Keeping People Healthy and Out of Hospital

Yesterday a report released by the AHRQ revealed that 1 percent of Americans were responsible for about 22 percent of healthcare costs and 5 percent spent 55 percent of costs. No surprises here. We’ve known for years that only a small portion of Americans use most of the healthcare services. These are the poorest and sickest among us-those left behind and forgotten about. Treated and discharged from hospitals with no follow-up plan until the next emergency brings them back to hospital. Many of these folks spend more time in the hospital than at home. Instead of spending more money on “studies” let’s focus our efforts on keeping the sickest among us healthy.

Last year Atul Gawande wrote an article in the New Yorker which described work done by a primary care doc in New Jersey, Dr. Brenner, who decided to try to do something about the high costs of healthcare. Dr. Brenner mapped out the spots in Camden which had the highest healthcare costs (and sickest people). Like the study mentioned above, he found that 1 percent of the population of Camden was accountable for 33 percent of  healthcare costs. Dr. Brenner mapped the sickest (and most expensive) folks to just one nursing home and one low income housing project!

He found that between January of 2002 and June of 2008 some nine hundred people in the two buildings accounted for more than 4,000 hospital visits and about $200 million dollars in healthcare bills. One patient had three hundred and twenty-four admissions in five years! The most expensive patient cost insurers $3.5 million (by insurers, I mean you and I). Holy crap! However, instead of merely reporting the data and being finished with it, Dr. Brenner took it upon himself to try to do something to help these people.

Basically, he found if he spent time with the neediest patients helping them to understand and manage their diseases, their health improved dramatically-which saved mucho $$$$. In May, 2009, Brenner closed his regular medical practice to focus on the program, now called the Camden Coalition, full time.

The Camden Coalition has been able to measure its long-term effect on its first thirty-six “super-utilizers”. These folks averaged sixty-two hospital and E.R. visits per month before joining the program and thirty-seven visits after—a 40-percent reduction. Their hospital bills averaged $1.2 million per month before and just over half a million after—a 56 percent reduction. This is truly amazing!

So, instead of spending more $$$ on studies let’s expand what Dr. Brenner has done in Camden to all of our urban areas. Let’s map out medical the hot spots and put a real emphasis on keeping people healthy and out of hospital. This would be a good way to spend our money.


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