Last month, Stanford University Medical Center quietly announced plans to open a new clinic in the spring of 2012. That is not unusual. What is different is that while the clinic will one day be open to the community, it will initially serve only employees of Stanford University, Stanford Hospital (and clinics), and their family members.
Inside that group, the clinic will treat only those with serious chronic illnesses. It will operate under an innovative health care delivery model called "patient-centered intensive primary care." That’s a mouthful of medical jargon. But the model sometimes goes by another name: "medical hotspotting."
Medical hotspotting traces its roots to a law enforcement strategy that involves mapping where crimes are committed in a given region and then applying extra police resources in areas considered hot spots. Advocated by former New York Police Commissioner William Bratton in the mid-1990s, the approach was credited as an important element in reducing crime in New York City by 60%.
Just as identifying high crime areas and giving them special attention cuts crime rates, identifying, treating, and paying close attention to patients who have one or more serious chronic illnesses cuts the number of medical crises requiring expensive hospitalizations and treatments. This is an important realization in efforts to control rising health care costs.
The reasoning is in the numbers. According to the U.S. Department of Health and Human Services, 5% of the population accounts for almost half of total health care spending. The 15% most expensive health conditions account for 44% of total health care costs. And patients with multiple chronic conditions cost up to seven times as much as patients with just one chronic condition.
Medical hotspotting received national attention earlier this year when Harvard surgeon, author and New Yorker staff writer Atul Gawande wrote a piece in the magazine about Dr. Jeffrey Brenner, a primary care family physician in Camden, New Jersey. Dr. Brenner has been using medical hotspotting since 2007 to improve health care delivery in the city and potentially cut costs.
After five years, the verdict is still out on the cost impact of medical hotspotting in Camden. But projects in more controllable situations elsewhere offer a glimpse of medical hotspotting’s promise.
For example, the driver behind the new Stanford clinic, Dr. Arnold Milstein, was a key player in a two and a half year pilot sponsored by Boeing Co. for its employees in Puget Sound, Washington. For this pilot, Boeing partnered with its insurance carrier, Regence Blue Shield, and the Everett Clinic, a multi-specialty health care provider that already cared for some Boeing employees.
The project focused on 750 Boeing employee volunteers with severe health issues. Employees were matched with an Everett team of one physician and one nurse who worked on all aspects of the patients’ conditions and coordinated care among various practitioners. Payment accepted by Regence Blue Shield was an unusual combination of fees for services and monthly fees.
Completed in late 2009, the pilot enabled Boeing to save 20% on health care costs for participants compared to a control group. Savings were the result of fewer hospitalizations and emergency room visits, which more than made up for the expense of providing such intensive and focused care to patients with serious illnesses. The program has since been expanded to more Boeing employees.
The Boeing program is a glimpse of success in America’s war on health care costs. It offers hope to other employers and their employee-patients that innovative health care delivery models such as medical hotspotting can achieve their goals of improving patient outcomes while cutting costs.
What’s needed now—and what the Stanford clinic and other programs like it no doubt hope to do—is to replicate the early successes of medical hotspotting. Because without proof, it’s hard to believe. Who would have thought that providing more health care could actually lower health care costs?