Programs focus on high-risk patients to reduce spending

By the time Donnie Missouri met Rosaleita Fulford, the soft-spoken 44-year-old woman had funded a drug habit with prostitution and theft. "I was off the chain," she says. Fulford's T-cell count was low; she missed doctor's appointments to look for her next high. She got sick often, and when she did, she went to the emergency room instead of to an inexpensive clinic. It all came at the government's expense. Fulford represents the nation's "super-utilizers," the 1% of the population who account for 22% of health care spending, according to the Centers for Medicare and Medicaid Services. In the states' Medicaid programs — which increased by at least 3 million people in 2014 because of the Affordable Care Act — 5% of users account for 54% of spending.