I just read The Greater New Brunswick Hotspotting Project Report by the Robert Wood Johnson Medical School and had two immediate thoughts — hot spotting gives a structure to the medical neighborhood concept and opens up new business opportunities for provider organizations.
First, what is hot spotting? This approach collects geospatial data that combines outcomes data with location data, often to identify and implement preventative care for consumers with complex health care needs and high resource use (aka “super utilizers”). Recent headlines show that the approach is being used often in health care and social services – ‘Hot-Spotting,’ How Gun Violence Spreads, & Living In America On $2 A Day and Students Learn Hotspotting To Help Patients While Reducing Costs.
The Greater New Brunswick Hotspotting Project analyzed utilization patterns of consumers who visited Robert Wood Johnson University Hospital and Saint Peter’s University Hospital in the city of New Brunswick and in Franklin County in New Jersey through the use of hot spotting. What did the study find?
- Of 43,000+ consumers visiting the two local hospitals, 3% were “high utilizers” – defined as 5+ emergency department visits or 3+ hospitalizations in two years
- The cost for those consumers totaled $14 million – about one-fifth of the $44.2 million in Medicaid costs for hospital visits in the area, with average two-year costs for the group at $18,000, and ranging as high as $38,000
- This population had multiple comorbid conditions including behavioral health conditions – and a higher percentage of consumers with “extreme” emergency department use had behavioral disorders
- The analysis identified ten Census blocks and eight buildings/apartment complexes as having a high proportion of the high utilizer population
The geographic density of the group of high-needs consumers made me think of the medical neighborhood concept. It is a group of health care organizations, clinical professionals, and social service organizations that operate in a geographic area under a collaborative care agreement delineating a set of principles and expectations – with requisite systems and processes – to provide coordinated care for all consumers in the area (see The “Medical Neighborhood” Integrating Primary & Specialty Care For Ambulatory Patients).
This construct is the goal of medical homes and specialty medical homes – with the assumption that the provider organization serving as the medical home manager will organize just such a “medical neighborhood” (see The Medical Home As Gateway To The Future Of Health Integration and Coordinating Care In The Medical Neighborhood; Critical Components And Available Mechanisms).
When I think about this specific hot spotting analysis in New Jersey – and hot spotting analysis as a tool – what comes to mind is an even more refined approach to business development for provider organization strategy and marketing planning. Hot spotting becomes another tool in identifying “gaps” in the service delivery system – and an opportunity to engage health plans in a discussion about geographically-specific solutions for consumers with some very specific health and social support needs (see Think Hot Spotting & Automated Hovering). I think this is a great example of moving the health and human service organizations away from the “transactional” nature of the field to more “transformational” practices. In Rethinking Human Services Delivery, authors B. J. Walker and Tiffany Dovey Fishman note:
Health and human service agencies, by design, take a program-centric view of the world and are often more transactional in nature than transformational. Rather than identifying and addressing the problems that bring individuals and families into contact with the social safety net, human service programs instead tend to see people through the lens of eligibility… This program-centric view is a lingering byproduct of the way health and human service programs were originally created – as a stand-alone programs rather than an integrated safety net… Analytics holds the potential for transforming the entire human services delivery cycle, from how human services agencies define and target problems, to how they use data to inform how case workers approach their day-to-day work, to how they challenge long-standing beliefs about what works and then use what they learn to reform their policies and practices…”
This is exactly the “transformation” that is being driven by the move to value-based reimbursement and pay-for-success initiatives. Executive teams need to develop the link between data and analytics, strategy, solution, and new service line development to gain market advantage. For a deep dive into the hot spotting approach, check out these resources from the OPEN MINDS Industry Library:
- Think Hot Spotting & Automated Hovering
- Making “Hot Spotting” Work In Your Organization
- One More Treatment Tech Criteria – Passive Vs. Active
- Child Welfare System Is Changing, But Slowly
- ‘Must Have’ Technologies For Cutting Edge Population Management
And for more on using your data to your best advantage, join the OPEN MINDS team on November 7 for the session, “Moving From Big Data To Smart Data: How To Integrate Clinical & Financial Data To Manage Performance” at The 2017 OPEN MINDS Technology & Informatics Institute in Philadelphia, Pennsylvania.