Q&A: Jeffrey Brenner, MD, discusses the nation's failing healthcare system
As the founder and executive director of the Camden Coalition of Healthcare Providers and the medical director for the Urban Health Institute at Cooper Hospital – both in Camden, N.J. – Jeffrey Brenner, MD, is on a mission to improve the quality and cost of healthcare delivery in his community. He is particularly focused on ‘super-utilizers,’ the segment of the population that uses a disproportionately high amount of hospital and ER services. Brenner spoke recently with Healthcare Finance News Editor René Letourneau about his research and his views on the nation’s failing healthcare systems.
Q: Can you tell me about your research?
A: As we began to look at the data in Camden, we managed to get hospital claims data from three local hospitals, and there was clearly a subset of patients that were outliers that had very extreme numbers of admissions to the hospital and/or ER visits. We got really curious about these patients and really wanted to understand more about them, what was driving them to go to the ER and hospital and see what we could do about it. We began one patient at a time building an intervention in one of America’s poorest cities. Camden is a very, very poor city.
Q: Did you find any trends among these super-utilizers?
A: I think the biggest trend we found was a trend of complexity and that there wasn’t one simple answer as to why people go to the ER and hospital. People want a nice, pat, easy answer, but the way I would describe it is that there are risk factors to being a high utilizer of the ER and hospital. If you are blind, if you are deaf, if you are in a wheelchair, if you are disabled, if you are older, if you have co-morbidities, if you have a low literacy level, if you don’t have family support, if you don’t have a car, if you are an addict, if you are mentally ill, all these things are compounding risk factors. These things add up and if you’ve got four or five of them, you become a more extreme, high utilizer…. What we have found is driving this is that our healthcare system doesn’t do a good job of meeting the needs of very sick patients. We are really good at cutting, scanning, zapping and hospitalizing sick people. We are not good at talking to them; we are not good at educating them, coordinating care for them. The system doesn’t really meet the needs of these patients.
Q: Is there a greater need for coordinated primary care?