Ethan Balgley Manelin

ETHAN B. MANELIN, then a graduate student at Harvard University, Cambridge, Massachusetts, was awarded funding in April 2018 to aid research on ‘Making Superutilizers: Care and Neo-Welfarism in Late Capitalist Los Angeles,’ supervised by Dr. Arthur Kleinman. This research examined the design and implementation of Whole Person Care-Los Angeles (WPC), a program of the county health system that seeks to manage ‘high-needs, high-cost’ patients in order to reduce costs and improve care. WPC and similar ‘complex care management’ programs are predicated on the observation that a small fraction of patients account for a large proportion of healthcare spending. These patients typically have severe medical and psychiatric illnesses as well as complicating social factors like homelessness, addiction, and incarceration, so WPC provides non-healthcare resources and services, such as housing, cash benefits, system navigation, and peer support. This work asked three central questions: 1) What is the political economic terrain on which WPC was implemented, and what were its effects on this terrain? 2) Who are ‘high need, high cost patients,’ from both conceptual and ethnographic perspectives? 3) What forces shape ‘care’ on the front lines of complex care management? Thanks to support from both budget hawks and progressive reformers, WPC experimented with integrating traditional social service methods into the healthcare system, as well as with a new type of care work at the crux of this integration that emphasized shared ‘lived experience’ with patients.