Government Technology
By Wayne Hanson: What makes an ideal community, and how can civic leaders help their cities, counties and regions evolve to better meet old necessities and new opportunities?

Health Care "Hot Spotting"

August 12, 2011 By

Today a federal court in Atlanta ruled the health care reform law's insurance mandate is unconstitutional. Regardless of the outcome of the law -- which will most likely be decided by the U.S. Supreme Court -- health care costs have been and will continue to be a very stubborn issue. When people cannot pay for medical care, emergency rooms -- with extremely high costs -- become the default. But there may be a way to mitigate some of those costs.

In January, the New Yorker ran a story about something called "Hot Spotting" that has the potential to lower medical costs. The story takes place in Camden, N.J., reportedly one of the poorest cities in the country, where one percent of its residents run up 33 percent of the city's medical costs.

The idea for "hot spotting" came from a policing strategy wherein crime was reduced by looking for crime hot spots -- locations and times of day where crime was most likely to occur. The strategy was covered years ago by Government Technology and is called  Compstat or Comstat. Once hot spots for crime are located, police resources are deployed there before crimes occur. Crime drops, as it did in New York City and other cities around the country that adopted it.

There are health hot spots as well, according to Dr. Jeffrey Brenner, a Camden, N.J. physician who gathered data from hospital emergency room admissions and began using it to zero in on health emergencies. "His calculations," according to the New Yorker, "revealed that just one per cent of the hundred thousand people who made use of Camden’s medical facilities accounted for thirty per cent of its costs.

"He made block-by-block maps of the city," said the New Yorker article, "color-coded by the hospital costs of its residents, and looked for the hot spots. The two most expensive city blocks were in north Camden, one that had a large nursing home called Abigail House and one that had a low-income housing tower called Northgate II. He found that between January of 2002 and June of 2008 some nine hundred people in the two buildings accounted for more than four thousand hospital visits and about two hundred million dollars in health-care bills. One patient had three hundred and twenty-four admissions in five years. The most expensive patient cost insurers $3.5 million."

At this point, Brenner rolled up his sleeves and with the help of small grants, assembled the "Camden Coalition of Healthcare Providers" and began to visit "the worst patients" in terms of costs, to see what could be done. Sometimes an ounce of prevention was worth a pound of cure at least in terms of expensive emergency room visits for such troubles as diabetes, asthma, cancer, heart trouble, etc. Brenner's coalition visited patients in their homes, discovering conditions that exacerbated medical problems -- mold and dust in the apartments of people with asthma, confusions about medication, lack of transportation to medical appointments, etc.

In three years, Brenner's team has reportedly helped some 300 of the city's most expensive patients with a 40-50 percent reduction in visits and costs, and if the hot spotting of the most expensive patients could spread across the country, he says it would be a game changer.

Watch a 13-minute PBS Frontline program on "Hot Spotting," by New Yorker writer and Frontline correspondent Atul Gawande.

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Wayne Hanson is editorial director of Digital Communities. His interest is in the future of communities and the elements necessary to create those places in which we would most want to live and work. What makes an ideal community, and how can civic leaders help their cities, counties and regions evolve to better meet old necessities and new opportunities?