Frequent Users of Health Services Initiative

Project Overview

This is archived content, for historical reference only.

The Frequent Users of Health Services Initiative was a five-year, $10-million joint project of The California Endowment and the California HealthCare Foundation (CHCF). The initiative focused on promoting a more responsive system of care that addresses patients’ needs, improves outcomes, and decreases unnecessary use of emergency rooms and avoidable hospital stays.

“Frequent users” are people who are often chronically ill and under- or uninsured who repeatedly use emergency rooms and hospitals for medical crises that could be prevented with more appropriate ongoing care. They often have multiple psychosocial risk factors, such as mental illness, alcohol or substance use disorders, and homelessness, and they lack social supports, which affects their ability to get continuous, coordinated care.

The initiative supported innovative approaches that addressed frequent user patients’ multiple needs — for example, medical, mental health, housing, and alcohol or substance abuse treatment — through multidisciplinary care, data sharing, adoption of best practices, and engagement of patients in the most appropriate setting. The foundations created the initiative to encourage such approaches and to stimulate the development of a cost-effective, comprehensive, and coordinated delivery system for health and social services.

The initiative funded six demonstration projects across California that emphasized integrated strategies to meet the health and related needs of the frequent user population. Pilot programs were located in Alameda, Los Angeles, Sacramento, Santa Clara, Santa Cruz, and Tulare Counties. Ultimately, the initiative aimed to relieve pressure on overburdened medical systems and to promote more effective use of resources.

Independent Project Evaluation

An independent evaluation of the initiative was conducted by The Lewin Group, a health care policy research and management consulting firm. The evaluation showed that coordinated, multidisciplinary care can reduce hospital visits and costs while helping to improve stability and quality of life for patients. The results included a 61% decrease in emergency department visits and a 62% decrease in hospital inpatient days for clients enrolled in the programs for two years. For those clients on Medi-Cal at enrollment, ED visits decreased by 60% and inpatient days decreased by 69% after two years in the programs. The complete evaluation report and a summary are available as Document Downloads.

The 10-minute video below highlights a few success stories of one of the grants, Project Connect in Santa Cruz County.


The initiative was managed by the Corporation for Supportive Housing’s California office in Oakland, which continues to focus on this issue. The lessons learned by the initiative pilot programs are summarized in the toolkit Meeting the Needs of Frequent Users: Building Blocks for Success. The toolkit has been designed for communities interested in replicating the successes of the initiative pilot programs.

To learn more about the initiative and the toolkit, visit the CSH website through the External Link below.

Frequent User Programs: How Services Are Provided to People Who Frequently Use Emergency Departments in California (August 2010)

CHCF engaged the Corporation for Supportive Housing (CSH) to survey existing frequent user programs in California. CSH identified 12 existing frequent user programs throughout the state, and some programs described are replicated in multiple hospitals or across multiple sites. CSH interviewed program directors and reviewed reports regarding program outcomes. The report includes a comparison of program approaches, a description of each program by county, and an overview of observations from program directors. Finally, the report identifies best practices and challenges of developing future frequent user programs. Released in August 2010, the complete report can be downloaded from the CSH site listed under External Links.