December 4, 2012

Health care expert lauds Maine's management of frequent hospital users

By Susan M. Cover
State House Bureau

AUGUSTA -- Maine is at the forefront in trying to improve health care for the patients who make multiple trips to the hospital and drive up costs for everyone else, a national health care expert said Tuesday.

click image to enlarge

Jeffrey Brenner

Photo courtesy Robert Wood Johnson Medical School

Jeffrey Brenner, director of the Institute of Urban Health at Cooper Hospital in Camden, N.J., spoke to dozens of Maine health care providers during a meeting at MaineGeneral's Harold Alfond Center for Cancer Care.

"Maine is on the cutting edge of trying to figure this out," he said. "There's a real sense of collaboration and teamwork in Maine."

Brenner is a nationally recognized expert for his work in New Jersey to gather reams of data about health care spending and to pinpoint the high-cost patients. He founded the Camden Coalition of Healthcare Providers in 2003 to improve the quality and accessibility of health care, and was featured in a 2011 story in The New Yorker magazine that highlighted his approach to providing personal care to the poorest and sickest in his community.

In Maine, similar efforts to improve the quality of health care began in 2009 with the creation of Patient Centered Medical Homes and the addition of Community Care Teams in 2010, said Kellie Miller, spokeswoman for Maine Quality Counts.

MaineGeneral Health began a pilot project with five primary care physicians in 2010 to help the identify and treat the "super-utilizers" who often have multiple health problems that are difficult to address, said Barbara Crowley, executive vice-president of MaineGeneral Health and MaineGeneral Medical Center.

"It is our intention to bend the cost curve," she said.

Five physician practices will be added next year as the program expands, she said.

MaineGeneral was chosen earlier this year to work directly with Brenner and his team to improve the program, thanks to a $200,000 grant from the Robert Wood Johnson Foundation.

Brenner cautioned that it will take time to see costs drop. Nationally, health care costs are the major driver of the federal deficit and the health care industry has little incentive to reduce costs, he said.

"The revenue driver for health care is more utilization," he said. "There's no business model for doing the right thing."

Another difficulty is that every case is different. Brenner's group sends staff to patients' homes to see why they cannot manage their medication, if they are monitoring their diabetes or other ongoing health issues, and whether they would benefit from substance abuse programs or a visit from local clergy.

Brenner said his programs seem to have a better chance of success in rural states such as Maine, where there's less dependence on health care as an economic driver and less competition between hospitals.

"The ethic of a rural community is not to waste," he said.

Susan Cover -- 621-5643

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