Healthcare hotspotting is the strategic use of data to reallocate resources to a small subset of high-needs, high-cost patients who standard systems of care have failed. Developed initially at the Camden Coalition in New Jersey, the approach has spread across the country, and some health systems are integrating it into interprofessional medical training.
In a recent talk hosted by the National Center for Interprofessional Practice and Education, Sara Hart, Ph.D., R.N., described the University of Utah’s approach to developing a community-education-healthcare partnership that works at the intersection of social determinants of health and health access for individuals with complex health and social needs.
“We started small, working with one agency, the Housing Authority of the County of Salt Lake, which provides permanent supportive housing with wraparound housing for chronically homeless single adults,” said Hart, who is vice chair of interprofessional student hotspotting, associate professor of health systems & community-based care, and director of student & community engagement at the University of Utah College of Nursing.
Her group was one of 16 nursing schools that won grants from the National Center. For two years, these schools of nursing and their universities have partnered with community-based organizations to deliver new models of healthcare and education to benefit the people served, students and health systems.
“Our program was built with a foundation of an established relationship,” Hart said. In 2015, the college of nursing and the housing authority began to partner to better address unexpected resident deaths. Undergraduate nursing students began doing needs assessments. The university’s Interprofessional Practice and Education (IPE) program director became interested in a hotspotting collaborative hosted by the Association of American Medical Colleges and the Camden Coalition. “We were able to create a proposal to be funded,” said Hart, who added that the Camden Coalition holds tremendous knowledge about how to access health system data and how to build community-based complex care curriculum.
“We learned we had to put people first,” Hart said. “One challenge was to step away from the structures of our system and think about the people being served and collectively identify their needs. We were able to identify specific linkages among partners engaged in the work and student learning. We brought in new providers and payers and holders of data who had a recognition of the importance of social determinants of health.
The University’s initial core team included the College of Nursing, the College of Pharmacy, the College of Social Work and the IPE program.
One of the big changes from this work was a better understanding of the concept of a “nexus” of stakeholders and how it relates to students and community-based education, Hart explained. “We started by asking community partners about their needs and how we could help them, before asking how students could be integrated. Putting the partners’ needs first leads to a much higher chance of long-term sustainability,” she said.
They created a longitudinal six-month program for students that allowed them to engage with the multisector collaboration. “We focus on people, patients, and family first, not courses or learning outcomes, or provider needs,” Hart said. “We had to learn to listen and try to understand each other’s needs and accommodate changing needs. We recognized that building trust takes time and that community partners need to be on the leadership team from the earliest planning stages.”
There are five to six students per team, representing all health professions. Community-based case managers serve as their advisors. Each week the teams have structured check-ins and reflection activities. Once a month, they present their work in sessions with Camden Coalition experts.
In 2017 one pilot team was critical to their learning success. “We were able to keep all the partners and flex to their needs. We have been able to reframe our work and keep everyone at the table.”
Then in late 2017, the University of Utah launched eight teams of interprofessional students, some in community clinics and others with the housing authority. Now in its third year, they are still using that eight-team model. “We have paused and evaluated the idea of expanding the number of teams,” Hart said. “What we have learned is that when growth happens too rapidly it can damage sustainability. We are focused on data-driven expansion instead of enthusiasm-driven expansion. We are looking for new partnerships to bring health system integration and sustainability. We are constantly seeking financial stability. Health system integration will be critical to our future.”
