Hot Spotting:
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When planning the conference, the biggest question we faced was determining what we can do to make an improvement, both for patients and for the system we will be entering? With this driving us, we kept our vision in mind: connect professionals from all perspectives, whether clinical, administrative, or supervisory, to share ideas and engage in dialogue. Many clinics have developed different approaches that share similar goals to Hot Spotting. Our goal of the conference was to create space for collaboration among these different perspectives.
The next portion of our conference was dedicated to presentations and a panel session. Our keynote speaker was Dr. Eileen Weber: a nurse, attorney, clinical assistant professor at the UMN School of Nursing, and faculty advisor to UMN Hot Spotters. She emphasized the connection between the work to advance health equity and hot spotting efforts that address super utilization. Hotspotting builds on well-tested and evidence-based interdisciplinary models successfully implemented throughout the country. She spoke about the goals of a national center for Hot Spotting and ways it could address health inequity on a larger, more uniform scale. The national center aims to develop manageable strategies that clinics can implement to improve their care for these patients. Lastly, Dr. Weber challenged us to hotspot health systems rather than individual patients.
The conference then proceeded to a panel session, which involved several local leaders whose work and organizations have worked to better meet the needs of these patients and reduce healthcare costs. This included Ross Owen, the director of Hennepin Health; Kate Vickery, MD, a researcher and a physician at the HCMC Coordinated Care clinic; Shailey Prasad, MD, the director of the North Memorial Family Medicine Residency, who works with interprofessional teams that assist those facing barriers to good health; and Andrew Olson, MD, a hospitalist at the University Medical Center.
The conference then proceeded to a panel session, which involved several local leaders whose work and organizations have worked to better meet the needs of these patients and reduce healthcare costs. This included Ross Owen, the director of Hennepin Health; Kate Vickery, MD, a researcher and a physician at the HCMC Coordinated Care clinic; Shailey Prasad, MD, the director of the North Memorial Family Medicine Residency, who works with interprofessional teams that assist those facing barriers to good health; and Andrew Olson, MD, a hospitalist at the University Medical Center.
Ross Owen described how Hennepin Health has transitioned from a fee-for-service model to a value-based model, with an implication being that the shifts in incentives, coupled with more flexible healthcare spending, have allowed for more innovation, and also for cost savings used to reinvest in the system. Dr. Vickery described how increased flexibility in spending has been an asset in the model at the coordinated care clinic. This, along with a consistent multidisciplinary provider team with frequent, direct contact with the patient is important for the CCC model.
Dr. Prasad emphasized how the ‘hot spots’ we discussed are often the result of large gaps in social support systems and community health, affecting a much broader segment of the population than just high-utilizer patients. One provider mentioned that high-utilizers are often past the point where many of their medical issues can be corrected, and ways to prevent this phenomenon in the first place will likely be effective. This led to a discussion about social service spending as a possible part of this solution, as US spending in this category is comparatively low. All panelists emphasized the importance of social and economic factors as the largest contributor to health, and are particularly important in this population.
Many shared a belief that certain issues in some communities prevent building a strong enough support system for some of its members. For some, this deficiency leads to long-term, chronic problems that bring them repeatedly to the medical system. Many believe that above all, the best way to help these patients is to empower the communities to give them the resources to make their members more successful. Patients using the hospital most frequently are a small group of patients which more often represent a struggling community they belong to, instead of an inherent, rare deficiency in themselves. This concept led the discussion to what the role of providers is with these difficult issues. How can providers help patients’ health when the key determinants to health cannot be improved inside the office? A variety of ideas from both clinicians and non-clinicians discussed the importance of strengthening the communities, such as community organizing, patient education, and preventative care. Other ideas included integration of community health into medical education and political advocacy.
Dr. Prasad emphasized how the ‘hot spots’ we discussed are often the result of large gaps in social support systems and community health, affecting a much broader segment of the population than just high-utilizer patients. One provider mentioned that high-utilizers are often past the point where many of their medical issues can be corrected, and ways to prevent this phenomenon in the first place will likely be effective. This led to a discussion about social service spending as a possible part of this solution, as US spending in this category is comparatively low. All panelists emphasized the importance of social and economic factors as the largest contributor to health, and are particularly important in this population.
Many shared a belief that certain issues in some communities prevent building a strong enough support system for some of its members. For some, this deficiency leads to long-term, chronic problems that bring them repeatedly to the medical system. Many believe that above all, the best way to help these patients is to empower the communities to give them the resources to make their members more successful. Patients using the hospital most frequently are a small group of patients which more often represent a struggling community they belong to, instead of an inherent, rare deficiency in themselves. This concept led the discussion to what the role of providers is with these difficult issues. How can providers help patients’ health when the key determinants to health cannot be improved inside the office? A variety of ideas from both clinicians and non-clinicians discussed the importance of strengthening the communities, such as community organizing, patient education, and preventative care. Other ideas included integration of community health into medical education and political advocacy.
As we transitioned to discussing solutions for super utilization, Chrystian Pereira, a pharmacist at Smiley’s Family Medicine, presented an example on how developing a systematic approach to incorporating a pharmacy visit into the post-ED and post-hospitalization follow-up reduced drug therapy problems. Both the patients and medical teams were satisfied with the process and outcomes. This successful program urges us to make habit of calling on the expertise of each team member.
In the time remaining, we continued the idea sharing and encouraged networking with a world-cafe style session and informal networking. Some key ideas from the discussion were clinics providing needed services under one roof, discussing patient goals with patients and documenting them, and curriculum changes to train the next generation of providers. Our goal moving forward is to keep this conversation alive and dive deeper into super-utilization and hot spotting work. It is often assumed that patients with high healthcare utilization turn to the ED because of a lack of access to alternative care. Although this may be the case, we discovered that many patients have sufficient insurance and access to providers. They had frequent appointments with many healthcare providers, and access to multiple care coordinators. However, their underlying state of health was not improving. At the conference, discussion addressed ways to improve this system of providing care and considering alternative ways these needs can be met. This is an area where future discussion may bring great benefit.
In the time remaining, we continued the idea sharing and encouraged networking with a world-cafe style session and informal networking. Some key ideas from the discussion were clinics providing needed services under one roof, discussing patient goals with patients and documenting them, and curriculum changes to train the next generation of providers. Our goal moving forward is to keep this conversation alive and dive deeper into super-utilization and hot spotting work. It is often assumed that patients with high healthcare utilization turn to the ED because of a lack of access to alternative care. Although this may be the case, we discovered that many patients have sufficient insurance and access to providers. They had frequent appointments with many healthcare providers, and access to multiple care coordinators. However, their underlying state of health was not improving. At the conference, discussion addressed ways to improve this system of providing care and considering alternative ways these needs can be met. This is an area where future discussion may bring great benefit.