Dan Diamond, Managing Editor
HHS Secretary Kathleen Sebelius oversees a staff of more than 83,000 and is charged with carrying out the nation's health care agenda.
Dr. Jeffrey Brenner, director of the Camden Coalition of Health Care Providers, works with a team of 60 to tackle health care challenges in Camden, N.J.
I don't know if the two have ever met. But their presentations at last week's Care Innovation Summit, delivered about an hour apart, captured two different sides of transformation. The national reforms that Sebelius is implementing, the changes that she wants to see—well, Brenner is working hard to make them real on the ground.
Sebelius: Activating 'lazy data' is the key
In her address, which keynoted the Summit, Sebelius remarked that the industry has undergone rapid transformation in just the past few years. Take electronic health records, the secretary said. In 2009, only 1 in 8 hospitals was using a basic EHR; by 2012, that figure had more than tripled. There's an ongoing shift away from fee-for-service and toward pay-for-outcomes. The health care cost curve continues to bend.
But it's not enough.
When it comes to health care, we "live in a 21st century world with a 20th century delivery system," the secretary said. And "if you were to give our nation a grade on health innovation, at best I'd say we'd get an incomplete," noting that visiting a physician today is little different from 40 years ago. (The only real change in doctors' offices? The dates on the magazines, she joked.)
Sebelius said the federal government can play a key role: Share its data with the public. Especially because so much of that data is "lazy"—it's stored in various databases, far from the providers and entrepreneurs who are dying to make it "active" and use it to transform elements of the health system.
"What we're finding," she said "is if we make data open and accessible, the private and nonprofit sectors use it to start innovating."
For example, one participant in an HHS "Datapalooza" came up with the idea to put a GPS device on an asthma inhaler, which Sebelius said has helped patients better track and manage their asthma.
"It’s been described as “hacking the inhaler” to give patients and their doctors the information they need to control their asthma, she added. No small fix, given that medical expenses associated with asthma have increased to about $56 billion.
That’s why even those kinds of simple innovations, Sebelius argues, can lead to lasting improvements in health care delivery and spending.
Brenner: Making population health real
The Camden Coalition's experience, meanwhile, is the story of a more complex intervention.
In his talk, Brenner—a MacArthur "genius" award winner—discussed how he used hospital billing data to identify the highest cost patients in Camden, N.J., theorizing that they were receiving the worst care.
Working with a small team that's steadily grown over the years, Brenner targets these "super utilizers," builds personal relationships with them, and institutes interventions centered on the patient and designed to keep them out of the hospital.
And it's working. When detailing Camden Coalition's success in the New Yorker, Atul Gawande wrote that the coalition's cohort of patients "averaged 62 hospital and [ED] visits per month before joining the program and 37 after—a 40% reduction," He added, "their hospital bills averaged $1.2 million per month before and just over a half a million after—a 56% reduction."
Brenner stressed that failure is OK, a principle that means his group isn’t afraid to try unique interventions. For example, Camden Coalition identified a subsidized, senior housing building as a "hot spot"—the residents had been racking up more than $1 million a year in hospitalizations and ED visits for about a decade. To better meet the needs of residents, and keep them out of the hospital, the coalition and one of its partners opened a clinic in the apartment building. (The move wasn't a dramatic success story out of the gate, but the in-building clinic is making progress toward the coalition's goals.)
The Camden Coalition story celebrates the power of data—the initial idea stemmed from how New York City police used "hot-spotting" to identify the most crime-ridden areas of their city. Although like Sebelius, Brenner bemoaned the lack of easy-to-use data throughout the health care system.
"Capitalism doesn't fly blind," he ruefully said, "but health care still does."