Hope for a better future in a deeply flawed system

March 2, 2016

By Kim DiGioia, MSPH

An interview with Jeffrey Brenner, MD

Jeffrey Brenner, MD is a family physician in Camden, NJ. Dr. Brenner owned and operated a solo-practice, urban family medicine office that provided full-spectrum family health services to a largely Hispanic, Medicaid population including delivering babies, caring for children and adults, and doing home visits.  Recognizing the need for a new way for hospitals, providers, and community residents to collaborate he founded and has served as the Executive Director of the Camden Coalition of Healthcare Providers since 2003.  Through the Camden Coalition, local stakeholders are working to build an integrated, health delivery model to provide better care for Camden City residents.  Dr. Brenner will give a keynote at the 2016 Lown Conference in Chicago on Saturday morning, April 16. 

You’re going to be speaking about “moving toward right care.” Can you give us just a taste of the topics you’ll cover?

Health care is imbalanced in a number of ways. One of those is the way in which we medicalize and criminalize social problems. Right care starts with a much more holistic understanding of who our patients are, what drives their needs for health care, and what we need to do about it.

In America, the sickest and most complex patients get lost in our system, and there’s a mismatch between the services they need and the services we’re delivering. The medical side of the system is overly complicated, and within the broader context we’re not unearthing those more holistic drivers.

Another part of the imbalance is that we have a pretty big divide between the mental health system, the housing system, and the medical community.

You’ve mentioned a few of the major dysfunctions that need to change in health care. How do we begin to move in that direction?

The first step in solving really complex problems is to have a clear vision for the future and a clear-eyed view of the problem. Right now we have a fairly superficial view of these problems. The way you know that is when patients are called “non-compliant” or “non-adherent,” or when we say that services are “fragmented” — that’s a very simplistic word. The first step isn’t rushing the solutions, but fully understanding how broken this is. The four fields of housing, behavioral health, addiction services, and primary care are going to need to reinvent how they think about what they do: how they train, how they hire, how they supervise. It’s a deeper analysis than is typically even talked about.

What is the biggest barrier to change?

Other than an inarticulate view of the problem, the money, power, and influence in the system. The way people are trained is pretty flawed, as is the way we’ve organized the payment of these systems.

What gives you hope for a better future?

Two things. I’m very optimistic about our student hotspotting project. There are teams in 20 communities across the country, comprised of five to six students in public health, medicine, physical therapy or occupational therapy, social work, or nursing. Each group cares for three to five high cost patients, goes with patients to every appointment, and has a front row view of the incredible system dysfunctions. They’ve been extraordinarily good at beginning to build workarounds in the systems. The students receive training on harm reduction, motivational interviewing, how to work as teams, and leadership skills. They make me very hopeful for the future — that the next generation will be able to talk to each other in different ways, collaborate in different ways, and break down hierarchy.

We’re also having conversations inside of health care that we haven’t had before about the need to change payment and delivery models, and integrate behavioral health and addiction into delivery models. This gives me hope that we’re directionally correct, though we haven’t yet grappled with how hard this is going to be to fix.

What do you hope to learn from the Conference?

Right care is a pretty complicated topic and could go in a lot of different directions; I’m curious to see where the dialogue is headed.