Hotspotting is hot!
I have had friends on hotspotting teams telling me about it for some time now. Certainly there are other terms for the process of using claims data to identify those patients who frequently use healthcare systems, but are poorly served by them. It’s probably happening in a health system near you.
Whatever your organization calls it, There’s quite a lot of communication going on – within the team, and between the team members and the patients and communities they serve. So I want to take this opportunity to write about some considerations for communication – what you might want to keep in mind – if you’re on a hotspotting team.
Begun in Camden, New Jersey, in 2007, hotspotting involves interdisciplinary teams who seek to understand why some patients have frequent hospital visits, and how better outcomes can be reached.
One of the goals is to provide patients with enhanced care and targeted intervention programs. Another is cost containment for the health systems.
Being a member of a hotspotting team involves many learning opportunities. It touches on cultural humility, motivational interviewing, teamwork, coordinated care, complex patient care, and healthcare super-utilizers.
That explains why educators, clinicians, practitioners, students, researchers, health system leaders, patient organizations, and policymakers are some of the folks involved and interested in hotspotting.
So with all of this action going on, let’s take a moment to think about communication.
Communication in the patient’s lifeworld
Hotspotting teams depend on gathering information about the patient, her surroundings, and her background knowledge and assumptions about her condition. All of these are helpful building blocks for patient care in and beyond the clinical setting.
This is often done through home visits. So that’s where I’m going to start: what you are looking for, noticing, and saying when you are talking with and about your patient in the home or community setting.
You know by now (and you’ve heard me say) that our understandings of health are culturally mediated.
This means we each draw on a range of ways of understanding the body, science, procedures, insurance, nutrition, and more. These ways of understanding are shaped by our knowledge and our experiences–with our bodies and with the health care system. And we all learn how to make sense of and use this knowledge and experience from the various communities we belong to.
Whether or not our understandings of health and being healthy correspond to the latest medical knowledge, they make sense to us. Our understandings of health shape how we read, write, talk about, think about, listen to, process, and act on what it means to be healthy in our communities.
It can be easy to think of the ways other people understand their health, health care, and health information as problematic. Especially when it’s not what you think should be normal or basic. This can lead to a deficit perspective on a patient.
As a health care professional, serving the patient means starting where the patient is at, including knowing what’s important to them, and seeing others’ bodies and health as they see them.
Our ideas about health are culturally shaped, but these ideas are not fixed. They shift, and can be changed.
So find out what’s important to the patient, remember this has basis in community. Start where they’re at, and avoid that deficit perspective.
Communication with the patient
Hotspotting had its basis in health professionals noticing that a small amount of patients were responsible for high amounts of charges, many of which were preventable, and many of which did not result in good outcomes for the patient. Part of why hotspotting has gained traction is its potential to lead to more efficient use of the health system, which in part saves systems money. As you know, Individuals with complex health and social needs drive much of the total cost of care.
This situation tends to lead to – or at least reinforce – a negative or deficit view of these patients. This view is reflected in some of the terminology used to describe them.
In a great podcast episode on hotspotting from North Carolina Public Radio, Mark Humowiecki, director of the National Center for Complex Health and Social Needs at the Camden Coalition of Healthcare Providers, says:
A big piece of this is these are patients that typically the health system looks down on, labels as frequent fliers, thinks of as noncompliant.”
So when it comes to the patient, and to her health communication—what she reads, says, views, writes, or listens to–I’ll make one important point: Be careful with your language.
What terms are you using, about the patient or client (besides patient or client?) what kinds of values or priorities do these terms reflect? Are they frequent fliers? Or people least well served by current arrangements?
For another example, “illiterate” has been used a threatening and pejorative term for decades. It can quickly take on connotations of someone being unintelligent, uninformed, backward, or somehow lacking. People who are repeatedly told they are illiterate can come to believe that about themselves.
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As I’ve pointed out before, mulitiple studies prove that people who are labelled or thought of as illiterate have multiple sophisticated ways of reading a text or image, keeping track of items, measuring and weighing, estimating and calculating, and accessing information.
So first, ditch the negative terminology. This will help you see your patient, and their communication—including their health literacy–in a new light.
For instance, think of all the common, everyday tasks that involve literacy, which your patient might engage in:
- making or using shopping lists
- calculating prices
- reading recipes
- using the internet through smartphones or computers
- reading signs
- reading/annotating/reciting sacred texts
When confronted with complex health-related experiences, patients with literacy difficulties draw on a broad range of strategies and skills to understand their situation and navigate the health care system.
I’ve often mentioned cell phones when I’m talking about health literacy. Smartphones tend to cut across income levels and cultures. Smartphones are incredibly demanding, in terms of the reading, writing, and numeracy skills needed to operate them. They also make us all capable of producing and sharing complex materials full of images, motion, and text.
Keeping in mind the many everyday ways your patient engages in literacy activities can be useful. You get to know your patient as a person. And you have a basis for beginning, and going forward with, the communication and education of this patient.
Communication within the team
Communication within a hotspotting team is important because hotspotting is, by design, a broad based collaborative. Teams extend across medical specializations, but also across disciplines. People who don’t usually work together!
Interprofessional (IP) team work has been shown to decrease burnout and improve care and decrease costs. But it can be a tough spot for communication.
“We’re trying to teach students to work with each other and also try to serve these patients.”
So in an effort to help out around here, I offer some reminders.
We all tend to think our way of seeing things, and talking about things, is normal.
This is because we are socialized into the ways we talk, think, act, and more. Earning a professional degree is a significant socialization process. In various professional programs, people learn to talk, think, read and write in ways that are necessarily specific to an area of expertise.
As you’re aware, across and within groups in the health professions, the terminology is different. The focus is different. The knowledge, assumptions, and motivations are different.
In short, even within health care, people’s ways of thinking, talking about, and ‘doing’ health and health care are different. as a result of our participation in our various professional communities.
So when it comes to talking about health, talking to someone outside your professional neighborhood takes work.
The important first step is to remember this: we all tend to take our ‘normal’ for granted. When in fact, it’s shaped by our communities. in this case, our professional communities. Our way of doing and saying things makes sense to us, but maybe not to those outside our professional community. So, yes, specializations each have their own ways of doing things, and the language and terminology that goes with it.
Keep an eye on how your team is navigating this kind of cross-disciplinary translation. Does one way of talking about and doing things tend to dominate? Whose professional or academic approaches are marginalized or glossed over?
Hotspotting programs seek to serve the most vulnerable members of society by providing enhanced care and services. At the same time, hotspotting seems to hold great potential for addressing the social determinants of health, increasing interprofessional learning, avoiding penalties to hospitals for high rates of readmission, and reducing unnecessary patient hospitalizations.
And its popularity shows no signs of slowing, check out #hotspotting; there’s nice stories there!
As I’ve pointed out here, there’s no lack of communication considerations for these teams. If you would like further information on communication and hotspotting, click on the ‘contact’ link at the top of the page.