Jeffrey C. Brenner isn’t changing his office. The primary care physician will still commute across the Ben Franklin Bridge to the same building in Camden, where he founded the Camden Coalition of Healthcare Providers.
He’s not moving out of his West Philadelphia home either, even though his new employer, UnitedHealthcare, one of the nation’s largest health insurers, is headquartered half a continent away in Minnetonka, Minnesota.
What is changing for Brenner is the scale of his work.
And what is changing for the Coalition is the size of its budget, growing by about 50 percent per year over three years. Even as UnitedHealthcare is luring Brenner away from the Coalition he founded in 2003 and now leads, the insurer is initiating a $15 million, three-year strategic partnership with the coalition to develop new models of care for the sickest patients, those with complex health, behavior and social needs.
“I think we have a massive scaling problem,” Brenner said. “How do we take all those pilots and dramatically scale them? How do we take the learning that’s cropping all over the country and make them more than interesting pilot projects?”
Widely credited for developing an innovative approach to caring for Camden’s sickest patients and highest users of government health benefits, Brenner, 47, a MacArthur Fellow, will be in charge of expanding UnitedHealthcare's fledgling myConnections program, based on the ideas that Brenner pioneered. His new title will be senior vice president, Integrated Health and Human Services. Meanwhile, the coalition will be looking for a new director.
In Camden, Brenner used insurance data to identify the patients with the most expensive hospital and emergency room visits. All were gravely ill with complicated conditions, such as HIV and diabetes. Many had addictions and mental illness – conditions exacerbated by persistent poverty and homelessness. He found that by connecting patients to housing, employment, transportation and primary care, their utilization of hospitals and emergency rooms dropped by 40 percent.
“We show up right at the bedside, build a relationship, follow them out of the hospital, find them a brand new apartment of their choosing in the suburbs and we make sure they are able to get they need. We hire a highly elite team to wrap around them,” he said. Within about six months, he said, mental health issues have abated, recovery is in progress, they’ve connected with friends and they are getting rides to the doctor.
“The key is a bedroom door with a lock on it and having a sense of safety,” he said. These patients are admitted to hospitals multiple times in a year and a typical two to three day hospital stay runs about $10,000. A room with a lock might cost $4,800 a year.
The top one percent of the most expensive patients consume just over a third of all Medicaid dollars, said UnitedHealthCare spokesman Steven Cragle.
Last year, the coalition, which started in 2003, went national, creating the National Center for Complex Health and Social Needs with $8.7 million from AARP, the Atlantic Philanthropies, and the Robert Wood Johnson Foundation.
What the insurer gives Brenner is entry to markets and a corporate infrastructure to take his ideas nationwide. UnitedHealthcare's myConnections program already exists in Arizona, Michigan, New York and North Carolina. It’ll be up to Brenner to expand that program, which now employs 50.
“By partnering with the Camden Coalition, we have an unprecedented opportunity to make a transformational impact on our health, behavioral and social service systems,” Austin Pittman, chief executive of UnitedHealthcare Community & State, said in a statement.
The move comes at a time of upheaval as the new administration begins to dismantle the Affordable Care Act created during the Obama administration. “For good or bad, Trump is rattling the systems and it may create cracks and opportunities for new models,” Brenner said. “He’s moving back to a lot more state autonomy through Medicaid. He’s interested in addiction and that’s part of the problem.
“I need to find a silver lining in all this,” Brenner said. “I wouldn’t be in this business if I weren’t an optimist.”