Frequent Users of Health Services Initiative

California HealthCare Foundation and The California Endowment

The Challenge:  Leveraging Evaluation Results to Replicate a Model Program

Many of California’s hospital emergency departments are faced with the burden of treating certain individuals repeatedly. These “frequent users” often have multiple physical, mental, and social needs, such as mental illness, substance abuse and homelessness. Launched in 2002, the Frequent Users of Health Services Initiative was a six-year joint project of The California Endowment and the California HealthCare Foundation, with program support from the Corporation for Supportive Housing. Its purpose was to test new care models for “frequent users” through pilot programs in six counties.

Our Role

i.e. was retained in 2007 to help communicate the needs of this complex population and its impact on emergency rooms. The end goal was to influence policy and systems changes to improve the care given to frequent users and to use hospital resources more effectively.  Working with the initiative, i.e. created and implemented a strategic communications plan that helped the foundations make the case for a smarter approach to providing care to this population and share the lessons learned throughout the state.

Key Deliverables

  • Research – To gain the perspectives of various stakeholder groups, i.e. conducted interviews with target audiences and an audit of mainstream media and academic health/medical journals.
  • Branding, Framing, and Messagingi.e. recommended framing and messaging to overcome the dual challenges of the complexity of the issues and the public’s lack of empathy for frequent users. We positioned the Initiative as a “rational, right, and smart” approach to using scarce health care resources.
  • Government Affairs i.e. assisted in the development of a statewide and local-level policy agenda, providing consultation, policy advocacy materials, and committee hearing testimony.
  • Collateral Materials1.e. developed content and provided design direction for two products, a summary report and a toolkit. Both were distributed statewide to key stakeholders, decision makers, and service providers to help further a 2009 frequent user policy agenda.
  • Media Services and Spokesperson Training i.e. identified media opportunities and created and distributed press materials tailored for each pilot program. To ensure consistent messaging, i.e. developed and led technical assistance trainings with custom-made worksheets, talking points, and group exercises for spokespeople.


  • Called attention to the problem – The Initiative was able clearly define the frequent user population, which was an important step in recognizing their needs and in addressing the challenges and barriers to their access to care.
  • Passed legislation – The Initiative was able to create a policy agenda, and to pass a key piece of legislation, SB 1738, which required the state to establish frequent user programs. The bill had overwhelming bi-partisan support.
  • Gained gubernatorial support – Governor Schwarzenegger has expressed a commitment to working with stakeholders to develop strategies to ensure that frequent users receive the most effective care at the right time in the most appropriate settings.
  • Programs Maintained and Expanded – Four of the six programs created under the Initiative still exist, despite the end of grant funding in 2008. Other programs have begun or have expanded, resulting in a total of 12 programs in California that target people who use the emergency room frequently.

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