Don Meade doesnât like hospitals, but he uses them. In just one year, he made 62 trips to the emergency room. He rattles off the names of local hospitals in Orange and Los Angeles counties like theyâre a handful of pills.
âSt. Josephâs in Orange, [Saddleback Memorial in] Laguna Hills,â he says. âThe best one for me around here is PIH in Whittier.â
At 52, Meade has chronic heart disease and other serious ailments, and he is recovering from a longtime addiction to crack cocaine. Today, he lives with his dog Scrappy in a small apartment in Fullerton.
Beyond making a trip to the ER pretty much every week of the year, Meade has had innumerable X-rays, scans, tests and hospital admissions â all of it on the taxpayersâ and hospitalsâ dime, since he is a beneficiary of Medi-Cal, the state and federal program for the poor.
âThe doctors and a few nurses knew me [by name], and I told them I should get some stock in the hospital because I was there so much,â he muses.
As health care costs continue to rise, attention has turned to a tiny number of expensive patients like Meade, called super-utilizers. A program that started in Orange County has taken a different approach to treating Meade and other high-cost patients: Over the past two years, it has tracked them, healed them and saved a ton of money along the way.
Meade received more than a million dollars worth of care in each of the two years before he entered the program, according to Paul Leon, CEO of the Illumination Foundation, a homeless health services group based in Irvine. Leonâs foundation runs the program, known as Chronic Care Plus, which has stabilized Meade and found him housing.
âItâs crazy,â said Maria Raven, an associate professor at the University of California, San Francisco who specializes in frequent-user policy. âThis small group of people makes quite an impact on the health care system, and on the finances of the health care system.â
In Medi-Cal, the stateâs health insurance program for the poor, frequent health care users representing just 1 percent of the patient population account for about one-fourth of health care spending, according to Kenneth Kizer, MD at the Institute for Population Health Improvement at UC Davis.
Thatâs why health professionals across California have started targeting this problem group.
In a small, busy room at a recuperative care center in Santa Fe Springs, just up Highway 5 from Disneyland, the Chronic Care Plus programâs lead nurse, John Simmons, directs treatment for a select group of homeless frequent users.
Simmons says the big secret about these health care frequent fliers is that theyâre not necessarily the sickest patients â theyâre often just homeless, with substance abuse or mental health issues, and they routinely end up in the emergency room.
âIt was them relying on the ER for everything,â Simmons said. âThey got a common cold, theyâd want to run to the ER.â
To break the cycle, Simmons conducts what is known as intensive care coordination. He helps the 37 participants, including Don Meade, find housing, get off drugs, get access to services, and make appointments with primary care doctors.
Meade, an Army veteran, was living outside the Santa Ana Civic Center for years before he found housing through the Illumination Foundationâs Chronic Care Plus program. The program identifies homeless patients being discharged from hospitals and helps place them in apartments. (Heidi de Marco/KHN)
The Illumination Foundation launched the program with the goal of breaking the vicious cycle into which these patients had fallen, then following them over a two-year period. Getting consistent care and support for that length of time, Simmons says, can change their lives for good.
âThe beauty of the program was, we took those people and got them self-sufficient,â Simmons said, âand you notice their health [go] on an upward trend.â
The program saved $14 million in health care spending for just those 37 people over two years, compared with the two years prior to the launch of the program.
That doesnât count the savings attained by using fewer police and emergency transportation services, Simmons said.
Saving so much money with so few participants is an open invitation to expand the program, said Pat Brydges, an administrator at St. Josephâs Hospital, which helped fund the program.
âThere are homeless people in every city in every state,â Brydges said. âThereâs no reason why this wouldnât work across the nation.â
The program is consistent with St. Josephâs mission to help all people, and the cost savings is an extra perk, she said.
She pauses briefly to contemplate how much money would be saved if this tiny pilot program went national.
âWow, I donât even know if I could count that much,â Brydges said. âBut if we can do $14 million in this one area alone, itâs amazing what we could do across the nation.â
Back in his Fullerton apartment, Meade said he now sees a primary care doctor instead of going to the emergency room. He still has ongoing heart and health problems.
Donald Meade plays with his puppy Scrappy in his apartment patio. âIf I lost this apartment, I would give Scrappy to my neighbors ⊠I wouldnât want him to be stressed out living in the streets.â (Heidi de Marco/KHN)
Being followed by program coordinators over such a long time has really made a difference in his life, Meade said.
âA lot of the stress leaves after youâre in your own home, but if youâre out in the street youâre worried so much all the time,â he said.
Getting off the street is one thing, Meade said, but the staying off it is another. Itâs not just that he has his own doctor now, and better health. He has a new life, he said.
The Illumination Foundation plans to release data at the end of June on its first two years.
This story was produced by , which publishes , a service of the .
This story is part of a partnership that includes , and Kaiser Health News.