Healthcare’s Million Dollar Blocks

by Kim Bellard, April 28, 2021

Since I first heard about them, I have been fascinated, and dismayed, by the concept of “million dollar blocks.” For those of you unfamiliar with the term, it doesn’t refer to, say, Beverly Hills. No, it refers to city blocks for which society spends over a million dollars annually to incarcerate residents of that block.

I, of course, have to think about the healthcare parallels.

The concept dates back many years, credited to Eric Cadora, now at Justice Mapping, and Laura Kurgan, a professor of architecture at Columbia University, where she is the Director of the Center for Spatial Research (CSR). The power of the concept is to use data visualization to illustrate the problem.

But if, as they say, a picture is worth a thousand words, then perhaps data visualization is worth a million dollars. Even hardened criminal justice advocates have to blanche at how spending is so often concentrated in certain blocks, and should wonder if perhaps there are better ways to use that money for them.

CSR has a variety of projects in addition to their criminal justice work, including some focused on healthcare. Late last year their New Politics of Care project used an interactive map to highlight existing areas of health care needs. They proposed a New Deal for Public Health, with a million new community health workers deployed around the country based on the identified needs.

Somehow the Community Health Corps didn’t make it into the Biden infrastructure proposal. Perhaps no one in the Administration has seen the map.

Data visualization is nothing new for healthcare. The CDC has an Interactive Atlas of Heart Disease and Stroke, the Dartmouth Atlas has been highlighting healthcare variations for close to thirty years, and, more recently, the Johns Hopkins Coronarvirus Resource Center has been tracking what’s been happening in the pandemic.

Still, if anyone is tracking where healthcare’s “million dollar blocks” are, I’d like to hear about it.

We know — or think we know — that there are underserved communities where too many people end up in the emergency room. We know that there are communities in which maternal and infant mortality/morbidity are much worse.

But do we know where these are concentrated, or do we know how much we’re spending on the results of them? No.

I want to know in which communities the hospitals are the predominant healthcare institution. I want to know what communities are falling behind on preventive screenings and vaccinations. I want to know which communities have suspiciously low healthcare spending, and whether that is a function of better health or lack of healthcare resources.

I want to see the interactive data visualizations for these types of issues, and I want smart people acting on them.

If the pandemic has highlighted anything, it’s that our public health system is woefully inadequate. It doesn’t have the right resources and doesn’t have the right data, collected and acted upon at the right time.

Healthcare generates scads of data, but not the right data, timely, aggregated across all payors for all kinds of services, and we certainly don’t have anyone in a position to really use it to manage.

The “million dollar block” concept highlights the fact that we’re good at spending money, but we’re not very good about how we end up spending it. It emphasizes the rationale of “defund police” movement, and should be applied to healthcare as well (as I’ve discussed before).

I guess we need to see the pictures first.

This post is an abridged version of the original posting in Medium. Please follow Kim on Medium and on Twitter (@kimbbellard)