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Thu September 26, 2013
MacArthur Fellow Crunches Data To Streamline Health Care
Originally published on Thu September 26, 2013 1:17 pm
MICHEL MARTIN, HOST:
This is TELL ME MORE from NPR News. I'm Michel Martin. We're talking this week with some of the fellows who've won a coveted MacArthur grant this week. Those are the so-called genius grants that recognize exceptional creativity in a number of fields including the arts and public policy. Yesterday, we spoke with Angela Duckworth. She was recognized for her research on how grit and self-control contribute to educational success.
But we couldn't help but notice that 5 of the 24 winners this year specialize in healthcare or public health. One of those winners is Dr. Jeffrey Brenner. He's a primary care physician who was recognized for his efforts to improve healthcare in Camden, New Jersey. It is one of the poorest cities in America, according to the U.S. Census Bureau. He's the founder and executive director of the Camden Coalition of Healthcare Providers, and he's with us now via Skype from his office. Dr. Brenner, welcome. Congratulations.
JEFFREY BRENNER: Thank you, Michel. It's such a delight to be on your program.
MARTIN: You know, I have to ask where you were and what you were doing when you found out.
BRENNER: I was in the middle of the day and the phone rang, and it was quite a wonderful surprise.
MARTIN: Tell us about your project. I mean, first of all, how does your practice differ from what most people understand as a kind of primary care practice or even a clinical practice?
BRENNER: We're an umbrella organization. We're a citywide nonprofit, and we've rounded up all the stakeholders, including patients, so local hospitals and providers, and we try and get them to work together to build a better healthcare delivery system for patients.
MARTIN: I understand that what kind of started you on this is just looking at the data and realizing that, like, 1 percent of the patients in Camden were responsible for 30 percent of the costs.
BRENNER: That's exactly right, and that's true all over the country. That's true for an employer. If you looked at their employees and their dependents, no matter where you look in healthcare, a small proportion of the patients are responsible for much of the utilization and for much of the cost. But we largely ignore those patients, unless you can cut, scan, zap and hospitalize them.
MARTIN: What's the biggest thing that you do differently?
BRENNER: We've built out real-time data systems so that we know moment by moment who's admitted to the local hospitals, and we go right to the bedside. We build a relationship with the patient. And if you've been 10 times in the last six months - you know, it's a teachable moment - it's a real opportunity for someone to be ready to change. And our nurses then go to their house within 24 hours, go with them to their primary care office and with them to the specialty office. We work very closely with them for about 90 days.
MARTIN: Is there a typical patient who fits this profile, that 1 percent? I mean, I'm sure everybody's story is different, but are there some defining characteristics?
BRENNER: Absolutely. Let me give you an example. We met a 70-year-old patient who was a poorly controlled diabetic going frequently to the local hospitals and emergency rooms. Our teams went out to meet him and wanted to watch him use his insulin. And he set a little bottle down and he put the syringe into the bottle and he drew up 50 cc's of air and went to inject it into his arm. And it turned out he was sight impaired. He couldn't see the syringe.
Then he went to the refrigerator and he pulled out two bags filled with little insulin bottles, and he said, I use my insulin every day but I can't seem to empty the bottles. So the pharmacy kept bringing the medicine. That's really a failure story, and those kind of failures happen every day, all over the country. You know, it's costing us a lot of money. So we need to really rethink how the delivery system works and how we make sure that every patient gets what they need every day from the healthcare system.
MARTIN: So what you're telling me is that he didn't know how to use his medication and that he didn't have anybody to help him. He was basically not helping himself, and in some cases, maybe making himself sick - sicker?
BRENNER: That's right. He was sight impaired. He couldn't see the syringe.
MARTIN: And he didn't have any family to help him or...
BRENNER: That's right. Sometimes people don't have family or they feel embarrassed getting help from their family members. So in many ways, this is a sign of success. We can do incredible things for people now. We can transplant hearts and lungs. We can cure cancer now. We can treat AIDS. That's amazing, but we've made a very complicated healthcare system, and this is not just a story of poverty. This is true for everyone. I bet even in your family you've had situations where the complexity's overwhelming.
MARTIN: I was going to ask you about that. I mean, obviously, one question I have is how is this paid for? Are the existing resources sufficient to take care of this? I guess, I think the premise is that actually you can bring costs down if you use this approach.
BRENNER: We spend 2.8 trillion dollars on health care in America, and we spend twice as much as many other countries. There's more than enough money in the health care system to make sure everyone gets great care every day, but we have one of the most unproductive sectors of the economy. You know, the big answer to the question is there's plenty of money in the health care system for everyone to get great care everyday. The small answer is that in Camden, we're funded right now through an innovation grant. Part of the Affordable Care Act was to fund innovation projects around the country to find out better ways to deliver care at lower costs. So we were fortunate enough to win one of those grants.
MARTIN: And the second question I had is something you actually raised yourself which is, are your techniques things that people who are not low-income, not financially disadvantaged, could benefit from because I'm not sure that people who, you know, who don't have all these metrics are satisfied with their care. I mean, I know that there's sort of dispute about that, but I think it's really clear that one of the problems with our healthcare system is that a lot of people are disgruntled with it. A lot of people don't feel that they're getting good care, even though they're paying a lot of money.
BRENNER: Let me tell you a story of a middle-class woman. We have partners all over the country now doing similar work, and a group of residents in training decided they wanted to learn how to hotspot. And they found a middle-class woman with a master's degree who'd had over 75 CAT scans of the head over a few-year period. And really what was going on was severe anxiety. And they got to know her. They spent a lot of time with her, and she stopped going. She just needed someone to pay attention to her. So we have an amazing system if you need to be cut, scanned, zapped and hospitalized, but we have a very passive healthcare system if you really need someone to pay attention to you and talk to you.
MARTIN: So what are you going to do with the money? I hope a nice bottle of wine is in your future. Or - I don't know, maybe some really expensive running shoes or something. I don't know, whatever it is that you're into. What are you going to do with it?
BRENNER: I had a private Medicaid practice in Camden for a number of years, and if you're looking for a business opportunity, I don't recommend running a Medicaid primary care office in the city of Camden. My rates kept getting cut by state government, so we built bigger hospitals. We built new emergency rooms. We hired more specialists. We bought more scanners in Camden. But all over the city of Camden, offices like mine are boarded up and closed. So I have a business loan partly to pay off. I think we've got a problem in America when primary care offices can't make a living and we're building new wings on hospitals.
MARTIN: So you're going to pay off your loan and then will you be - what are you going to do then? You'll basically be even, or? I guess what I'm wondering is, does this grant make your life better?
BRENNER: You know it does.
MARTIN: Does it make your life better?
BRENNER: I'll tell you why it makes my life better because fixing healthcare in America and fixing healthcare in a place like Camden is one of the hardest things I've ever tried to do. And some days, you beat your head against the wall and, you know, the dent is getting deeper and you wonder if you're ever going to make any progress. And recognition like this really puts wind in our sails and is a vote of confidence that, even on a bad day, we can actually figure this out.
MARTIN: That was a Dr. Jeffrey Brenner. He is one of the 2013 class of MacArthur Fellows, the so-called genius grant. He's been awarded more than $600,000 over five years, recognizing his work in public health in Camden, New Jersey. And we reached him via Skype from his office. Dr. Brenner, thank you so much for joining us.
BRENNER: Thank you. Transcript provided by NPR, Copyright NPR.