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Improving health and lowering costs for the sickest and most expensive patients in America is a dream harder to realize than many health care leaders had hoped, according to by the New England Journal of Medicine.

Researchers tested whether pairing frequently hospitalized patients in Camden, New Jersey, with nurses and social workers could stop that costly cycle of readmissions. The study found no effect: Patients receiving extra support were just as likely to return to the hospital within 180 days as those not receiving that help.

The results are a blow to , the organization he founded nearly 20 years ago.

鈥淚t鈥檚 my life鈥檚 work. So, of course, you鈥檙e upset and sad,鈥� said Brenner, who now does similar work with health insurance giant UnitedHealthcare.

The model of care, pioneered in part by Brenner and profiled in a widely read 2011 article in The New Yorker, has inspired dozens of similar projects across the country and attracted millions in philanthropic funding.

鈥淭his is the messy thing about science,鈥� said Brenner, who won a MacArthur Foundation 鈥淕enius Grant鈥� for his efforts. 鈥淪ometimes things work the way you want them to do work and sometimes they don鈥檛.鈥�

The Hope

Many hospital and insurance executives have pinned their hopes on this work because it promised to solve a common problem: when patients lives are so complicated by social factors like poverty and addiction that their manageable medical conditions, like diabetes and asthma, lead to expensive, recurring hospital stays.

Writer and physician Atul Gawande introduced Brenner as a brash visionary crusading on behalf of the 鈥渨orst-of-the-worst patients鈥� in the New Yorker piece, .鈥� (Gawande, who now , a joint venture of Amazon, Berkshire Hathaway and JPMorgan Chase, declined to be interviewed for this article.)

Brenner鈥檚 prescription: Pair these people with front-line care workers who would shepherd them to the social and medical services they needed. Early evidence was promising, the anecdotes inspiring. Brenner boiled the model鈥檚 potential down to four words and two tantalizing goals: better care, lower costs.

As word spread, breathless headlines popped up like 鈥溾�� and 鈥溾��

鈥淟ots of organizations make claims that their programs work and they鈥檝e never been rigorously tested,鈥� Brenner said.

Instead, Brenner took the unusual step of inviting the scrutiny of respected researchers.

In 2014, Massachusetts Institute of Technology economist Amy Finkelstein began a randomized controlled trial, the same rigorous method used to evaluate new drugs. Over four years, the coalition enrolled 800 patients, all who had been recently hospitalized and struggled with social problems. Half received the usual care patients get when leaving the hospital. The other half got about 90 days of intensive social and medical assistance from the coalition.

And the result: The 400 patients who received the intensive help were just as likely to return to the hospital as the patients who didn鈥檛. In both groups, nearly two-thirds of people were readmitted within 180 days.

So why did the coalition fail? Why did the savings touted in their early data, which Gawande had declared 鈥渞evolutionary鈥� in The New Yorker nearly a decade ago, disappear when put to this rigorous test?

Larry Moore is doing well today, but his story illustrates how difficult it is to take care of people with complex social and medical problems.(Courtesy of Brian Thompson/Camden Coalition)

鈥楳y Daily Routine鈥�

Larry Moore, who has hypertension, alcohol addiction, chronic seizures and difficulty walking, was one of the first people to enroll in the coalition鈥檚 trial.

Moore鈥檚 experience serves as a road map for understanding why the coalition missed its mark.

His first months were promising: prescriptions filled, medical appointments attended, Social Security benefits claim in process. The 47-year-old even started to trust the team with the details of his deep-seated addiction, confiding how he would consume mouthwash, vanilla extract and even hand sanitizer at times.

鈥淵ou couldn鈥檛 keep anything with alcohol in it鈥� around him, Moore recalled. 鈥淭hat鈥檚 addiction.鈥�

But all the progress suddenly stopped when Moore seemed to disappear from the coalition鈥檚 radar.

鈥淲e didn鈥檛 see Mr. Moore after November,鈥� said nurse Jeneen Skinner. 鈥淲e went to the house. We sent text messages. We [made] phone calls.鈥�

The coalition has learned that for people living in poverty and with poor health, a small hiccup 鈥� in Moore鈥檚 case, a missed rent payment 鈥� can spiral into a major setback.

Moore spent the next 2陆 years mostly homeless, completely out of touch with the coalition.

鈥淚 was going from place to place. I sleep on a bench or a rock until the next day when the liquor store opens,鈥� remembered Moore. 鈥淭hat was my daily routine.鈥�

Seventy emergency room visits and six hospital admissions later, Skinner reconnected with Moore.

He told her the one thing that would keep him out of the hospital: housing.

The 鈥楥amden Coalition鈥�

Too many times, during the trial, people ended up back in the hospital despite the intervention. But the coalition is convinced it didn鈥檛 fail as much as the larger social safety net did.

鈥淭he bottom line is, we built a brilliant intervention to navigate people to nowhere,鈥� said Brenner.

Coalition staff and their patients usually knew what was needed 鈥� evidence-based addiction treatment, housing, mental health services 鈥� but resources were often in short supply.

Over the past three years, the coalition set out to fill in those gaps, undergoing a kind of metamorphosis.

鈥淲e think of ourselves now as the Camden Coalition鈥� steering away from the 鈥渉ealth care providers鈥� part of the name,聽said Kathleen Noonan, who succeeded Brenner as head of the organization.

It has forged partnerships with jails, lawyers and legislators, and started its own housing program. Many of these efforts began as the clinical trial was ongoing 鈥� a sign the coalition had seen the writing on the wall.

The Camden Coalition helped Moore get an apartment. (Dan Gorenstein/Tradeoffs)

Moore says it took him a month to sleep in his bed, after years of intermittent homelessness.(Dan Gorenstein/Tradeoffs)

鈥業 Kid You Not鈥�

鈥淚 would have never imagined this,鈥� said Moore, sweeping his arm around his one-bedroom apartment.

A green houseplant sits in the sunshine. A fluorescent-colored stuffed animal decorates the bed.

鈥淲hen I first moved in here,鈥� Moore explained, 鈥渋t took me about a month to even sleep in my bed. I slept on a couch.鈥�

Housing made it easier to face his other problem, choosing to try the drug naltrexone, a long-acting injection to treat alcohol addiction.

Moore is nearly two years sober today. He meets with a coalition support group on Wednesdays. He鈥檚 becoming a deacon at his church. In the 22 months he has lived in the apartment, Moore鈥檚 trips to the hospital have plummeted: just one admission and one ER visit.

鈥淚 kid you not, when I saw Mr. Moore probably a month ago, I was standing next to him and did not recognize him,鈥� said nurse Skinner. 鈥淗e looked at me, and said, 鈥楯eneen, it鈥檚 me. And I was like, 鈥楳y God, you look amazing!鈥欌��

Larry Moore鈥檚 story is just that: one story.

Yet it represents a larger trend. Insurers 鈥� including UnitedHealthcare under Brenner鈥檚 direction 鈥� hospitals and many state Medicaid agencies have begun spending millions to meet patients鈥� social needs.

The new study, though, backs up the skepticism of other researchers that, when it comes to saving money at least, these approaches don鈥檛 work well. For one, programs are expensive and hard to scale. The coalition鈥檚 housing effort currently serves only 50 people and costs about $14,000 per person per year. Secondly, the data is lacking, cautioned Boston University economist Austin Frakt. 鈥淒espite what people would like to believe, there鈥檚 not a lot of evidence you can reduce health spending by spending more in other areas.鈥�

Finkelstein said that as health care companies move further beyond the four walls of a hospital, the need for rigorous evaluation grows. 鈥淚 think a lot of well-intentioned people in health care can鈥檛 handle the truth,鈥� she said. 鈥淭hey鈥檙e trying to do good, but they don鈥檛 have the courage to say, 鈥楲et鈥檚 do a gut check on ourselves.鈥欌��

Dan Gorenstein is the creator and co-host of podcast and Leslie Walker is a producer on the show, which features the study on the Camden Coalition in episode 7.