Publication: Time to "Cool Off" on Hotspotting in Primary Care?

Health care "hotspotting" -- defined by some as "the strategic use of data to reallocate resources to a small subset of high-needs, high-cost patients" -- has become widely popular among physician groups, hospitals, and health systems as a way to manage health care spending. Hotspotting is directed at "super utilizers", patients who are outliers with respect to high health care utilization and spending.

Many super utilizers are individuals with chronic conditions and complex care needs that can be challenging to manage with processes and strategies that are prevalent in the current US health system. Therefore, the intuition for using hotspotting in primary is straightforward: identify high utilization/cost outliers, implement tailored (and often intensive) primary care interventions to manage their care, improve outcomes, and drive down spending.

However, the evidence supporting hotspotting in primary care is far from definitive. In a recent article published in the Journal of General Internal Medicine, VSSL members Drs. Leah Marcotte, Ashok Reddy, and Joshua Liao weigh in on the issue.

One key point the authors make is that while a large proportion of spending may be concentrated among a small number of high-cost patients, there are still benefits to implementing solutions relevant to average- or -low-cost patients. In particular, given the large number of these individuals across a population, smaller gains achieved over more individuals can yield cost reductions that equal or extend beyond savings from achieving larger gains in a much smaller group of high-cost or super-utilizer individuals. As Drs. Marcotte, Reddy, and Liao point out, the concept comes from Geoffrey Rose's theory and strategy of preventive medicine.

The abstract for Drs. Marcotte, Reddy, and Liao's article:

One increasingly popular strategy for addressing avoidable healthcare costs is to couple “hotspotting” with interventions that deliver expanded, more intense primary care services to high-cost patient populations. While there is rationale for such intensive primary care programs, early results have been lackluster. Geoffrey Rose’s preventive medicine strategy provides insight about a potential explanation: that the narrow scope of these initiatives on small groups of high-cost patients may inherently prevent them from achieving overall cost reductions across entire patient populations. While additional work and results from innovative non-healthcare-based interventions are needed, healthcare organizations may benefit from instead investing in broader interventions that impact patients across cost levels, including average- or low-cost patients.