Hot Spotters and Frequent Flyers: Caring for the Most Expensive Patients

In a January New Yorker article, physician-writer Atul Gawande described Dr. Jeffrey Brenner as one of a new generation of "hot spotters" – physicians and advocates working to lower health costs by focusing on their communities' most costly patients.  

Brenner and his team are out there on the boulevards of Camden demonstrating the possibilities of a strange new approach to health care: to look for the most expensive patients in the system and then direct resources and brainpower toward helping them.

This week, Brenner shared his work – and some story ideas – in a ReportingonHealth webinar jointly sponsored by the Society of Professional Journalists. You can find his slides and a replay of the webinar here.

"We ignore patients unless we can cut into them (surgery) or hospitalize them," Brenner told webinar participants."We don’t pay attention to people are leaving the hospital. They're sent out to the community and they fall off a cliff into a disorganized and fragmented health care system."

Health providers, particularly safety net hospitals, have long tried to reduce the costs of "frequent flyers" – patients, often low-income or homeless, whose frequent emergency room visits and hospitalizations could be prevented. Their experiments have met with mixed success.

Brenner and his compatriots use more sophisticated patient data, however, and hone in on neighborhoods with the most costly patients in a community-based approach that might yield better results.

Brenner encouraged journalists attending the webinar to "embed themselves in clinical programs" like his to better report on efforts to cut health care costs.

Here are some other resources for reporting on "frequent flyer" and other high-cost patients in your community:

The Million Dollar (Homeless) Patient: Calculating the health care costs of chronic homelessness: Journalist Sara Arnquist offers ideas for how to report on the costs of homeless health care in your community.

Doc Gurley's Urban Health Beat: in a series of blog posts, public health physician and writer Jan Gurley offers context and ideas for reporting on health care for low income and homeless patients.

Street Medicine: How Doctors are Helping the Homeless in Their Communities: Journalist Tammy Worth examines the fledgling specialty of street medicine.

Camden Coalition of Healthcare Providers: More information about Dr. Jeffrey Brenner and his team's approach to treating high-cost patients in Camden, New Jersey.

Photo credit: Franco Folini via Flickr