Cold water or rocket fuel? Lessons from the Camden “hot-spotting” randomized controlled trial

A recent study has seemingly thrown cold water on “hot-spotting,” a widely-publicized, promising intervention aimed at improving care for people with substantial health and social needs. Built on the logic that a fairly small number of individuals have disproportionately high health care costs because they use more emergency and hospital care, the Camden Coalition designed and implemented an intuitively appealing intervention: intensive case management to achieve better coordination of care and remedy the unmet social, medical, and emotional needs that can drive a revolving door of emergency care visits. Evidence seemed to support the intervention. Other studies, including at least one with a non-randomized control group, suggested large reductions in emergency and hospital care after hot-spotting. Prior randomized controlled trials (RCTs) of case management programs among elderly Medicare beneficiaries also suggested it ought to work.