How California hopes to halt the revolving door to the ER

The state budget that kicked in last month devotes more than $100 billion to Medi-Cal, California’s health system for the poor. The bulk of that money will be spent on a tiny fraction of patients. And although they’re in need of help, they’re not the sickest people.

Inappropriate use of the ER falls into two main categories, said Jacey Cooper, an assistant deputy director at the state Department of Health Care Services, which oversees Medi-Cal and the pilot programs. Some patients don’t need emergency care and use the ER like they’re visiting a friend. Some have a genuine emergency, often because they’ve delayed care of a problem or illness until it reached a crisis. At that point, it’s difficult to treat—and more expensive.

Many such patients are homeless, Cooper said. “They have no circle of support; they often have mental health issues or substance use problems.”

Cooper said some counties in the pilot program reach people as they’re released from jail, assigning them a care manager because they’re at high risk for homelessness, drug abuse and frequent use of the health system. And someplace a health professional in the ER to find and coordinate care for high users. It can be easy to identify them there, because personnel may greet them by name, she said.  

That was the case for   *******  , a former Illumination Foundation resident who now lives in Riverside. “I was in the ER all the time,” Miller says.   She’s sitting in the dining area of her small apartment, her perky Australian terrier-mix dog in her lap. She’s been sober for nine months—and counting. But in 2015 and 2016, she went to the ER regularly for episodes of severe depression, and for nerve pain so bad she couldn’t walk, which she attributed to drinking. She went several times after falls, which she said were due to lost consciousness after drug use.

“And one time I went to the ER just because I didn’t want to sleep on the street,” she says, laughing now. “I don’t remember what I told them was wrong with me. But I just wanted a bed to sleep in.”   Homelessness contributes greatly to unneeded ER visits.

Treatment of her physical and psychological problems, along with help obtaining county and state services after she transferred to an Illumination Foundation center, have helped turn her life around. She used to teach at community colleges and hopes to get back to the classroom soon.

How California hopes to halt the revolving door to the ER | CALmatters: More than half the state’s health care budget will be spent on just 5 percent of its patients—and they’re not the sickest people. Officials are staging an intervention.