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The online comments were a little harsh. Viewers of NPR’s online story about a Chicago hospital deciding to pay rent for a homeless man who had been spending as many as 20 days a month at various ERs around town. Sometimes the man had genuine medical problems. Other times, it was very cold outside. Many online commenters called the man a “freeloader,” undeserving of the hospital’s generosity.

I think I understand the resentment, but when you learn more about the University of Illinois Hospital’s decision, it makes perfect sense. Medicaid data shows that about half of the program’s annual resources go to just 5 percent of the beneficiaries, many of them frequent users of the ER. So if a hospital could identify and then target this small population of “super-utilizers,” it might be able to reduce the staggering costs of unnecessary ER use.

For the University of Illinois Hospital, identifying the biggest users of the ER was relatively easy. What the hospital discovered in this population was a recurring mix of three characteristics:

chronic medical problems
mental illness

Armed with this information, the hospital made a decision that was both humane and strategic: It must address the housing problem first, or all other attempts at improving medical care would ultimately fail. So it moved 25 frequent users of the ER to apartments and assigned each patient a case manager whose job includes helping schedule regular doctor’s appointments. Thus, patients are learning personal health care strategies that don’t involve the ER.

Is it worth the cost? Decidedly so. Rent on a small apartment costs $1,000 a month. A stay in the ER is $3,000 a day.

Ultimately, this story surfaces an interesting question: Is housing health care? Conventional wisdom might say no. The University of Illinois Hospital might say yes.

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