"Doctor Hotspot Demonstrates Just

How Vital Case Managers Are"

By Catherine M. Mullahy, RN, BS, CRRN, CCM

Every now and then, you have an "Aha moment" that is especially gratifying. I had one recently when I had the opportunity to view a compelling news story broadcast on PBS' Frontline and reported by journalist and physician Dr. Atul Gawande. The report centered on Dr. Jeffrey Brenner, a Camden, New Jersey physician, who many believe may be on to providing a solution to one of America's most critical problems - the high cost of healthcare especially as it relates to

Guess what? Dr. Jeffrey Brenner's findings fully support this platform. Aha!!! Here is a dedicated physician who sees the light and is going public with his message. This is a major breakthrough for case managers and professional patient advocates everywhere.

Let me tell you more about "Doctor Hotspot," but I encourage you to view the program directly by following this link: http://www.pbs.org/wgbh/pages/frontline/doctor-hotspot/. You will be truly enlightened and inspired.

Dr. Brenner's home base is Camden, New Jersey. For those of you who may not know, Camden is a city of 79,000 people and among the top three poorest and most dangerous cities in America. There are two hospitals and three emergency rooms. Since crimes are so high, many people are afraid to exercise outdoors, bike, run, etc. In addition, the city is notorious for corruption. To sum up, the environment in Camden places a terrible toll on its residents' health. Gunshots ring out regularly and the casualties follow. Dr. Brenner had a watershed moment when, one evening, he was working from home when a neighbor alerted him to the fact that someone had been shot. Dr. Brenner headed down the street where police cars and flashing lights welcomed him. He identified himself as a doctor and asked where the victim was. He was alarmed to see the police had done nothing to help the victim who lay bleeding on the street. Eventually, an ambulance was called and Dr. Brenner was left angry, asking the police, "Why didn't you guys do anything?" You should know that the victim was someone who was trying to get out of Camden and succeed. He was about to graduate from Rutgers. Incensed by the police's reaction to the shooting and failure to help the victim, Dr. Brenner decided to do something.

His first step was to organize a march to bring awareness to the problem and make the police more accountable. Then, his thoughts turned to identifying "hot spots" for crime. He found that the police did not have good data, so he turned to the hospitals which did have records of people who had been shot, assaulted, injured, etc. From there, he expanded his data base of "hot spots" to include claims data and began to see a pattern.

That pattern was that the greatest claims were coming from the elderly and disabled who were returning to the emergency rooms over and over again. He had discovered what many in the healthcare industry already recognized, but were not addressing. It is that one percent of patients account for 30 percent of costs. Or, very sick or chronically-ill individuals are the most expensive patients who consume the most healthcare resources. Another realization Dr. Brenner had was that, despite the costs associated with treating these patients, the care they were receiving was not very good. High costs, poor care. Sound familiar?

Dr. Brenner realized that one way to help these patients receive better care at a low cost would be to bring the care to them. Another realization he had was that nurse practitioners, community health workers, social workers and case managers can be the "team" that these patients need to advocate for them and make sure they are following their prescribed treatment plans. He came to believe that these patients, in particular, didn't need as many specialists, but needed advocates to help them access better quality care.

We at Mullahy & Associates are very pleased with all the attention Dr. Brenner and his "Doctor Hotspots" program is gaining across the country. Furthermore, we intend to join his team and help further campaign to help this initiative of professional patient advocates for our most complex patients take root in communities nationwide. It is our plan to reach out Dr. Brenner and Dr. Gawande who brought the "Doctor Hotspot" story to light.

I will keep you posted.