Recently, the UHC Community Plan of Iowa identified Alisa* as a high-utilizer, with 50 ER visits in three months. Records showed multiple acute and chronic conditions, including opioid addiction and mental illness.
A community health worker located Alisa in an ER but was unsuccessful in engaging her—but she persisted. The community health worker is currently working one on one with Alisa to build trust before determining a care plan.
How did the plan find Alisa in the first place?
The answer is hotspotting.
Providing high-touch, compassionate care for the most vulnerable people in our society doesn’t necessarily begin in a doctor’s office, or even with a social worker. It begins with data, by asking the question: who needs our help the most?
The hotspotting process used by UnitedHealthcare is both nuanced and powerful. It can search for high-need, high-cost populations, usually through hospital reimbursement claims, based on criteria such as homelessness, ER utilization and inpatient stays, complex conditions, demographics, and more. In addition, health coaches can further pinpoint complex members by applying additional hotspotting measures, including individuals who may seek care at different hospital systems.
UHC also maps and visualizes hotspots by state, city, county, or zip code, identifying communities that might have a high concentration of members who meet the hotspotting criteria. For example, this can be crucial for determining the best placement for a housing complex, such as in Las Vegas, which might make the most sense in a particular region.
Let’s take a look a 12-month nationwide snapshot of data. When we dig into the ER utilization and cost of members who have experienced homelessness, based on claims, we can see an important story about health care take shape. But what is it?
- All UHC Patients: 0.6 average ER visits, $450 paid per member
- UHC High-Cost Homeless Patients: 9.5 average ER visits, $8,000 paid per member
- UHC Highest-Cost Homeless Patients: 13.3 average ER visits, $32,000 paid per member
Uncovering this story requires getting away from the top-down, transactional view of health care and seeing day-to-day life as the most vulnerable members of society see it, often dealing with trauma and unable to get their feet underneath them. Many chronically ill people who experience homelessness cycle in and out of high-cost services without optimal solutions.
If you’re marginalized, isolated, and withdrawn, with multiple chronic conditions and behavioral health issues, it’s not irrational to use the ER as a warm, safe place to stay if you have no other options. And this person might not only need medical care, but could very well use a safe home, a ride to a job, or fresh groceries.
Hotspotting has already been used by UnitedHealthcare to help identify optimal geographies for targeted, specific interventions throughout the country. Some of these interventions include housing, opioid programs, complex care management, in-home primary care, and temporary stabilization services.
Of course, this is only the beginning of the story. The data needs to be translated into information—about a person.
A person like Alisa.
*Name changed to protect member’s identity