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Camden New Jersey sits in the Shadow of Philadelphia. It's a city that seems in a constant state of Peril
Poverty here is rife
unemployment, it's double the National average
Public institutions are in crisis or like the local library simply shuttered
It's officially one of America's most dangerous cities
But Camden may also be the city to help solve one of America's most intractable problems lowering the cost of Health [care]
As a doctor and writer for [the] new Yorker [I] came here to meet the local physician who began to figure it out
It all started 10 years ago with a shooting I
Was working my house one evening heard gunshots
Then got a call from a neighbor, so I went running down the street the police had gotten there already
So I ran up and said you know I'm a physician
where's the Victim and
And they all sort of turned around instead. He's over there
He was laying on [a] side facing the back tire and he had a pulse he wasn't breathing started rescue breathing
eventually his pulse stops
so I was just
Pretty overwhelmed by the whole [thing] and angry and you were angry that they hadn't been even tending to the victim
You [know] I said, why didn't you guys?
help him and
The police officer said [we] didn't want to dislodge the bullet. [I] mean it was just it's a complete blow off and I
Couldn't imagine
How we could have reached the point in our society in the city where you would just leave a victim lying there in their own
blood
He was a rutgers student and he was close to graduating
You know he was one of the the [wonder] kids that make it out of urban communities and here
He was [just] about to make it out
Brenner's immediate response was to get involved in police reform
He thought if he could get a hold of crime statistics. He could map hotspots the places where good policing would make a difference
But the department wasn't interested in helping a local doctor
So he went to another place when he knew well
the Hospital
They're buried in billing records from the Er. Where violent assaults get treated he found crime patterns as
He crunched the hospital Data Brenner discovered something totally unexpected
other kinds of hot spots
It became clear that there were hot spots of everything there were hot spots by disease
Hot spots bite by patient there were certain patients, who'd been over and over and over?
Going to the emergency room in hospital too much there were hot spots by zip code and by neighborhood
And so you sit and begin to look through the data
And I'm looking at my patients who are in the data and realizing. I had no idea how much [healthcare] cost
I had no idea how expensive it was and it was just shocking
Brenner says the numbers showed that 1% of people living in Camden
accounted for 30% of hospital charges
Most of those racked up in the emergency room
So you're compiling all of this?
Information coming from all of the hospitals in the local area compiling massive amounts of data so a fully render then turned that raw information
Into visual information, so this is a map [of] the city of Camden and this is looking at cost data
So the red areas are high-cost hotspots these are parts of the community where people who have more than a million dollars in
Payments to the Hospitals live and this is over a five and a [half] year period So here you pulled out the two most expensive
City blocks yep, but you found in your community there are two buildings
That's right
That are the most expensive places that's exactly right
So the the building on the bottom abigail house is a nursing home
And the top one North gate [to] is an apartment tower of with elderly and disabled people
83 million Dollars in bills that's right high more than the cost of the building yes, yep
This being America where we all demand the best that medicine can offer
You might assume that at least for the money the residents were getting good care
But brenner found the majority [of] the care for chronic diseases from [Asthma] to cancer to diabetes
Was being done in the Er. Not a good place to treat chronically ill patients
Treatment was not coordinated follow-ups were not part of the plan
It was really obvious in the data that the most expensive people were getting terrible care
And I knew them so I'd walk in the exam room and say Mrs., Rodriguez
I haven't seen you in three months where you've been well
I've been in the Icu for a month and a half I've been in the hospital for another couple of weeks
And I said well what happened, and she'd say well. I'm not really sure a lot of doctors came in the room
they never really explained anything to me, but I've got this whole bag of [medicine], so
American [Healthcare] doesn't do a good job taking care of sick people
The way we built our system is really a system. That's very hard to access
It works well for the average patient
but if you are blind if you're deaf if you're disabled if you're in a wheelchair if you don't
speak the language if your development delayed if you have a
Complex mix of illnesses with many providers involved the whole system starts to break down
Brenner's big insight was to use his data to target the sickest and most expensive patients in the city in
2007 Supported by small Grants from Foundations
He put together his team of medical hot spotters. Hey, Angela
It's Kathy Jackson giving a call from the coalition was what if you had a chance to do your blood glucose logs?
The most visible part of the Camden coalition of [healthcare] providers are these nurses social workers and medical assistants?
According to show he was really going all over the state and where every three years later
His team of troubleshooters has sought out an organized care for more than 300 people
Yeah
Make sure we have transportation that's going to be able to accommodate a disability when I visited Cathy Jackson was making a house call
to one of her most challenging patients
Derek
Do give me the briefing on Derek because I haven't met him to the darks in his 30s
He has seizure disorder, and then his other problem which gets him in the house for Mr.. Time is asthma
It's always an issue. He's always wheezing and the house isn't it's dirty disgusting
the roaches all kinds of all kinds [of] triggers, so we took a
contractor there and a contractor said that he
Really wouldn't want to be liable to fix it up because he's afraid it would actually like a crumble
Hi, Derek. How you doing?
I'm atul Gawande. I'm a doctor from Boston, But also a writer
so Derek you've had a number of
Hospital stays [and] emergency room visits because of asthma [I] hear all right just what happens when you have your asthma attack
when I start wheezing
My lungs are actually
no, it's like a [rubber] [band] it just
closes up like really
Tight and it'll be hard for me to breathe
we think the house probably [part] of it [is] lot of dust with the walls the walls and
Would you mind Derek if I have cathy just show me around the places in the house that she thinks might be?
contributing to your asthma
Yeah, sure okay. I mean great. Just like to see for myself okay. Yeah, where did the waving
Before cathy started working with him Derek was in the emergency room 35 times over six months
Lots of [there], I cannot help your asthma
Cathy's work with derek includes everything from inhalers to insurance to finding a contractor willing to rehab the house
Why don't we just say Derek?
Fix your house. You've got this in that falling apart
his family [probably] lives on about a thousand dollars [a] month, so
They're not really capable. They're barely able to make ends meet
Without the team Derek didn't have enough help with another medical problem
epileptic seizures
What are all the crosses no? That's [this] that helps me. You know in case if I have an epilepsy?
How does that help you know I just start praying. That's all
Have you had any seizures recently no [Helens] have been a week a month a week I?
Feel more comfortable with Cathy Jackson than the doctors and nurses in the hospital
You know I can tell cathy
My problems you [know] wheezing the stuff like that
She checks me out. You know um
[here] my lungs. You know [I] mean talk to me
Oh, he's as always you always have some wheezes, but you're moving [pretty] good air, so that's good
She's the one that keeps me out of the hospital
We're Gonna go back in my mom June 13th, but 11
Under Kathy's care over the last six months Derek's, Er
visits have been reduced from 35 to just - yeah and
Brenner thinks they can do even better if he can get other people from around the city to think like hot spotters
We've formed. This is really a way of beginning to think agency by agency
How we can pull together for the most challenging cases every month the whole City comes together?
Frontline providers social workers, and we do anonymous case discussions at the City level
So when someone [like] Derek shows up at one of the emergency rooms that call us right away actually 2011 here [-] hospitalizations
And not in april and only one since may and so how much has your team been able to lower the cost?
for this really expensive group of patients
So we've seen some preliminary results of forty to fifty percent reductions in visits and cost
We're now forty to fifty percent reduction in costs in cost and visits
The Savings are hard-won and it takes persistence
Mr.. [Harrison's], [Kelley], Indiana from the coalition
You can't completely alter people's life circumstances. We're not going to cure poverty
The question is how can you take the current situation that a patient's in and improve it enough
To make them a little bit healthier and and lower their unnecessary or in hospital use and make them
Have a more productive interaction with the healthcare system
This idea of focusing on the sickest to lower cost for everyone seems to be working here in Camden
But there are hotspots in every community?
What if you took this idea and put it in play across the country?
It might just work
But there's a catch
How would the medical establishment react if suddenly their most expensive and lucrative patients?
Started costing half of what they do now
As this kind of an experiment works though you're talking about?
Dropping the number of hospital visits as a whole you're talking about
Removing people from emergency rooms they could have to shut down floors and beds
[they're] not going to be with you on this are they this kind of work is a game changer
And this is a blockbuster video moment for AMerica's hospitals
What do you mean by a blockbuster video moment, so along comes, Netflix?
and there had to admit a moment when a young executive walked in and said hey, they're starting to rent videos online and
Blockbuster said nah
People like coming to the video store. We're not going to make any change so
disruptive change Comes along
And I think better care for sick people is disruptive change
We have inflated a capacity bubble in our country to
Do expensive [hi-tech] hospital based care?
So what's your ultimate goal here?
So I I'd like Camden to be the first city in the country that bends the cost curve dramatically while improving quality
Because if the poor city in the country can do it it makes the rest of the country look silly