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As part of the California Endowment Health Journalism Fellowship, journalists work with a senior fellow to develop a special project. Recent projects have examined health disparities by ZIP code in the San Francisco Bay Area, anxiety disorders and depression in the Hispanic immigrant community in Washington state, and the importance of foreign-born doctors to health care in rural communities.
Dr. Abby Letcher, medical director of the Neighborhood Health Centers of the Lehigh Valley, participates in health and wellness discussion with team members and patients in the Lehigh Valley Super Utilizer Partnership.
An effort to reduce the number of patients who are "super-utilizers" in Pennsylvania's Lehigh Valley requires providers to enter into what one expert calls the "messy space" — a relationship that's closer and more personal than the traditional doctor-patient relationship.
 Waiting to go home patient Elaine Dries, of Allentown who does dialysis 3 times a week at Fresenius Dialysis Center on Hamilton Blvd. in Allentown, waits to be helped loaded onto a LANta Van to be driven home. (APRIL BARTHOLOMEW / THE MORNING CALL)
Health care super-users are often chronically ill, alone and with limited incomes. They typically need the medical skills of a trained health-care professional, but also the listening, counseling and support offered by social workers and clergy.
Mark Lewis sits in his new apartment after a dialysis session. He was a participant in the Lehigh Valley Super Utilizer Partnership. DONNA FISHER / THE MORNING CALL
For many of the patients who are known as "super-utilizers" of the health care system, the issue of simply getting to treatment is critical and sometimes more problematic than getting the treatment itself. The picture is often complicated by the disabilities and haphazard lives of these patients.
Matt Zavadsky of MedStar Mobile Healthcare says his ambulance service had to change to help keep people healthy at home. MedStar now shares in the savings hospitals realize when patients don't need to be transported for emergency or in-patient care. (REDFLASH GROUP, CONTRIBUTED PHOTO)
Ambulances benefits from frequent users. Place a call for patient transport and a bill is generated. But what if the ambulance service was paid to keep patients out of the hospital? A new model pioneered in Fort Worth, Texas has caught the interest of other communities.
Alvin Bolster who is a "super utilizer" of the healthcare system sits in his wheelchair inside his room at the Scottish Inn on Catasauqua Road in Hanover Township, Lehigh County. He has congestive heart failure and has been in and out of hospitals and hospice.
Can "super-utilizers" be helped? A partnership of health care workers, case managers, social workers, parish nurses, clergy and community members in Allentown, Penn. thinks so. The group is building a program to help those with manageable chronic illnesses stay out of the hospital.
Walmart recently opened a Care Clinic in Copperas Cove, Texas, near the Fort Hood military base. Veronica Zaragovia/KUT
Although the Affordable Care Act has led to thousands of people in Texas getting insurance for the first time, many consumers aren’t turning to care at a doctor’s office. Instead they’re turning to places that are convenient, like Walmart.
Erynn Smith of The Abundant Table in Santa Paula, Jeremy Schoengart, director of child nutrition services for Santa Paula Unified School District, Alondra Navarro, a senior at Santa Paula High School, and Mireille Vargas, a student at Santa Paula High School (both Navarro and Vargas are members of the group Students Encouraging Social Political and Environmental Action) talk about better nutrition and exercise to fight against childhood obesity. Photo by: Heber Palayo.
In small towns in California's Ventura County, the number of children who are overweight or obese has reached nearly 48 percent, among the highest figures in the state. With the help of two activist groups, one group of students has resolved to do something about the problem.
California's Medicaid expansion has extended coverage to many Chinese Americans in the state. But the imbalance between the numbers of newly insured and available providers means some doctors are swamped while patients often have difficulty accessing care. Low reimbursement rates aren't helping.
The barren river bed in the photo on the left is the channel off of the Tule River that in a wet year refuels the aquifer to homes in East Porterville. The photo on the right is of the Tule River just a mile north of where the wells have gone dry. (Ezra David Romero/KVPR)
Drought conditions have gotten so bad in California that in some places, turning on the tap and having nothing come out is common. The lack of running water has especially plagued the little farming town of East Porterville in the San Joaquin Valley, leaving scores of homes without working wells.
Photo: View of Cliffside Malibu, a private addiction center with a holistic approach.
Obamacare is changing addiction rehab, with health insurance companies and HMOs now required to cover treatment for addiction like any other disease. Private rehab centers like Betty Ford are looking to open mid-priced outpatient clinics, and high-priced private rehab centers could lose business.

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