Atul Gawande’s refers to them in his New Yorker piece as The Hot Spotters. Just as law enforcement in community policing identifies crime. Can we lower medical costs by giving the neediest patients better care? If Camden, New Jersey, becomes the first American community to. New Yorker. Jan The hot spotters: can we lower medical costs by giving the neediest patients better care? Gawande A. PMID: ; [Indexed .

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The most recent was about hospice care. Chemistry has the periodic table, physics has Newtonian equations, biology has the theory of evolution.

One that did was the Medicare Care Coordination demonstrationa program in which 15 healthcare organizations from around the country were given the opportunity to develop programs for improving care coordination among the most complex populations.

Calibrating the ‘Hot-Spotting’ Hype

Without rigorous research to determine the exact impact of such programs, practitioners and patients alike cannot assume that complex care management is the primary reason for any improvement of such high-use patients, says Steven Asch, MD, professor of medicine at Stanford University and an expert in the field. As a result, many “super-users” of hospital facilities today are likely to stop being high-volume users in the future, regardless of whether they receive intensive targeted services — often referred to as “complex care management” — or not.

By latehis team had provided care for more than three hundred of these most costly people. A pile of meaningless terms and poorly tested ideas. Because most coordinators had caseloads of well under patients, they were able to contact their assigned patients frequently — often several times a month or more. Unlike other less successful programs in that demonstration, the care coordinators had regular in-person interaction with their assigned patients and were closely connected with their patients’ primary care providers.

For example, a program could be piloted in one clinic and compared with a nearby similar control clinic. Many of the other rigorous studies of “hot-spotter” approaches have come to similar disappointing conclusions.

Link to full text in the New Yorkert: Brenner’s program, the Camden Coalitionis widely considered the prototype for the country’s growing number of programs for high-need and high-cost populations. It turns out that we easily can be tricked by simple analyses of programs targeting high-risk populations because of a well-established — but counter-intuitive — statistical principle known as regression to the mean. After an initial intake visit, the team contacts enrolled patients at a minimum of twice monthly.


Yet it is clear these efforts are falling short of expectations, and much more work — and rigorous evaluation — will be needed to deliver on the promise of better, more efficient care for this population. The best I can do for now is summarize the article and encourage you to either purchase the issue or read it online at a later date. Wed, Jul 10th, Having heard Clay Christensen expound on disruptive Recent efforts by the Camden Coalition and other similar-minded innovators have inspired a much-needed renewed focus on the most complex patients in our healthcare system.

Cancer Patients and Social Media. Another example of a successful complex care management effort was a program for high-risk older adults in Pennsylvania led by an organization called Health Quality Partners as part of the same Medicare demonstration described above.

The paradigm — referred to as “hot-spotting” — has sprung up in dozens of places in the U. Nearly everyone involved anticipated success, and indeed enrolled patients experienced substantial improvements in health and reductions in hospitalization rates. To their credit, the Camden Coalition has acknowledged that the dramatic data initially reported about their program may be overblown.

To rigorously assess their model, the Camden Coalition is now participating in a randomized trial of their program.

We don’t understand what drives some patients to over-utilize healthcare services and others to under-utilize care. Links to all articles in the wpotters are available on the Gehr Center and Updates in Slow Medicine websites. It would be hard to say it better.

But when independent researchers conducted a pre-planned evaluation of the program in which they compared enrolled patients with similar controls, the data told a different story.

Leave a Reply Cancel reply Your email address will not be published. While emergency room visits, hospitalizations, and overall costs among enrolled patients may have dropped substantially, there is no telling whether patients would have experienced these same improvements even without the program. Brenner’s spottwrs defines healthcare hot-spotting as “the strategic use of data to reallocate resources to a small subset of high-needs, high-cost patients. When Jeffrey Brenner, MD, took notice more than a decade ago of the spotty care afforded certain high-risk, high-need patients in Camden, N.


Brenner used data mining and statistical analysis to map health-care use and expenses. According to a report published in the Journal of the American Medical Associationpatients assigned to the control group improved hpt about as much as those receiving the intensive services.

Even when a randomized trial is not feasible, however, the rigor of a complex care management program evaluation can be enhanced by the inclusion of a matched contemporaneous control population. While it is too early to report fhe or to atkl conclusions from that study, these results should provide insights about the program’s true impact. But upon closer inspection, careful analysis of the Camden program and others like it raises concerns that these apparent jaw-dropping improvements may be overstated.

The hot spotters: can we lower medical costs by giving the neediest patients better care?

Gawande then describes the difficulties in implementing these and other innovative ideas on a larger scale, including opposition from insurance companies and the health-care lobby. And he does it so well…. Joel Greenberg has been a science journalist for four decades. You may use these HTML tags and attributes: Fri, Jun 21st, Nobel peace prize winner Muhammad Yunus is no One of the doctors that works for Verisk, Nathan Gunn, who explains the way data mining can be used to identify the most frequent users of health-care facilities and reduce their costs.

Click here to read the rest of the New Yorker article. This idea led to the creation of the Camden Coalition of Healthcare Providers. In the Hot Spotter article Gawande writes about several innovative approaches to reducing health-care costs.

This second article in the series explains why targeted programs for high needs, high cost patient populations may not be achieving their intended goals. The coordinators also focused their efforts on hospital-to-home care transitions and medication management.

He created a way to find the people whose use of medical care was highest, and go after them and provide better care. The patients were also markedly healthier.