In our annual HealthLeaders 20, we profile individuals who are changing healthcare for the better. Some are longtime industry fixtures; others would clearly be considered outsiders. Some are revered; others would not win many popularity contests. All of them are playing a crucial role in making the healthcare industry better. This is the story of Jeffrey Brenner, MD.
This profile was published in the December, 2013 issue of HealthLeaders magazine.
"Healthcare is incredibly expensive, and we are not getting our money's worth."
Jeffrey Brenner, MD, 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.—one of the poorest communities in the country—became interested in providing primary care to highly complex patients as a medical student working in an inner-city free clinic.
While training alongside a passionate physician and mentor, Brenner says he realized how important it is to take the time to build strong relationships with patients who have complicated barriers to care. "I saw how transformative it was to patients' lives."
Soon after, Brenner began working at a student-run health clinic, and that experience changed the trajectory of his career.
"I loved taking care of complex patients who really need good medical care. … I thought primary care was boring and mundane, but it is actually more complex than any other specialty if you bring science and rigor to it. It was an 'a-ha' moment for me. I was going to get a PhD in neuroscience, but I switched off that and got very interested in the science of healthcare delivery and the science of primary care."
Today, Brenner focuses his work on improving care for patients who use a disproportionately high amount of hospital and emergency services, a group he calls superutilizers.
"Everywhere I have looked, I see the same basic rule of thumb ... a small portion of the population is driving all the healthcare costs. It's a basic law of human systems that a small number of people drive many of the challenges," Brenner says.
By analyzing the medical records from the three major hospitals in Camden from 2002 through 2011, Brenner found that 1% of the city's patients generated 30% of hospital inpatient and emergency room expenses and that 20% of patients were responsible for 90% of inpatient and ER costs.
Brenner says the top reasons for ED visits among all Camden residents include basic, nonacute issues, such as head colds, ear infections, sore throats, headaches, and other nonemergent health concerns. "We are occupying emergency rooms with things that don't need it," he says. "Healthcare is incredibly expensive, and we are not getting our money's worth."
"I think it's a solvable problem, but it is such a multilayered problem," Brenner adds, noting it will take better data, workflows, physician training, and workload delegation to begin to improve care and lower the costs associated with this patient population. "You have to pull on many different levers to fix the problem."
Because the care they receive in the primary care setting is inadequate for the complexity of their health needs, superutilizers ultimately end up in the hospital, the most expensive care setting, Brenner says. He advocates for a new, team-based model for primary care where much of the work physicians currently do is delegated to nurses and health coaches.
"Helping primary care physicians learn a new model is challenging. It requires a lot of delegation and is a much flatter, more collaborative structure. It's a new role that doctors may not be comfortable with." Brenner says. "A lot of the failures in healthcare are not clinical delivery failures. They are project management and operational failures."
Despite the challenges and occasional setbacks he experiences in his work, Brenner says he feels encouraged by the new dialogue that is occurring among healthcare stakeholders with regard to how to improve the system.
"People are having conversations now that I never heard 15 years ago. Hospital administrators, insurance executives, state and federal officials are talking about the cost drivers in healthcare and about what we are doing right, what we are doing wrong, and how to envision a better system. … The world has caught up with the idea that you need to go where the costs are. It's not easy to figure out for one patient, and it's not easy to scale it across millions of patients, but I am very hopeful that we are having the right conversation now."