Accountable Care — done the hard way

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Dr. Jeffrey C. Brenner, family doctor, is a 2013 fellow of the MacArthur Foundation.  He was awarded the distinguished position with a simple observation that medicine needs to be industrialized, meaning  standardized and protocolized.  He observed that physicians “try to do it all” when”they should be handing off less complex patients to clinical team members”.

His success was reported by Mary Ellen Schneider “Coalition Brings Health Care To N.J. City’s Neediest” in the October 15, 2013 edition of Internal Medicine News.  His accomplishments in Camden, N.J. are remarkable.

He managed to reduce repeat hospitalizations for patients with very difficult social situations.   Hospitals were loosing Medicare payments due to rehospitalizations so he convinced the hospitals, social services and outpatient doctors to be accountable for outpatients.  In essence, he built an accountable care organization the hard way.  No overarching organization, no mandated cooperation,  just the presence of an idea and protocols.

Could this happen elsewhere?  Probably not since Dr. Brenner does not have a twin brother.   But, he recognized the problem when 90% of hospital cost is due to 20% of patients.  He endeavored to treat that 20% more intently as outpatients with the benefit of hospital financial resources, nurses, social workers, physicians  and organizational know-how.  And, it worked.

Dr. Brenner attributes success to his organization (Camden Coalition of Healthcare Providers) making outpatient treatment more of a team effort guided by hospital data.  Past failure seems to be the lack of system thinking.  Primary care doctors  expect patients to seek outpatient help by walking through the office door.  Patients who do not walk through that door fail to receive medicines or social service help.  And, usually there is no money made by changing the approach.

Industrialization sounds mechanical and uncaring.  But, the approach in Camden was just the opposite.  Procedures, rules, data and delegated care lead to more caring and less illness.   Accountable care organizations have the same incentive and the same goals.  Hopefully, under the name ACO they can do as well as Dr. Brenner elsewhere in America.

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