Medicaid and the future of health care hot-spotting

A recently published randomized clinical trial of the Camden Coalition’s hot-spotting model, which uses teams to identify and manage the care of high-frequency hospital users, found no impact on hospital readmission rates. The limitations and implications of the trial have been widely discussed. This brief looks at the significance of the trial results and at the experiences of a completed New Jersey Medicaid ACO demonstration that also used a hot-spotting approach, for Medicaid, the principal source of coverage for the nation’s most medically and socially complex patients. The author considers questions relevant to Medicaid agencies, such as whether targeting patients with repeated hospitalizations makes sense; if care management is sufficient; and what outcomes we should expect hot-spotting interventions to improve.