Atul Gawande’s New Yorker article, “The Hot Spotters," is a fascinating story of health care visionaries creating new solutions to seemingly hopeless problems. He describes unexpected leaders who realize that the most perplexing fact about health care spending in this country is also the most promising opportunity: 5% of people in the U.S. account for 50% of health care costs. At Community Solutions, we see vexing social problems as huge opportunities to set things right. We are inspired by the innovators’ spirit and openness to find solutions in unlikely places. Gawande outlines how Dr. Brenner in Camden N.J. first became involved in a police reform commission, then realized he could use the police’s approach of deploying beat cops to high crime areas to rethink what might solve the riddle of rising health care costs.
Homing In On the “Hot Spots” of High Health Care Costs
So Dr. Brenner collected data and found neighborhoods that were “hot spots” of extremely high health care costs, and he read the dollar amounts as flags that people in those neighborhoods were not getting high-quality care. He talked with emergency room doctors, offering to provide primary care to the people who were hospitalized most frequently. In doing this, he found Camden’s community members with very high medical care costs, and then he did perhaps the most remarkable thing. He listened to each person who came into his care. He found out what people were struggling with: many chronic illnesses at the same time, sometimes with substance abuse or mental health needs, often without the basic necessities for health: decent housing, adequate food, consistent income.
A Country Doctor Approach: Providing Personal, Effective Care
The way Dr. Brenner set to work with each individual looks a lot like a nostalgic vision of the country doctor. Brenner became known to his patients, checking in to see how the treatment worked, making adjustments, looping in specialty doctors to make sure that care plans were safe and consistent. He brought on a skilled and empathic nurse who could see patients in the community, and could even solve issues on the phone, averting crises. In the close relationships that Dr Brenner and Kathy Jackson developed with their patients, people learned how to take their medications, eat better, smoke less, and recognize when to ask for assistance. Together, they were able to identify health needs early, keeping people healthy in the community and dramatically reducing time spent in the hospital. The team tracked costs of their patients who came in with the highest health care price tag, and found they’d managed to cut costs by more than half – all while providing personal, effective care.
Dr. Brenner realized that many of the things that his patients needed to have a chance at health were out there in the community: disability assistance, churches, Alcoholics Anonymous, better housing. A lot of the work was in aligning the existing resources to weave a personalized safety net around each individual.
It Takes Systems Change To Transform Lives of Most Vulnerable
Dr. Brenner’s approach reminds us of our founding principles at Community Solutions: Data can help us to learn who is most in need of our care. Current systems—health care or housing—are not designed to meet the needs of the most vulnerable. Targeting our efforts to the most vulnerable makes sense. And struggling communities can light the path for all of us as they transform their systems and better serve the most vulnerable.
The 100,000 Homes Campaign works with communities to reshape the housing system, turning the first-come, first-served notion on its head. We first recognize who is at risk of death with continued homelessness, then work to re-align the housing and support resources to end homelessness for the most vulnerable first. Many of those vulnerable individuals use the healthcare system in ways that drives up cost without offering the coordinated care they need to be healthy. Together through the Campaign, communities are welcoming into housing their most vulnerable neighbors, realigning the housing and care systems to work well together, and then better serving the whole community as a result.