“I’d just sit there and play with the data for hours,” he says, and the more he played the more he found. For instance, he ran the data on the locations where ambulances picked up patients with fall injuries, and discovered that a single building in central Camden sent more people to the hospital with serious falls—fifty-seven elderly in two years—than any other in the city, resulting in almost three million dollars in health-care bills. “It was just this amazing window into the health-care delivery system,” he says.Upon further study, Brenner, who is far more interested in wellness than healthcare economics, determined that two city blocks in north Camden accounted for 4,000 hospital visits and $200 million in health care bills during a six-year period. His proposed reform, originally dismissed as malarkey, now sounds pretty logical: assemble a group of doctors, nurses, social workers, and therapists (they called themselves the “Camden Coalition)", identify the 1% of patients with the highest bills and greatest medical needs (Brenner calls them “super-utilizers”), and offer them an array of services. These services include home visits.
Today’s Philadelphia Inquirer has an article with a headline that reminded me of Gawande’s article, and not only because of the Camden connection. (Imagine my surprise when Brenner’s name popped up!) A year ago Camden Superintendent Paymon Rouhanifard and his staff identified thirteen students most at risk of not graduating from high school. They assembled a team and piloted a program that directly addressed the “root causes of problems that interfere in the lives of Camden’s students and prevent them from succeeding." And they met with Jeffrey Brenner.
Camden’s program, just like Brenner’s, relies on “hot-spotting” students and providing an array of services, including knocking on front doors. Here’s an example from the article:
The student Rouhanifard worked with was living in an unstable home situation, and was not going to school because he was being bullied. He had missed months of school, but after he transferred to another school and connected with agencies that helped him move in with another relative, he didn't miss another day, Rouhanifard said.It’s too soon to know if this sort of up-close-and-personal intervention will have the same impact as Brenner’s work with high-risk medical patients.
"We're playing the long game," Rouhanifard said last week. "This is as complex as our work gets."
But the results are successful enough that the Camden administration intends to expand the program to include 200 students this year. It’s expensive -- projections are $3 million over the next three years -- and the district is actively searching for private grants and federal funding.
Rouhanifard is a traditional school superintendent who thinks like a reformer, much like Brenner is a regular Jersey doctor who isn’t afraid to dig through data and test innovative strategies. Gawande ends his article by describing "well-organized opposition" to scaling up Brenner’s ideas by lobbyists who represent hospitals that would see reductions in admissions and medical companies and specialists that profit from over-prescription of procedures.
“In the next few years,” Brenner tells Gawande, “ we’re going to have absolutely irrefutable evidence that there are ways to reduce health-care costs, and they are ‘high touch’ and they are at the level of care. We are going to know that, hands down, this is possible.” From that point onward, he said, “it’s a political problem.” The struggle will be to survive the obstruction of lobbies, and the partisan tendency to view success as victory for the other side.
Sounds like education reform to me.