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Team approach best

May 5, 2014
by Charlene Marietti
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National Council for Behavioral Health Conference 2014
When Jeffrey Brenner, MD talks about integrated care, it is with passion. He's done his due diligence as a family  physician providing full-spectrum family health services to a largely Medicaid population Camden, NJ, one of the poorest cities in the country.
Recognizing the need for collaboration among care providers, he founded the Camden Coalition of Healthcare Providers, where he serves as the executive director. He is also the medical director of the Urban Health Institute, a Cooper Health System (Camden, NJ) business unit, which aims to apply modern business thinking, practices and strategies to clinical care models.
Brenner is most concerned with individuals who are the highest utilizers of services and, of course, incur the highest costs. Most have co-morbidities and their disorders are complex. Writing prescriptions neither keeps them stable or out of the emergency room. 
There is a bewildering array of services surrounding patients with multiple complex disorders, he told attendees at the National Council for Behavioral Health in Washington, DC. And the mainstream biomedical healthcare community has little incentive to change the current model of care. There are certainly no economic incentives to do so.
"Behavioral health is closer to solving this problem," he noted citing the industry's ACT and PACE models, which he would like to see brought into the mainstream of healthcare. "There is no EHR or HIE that is going to solve this [disjointed biomedical] model." 
The behavioral health community works collaboratively within a care team. They talk to their clients and develop longstanding relationships with them. They have the clients' trust. And they continue to perform well despite tight budgets.
He believes it's possible to lower costs and improve quality, citing a 2012 study that found that the combination of a highly skilled nurse and well structured care plan resulted in a 48 percent reduction in deaths and 33 percent reduction in hospitalization among the highest risk patients. 
Like many other visionaries, Brenner believes the primary care provider model is outdated. What is needed, he added, is to medicalize social programs. Ninety five percent of what physicians regularly do can be delegated to a properly trained nurse of physician assistant--and should be--so that the physician can focus on diagnosis and co-morbidities.