'Hotspotting' Study Raises Questions About Social Determinants of Health

by Leslie Small

A newly published study suggests that efforts to improve care and lower costs associated with health care "superutilizers" — typically patients with complex medical and social challenges —aren't always as effective as they're heralded to be.

The subject of the study in question is the Camden Coalition of Healthcare Providers, which convened health systems, primary care officers, community organizations and other stakeholders in a bid to test whether short-term, intensive care management would help reduce the cost of caring for some of the hardest-to-treat patients after they’re discharged from the hospital.

For the study, researchers randomly assigned 800 hospitalized patients with medically and socially complex conditions to the Camden Coalition's care-transition program or to usual care. Medicare was the primary payer for 48% of the trial population, and Medicaid was the primary payer for 45% of the population. The study found that the 180-day readmission rate was 62.3% in the intervention group and 61.7% in the control group.

"I think that navigation and coordination is totally necessary, but it's insufficient to solve the problem," says Jeffrey Brenner, M.D., who founded the program, and is now senior vice president of integrated health and social services at UnitedHealthcare's Community & State division. "In many instances we found we were navigating patients to nowhere," he adds.

Brian Castrucci, CEO of the de Beaumont Foundation, says that the Camden Coalition experiment underscores how the health care industry is thinking about social determinants of health in the wrong way.

While it's good that "we finally understood that there are social conditions that impact our health," Castrucci says, "instead of dealing with those social conditions, we're still trying to do it from an individual basis."

"You don't clean the fish tank by focusing on the fish. What this study has shown is that the context that people live [in] is a lot harder to deal with than just signing them up for a social worker, referring to housing — because when you refer someone to housing, it assumes that there is housing for them to be placed into," he says.

From Health Plan Weekly