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Atul Gawande has put faces on the Accountable Care Organization potential. He is the author who put a face on Medicare spending in his documentation of the differences between doctors in McAllen Texas and Grand Junction Colorado which I wrote about here. In this months New Yorker he writes of primary care intervention in Camden New Jersey making a difference in an article entitled “The Hot Spotters.”

He first interviews a Family Physician named Jeffery Brenner who has devoted his professional career to trying to determine why folks who utilize a lot of health care do so and figuring out what can lessen costs. He figured out quickly that

“People are people, and they get into situations they don’t necessarily plan on. My philosophy about primary care is that the only person who has changed anyone’s life is their mother. The reason is that she cares about them, and she says the same simple thing over and over and over.”

In other words, for a lot of people, a caring health care professional (coupled with knowledge of resources brought in by other professionals) was often (50% of the time) sufficient to dramatically reduce emergency room visits and hospitalizations

“High-utilizer work is about building relationships with people who are in crisis,” Brenner said. “The ones you build a relationship with, you can change behavior. Half we can build a relationship with. Half we can’t.”
The outcomes are impressive. When the first thirty-six super-utilizers from another group using the same techniques were studied in depth, they averaged sixty-two hospital and E.R. visits per month before joining the program and thirty-seven visits after—a forty-per-cent reduction. There was a fifty-six-per-cent reduction in hospital costs, hospital bills averaged $1.2 million per month before and just over half a million after.
As Dr Gawande emphasizes
The critical flaw in our health-care system that people like Gunn and Brenner are finding is that it was never designed for the kind of patients who incur the highest costs. Medicine’s primary mechanism of service is the doctor visit and the E.R. visit. (Americans make more than a billion such visits each year, according to the Centers for Disease Control.) For a thirty-year-old with a fever, a twenty-minute visit to the doctor’s office may be just the thing. For a pedestrian hit by a minivan, there’s nowhere better than an emergency room. But these institutions are vastly inadequate for people with complex problems: the forty-year-old with drug and alcohol addiction; the eighty-four-year-old with advanced Alzheimer’s disease and a pneumonia; the sixty-year-old with heart failure, obesity, gout, a bad memory for his eleven medications, and half a dozen specialists recommending different tests and procedures. It’s like arriving at a major construction project with nothing but a screwdriver and a crane.
Obamacare, anyone?