My mother was a favorite at the nursing home where she spent her last years. She retained cognition almost to the end and was what people of her generation would call a wisenheimer. The nurses doted on her, possibly because her reaction to a needle or what she perceived to be an overly rough transfer would be “You’re no Florence Nightingale.”
Or the nicknames. One young physician extender who paid particular attention to her was dubbed “Bad News Betty.” Alas, Bad News Betty cried when Mom died, and I found myself in the ironic position of comforter, reminding Bad News that at 92, Mom had lived a long and good life that the rest of us should celebrate rather than mourn.
Our cover story is about high utilizers and how some health plans have enlisted a band of Bad News Bettys to work with highly vulnerable populations to improve outcomes and cut costs. It’s not a new idea, keeping people out of the emergency room.
Not all health plans are on board and, in fact, Jeffrey Brenner, MD, who heads the Camden Coalition of Health Care Providers, wishes the industry would take more notice of what he’s up to. Ignoring the worst of the worst is no way to run a system, he argues. Especially when 1% of patients account for 21% of costs.
Contributing Editor Joseph Burns lays out how Brenner’s teams of providers helped turn health care service around in one of the poorest cities in the country. What Brenner does may look expensive, but it’s nowhere near as expensive as paying for avoidable emergency department care and inpatient care over and over and over again.
The only way to reach some of the people before they go to the ED is to knock on doors.