November 28, 2011 Dylan Ratigan

Greedy Bastards Antidote: Dr. Jeffrey Brenner and Hot-Spotting Healthcare

Is there a problem with the way we solve social problems in America?  More often than not, our problems in government and society can be traced back to behavior we call “Greedy Bastardism” — decisions that seek to exploit lack of shared visibility and breach personal and group integrity to get what one group wants over what another group needs.   On the other side, there are those out there who we consider to be the “scientists” fighting Greedy Bastardism in America — those who are finding the “Antidotes.”  Over the next few weeks, we’ll be discussing creative methods of problem solving that can help pull our country out of the mess that we’re currently mired in.

The first is called hot-spotting.  Hot-spotting was originally used in criminal justice in New York City when William Bratton, the city’s former police commissioner, revolutionized urban policing by using data to map when and where crimes took place, and then sending extra officers to the areas where crimes were committed most often.  By putting extra resources to areas with the highest crime rates, Bratton found it was possible to lower crime across New York.

This is hot-spotting: a problem solving technique that targets the most expensive problems or in-need people by allocating resources to specific problem areas as revealed by data.

Let’s take a health care example.  Imagine if you could identify a small number of patients who end up eating up most health care dollars.  Let’s say you could focus resources just on them, improve their health outcomes,while also cutting the overall amount of health care spending dramatically.  This wouldn’t be a question of how much, but how.  This isn’t fiction, it comes from Camden, New Jersey, one of the poorest cities in the country.  And the technique is known as hotspotting, or targeting resources to needs.

A remarkable physician, Dr. Jeffrey Brenner, is Founder and Executive Director of the Camden Coalition of Healthcare Providers.  He figured out that the sickest patients in Camden were returning repeatedly to the emergency room, costing the health care system enormous sums of money.  Because they were always seeing specialists or coming to the ER, they had no real advocate overseeing their health.  The health care system was fragmented and passive, and so it failed to deliver care where it was needed even though it cost huge sums of money.

“So one of the problems in lots of fields, whether it be education, in policing, or in healthcare, is that that we don’t strategically allocate resources, that when a patient begins to feel overwhelmed, when their illnesses are overwhelming them, they are scared, they are frightened, we have a really passive healthcare system,” Dr. Brenner explains. “Doctors don’t wake up every day and think, “Which of my patients are having a hard time today?  How do I deploy staff out to find those patients and take good care of them?”  We are very reactive.  We prefer patients to come to us and often when they come to us, it’s sort of too late, or it’s pretty far down the trajectory,” says Dr. Brenner.

Brenner told me of one older diabetic patient who kept getting sick.  Brenner sent a community outreach team to his home to see what the problems were. As they asked the man to show them his his routine, the team realized he was sight impaired.  So he would put a syringe into his bottle of insulin to draw medicine, but instead it would draw in 50 cc’s of air.  That’s why he kept getting sick, there was no complicated medical issue here, he didn’t need to see another expensive specialist. The guy just needed glasses!

This process, of sending a team to one sick patient’s home to see what was going on saved money for all of us and improved health outcomes.

This is hotspotting.

Dr. Brenner believes that this community-based healthcare is the way to go for fixing our medical system. To solve the catastrophe of our ever-increasing healthcare costs, he believes that “we are going to need to de-institutionalize medical care.  We are going to need to take all of this money and resource that we’ve applied to intensive care units in hospitals, and build the system on the outpatient side in the community to begin taking care of people better, which is going to create all kinds of new jobs and its going to eliminate some old jobs.  And we probably need fewer hospitals beds, fewer specialists, we are going to need some of that and the money that we are spending on those things are going to be spend out on the community for primary care providers, community health workers, patient navigators, for care assistance, and a whole different kind of delivery system.

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