Atul Gawande and the Hot Spotters
Jacob Schor ND
January 22, 1011

Atul Gawande has again written what will most probably become a landmark article for The New Yorker.  Appearing in this week’s issue (Jan. 24, 2011) is an article called The Hot Spotters.  Unfortunately there isn’t a free download available yet.  The best I can do for now is summarize the article and encourage you to either purchase the issue or read it online at a later date.
With our background practicing naturopathy, much of what Gawande describes seems so obvious, kind of preaching to the choir.  But for a mainstream doctor to say that proactive patient centered care saves money and is worthwhile is, I think, monumental.  And he does it so well….
In the Hot Spotter article Gawande writes about several innovative approaches to reducing health-care costs. He starts by telling the story of Jeffrey Brenner, MD who practices in Camden, New Jersey.  Brenner used data mining and statistical analysis to map health-care use and expenses. His found that just 1 % of the 100,000 people who use Camden’s medical facilities accounted for 30% of its costs. In Brenner’s experience the people with the highest medical costs were usually the people receiving the worst care. He created a way to find the people whose use of medical care was highest, and go after them and provide better care.  This idea led to the creation of the Camden Coalition of Healthcare Providers. By late 2010, his team had provided care for more than three hundred of these most costly people.  These people averaged 62 hospital and E.R. visits per month before joining the program and 37 visits after—a 40% reduction. Their hospital bills averaged $1.2 million per month
before and just over half a million after—a 56% reduction. These kinds of cost savings are revolutionary.
Gawande moves on in his article to talk about a company called Verisk Health, a data-mining company, which supplies “medical intelligence” to organizations that pay for health benefits. One of the doctors that works for Verisk, Nathan Gunn, who explains the way data mining can be used to identify the most frequent users of health-care facilities and reduce their costs.
Gawande also describes a visit he made to the Special Care Center, a clinic in Atlantic City, an experimental approach to primary care. He writes about the Center’s leader, Rushika Fernandopulle, and the intensive outpatient care for complex high-needs patients the Center provides. In addition to physicians and nurses, the Center employs eight full-time “health coaches,” who help patients manage their health. Fernandopulle carefully tracks the statistics of the Center’s 1,200 patients. After twelve months in the program, he found, their emergency-room visits and hospital admissions were reduced by more than 40%.  Surgical procedures were down by 25%. The patients were also markedly healthier. Gawande then describes the difficulties in implementing these and other innovative ideas on a larger scale, including opposition from insurance companies and the health-care lobby.
 Link to full text in the New Yorkert:
Atul Gawande was interviewed in National Public Radio’s Fresh Air just last week when the article first appeared.  You can listen to the interview at:
I’ve posted links to Gawande’s articles in the past.  The most recent was about hospice care.
You may recall an earlier article by Gawande from April 2009.  This is what triggered the focus on Grand Junction’s health system because it cared for Medicare patients for far less money per capita than McAllen, Texas does.
More information about Atul Gawande is on his website: