensive patients in the system, then direct resources and brainpower toward helping them. This approach is being replicated in many communities across America. Health care providers and the health care industry are becoming hot spotters…and trying to make a difference.
I believe the phenomenon in Camden is typical of the health care system in many communities throughout the country. Think of the people in your community who aren’t getting the health care services they need. Think of the costs to the health care system of their untreated or unmanaged physical and mental health conditions. What if we all became hot spotters and agents of change? Could we truly impact the health care system in a profound way that results in improved health outcomes? After hearing Dr. Brenner speak about his experiences, I believe we could.