Lowering Medical Costs By Providing Better Care

Atul Gawande i i

Atul Gawande is a staff member of Brigham and Women's Hospital and the Dana-Farber Cancer Institute. His books include Better and Complications. Fred Field hide caption

itoggle caption Fred Field
Atul Gawande

Atul Gawande is a staff member of Brigham and Women's Hospital and the Dana-Farber Cancer Institute. His books include Better and Complications.

Fred Field

One of the criticisms of the health care reform bill enacted last year is that it expanded coverage without doing enough to control rising health care costs. Surgeon and journalist Atul Gawande says there are hopeful signs that costs can be contained — not by cutting back, but by providing more intensive services to chronically ill patients who incur huge costs with long stays in hospital rooms and intensive care units.

Gawande's piece in the current issue of the New Yorker about those who focus on patients with the highest medical costs is called "The Hot Spotters."

One of the physicians he profiles, Jeff Brenner, is a family practitioner working in Camden, N.J. In 2007, Brenner started treating chronically sick people who accounted for a significant percentage of the health care costs in Camden.

Brenner was operating under a hypothesis: He figured that the people who had the highest costs in the health care system were also getting the worst care. By helping them, he could also lower the health care costs — not just for them but for the entire city of Camden.

After three years, Brenner and his team appear to be having a major impact. Gawande writes that his patients  "averaged 62 hospital and E.R. visits per month before joining the program and 37 visits afterwards — a 40 percent reduction. Their hospital bills averaged $1.2 million per month before and just over half a million after — a 56 percent reduction."

That net savings, Gawande tells Fresh Air's Dave Davies, is absolutely "revolutionary."

"Jeff Brenner is something of a saint," he says. "He ended up taking patient after patient [and] being very successful — lowering their cost by double-digit percentages while improving the quality of care to the point where he had more than 300 patients enrolled."

But Brenner didn't work alone. He also employed a nurse practitioner and a social worker to follow patients — using a team approach to make sure patients had access to health care professionals.

"Brenner and his team are out there on the boulevards of Camden demonstrating the possibilities of a strange new approach to health care," says Gawande. "In the current health care system, you're not paid to keep people healthy. If you're a complex patient with a range of problems, it doesn't fit into the world [of primary care visits]. You need a project manager — a whole team to take you under their wing and see you through this course of illness. What [Brenner's] creating is the system as it should be."

Atul Gawande is a staff member of Brigham and Women’s Hospital, an associate professor of surgery at Harvard Medical School and an associate professor in the Department of Health Policy and Management at the Harvard School of Public Health. He was a senior health policy adviser for President Clinton. He is a staff writer for The New Yorker magazine and also the author of several books, including The Checklist Manifesto and Better.

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