Los Angeles Frequent Users Systems Engagement (FUSE) Program

Target Population: 10th Decile

Among the overall population of homeless single adults in Los Angeles, the ten percent who incur the greatest public costs have average public costs of $6,529 per month, compared to $574 per month among the other 90%. However, when living in supportive housing, public cost reductions total $4,589 per month per frequent user.

The target population for the Los Angeles FUSE initiative is the “10th decile,” i.e.,  the highest-need, highest-cost homeless persons in Los Angeles County.  These individuals all have some combination of the following characteristics: mental illness, substance abuse, incarceration in a jail medical facility in the past five years, incarceration in a jail mental health facility in the past five years, multiple visits to hospital emergency rooms in the past two years, and inpatient stays in hospitals in the past two years.

The pilot program uses supportive housing integrated with care management and primary and behavioral health services to improve health outcomes while reducing public costs among individuals with complex health needs. Funding comes from the Hilton Foundation and the UniHealth Foundation.


  • To end the cycle of chronic homelessness and repeated use of hospital emergency rooms for the highest-need, highest-cost homeless persons in Los Angeles County.
  • To collaborate with government agencies, funders, healthcare networks, partner hospitals, FQHCs, and housing organizations to secure adequate and coordinated public funding mechanisms to facilitate funding for PSH and continued housing navigator services for frequent users of public systems.


To improve the quality of their lives and better utilize limited public resources, FUSE pilot identifies and houses 60 homeless frequent users through regional hospital-FQHC-housing collaborations using the Economic Roundtable’s 10th Decile Triage Tool. Three collaboratives to date are located in Westside and Downton Los Angeles.

CSH's Role

  • Start-up: Identify and convene 5 collaboratives, and manage grants to collaborative members
  • TA: Provide technical assistance individually and collectively through a initiative-wide Learning Community
  • Data: Manage evaluation and data
  • Systems Change: Connect to systemic reform efforts that create sustainable funding models, such as MediCal; and connect to housing agencies that provide supportive housing units for frequent users

Impact and Outcomes

  • 30% decrease in hospital emergency room care utilization and 25% reduction in inpatient care.
  • Housing 60 frequent users result in public cost reductions of  $3.3 million  annually.
  • With housing stabilized, clients begin to show health improvements, and housing retention rates are high due to effective case management
  • Health care systems change: Hospital incorporates FUSE “triage“ tools and housing “navigator” services as part of intake and discharge processes.
  • Housing systems change: Housing agencies integrate frequent users as a priority population into City/County funded supportive housing units, with enhanced services linked to FQHCs.

Next Steps

CSH is seeking to fund a fourth healthcare–housing collaborative between a homeless service provider, housing provider, federal qualified health care center (FQHC) and a hospital, that partners to identify, support, and house 10 chronically homeless frequent users of health services during the project period. For application instructions, please click here.

In March 2012, CSH selected a large network of partners in Los Angeles led by the Economic Roundtable to receive a multi-year Social Innovation Fund subgrant. This grant will allow Los Angeles to expand current FUSE efforts in Westside and Downton Los Angeles and launch new FUSE efforts in Hollywood, West Hollywood, Pasadena and Glendale.


The Economic Roundtable, OPCC, Housing Works, Homeless Health Care LA, Venice Family Clinic, JWCH, Clínica Monseñor Oscar A. Romero, St. John’s Hospital and Health Center, Santa Monica-UCLA Medical Center, California Hospital Medical Center, LAC+USC Healthcare Network

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