Students Learn Hotspotting to Help Patients While Reducing Costs

Lilo H. Stainton | July 15, 2016 | Health Care
An innovative healthcare program that started in Camden has grown into a movement, trained hundreds in its methods, and continues to expand

Credit: Camden Coalition of Healthcare Partners
Dr. Jeffrey Brenner (left) with some of the members of the 2015 Interprofessional Student Hotspotting Collaborative.
The concept of healthcare hotspotting – using data to identify patients with chronic, costly maladies and help build a comprehensive care system that better meets their individual needs – has grown from its roots in Camden, New Jersey, into a movement.

For the third year in a row, the Camden Coalition of Healthcare Providers is partnering with the Association of American Medical Colleges (AAMC) and Primary Care Progress, a nonprofit advocate for healthcare change, to train college students in hotspotting techniques that can reduce expenses and improve clinical outcomes.

This weekend it will join the AAMC in Philadelphia to welcome nearly 200 college students at the Interprofessional Student Hotspotting Collaborative.

The Camden coalition has in recent years trained hundreds of future hotspotters on how to bridge traditional healthcare boundaries and treat patients with empathy in an effort to keep them healthier.

The students – enrolled in a range of healthcare, social work and business graduate programs – apply to the program as teams; this year, 31 teams will participate, representing 27 colleges nationwide, including Rowan University in southern New Jersey.

They learn hotspotting basics, like how to better connect with patients — making eye contact and removing the symbolic white lab coat — and, without being judgmental, encourage them to share their full medical and social history. Students also practice leadership, advocacy, and teamwork skills at the gathering in Philly.

When participants return to their home schools to put into practice what they learned, they work with faculty advisors to identify patients with complex, under-treated needs; these patients are sometimes called “superutilizers” for their multitude of problems and frequent visits to local healthcare facilities.

Students work closely with these patients, visiting them at home and helping to coordinate transportation or social services, in a quest to better understand how their health and wellness is impacted by poverty, family situations and other factors, organizers said. They focus on the root cause of problems and try and find creative solutions to medical, logistical, and even emotional needs.

“The program provides students an opportunity to witness, first-hand, the ways in which social determinants of health impact individual health, community well-being and healthcare costs, and how to effectively intervene with patients in need,” explained Philip Alberti, the senior director of health equity research and policy at the AAMC, which joined the hotspotting program two years ago. “This kind of knowledge is increasingly important as physicians and health systems are, rightfully, held accountable for health outcomes.“

[related]Program officials provide regular input through online curricula and monthly case conference calls. Advisors at the students’ own colleges – from the medical, nursing, and social work schools – provide regular guidance. The students summarize their findings in writing and return to Philadelphia for a wrap-up meeting in mid-January. In addition to their work with the hotspotting collaborative, they must maintain a full schedule of regular classes.

The goal of the program, organizers explained, is to provide students with hands-on experience working as part of an interdisciplinary team providing comprehensive, considerate care – and also to improve the health of the patient participants. “Value-based healthcare requires a patient-centered, team-based approach. It is imperative that we train the next generation of caregivers to work in such an environment,” said Dr. Randy Wexler, a professor of family medicine at Ohio State University, who will be a faculty advisor this year.

The program draws from successful patient-focused healthcare efforts like the Southcentral Foundation’s Nuka System of Care, a program created, owned and managed by Alaska Native people to promote physical, mental and spiritual wellness.

It is also informed by the ongoing work of the Camden coalition, founded in 2002 by a family physician, Dr. Jeffrey Brenner, who had grown frustrated with the quality of care available for impoverished residents of Camden, too many of whom are struggling with chronic addictions and other diseases, mental illness, homelessness, and other concerns.

Brenner was disturbed to see how a small number of desperately ill patients cycled in and out of the same few healthcare facilities, requiring enormous amounts of government-funded care, and never seemed to get better. “I thought it was just an engagement, coordination, and navigation problem,” Brenner said earlier this year. “But the primary-care system is utterly broken.”

The coalition helped Brenner build partnerships with other healthcare, addiction and mental health providers, establish a system that now enables many local facilities to share patient data, and track the city’s “superutilizers.” They learned that one in five patients absorbs almost $4 out of every $5 spent on healthcare and they have started to prove how keeping these individuals healthier can save the public millions of dollars.

The hotspotting work has expanded and evolved in the years since, while attracting national attention; Brenner’s work was featured in a “New Yorker” article and he was awarded a McArthur Foundation “genius” grant. Earlier this year the Camden coalition received an $8.7 million grant to help build a virtual collaboration among like-minded healthcare providers, like those involved with the Nuka System and Sutter Health, a northern California non-profit.