Can we lower medical costs by giving the neediest patients better care? 9 years ago my @NewYorker article, The Hot Spotters, highlighted the heroic work of the Camden Coalition to try and prove it could. newyorker.com/magazine/2011/…
@NewYorker But an important new study shows that their “hot spotting” program didn’t lower costs. nytimes.com/2020/01/08/hea…
@NewYorker 1. Kudos to the coalition and founder Jeff Brenner for putting to an RCT their program supporting the sickest patients after hospital discharge. Few programs do. But the work identifies a key Q.
@NewYorker 2. In the sickest MEDICARE patients, care support after hospital discharge DOES work, as the researchers point out. RCTs show 15-45% reductions in readmissions. So what gives?
3. Camden Coalition takes on a younger, poorer population in not only health distress, but also financial/social distress. The study showed they did not much improve food, financial, housing resources from govt to prevent bouncing back into the hospital.
4. This suggests that the elderly ill have better safety net systems – health care, Social Security, etc. So when support programs help them connect the pieces together, it makes a big difference.
5. The systems for the social needs of the younger sick in poverty are far weaker and more difficult to connect.
6. We should be enormously grateful that the Camden Coalition and others are still working to solve these problems for the sickest who have the highest costs.
7. It also suggests that the hot spots are identifying the upstream failures and broken systems that need our attention if we’re going to do better.
8. Snaps to the researchers for this important work – and a key implication: that making hot spotting work depends on who you are trying to help and what you can offer.
