April 1, 2026 Forum

Bill G

I’d like to contradict what Jack was talking about. There are hot spots both globally and individually. However, the healthcare problems of about half of the patients that come up with hot spots don’t have anything to do with their style of living. They respond to an integrated care, but only about half of them respond. We did an experiment during the trial of care where we had half the patients in hot spot areas and half the patients in non-hot spot areas. Half of the patients did not respond to any kind of intervention. Even the global intervention that Jack mentions, were still failure of life.

Jack

I don’t pose this as the cure for everything, but I will say that the individualism that Jeremy talked about—concerning taking care of the individual oftentimes—simply provides evidence that an individual person may get better and move on. These are what we called the pre-super-utilizer, when I was at Santa Clara. We could tell who was about to become a super-utilizer, and so we called them pre-hot spots, and we would try to intervene. But it was churning a wheel of individuals rather than trying to fix the environment in which they lived and the places in which they received a broader array of services and care.

Bill B

So, Bill G, was there anything discovered in your study about the other half?

Bill G

I was going to comment on that. We tried to intervene and predict the pre-hot spotters, and the reality was that we couldn’t really differentiate that half of the hot spotters, became non-hot spotters were just of their own individual path, whatever that path was. We couldn’t really tell. We never got far enough along with our study to actually predict which of the pre-hot spotters would become hot spotters and then would move on to become non-hot spotters over time.

This was just not indicated.

Bill B

It sounds a bit like what’s occurring in the weather. It’s the butterfly effect. For half of the people you studies, no predictions could be made because some small event occurred that began to change everything. I was thinking, for instance, of Mark’s statements at previous forums about how people, and neighborhoods can have an impact. Sometimes it takes just one person caring that makes all the difference. So, in some sense, it’s a butterfly effect. There are some small conditions or events that changes everything for this person, and we simply cannot predict it.

We can for half of the people, so we do a pretty damn good job of predicting the weather in general, but about half the time we’re wrong. And about the half time, Bill G, it sounds like the model didn’t work for you either.

Bill G

Yeah, that’s correct.  About half the time, we weren’t able to predict what was going on.

Jeremy

And Jack, maybe you could speak to this. I’m not sure whether this data is there, but is it not true that the hot spotters are more highly concentrated in cold spot communities? Is there a correlation there?