Forty-year-old Jeremie Seals has had a tough life.
He left home at 14, and his health isn't good. He had a heart attack when he was 35. He has congestive heart failure, and nerve pain in his legs that he says is "real bad."
"Long story short, I'm terminal," he says, matter-of-factly.
Seals is unwilling to divulge too much about his past. But over the years, he says his health has deteriorated to such a degree that he can no longer hold a job.
By 2011, he was sleeping in his car, and that's when his medical problems started having a big financial impact. That year, he visited the emergency room at Oregon Health & Science University in Portland 15 times and was admitted to the hospital 11 times.
"I basically lived at the emergency department," he said. "Ever since I'd had a heart attack, anytime my chest hurt, I'd either call the ambulance or go up to the hospital. And I think it was also out of desperation to just get out of my car and off the street."
His regular visits to the ER brought him to the attention of one of Oregon's new coordinated care organizations. As part of the nation's health care overhaul, Oregon has been given permission to conduct its own experiments. One way it's trying to reduce Medicaid costs is to encourage people who constantly turn up in the emergency room — so-called frequent fliers like Seals — to get their health care from regular doctors instead.
Lisa Pearlstein of Health Share of Oregon, one of the care coordinators, remembers her first meeting with Seals in 2011, when she began to guide him through the medical maze:
"He's sitting in a chair and complaining about his feet being wet. And I said, 'Why are your feet wet?' And he said, 'I have holes in my shoes.' And I said, 'Would you like a new pair of shoes?' And so I ended up getting him a new pair of shoes that day. And so we connected over those shoes."