Issue link: https://emsworld.epubxp.com/i/336320
CASE STUDY 20 Integrated Healthcare Delivery July 2014 www.ihdelivery.com 20 I t's ironic, but you can understand why those who utilize the healthcare system the most can get the worst care from it. Often they're patients who have chronic and complex conditions but lack primary care. Their lives may be complicated by poverty, addiction and mental illness. They seek care from multiple clinicians in various venues for different reasons. That care is episodic, fragmented and not followed up. Tests and services are repeated, knowledge isn't shared, and limited resources are wasted. These are the superutilizers, and while they can account for a prodigious percentage of your local healthcare costs, their outcomes are often suboptimal precisely because their care is not integrated, coordinated and holistic. That's what really chafed the physicians and others who came to Jeff Brenner's breakfast meetings a decade ago. Healthcare front- liners from around Camden, NJ, they were invited by Brenner, a reform-minded young primary care doc working a hardscrabble part of town, to discuss the challenges they faced delivering care in the decaying city. Camden was and is a rough place. It's reg- ularly among America's most dangerous cities. Around 40% of its residents live below the poverty line, and they have high rates of things like asthma and obesity. Crunching some hospital billing data back then, Brenner found just 1% of the people who used Camden's hos- pitals racked up 30% of their costs. The su- perutilizers were a problem for everyone. As the breakfasts became more popular and their attendees more diverse—coming to include specialists, nurses, PAs, social workers and other health advocates—a consensus de- veloped: The problems everyone found so vexing might better be addressed with a completely dif- ferent, inclusive kind of care, designed from the bottom up and driven by those with the closest perspective: the doctors themselves. The Camden Coalition fnds better ways to care for superutilizers By John Erich, Managing Editor THE BIGGEST USER IHD_20-22_CaseStudy0714.indd 20 6/13/14 11:24 AM