Family Medicine Vital Signs

By: Kyle M. Turner, PharmD

Consider, for a moment, your “toughest” patients in clinic – the ones who show up about half the time (or less), seem to be in and out of the hospital or ER on a regular basis. They may be the people that your team throws up their hands and scratches their heads at the question of what to do next. These patients are not new to those of us in primary care and they are among the most complex patients we see on a daily basis. They leave us frustrated, puzzled, and even angry that the system doesn’t seem to have a solution for what to do. Perhaps now we at least have somewhere to go. Perhaps Hotspotting can offer the beginnings of a solution for accomplishing the triple (or quadruple) aim.

Hotspotting, developed by Dr. Jeffrey Brenner and the Camden Coalition of Health Care Providers, is designed to fundamentally change how we care for the sickest and most complex patients in the health care system. By utilizing a data-driven approach to identify individuals with high utilization of acute care resources and targeting specific, patient-centered interventions to these patients, Hotspotting has the potential to accomplish all aspects of the quadruple aim of lower cost, better care, and an improved patient and provider experience.

A short intro to the work of the Camden Coalition and outcomes of their Hotspotting intervention.

Scaling: From Pilot to Hub

In 2016, as part of an effort to scale and spread this Hotspotting intervention, the University of Utah Interprofessional Education (IPE) Program launched its inaugural Student Hotspotting program with support from the Office of the Senior Vice President for Health Sciences. The first team, made up of students from medicine, nursing, pharmacy, social work, and public health, began to mine data through the Enterprise Data Warehouse (EDW) and talk with patients as means to improve care and deepen their education on topics such as social determinants of health, motivational interviewing, trauma-informed care, and more. This initial offering led University of Utah Health, through the IPE Program, to become a Student Hotspotting Hub in partnership with the National Center for Complex Health and Social Needs (affiliated with the Camden Coalition). Additionally, the formation of the hub was supported through the National Center for Interprofessional Practice and Education’s Accelerating IPE grant. As a Hotspotting Hub, the IPE Program scaled from one to eight pilot teams and served as a center to train teams from other academic medical centers in the western US.

Now, students from a wide array of health professions training programs, and also some pre-professional students, are immersed in a value-based learning experience unlike anything they have previously encountered in interprofessional education or their professional programs. In addition to the core educational elements above, students also learn the core IPE principles including engaging in effective teams, understanding roles and responsibilities, clear communication, and shared values. These students gain a real-life experience in how to effectively synergize the talents, strengths, professional backgrounds, and experiences of all team members for the benefit of patients and the health system.

Moving Forward

As the Student Hotspotting Hub moves into its second year, key partnerships from aligned stakeholders are taking the program to another level. For the first time, the program will partner with a payer, University of Utah Health Plans, in order to identify and engage with patients having high health care utilization in an effort to improve health outcomes and patients’ experience and reduce total cost of care. Additionally, the University of Utah Health Community Physicians Group will partner with the IPE program to coordinate student team efforts with team members such as providers, care managers, nurses, social workers, and pharmacists within primary care clinics to inform and share insights obtained from engaging with these complex patients. This move to align key stakeholders fulfills the IPE Program’s vision of utilizing interprofessional education to drive practice change and innovation. Not only are students learning to become better professionals, but their work becomes value-added as they contribute in a meaningful way to actual patient care in partnership with future colleagues, health care systems, and insurance providers.

As health care continues to evolve and move closer to value-based care, new models will be needed to ensure better outcomes and experiences for our patients, financial sustainability, and a more satisfying experience for all members of the health care team.  Student Hotspotting, which sits at the confluence of health professions education and clinical practice, can serve as a model for academic and health system partnerships centered around the patient and providing care in a forward-thinking and innovative way. This new and exciting opportunity places University of Utah Health and its Interprofessional Education Program at the leading edge of the next wave of health care transformation.

Kyle M. Turner, PharmD, is an Assistant Professor (Clinical) in the Department of Pharmacotherapy in the College of Pharmacy at the University of Utah.