Frequent Users of Health Services Initiative: Findings from a six county intervention in California

This presentation will discuss evaluation findings from the Frequent Users of Health Services Initiative, a 4 year program that funded six counties in CA to address the comprehensive health and social service needs of frequent users of emergency departments, and decrease avoidable emergency department visits and hospital stays. A range of models were tested, from various types of intensive case management to less intensive peer and paraprofessional driven interventions. The evaluation design was pre-post and examined three primary outcome types: 1) individual-level outcomes; 2) impact on emergency department and inpatient hospital utilization and costs; and 3) impact on organizational and community systems of care. Data sources included: hospital, primary care, and mental health claims, program enrollment, and case management records. Overall, the programs yielded statistically significant reductions in Emergency Department utilization (30%) and charges (17%) in the first year of enrollment, and by 60 percent after two years. Given the prevalence of homelessness in the population, connecting clients to housing became a major program focus. Overall, clients connected to permanent housing showed greater reductions in both ED use and charges compared to those who remained homeless or in less stable housing arrangements (a 34% reduction compared to a 12% in ED visits, a 32% reduction compared to a 2% in ED charges). Implications of the evaluation findings will be discussed, including lessons learned regarding sustainability and replicability of the models, and how data from the evaluation were used for legislative efforts regarding Medicaid policy in California.