One way to attack health care costs: 'Hot spotting'



Innovators are using population data to identify areas
with particularly high health care spending per capita,
known as medical 'hot spots,' to allocate health care
resources more efficiently and bring costs down.  

 By Deron Schriver

I remember a time when my mother would take me to the doctor as a kid. Dr. Herrold would spend a lot of time with us, and you could see his diagnostic “wheels” turning. At the end of the visit, my mother would always ask how much we owed him. He would quote an amount, she would hand him the cash and off we went.

A lot has changed with the health care system since that time. We’ve been facing cost increases that will not be sustainable forever. Our elected officials have passed the Patient Protection and Affordable Care Act to address the issue. Whether you agree or disagree with the contents of the bill, I think we can all agree that doing nothing is not an option.

In his New Yorker article “The Hot Spotters,” Atul Gawande discusses what a New Jersey physician and others like him are doing to address the issue of skyrocketing health care costs. The approach involves more intense outpatient management of the small subset of patients that make up a disproportionate share of health care spending. Dr. Gawande illustrates how these innovators are using population data from a variety of sources to identify medical “hot spots,” or areas with particularly high health care spending per capita.

Here’s one excerpt:

If (Dr. Jeffrey Brenner) could find the people whose use of medical care was highest, he figured, he could do something to help them. If he helped them, he would also be lowering their health care costs. And, if the stats approach to crime was right, targeting those with the highest health care costs would help lower the entire city’s healthcare costs. His calculations revealed that just 1 percent of the hundred thousand people who made use of Camden’s medical facilities accounted for 30 per cent of its costs. That’s only a thousand people—about half the size of a typical family physician’s panel of patients.

And the potential benefit?

(Brenner) and his team appear to be having a major impact. The Camden Coalition has been able to measure its long-term effect on its first 36 super-utilizers. They averaged 62 hospital and E.R. visits per month before joining the program and 37 visits after—a 40 percent reduction. Their hospital bills averaged $1.2 million per month before and just over $500,000 after—a 56 percent reduction.

These results don’t take into account Brenner’s personnel costs, or the costs of the medications the patients are now taking as prescribed, or the fact that some of the patients might have improved on their own (or died, reducing their costs permanently). The net savings are undoubtedly lower, but they remain, almost certainly, revolutionary. Brenner and his team are out there on the boulevards of Camden demonstrating the possibilities of a strange new approach to health care: to look for the most expensive patients in the system and then direct resources and brainpower toward helping them.

With chronic illnesses such as diabetes and hypertension making up 75 percent of total health care spending, it makes sense to direct resources to that area. The Pennsylvania Chronic Care Management, Reimbursement and Cost Reduction Commission was created to redesign how care is delivered to better address chronic conditions. This is an important step, since 50 percent of the population has at least one chronic condition, and our current system was designed to treat more acute illnesses. Here in South Central Pennsylvania, Aligning Forces for Quality is working with health care providers and patients to improve care and management of chronic diseases. To achieve its mission of improving health care quality at the local level, the program includes goals of increasing public reporting of quality data and improving health literacy throughout the community. Through greater awareness, AF4Q will be in a better position to improve health care quality.

As an industry insider, I can confidently say that we have the resources in York to make great strides in improving how health care is delivered. I challenge the local health care community, from the largest health system to the solo practitioner, to come together with unprecedented levels of teamwork. I challenge each citizen in our community to commit to leading a healthier lifestyle. In the health care system of the future, providers and patients will have a responsibility to prevent illness as opposed to waiting until it arrives and addressing it reactively. The doctor-patient relationship used to be the center of the health care universe, and it will be in our best interest to get back to that.

Deron Schriver is the executive administrator for The Women's Healthcare Group and a member of the Guiding Committee for Healthy World Café. He has a particular interest in studying and participating in solutions to address health issues affecting our society. Deron earned a bachelor's degree in accounting and a master's in business administration, both from York College. He lives in West Manchester Township with his wife, Lisa.