It's National Primary Care Week, and today we're celebrating one of our primary care heroes. We always knew Dr. Jeff Brenner was a genius, and now The MacArthur Foundation is putting their money on it.
By Sonya Collins
“You’re too smart for primary care.” Every primary care provider in training has heard it before. But Jeffrey Brenner, primary care physician in Camden, NJ, has just proven that there is no ceiling for intellect in this profession. He’s been named a “genius.”
Last month, the 44-year-old founder and executive director of Camden Coalition of Healthcare Providers won a prestigious MacArthur Fellowship, also known as “The Genius Grant,” in the amount of $625,000 that he can spend however he pleases. The award is recognition for his innovative “hot spotting” model of care, which identifies the sickest and most expensive patients in the health care system and makes targeted interventions in order to stop medical complications before they occur to avoid unnecessary ER visits and hospital admissions and drastically lower health care costs.
“Innovation is mostly twisting up a lot of good ideas that already exist,” Brenner says of this model of care.
Brenner got one of those good ideas from William Bratton, former NYPD commissioner. Bratton took over the police department when both its budget and workforce were shrinking dramatically. Brenner, as a member of the primary care workforce, was no stranger to the realities of shrinking funding and personnel. Bratton’s solution in the police force was to create a database, called CompStat, which would identify major crime hot spots where he could focus the PD’s limited resources.
“I thought, ‘Gee, all that stuff applies to health care, too,” Brenner says.
Police Commissioner Bratton’s strategy brought about a 17 percent overall drop in crime and a 39 percent drop in felonies. Murders plummeted by 50 percent and theft by 35 percent. By the end of Bratton’s two-year stint with NYPD in 1996, there were 200,000 fewer victims a year than there had been just six years earlier.
Borrowing Bratton’s idea, Brenner, too, created a database that would identify the patients who themselves were hot spots of chronic illness, potential social issues, and high medical costs, and he formed the Camden Coalition of Healthcare Providers to focus their efforts on those patients.
As for how to intervene with these patients, Brenner borrowed from two existing models of care that had helped keep two groups of notoriously high-risk patients, the elderly and the mentally ill, out of hospitals. In those two models, health professionals follow patients closely to make sure patients’ needs are continually met so that they can stay in their homes and communities rather than hospital rooms.
“Once again I said, ‘Gee, this is what our high-utilizers in Camden need.’ They need a multidisciplinary, proactive model that’s outreach and community-based,” Brenner says. “It’s good old-fashioned talking to people and making sure that they’re getting their needs met before they need to go to the hospital.”
Brenner’s strategy brings together government, community and religious leaders, doctors in community-based private practices, front-line hospital staff, and social workers to deliver comprehensive preventive and primary care through home visits and care coordination.
“We don’t need more primary care doctors, we don’t need more specialists. We need the doctors to get out of the way and work on teams to back up and support the most brilliant and talented nurses, social workers, community health workers.”
Brenner was completely shocked to win a Genius Grant for his work. No one applies for a MacArthur Fellowship. The grants are given to people who “show exceptional creativity in their work and prospect for more,” according to the foundation. When fellows receive a call that tells them they’ve won the award, they have no idea how or by whom they were nominated.
“You get a completely random phone call in the middle of your work day. The president of the foundation called in the midst of a crazy day and said, ‘I’m from the MacArthur Foundation, have you heard of us? I’m calling with good news,’” Brenner recalls. “It’s hard to go back to the rest of your day because they swear you to secrecy for three weeks until they make it public.”
An indicator of the state of primary care, Brenner will use a portion of the grant to pay off a business loan on his former practice, Camden Family Medicine, which he opened in 2003 and has since boarded up.
“I ambitiously opened a Medicaid primary care office in the poorest city in the country and kept it open for five years. The payment rates kept getting cut, so my office was boarded up,” he says. Brenner could have kept his office open if he’d stopped accepting Medicaid.
“The idea of having a primary care office in the poorest city in the country and not accepting Medicaid – that’s the kind of decision doctors have to make all the time. Very few doctors want to accept Medicaid. Not because we don’t like to take care of the patients, but because we can’t afford to.”
Brenner will be able to dedicate the remainder of the grant to the work that earned the MacArthur Foundation’s recognition in the first place. He is currently working with ten communities across the country to develop similar models of care, but he insists that anyone can hot spot.
“If you’re a med student up on the floors, find the person who’s been there the most this year, been admitted over and over and over. Go into the room, sit down and just get to know them. Find out who they are, how they got to this point, what some of their challenges are, what their life is like.”
Brenner’s “Ten Easy Steps to Hot Spotting” will soon be available on this site.
While Brenner points to a culture and health care system that don’t value primary care to explain the demise of his Medicaid clinic, he says that the MacArthur Foundation’s naming him a genius may point to a changing tide.
“People said I was pretty stupid to go into primary care and then live in Camden and practice in a small three-exam-room office. It was the most exciting thing I could with my life. I’m so glad I made the decisions that I made. I did it because I was doing what I love to do.”