April 1, 2026 Forum

This twentieth forum was convened on April 1 2026. In attendance were Mitch Applegate, William Bergquist, Jeremy Fish, Bill Gillanders, Jo Marie Reilly, Gay Teurman, Mark Vukalcic, and Jack Westfall. The Trigger topic for this forum was provided by Dr. Westfall who brought in the opportunities and challenges associated with the identification of hotspots and coldspots in health care systems.

Following is a narrative based on the dialogue that took place during this forum. It begins with the short formal presentation made by Jack Westfall:

Jack

Meet Bill. Bill lives near downtown Denver in a small apartment. He grew up in the San Luis Valley and moved to Denver after high school. He has been a truck driver, carpenter, a cabbie.

Now he is disabled, unable to work. He’s about 60 years old. Bill is a hotspot. Seven hospitalizations in the past year, an acute heart attack last year, heart failure three times. Pneumonia landed him in the hospital, diabetes, a non-healing foot ulcer, and hyperglycemia. Nine additional ER visits in the past year, chest pain a couple of times, leg swelling four times, cough once, and diabetes.

Bill was identified by the local emergency room as a super-utilizer, a hotspot. He was enrolled in an aggressive healthcare follow-up plan funded by the city. Bill got better. He lost 30 pounds. He sees his family doctor every two to three weeks. He checks his blood sugar, and his A1C dropped from 12 to 8. He saw a counselor in his primary care office for four months, and his depression is much better. He takes his medications and eats a regular diet.

His utilization dropped, and the cost of his care plummeted.

Jeffrey Brenner began his work in Camden, New Jersey. Dr. Brenner called these super-utilizers hotspots, and he took them on as their personal primary care doctor. He got help from local hospitals and social services. By providing enhanced primary care and social services to patients with high utilization of expensive emergency and hospital care, there’s evidence that their healthcare can improve and their costs can be lowered. This type of hotspotting identifies individual patients and dramatically improves the care of individual patients.

It also labels them, individual community members, as super-utilizers, puts a price tag on them, and reminds us that there are some people who just cost all of us more money.