Look beyond hotspotting to focus on a broader population’s unmet social needs

When Amy Finkelstein, a Massachusetts Institute of Technology (MIT) researcher and MacArthur genius, evaluates another MacArthur genius, Jeff Brenner, who was initially made popular by another MacArthur genius, Atul Gawande, it is likely to make news. That is especially true when the rigorous research suggests that a widely accepted truism in health care circles may actually be wrong.

MIT’s well-designed, randomized controlled trial (RCT) called into question a common belief that intensive interventions can substantially reduce readmissions while lowering costs for the sickest 5 percent of the population that accounts for 50 percent of health care spending. Indeed, Finkelstein’s January 2020 paper in the New England Journal of Medicine found no statistically significant difference in readmission rate reductions between Brenner’s “hotspotting” intervention—the approach popularized by the Camden Coalition, which relies on retrospective administrative data to reallocate resources to the most high-need, high-cost patients—and a control group.