Hub of the EnterpriseHow to manage high-utilizer populations
An increasing number of California hospitals are using data mapping to identify chronic "super-users" of health care services and streamline care efficiency, the San Francisco Chronicle's Victoria Colliver reports.
The technique is often called "hot spotting."
Gawande: Pinpointing care 'hot spots' key to controlling health costs
Who are California 'super-users'
According to the Chronicle, a small fraction of patients account for a large percentage of admissions at many hospitals.
- At San Francisco General Hospital, less than 3% of patients treated at its adult medical clinic are responsible for 35% of all admissions.
- In Oakland, just 5% of patients in Alameda Health System's Highland Hospital account for 50% of hospital's long, costly stays.
Hospital "super-users" tend to be individuals with serious chronic conditions, such as heart failure, diabetes, kidney disease, or mental health issues. Typically, they fall into one of three categories:
- Medicare beneficiaries who have difficulty affording the medicines they need to control their conditions;
- Dual eligibles who qualify for Medicaid and Medicare and tend to shift between emergency departments for treatment for medical conditions tied to substance misuse or homelessness; or
- Individuals who have private insurance.
Details of data mapping efforts
Some California organizations have begun "hot spotting" to identify patterns in admissions data and determine the proper resources to support such patients in hopes of decreasing their hospital visits.
Alta Bates Summit Medical Center in Oakland and Berkeley recently invested $400,000 in new software to better understand the health behaviors of Alameda county residents and identify their location down to their specific address. The insight can be used to determine which additional resources super-users may need to avoid hospitalizations, such as neighborhood clinics with more flexible hours.
Alta Bates—in partnership with the Camden Coalition of Healthcare Providers—is one of five hospitals nationwide to participate in an advisory committee that aims to spread the concept of "hot spotting."
Managing high-risk patients
Committee founder Jeffery Brenner says hospitals know how to "cut, scan, and zap" patients, but they don't always give them what they need. Instead, a personalized approach to chronic hospital goers, including visiting patients where they live, is more effective at reducing hospital visits and cut costs.
"Right now, laying there in hospitals all over San Francisco and every hospital in the region are people who've been there over and over and cost the system huge amounts of money," Brenner says, adding, "If you could take one of those patients and keep them out, that's a huge amount of savings."
ACA provides incentives for hot spotting
Elizabeth Davis, the head of care management program at San Francisco General, says concentration on the more costly and complex patients makes more financial sense under the Affordable Care Act.
"Suddenly, both the hospital and the health plans have an incentive to keep patients as healthy as possible," she says, adding, "Healthy patients have lower health care costs. When that risk is shared between providers of care and payers, that helps everyone work together" (Colliver, San Francisco Chronicle, 2/4).