Lower Costs Yet Better Care? Funders See a Key in Helping High-Need Patients

More than 10 years ago, Jeffrey Bremmer, a family doctor in Camden, New Jersey, wanted to understand why some of his Medicaid patients seemed to return disproportionately often to the emergency room. ER visits are not only costly, they’re inefficient, putting patients in front of unfamiliar emergency care providers unaware of their life situations or their medical histories, and who iare primarily trained to deal with right-this-minute health crises, rather than to manage chronic or multiple health problems for the long term.  

Brenner eventually found that 20 percent of patients accounted for 80 percent of hospital costs in Camden as a result of such disorganized care. One patient had been to the emergency department 113 times in a single year; another made 324 emergency visits in five years. At the center of the problem was the difficulty of providing care for patients with complex medical and social challenges that had traditionally been considered “nonmedical,” including addiction, housing, transportation, hunger, mental health, and emotional and educational support. 

Concluding that a new approach was needed, in 2002, Brenner established the Camden Coalition of Healthcare Providers, which brought together community doctors, 25 hospitals, frontline hospital staff and social workers in a novel strategy of comprehensive preventive and primary care. The system Brenner devised improved the spread of information and created care management teams consisting of nurses, health coaches, social workers to ensure better long-term healthcare and outcomes.

This was important enough to draw national attention. The MacArthur Foundation recently awarded Bremmer one of its so-called “genius fellowships.” And such patient-centered approaches have become a new field of focus within the healthcare industry.

Of course, these issues of care for patients with complex medical and social problems, with their concussive effect on costs and outcomes, are found everywhere, and are a significant driver of national healthcare costs. Now, a group of big health funders has kicked in a combined $8.7 million to support the Camden Coalition, and drive development of evidence-based research and best practices, and new patient-centered strategies.

AARP, The Atlantic Philanthropies, and the Robert Wood Johnson Foundation (which has been an earlier supporter of Camden Coalition) will bankroll the Camden Coalition’s mission to create a national version of its complex care program, studying ways to improve care for high-need patients who experience poor outcomes despite extreme patterns of hospitalizations or emergency care.

“Across the country, innovators are developing new models of health care delivery that lower costs and improve care for patients who are overwhelmed by the challenges of navigating the complexity of the American health care system,” said Brenner, Camden Coalition’s executive director, in a press release. “By developing a professional home for those who are involved in this rapidly growing field, we hope to bring disparate efforts together to improve the research base, share emerging ideas, and inspire the next generation of health care providers.”