The Hot Spotters Can We Lower Medical Costs by Giving the Neediest Patients Better Care?

Joe Gutierrez

Assignment for Module Two

The Hot Spotters

Can we lower medical costs by giving the neediest patients  better care?

(2015SP1-MGT-651628-01) Health Policy and Management

Professor Norman F. Angell, MD, PhD, MBA

What is my impression of the benefit of the model? My impression of the benefit of the model is one of great acceptance and enthusiasm that there exists a statistically supported way that can demonstrate what I and many believe is the need to place emphasis on effective, comprehensive primary care that utilizes more than just a revolving door, symptomatic treatment and prescription approach to health care that can significantly improve the lives of the population and reduce the overall cost of that ineffective care.

Hot Spotting, perhaps indirectly, supports the questioning of what the drivers are that keeps the current state of Healthcare as a business de-emphasizing the need for effective primary care by financially rewarding more expensive and complex treatments of diseases and conditions that could be minimized or prevented at an earlier stage/point of intervention by effective outcome-based, comprehensive primary care.

I find Brenner and this model to be remarkable in the manner in which it takes the otherwise static, readily available data of these health institutions, and manipulates/ transforms that data into what Brenner stated was an amazing window into the health-care delivery system by applying the New York City Police Department data-driven management model called CompStat.

It was this application that revealed the stunning fact that 1% of a given population could account for 30% of expenditures, and further correlates the reason for this to be uncoordinated ineffective health care. Hot Spotting also identified and emphasized significant socio-economic factors that at times were had a greater impact on improving the health of these Hot Spot patients than the medical part of the treatments benefitting the patient and the budget.

While I certainly believe that Brenner’s work deserves his “Genius” award, and I believe it is an original and creative way to use technology as a window into health care delivery, the findings and basis of his work will find acceptance as  is not without precedence.  It seems to support Blum's  "Force-Field and Well Being Paradigm of Health" (Blum, H.L.1981) and the conclusions of  The Institute of Medicine (IOM) that recommends a systems approach as being the most effective way to promote health and prevent disease/injury.  There are signs that Brenner’s approach is showing up in other start-ups  as well in the form of  rapidly growing  data-analysis company out of Boston called Verisk Health.

His message and model of Hot Spotting  shows signs of gaining momentum as it was also  featured in the magazine PSYCHIATRIC NEWS, volume 48, number 24, December 20, 2013 in an article by Mark Moran in which Brenner discusses the way in which it could be applied with similar positive results to psychiatric patients, again benefiting both patient and budgets.  

What do I believe are the flaws or weaknesses of the model? The initial funding.  Money is the greatest impetus for change, and it is very difficult to convert a projected dollar saved into a budget dollar that can be spent on an effort like Hot Spotting.  The fact is that Hot Spotting may be too difficult to monetarily incentivize on a small or large scale.  Another daunting task is the prospect of changing the behaviors of society on a large scale away from detrimental behaviors especially in the light of the fact that many come out of living in poverty; a factor that may be difficult at best to mitigate on a large scale from the Hot Spotting perspective.

The article posed the question if the success of Brenner’s model was replicable or scalable. In an ideal world Brenner felt he would recruit a whole staff of primary-care doctors and nurses and social workers and plant them in the very neighborhoods where the costliest patients lived, and with the millions of dollars in hospital bills savings, he could double the staff and rescue the city’s health-care system.  He quickly understood that our current health and insurance system as built are not likely to take a sum of money it did not spend and funnel it into efforts like Hot Spotting.  

Do I believe the model will be supported in the years to come? Yes, I do believe this model will gain much support in coming years.  Brenner’s work is resonating at many levels.  First is with his other Health Care professionals and concerned citizens who share his passion to improve the health and lives of the population if for no other reason than to do the right thing.

Secondly, and no less important, it especially resonates with those efforts of employers, some Insurance companies, and the ACA that hope to stem, contain, and reduce the spiraling costs of health care that offers little if any real improvement in the health of the population in return for expenditures that is more likely to lead to unnecessary rationing if Brenner’s type of thinking is ignored.

 Brenner has already received recognition for his this model obviously in “The Hot Spotters.” article by physician-author Atul Gawande, M.D., as well as having won a MacArthur “Genius” Award from the MacArthur foundation (interestingly the nation's largest privately held insurance company) that as stated on their website supports creative people and “effective institutions committed to building a more just, verdant, and peaceful world”. Recognition from an organization like this can certainly draw attention to and promote Brenner and his Hot Spot work. Brenner’s Hot Spot model will be supported in years to come especially given the fact that the focus of Hot Spotting is improving Quality of Care by improving the delivery and management of that care, tying the efforts, money expended, and reimbursements to the outcome.

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