Recent research indicates a hotspotting approach to meet physical, behavioral, and social needs of high-cost patients is too narrow to have a lasting impact.
A hotspotting program created by the Camden Coalition of Healthcare Providers has gained widespread momentum as a method to reduce spending and improve health care quality among patients referred to as “superutilizers,” those with an extremely high use of hospitals and emergency departments.
Although the “superutilizers” only account for five percent of the U.S. population, they contribute to 50 percent of health care spending, according to a study published in The New England Journal of Medicine (NEJM), which found readmission rates among patients were not reduced by the hotspotting approach.
Researchers from the Massachusetts Institute of Technology and the National Bureau of Economic Research attributed the program shortcomings to several limitations, including a lack of stable housing and telephone among patients, behavioral health complexities, and limited provider availability. Fundamental challenges also played a critical role according to the researchers, who noted patients who have high medical costs at this time will most likely not have such high costs in the future and few of those costs may be related to preventable hospitalizations.
To better understand the outcomes of hotspotting, Avalere’s Health Systems Transformation Research Coordinating Center (HSTRC) evaluated the study findings, operated focus groups with Medicaid beneficiaries, and conducted interviews with health system leaders. The Avalere team’s conclusion, which they shared earlier this month in a blog post for Health Affairs, was that while the techniques in the Camden approach seem adequate, the population needs to be broader.
Based on their research, the team shared three strategies health systems can implement to better address unmet social and clinical needs of Medicaid-eligible individuals:
- Partner with community organizations. During the interviews with the HSTRC, health system leaders emphasized the success found through data integration created between community organizations and health care systems. When both entities can access data across multiple sectors, such as food and housing, it enables the programs most needed to support Medicaid-eligible populations.
- Integrate community health workers (CHWs) into a data-driven approach. The HSTRC found that the models of care that use a data-driven approach and implement CHWs to areas in need were best equipped to address unmet needs such as behavioral health issues, social isolation, and food, housing, and income insecurities. Integrated data systems and electronic health record information helps identify the patients in need and enables CHWs to connect with the patients, address any physical health needs, and coordinate follow-up services with other community organizations for assistance with social needs.
- Measure a program beyond return on investment (ROI). Health systems struggle to gain support for long-term programs that address unmet social needs due to an inability to show ROI in the short term. To accurately assess how a program supports patients as well as their risk of returning to “superutilizing” status, the HSTRC recommends organizations assess other measures in addition to financial metrics, including physical and mental functioning, health-related quality of life, patient activation, and physiological intermediate outcome.