How hot-spotting stops bedbugs and other social ills

Too often, bedbugs prevent cost-effective and quality health care – both literally and figuratively.

In the literal sense, consider the case of an elderly woman we’ll call Mary. A frequent visitor to emergency rooms in Northern Colorado, Mary has a long list of medical and behavioral health problems.

Recently, a pilot project implemented by the North Colorado Health Alliance brings together a team of providers representing different walks of the health care system to determine why people like Mary keep returning to emergency rooms – a costly and ineffective scenario. In Mary’s case, our team determined that she lacked necessary in-home care because her house had bedbugs. Mary didn’t have the money to exterminate the infestation, and yet without in-home care she would likely keep returning to emergency rooms.

The team arranged to fumigate Mary’s house and replace her infested mattress at the cost of $380. Of course, they couldn’t bill Medicaid for it, but by making these simple arrangements the team kept Mary from many expensive emergency room visits by identifying an environmental factor contributing to her ill health.

Mary’s case underscores a growing acknowledgment among health care professionals that social and behavioral determinants of health have a strong influence and cannot be ignored if we are to improve the   health care system. In fact, the U.S. Department of Health and Human Services estimates that only ten percent of health is influenced by health care, with factors such as income, education, transportation, food insecurity, environment, and personal habits such as smoking, drinking and obesity rounding out the other 90 percent.

To serve the needs of the 2 percent of the population driving 50 percent of health care costs, we must take a closer look at what’s happening outside of the hospital walls.

That’s why the model developed by Jeffrey Brenner, MD, a family doctor from Camden, N.J., holds much promise. Brenner, who will speak at the upcoming Colorado Health Symposium, uses medical billing data from emergency rooms to map out “hot spots” of the city’s most costly patients. Brenner targets the sickest and most expensive patients in Camden. With support from medical foundation grants, he assembled a team of medical “hot-spotters” (nurses, social workers and physicians’ assistants), who make calls and home visits. So far they’ve reached more than 300 people in three years.

In some cases, Brenner said this innovative approach has delivered cost reductions as high as 50 percent, while also reducing emergency room visits and improving individuals’ health.

Dr. Brenner’s model helped inspire the North Colorado Health Alliance’s efforts to move away from traditional health care models and implement our own version of “hot-spotting.” Our community-based management team works within the spaces in which people get lost in the health care system. Although “hot-spotting” is potentially disruptive to the traditional health sector because it is so different, I’m convinced it’s effective.

Like the bedbugs I mentioned earlier, many social determinants of health could be eliminated with the right approach and care. But if left unchecked, they ultimately impact the health and well-being of many.

– Mark Wallace is President, North Colorado Health Alliance and Director, Weld County Department of Public Health and Environment.


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