Student Hotspotters Work to Reduce Healthcare Costs—One Patient at a Time

Despite juggling classwork, clinical rotations and studying for exams, Sidney Kimmel Medical College student Sean O’Sullivan still manages to make time in the kitchen, whipping up a batch of low-carb cookies—a surprise healthy treat for his patient with uncontrolled diabetes.

“I used coconut flour and almond flour and maple syrup instead of any processed sugars, so they still taste sweet,” O’Sullivan describes. 

Highly focused on earning his patient’s trust, he hopes his goodies are a start to closing the all-too-common patient-provider gap.

“He said it was the nicest thing anyone has done for him in as long as he can remember,” O’Sullivan recalls.

As the price of healthcare continues to skyrocket, O’Sullivan is among a group of interprofessional Jefferson students dedicated to reducing costs and improving health and well-being—by making connections one patient at a time.

Gaining Trust
Just 5 percent of patients in the country accounts for nearly 50 percent of healthcare costs, research shows. This staggering statistic drove Dr. Jeffrey Brenner, former director of the Camden Coalition of Healthcare Providers, to develop the concept of “hotspotting.” The idea is to identify this 5 percent, referred to as super-utilizers, and connect them with resources to educate them and address their needs, ultimately reducing unnecessary hospital visits.

In 2014, the Camden Coalition, Primary Care Progress and the Association of American Medical Colleges created a curriculum to educate students attending 24 institutions across the country about hotspotting. Today, Jefferson serves as the Northeast hotspotting hub to provide training and mentorship for schools in the region.

Through the Jefferson Student Interprofessional Hotspotting program, University students were assigned to eight interprofessional teams—each group tasked to help one patient navigate the complex world of healthcare over the course of the 2018-2019 academic year. Teams were also assigned interprofessional advisers who assisted with patient recruitment and provided ongoing program mentorship.

For O’Sullivan’s team, their patient deals with a wealth of health problems, including diabetes, partial blindness, rapidly declining kidneys and a resting heart rate of 130 beats per minute.

“This is a patient whose chart says, ‘difficult, resistant, not willing to be on dialysis, not willing to have the surgery requested by the medical team,’” O’Sullivan notes.

The student hotspotters found their patient’s initial resistance came from a lack of understanding for basic medical terminology and a failure to trust healthcare providers. Gaining their patient’s confidence became the biggest goal for O’Sullivan and his team.

“It’s amazing to see how something small like baking for them can really make a huge impact on your relationship with that person, particularly the behaviors you’re trying to change,” O’Sullivan says. 

Altering Perceptions
The majority of the super-utilizer population struggles with health literacy. For instance, Anne Bono, a third-year physical therapy student at Jefferson and hotspotter, says her patient’s medical records vastly contrasted with the patient’s own recount of prior doctor visits.

Similar to O’Sullivan, Bono and her team also understood that any change for their patient, who had a primary diagnosis of diabetes, only would come after they earned her trust.

“It took two or three home visits of talking and learning more about her for her to open up and feel like she felt comfortable,” Bono says.

After building an authentic healing relationship, their time together went far beyond helping with health literacy issues, she says. Her team quickly realized their patient battled extreme social isolation.

“She said there were days when she hadn’t left her house,” says Bono, who with her team set up a tour of a nearby senior center for their patient. “She was very interested in the religious group and exercise classes. She definitely came out of her shell.”

Both O’Sullivan and Bono say through this experience, it changed their perception of what a patient-provider relationship should look like.

“I think hotspotting is the future of medicine,” O’Sullivan says. “It’s how one can focus on the diseases of the current state of the United States, which isn’t infectious disease. It’s metabolic syndrome, diabetes, hypertension and obesity, and in order to treat those diseases, behavior change is necessary. We’ve bridged the gap between our patient and the healthcare system and showed him, ‘Your health is important. You’re important.’ That’s very powerful.”