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By Monica E. Oss

The much-awaited results of the “hot spotting” care coordination program from the Camden Coalition of Healthcare Providers were published in The New England Journal of Medicine (NEJM) last month (see Health Care Hotspotting—A Randomized, Controlled Trial). The results were unexpected – the effects of the program on hospital readmissions were not statistically significant.

To back up, the Camden’s Link2Care “Hotspotting” approach is to create customized care coordination plans focused on a consumer’s unique needs (see The Hot Spotters). It is the basic construct behind patient-centered medical homes and other specialty care coordination models. Founded almost two decades ago, the Camden Coalition invited a formal evaluation. The resulting study enrolled 800 people, who had been hospitalized at least once in the last six months, had two or more chronic conditions, five or more outpatient medications, and had behavioral health “complexities.” Half of the people in the control group got the usual care when leaving the hospital and the other half received about 90 days of intensive social and medical assistance from the coalition, which included “intensive care management services from a team of nurses, social workers, community health workers, and health coaches, who were accompanied by physicians during home visits (see Camden Coalition Intensive Care Coordination Program Effects On Hospital Admission Limited). The study found the 180-day readmission rate was 62.3% in the intervention group and 61.7% in the control group.

I thought comments made by Jeffrey Brenner, M.D., who founded the Camden Coalition and now works for UnitedHealthcare, on the program and its evaluation interesting. “The bottom line is, we built a brilliant intervention to navigate people to nowhere,” he said in a Kaiser Health Foundation article “Reduce Health Costs By Nurturing The Sickest? A Much-Touted Idea Disappoints”. In fact, the hurdles discussed following the evaluation were largely lack of social services – housing, addiction treatment, and mental health services. As a result, the Camden Coalition is broadening its scope beyond “health care providers.”

This may become a recurring theme as value-based reimbursement—often tied to performance measures like emergency room use, hospital readmissions, and total health care spending—becomes more common. For example, in a recent report, “The Science of Value-Based Care: An Industry View” almost 30% of health care executive respondents reported that addressing social determinants of care was an impediment to VBR success. They reported various reasons including lack of resources (cited by 13% of respondents) and lack of tools or processes to assess the social service needs of the consumers they serve (cited by 21% of respondents).

This also speaks to the reason that hospitals spent $2.5 billion on social determinant programs from 2017 to 2019. A recent study published in Health Affairs (see Quantifying Health Systems’ Investment In Social Determinants Of Health, By Sector, 2017-19) stated that social determinants of health account for more “variation in health outcomes than medical care does.” As a result, health system investments in social determinants of health have increased. These investments ranged from $1.6 billion on employment to $32 million on transportation and include education, food security, and social and community context Yet, the Health Affairs study authors note that “evidence for health outcome improvements from interventions focused on social determinants is thin” (see Hospitals Spent $2.5B On Social Determinant Programs From 2017 To 2019).

For any specialty provider organization that has worked with consumers with complex support needs or provides social support services, these new developments present an opportunity for market differentiation. An organizational competency for assessing individual consumer social support needs and providing for those needs is in high demand. But this has to be more than an anecdotal and casual process in order to become a market differentiator. The assessment model and model for meeting consumer needs must be more than traditional cold referrals. Quantifying the processes – and the effects – are the key. And the data needs to be collected and reported in terms that are meaningful to health plan and health system customers. To quote Amy Finkelstein, PhD, author of the NEJM study, “as health care companies move further beyond the four walls of a hospital, the need for rigorous evaluation grows.”

For more on how to build market positioning related to social needs and social services, OPEN MINDS Circle resources:

  1. What Are The Social Determinants Of Health?
  2. Addressing Social Determinants Of Health Via Medicaid Managed Care Contracts & Section 1115 Demonstrations
  3. Do You Have A SDoH Screening Tool?
  4. CMS Develops 10-Item Screening Tool Focused On Social Determinants
  5. States Using Approach With Mix Of Training, Screening & Support Services To Address Childhood Trauma
  6. CMS Accountable Health Communities Model Selects 32 Participants To Serve As Local Test ‘Hubs’
  7. Making Trauma-Informed Care A Scalable Reality
  8. California Medicaid To Pay For Trauma Screenings Beginning January 1, 2020
  9. A Holistic Approach With The I/DD Population Pays Off
  10. Prioritizing Innovation: It’s About Discipline & Thinking Creatively To Solve Challenges

And join us June 2 for “Innovation By Design: Capturing Value In Health Care” keynote session with Carl Clark, M.D., chief executive officer of the Mental Health Center of Denver, during the OPEN MINDS Strategy & Innovation Institute in New Orleans.


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