The Hot Spotters Can We Lower Medical Costs by Giving the Neediest Patients Better Care?

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This is in fact in a core focus and purpose of the ACA. To expand cost effective quality coverage and convert that coverage to care, particularly primary care, to improve the overall state of the nation’s population with initiatives like Coverage to Care to newly signed help people understand their benefits and connect to primary care and the preventive services, as well as a step-by-step quick reference "Roadmap to Better Care and a Healthier You” that line up well with Brenner’s approach.

Also in line with Brenner’s findings is one of the largest investigations ever conducted to assess associations between childhood maltreatment and later-life health and well-being by The Adverse Childhood Experiences (ACE) Study. The ACE Study findings suggest that certain experiences are major risk factors for the leading causes of illness and death as well as poor quality of life in the United States. All of these efforts point to early intervention in health factors that form components of what Brenner and others like him propose is effective and comprehensive primary care.

The article cites a good and difficult example to ignore that started two decades ago when Denmark made changes to strengthen the quality and availability of outpatient primary-care services that including payments to encourage physicians to provide e-mail access, off-hours consultation, and nurse managers for complex care that resulted in the country going from a hundred and fifty hospitals for its five million people down to seventy-one hospitals with projections within five years of the need for fewer than forty at the time of this article.

Recognizing this, in a PSYCHIATRIC NEWS article, Brenner stated that providing better and cheaper care will necessarily disrupt the established hospital industry the he believes emphasizes and is built on providing what he call “High Tech Sickness” care and a reimbursement system that is geared to rewarding procedures and test rather than “cognitive” services and talking to patients.

At one point the article asks if anything as dramatic as Denmark could happen in the U. S. Brenner’s model of hot spots reduces over-all health-care costs. A loss of revenue to hospitals like the ones in Brenner’s initial results might very well provoke the retaliation, counter-campaigns, intense lobbying for Washington to obstruct reform stated in the article that are very likely to be occur from the interest of a Health system that represents 17% of the U. S. economy.

With the new addition of Nearly 10.8 Million Additional Individuals Enrolled in Medicaid as of December 2014 as reported on February 23, 2015 www.hhs.gov/, it is likely that Hot Spotting or something very close to it will absolutely find its way to being a central tool in the effort to maintain the quality of care while controlling health care expenditure in the U.S. in the years to come.

Brenner model will not be without detractors or resistance from the status quo. After all, Brenner’s saving represents the current revenue stream of these institutions current state. From the reading the assigned article and other subsequent articles it led me to, Brenner did not start out to create a case against the established Business of Healthcare, but he soon discovered that there are enormous economic interests in the current state of the U.S. Health Care industry and its stakeholders that he would run up against when he discovered that in solving the problem of Hot Spotters, it would by its very nature shift the emphases away from that of the established healthcare business structure.

I believe that an approach like hot spotting was inevitability and was going to come sooner or later, and believe that its time has come. I agree with the article when it states that the ACA is betting big on the Brenner’s of the world who believe earnestly believe we can afford to subsidize insurance for millions, we can remove the ability of private and public insurers to cut high-cost patients from their rolls, and we can improve the quality of care for our nation’s population.

REFERENCES

http://www.camdenhealth.org/

http://www.macfound.org/about/

Blum, H.L. (1981). Planning for Health, 2nd Edition. Human Sciences Press

http://www.hhs.gov/healthcare/prevention/index.html

http://psychnews.psychiatryonline.org/pb/assets/raw/news/issue-pdfs/psychnews_48_24_complete_issue.pdf

http://www.iom.edu/~/media/Files/Activity%20Files/Quality/IntegrativeMed/Preventive%20Medicine%20Integrative%20Medicine%20and%20the%20Health%20of%20the%20Public.pdf

http://www.hhs.gov/healthcare/facts/blog/2015/02/medicaid-chip-enrollment-december.html?utm_campaign=022315_hhs_healthcare_blog_medicaid&utm_medium=email&utm_source=hhs_healthcare_blog&utm_content=022315_hhs_healthcare_blog_medicaid_titlelink

http://www.cdc.gov/violenceprevention/acestudy/