April 1, 2026 Forum

For Bill and Jane, our community of solution is already well on its way. There are many individuals and organizations that are coming together using local data and local assets to build a stronger community, and these assets and collaborations will help everyone in the community, the block, and the apartment where Bill and Jane and a dozen others will live. Cold spotting requires a shift in our thinking, a shift evident in the data described above.

Health care problems and overrun costs are not due to individual patients. Our problems are systemic and community-based. The problem sheds are not in individual homes or with individual patients, hot spots.

The problem sheds are larger, wider, cold spots. The cure requires a community approach, linking public health and primary care in explicit partnerships that address the needs of the individual and build an environment and community that supports healthy living. Together, when we build a community of solution, we eliminate the cold spots, which will also help eliminate our hot spots.

Jeremy

Well, I think that pretty clearly lays it out for everybody, that there’s the overabundant use of individualism, which has a tendency to label individuals as the problem. Then a whole bunch of resources go to help one person. They work, and then that gets spread. Every health system across the United States has heard of and tried hot spotting, right, Jack? I think that when you go to the institutions, they got to find the hot spotters, got to get those over-utilizers and get them the hell out of Dodge. You know, let’s get somebody out there to their house, let’s put all these services in place, let’s vertically integrate all the services to this one person. That does save the systems lots of money, but it’s an overabundant use of resources for a single person. And it doesn’t really address the larger issue. So, what does that bring to mind for folks?

Bill B

I’m interested in this notion about fractals—how patterns exist at multiple levels. I was thinking about how fractals relate to hot spotting. Doesn’t hot spotting also occur in the individual human body?  In the individual person, it is usually a specific organ of their body that gets all the attention, when in fact what’s really going on, as you said, is it’s the interlinking of all the different parts of the individual body that makes the greatest sense. I assume that we can also talk about hot spotting as an international phenomenon. Isn’t that what we’re talking about right now in the way of what’s going on in the world? There are some hot spots. And we focus on those hot spots when the real issues are global and systemic in nature. So, I was just thinking that  what Jack’s talking about is the replication of the same process again and again, and at all sorts of levels. A fractal is in operation.