A committed group of University of Minnesota students has come together to focus on the costly problem of high utilizers, or individuals who visit a hospital four or more times during a six-month period.
Calling themselves the UMN Hot Spotters after a program developed by Dr. Jeffrey Brenner, a Camden, New Jersey, physician and health-care advocate, this group has been awarded a $7,000 grant from the University of Minnesota’s Consortium on Law and Values in the Health, Environment and the Life Sciences Programs.
The UMN Hot Spotters, all affiliated with the University of Minnesota’s Academic Health Center, have begun to work with a small group of high utilizers at the University of Minnesota Medical Center-Fairview.
“We are conducting an inpatient needs assessment for high-utilizer patients admitted through the emergency department,” said Roma Patel, a UMN Hot Spotter and fourth-year law student who is also earning a master’s degree in public health and policy.
People become high utilizers because they have a hard time accessing health care through traditional channels, Patel explained. Some lack health insurance or work more than one job, making going to a physician’s office during regular business hours nearly impossible. Others don’t have access to reliable transportation.
Many high utilizers struggle with intertwined mental health and addiction issues.
“Mental health concerns are one of the most common factors among high utilizers,” said UMN Hot Spotter Hannah Chau, a third-year nursing student at the U of M. “Around 40 percent of high utilizers have mental health problems like depression and eating disorders.”
Sometimes, these conditions are only diagnosed after years of struggle.
“If a person is not consistently seeing a primary care provider, he or she might not be able to get their mental health conditions diagnosed,” Patel said. An emergency room physician who is not familiar with an individual’s health history may not notice a pattern indicating mental health or addiction issues, she said. “Not directly addressing mental health issues can quickly become costly.”
Humble beginnings
At the University of Minnesota Medical Center-Fairview, the UMN Hot Spotters are starting small, with a pilot study surveying five high-utilizing patients.
“We ask patients, ‘What are your needs?’ ” Patel said, “ ‘What are the barriers you are facing to accessing health care?’ Once we have gathered the data, we will reassess our survey tool and then finish the need assessment with 120 patients. Then we will work toward helping these patients find ways to more easily meet their health-care needs.”
Brenner’s project in Camden began when the physician started taking a more comprehensive look at the lives of his most expensive patients.
“He saw that he had a group of patients with a lot of complex chronic illness,” Patel said. “A lot of these patients’ needs weren’t being met. He investigated to see why that was happening. Brenner asked, ‘Does this patient have adequate transportation to get to their medical visits?’ “Do they have a bus pass?’ ‘Do they have adequate heating and cooling in their apartments?’ He found that all of these factors that don’t seem to have anything to do with a person’s health actually do have an impact on their overall health status.”
Patel’s group of Hot Spotters is trying to do the same thing in Minneapolis, narrowing their focus to a small group of high-needs patients at the hospital and drilling down on the barriers they face to accessing timely medical treatment.
“Hot Spotting means focusing on patients who use a high volume of services and trying to determine how we can structure care around them and their specific needs,” Patel said. “The whole idea is premised on the belief that we don’t need to throw more medical services at them or spend more money on their problems, but we do need to have access to a range of medical professionals — including nurse practitioners, pharmacists and physicians — to get them care in a more efficient manner.”
This effort is worth it, Chau said, because “high utilizer patients are costly to the system. They make up 1 percent of the patient population but they represent 21 percent of health-care spending.” Just as at the University of Minnesota Medical Center-Fairview, she explained: “Utilizers tend to turn to emergency departments, which are the costliest units in the hospital system.”
Next steps
The UMN Hot Spotters are still in the early stages of their work. “We are at the beginning of our pilot study,” Patel said. “I would imagine we’d have some results by middle to end of summer.”
The next step for the group, which at the moment is the first and only multidisciplinary student Hot Spotter group in the country (members include nursing, public health, law, pharmacy and medical students) is to “start thinking about potential interventions that we can introduce to meet patients’ needs a little bit better,” Patel said. “That leads into the policy and advocacy aspect, which is how we can translate these needs and interventions into meaningful policy.”
The UMN Hot Spotters are also working on gathering the personal stories of high-utilizing patients and their caregivers.
“One of the other projects we are trying to get off the ground is something called The Stories Project,” Patel said. “We’d interview patients about their lives, and talk to providers about what it’s like to work with high-utilizing patients.”
In March, the UMN Hot Spotters presented at the second-annual Camden Coalition High-Utilizer Conference.
“This is the very beginning of a pretty widespread movement,” Patel said. “There is a lot of money at stake and, more importantly, there are patients who often feel ignored or marginalized. We want to make it clear that these patients’ voices really matter. We felt that as students we have the energy and enthusiasm needed to really do something about this problem. We all want to use our education to create a positive change when we become professionals.”
