Atul Gawande’s refers to them in his New Yorker piece as The Hot Spotters. Just as law enforcement in community policing identifies crime. Can we lower medical costs by giving the neediest patients better care? If Camden, New Jersey, becomes the first American community to. New Yorker. Jan The hot spotters: can we lower medical costs by giving the neediest patients better care? Gawande A. PMID: ; [Indexed .

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But for a mainstream doctor to say sppotters proactive patient centered care saves money and is worthwhile is, I think, monumental. Gawande then describes the difficulties in implementing these and other innovative ideas on a larger scale, including opposition from insurance companies and the health-care lobby. But upon closer inspection, careful analysis of the Camden program and others like it raises concerns gawanre these apparent jaw-dropping improvements may be overstated.

Can we lower medical costs by giving the neediest patients better care? Very few of these programs have reached the level [of success] I would consider convincing,” he said.

Calibrating the ‘Hot-Spotting’ Hype | Medpage Today

The ideal study design for evaluating hot-spotting approaches, says Asch, is a randomized control trial. Gawande also describes a visit he made to the Special Care Center, a clinic in Atlantic City, an experimental approach to primary care. Cancer Patients and Social Media. Joel Greenberg has been a science journalist for four decades. With this in mind, the dramatic results reported about programs like the Camden Coalition seem much less impressive.

Yet it is clear these efforts are falling short of expectations, and much more work — and rigorous evaluation — will be needed to deliver on the promise of better, more efficient care for this population. For example, a program gawxnde be piloted in one clinic and compared with a nearby similar control clinic.

The patients were also markedly healthier.

But when independent researchers conducted atuo pre-planned thr of the program in which they compared enrolled patients with similar controls, the data told a different story. One of the doctors that works for Verisk, Nathan Gunn, who explains the way data mining can be used to identify the most frequent users of health-care facilities and reduce their costs. Link to full text in the New Yorkert: Without rigorous research to determine the exact impact of such programs, practitioners and patients alike cannot assume that complex care management is the primary reason for any improvement of such high-use atuul, says Steven Asch, MD, professor of medicine at Stanford University and an expert in the field.


The best I can do for now is summarize the article and encourage you to either purchase the issue or read it online at a later date. Keep Me Updated Signup to recieve latest updates and announcements. We don’t understand what drives some patients to over-utilize healthcare services and others to under-utilize care. This idea led to the creation of the Camden Coalition of Healthcare Providers. After an initial intake visit, the team contacts enrolled patients at a minimum of twice spotrers.

In the Hot Spotter article Gawande writes about several innovative approaches to reducing health-care costs. The paradigm — referred to as “hot-spotting” — has sprung up in dozens of places in the U.

The Hot Spotters by Atul Gawande |

A Critical Look at Healthcare Delivery Reform” unpacks the data behind healthcare delivery system interventions, highlighting well-intended reforms that have yet to achieve the impact many have assumed.

Recent efforts apotters the Camden Coalition and other similar-minded innovators have inspired a much-needed renewed focus on the most complex patients in our healthcare system.

These kinds of cost savings are revolutionary. By providing follow-up consultation and care to such patients before they might otherwise seek further in-hospital care, “hot-spotting” aims not only to cut healthcare costs associated with repeated hospitalizations, but ultimately to improve the health of those most in need. Sspotters created a way to find the people whose use of medical care was highest, and go after them and provide better care.

It turns out that we easily can be tricked by simple analyses of programs targeting high-risk populations because of a well-established — but counter-intuitive — statistical gawanve known as regression to the mean.

The Hot Spotters by Atul Gawande

Though enthusiasm for “hot-spotting” may be over-hyped, it is important to highlight that some programs have shown success, even in rigorous controlled evaluations. Because most coordinators had caseloads of well under patients, they were able to contact their assigned patients frequently — often several times a month or more.


Brenner’s group defines healthcare hot-spotting as “the strategic use of data to reallocate resources to a small subset of high-needs, high-cost patients. One that did was the Medicare Yhe Coordination demonstrationa program in which 15 healthcare organizations from around the country were given the opportunity to develop programs for improving care coordination among the most complex populations.

The hot spotters: can we lower medical costs by giving the neediest patients better care?

And he does it so well…. It would be hard to say it better. As a result, many “super-users” of hospital facilities today are likely to stop being high-volume users in the future, regardless of whether they receive intensive targeted services — often referred to as “complex care management” — or not.

A pile of meaningless terms and poorly tested ideas. This second article in the series explains why targeted programs for high needs, high cost patient populations may not be achieving their intended goals. According to a report published in the Journal of the American Medical Associationpatients assigned to the control group improved just about as much as those receiving the intensive services.

In response to Camden’s initial purported success, healthcare systems around the nation scrambled to develop similar approaches of their own. At nine-fifty on a February night ina twenty-two-year-old black man was shot while driving his Ford Taurus station wagon through a neighborhood on the edge of the Rutgers University campus.

With our background practicing naturopathy, much of what Gawande describes seems so obvious, kind of preaching to the choir. The study concluded that, relative to controls, “these programs had favorable effects on none of the adherence measures and only a few of many quality of care indicators examined,” and did not favorably impact the costs of care.

To rigorously assess their model, the Camden Coalition is now participating in a randomized trial of their program. A Vision of Connected Health: Your email address will not be published. You may use these HTML tags and attributes: Brenner used data mining and statistical analysis to map health-care use and expenses.