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."