DuPage County Health Department is a local health department in DuPage County, Illinois. DuPage is the second largest county in Illinois, sitting directly west of Cook County; the state' most populous county. Within its 336 square miles, the US Census Bureau in 2013 had estimated the population to be 932,126 residents, a 19.2 percent increase from 1990 (1, 2). Additionally, between 1990 and 2013, the Hispanic population increased by 275.4 percent and the Black population increased by 175 percent; there was a 124.3 percent increase in the 55 to 59 age group and a 162.4 percent increase in the 85 years and over age group; and, the DuPage portions of Aurora, Bartlett, Wayne, and West Chicago also experienced significant increases in population (1, 2). Between 2000 and 2009, the total number of births decreased by 25 percent, while the DuPage Hispanic birth rates were nearly double the overall birth rates in DuPage (1, 2). The DuPage County foreign born population increased by 24 percent between 2000 and 2013 (1, 2). Unemployment rates rose to a 10 year high of 8.4 percent in DuPage County in 2009, but have decreased since then and the unemployment rate in 2013 was 7.5 percent (1, 2) DCHD is a certified local health department that obtained accreditation from the Public Health Accreditation Board (PHAB) in June 2014. The array of direct clinical services offered by the health department include behavioral health, maternal child health, adult health, and oral health services. Some of our successful preventive interventions include: Fighting Obesity and Reducing Weight Among Residents of DuPage (FORWARD) - a program to address childhood obesity through schools, RxBox – designated prescription drug drop off boxes to decrease prescription drug abuse, and the DuPage Narcan Program – a collaborative community effort to reduce the number of deaths attributable to Heroin overdose. In addition to fulfilling the role as a healthcare safety net throughout the county, DCHD has also worked to assist its residents with completing benefit applications to ensure adequate access to health services and resources since 2005. Building off this foundation of assurance, and the growing need highlighted by the implementation of the Affordable Care Act, DuPage County had continued to work toward the goal of linking people to needed personal health services and the provision of health care when otherwise unavailable. The health department, along with other local health care systems and organizations, such as the DuPage Health Coalition (DHC), aims to address the growing need of this county-wide issue of inadequate access to quality health care; no longer looking for a solution in isolation, but as a collective for the benefit of the county' residents. By early 2013, through this joint effort, one of the area hospitals, Central DuPage Hospital (CDH), provided the data analysis conveying top ED diagnoses and costs of uncompensated care to begin to understand where and how this issue should first be addressed. Members hypothesized that through outreach and addressing social determinants within this patient population, three things could happen: - the amount of uncompensated care could be reduced,- the number of ED visits by frequent users would decrease, and - the intervention would be sustained through cost savings. This instantly appealed to the hospital as a partnership with community organizations would help them address their ED cost and usage. The issue of ED over-utilization was not an isolated issue to DuPage County, Illinois. In fact, roughly 1 in 9 patients utilize the ED as a medical home and may be eligible for health care benefits (3). Utilization of ED services can result in inefficient use of health care resources and suboptimal health outcomes. Overuse of the ED results in approximately 38 billion dollars in wasteful health care spending annually, where more than half of these visits are potentially avoidable (4). Contributing to this issue is the patients' lack of knowledge or health literacy. CDH found that only 20 patients accounted for more than 250 ER visits in 2012. Increasing access to primary care can be effective at reducing misuse, and adding more Case Managers and Community Health Workers to the workforce can help connect patients to insurance and a medical home. The project goals set out at the inception of Engage DuPage were:- improve the health status of self-pay ED patients- increase the revenue appropriately owed to hospital for services rendered,- improve the financial assistance processes involving self-pay ED patients, and- reduce the number of avoidable ED visits among self-pay patients. These top goals align with the Triple Aim approach of providing better care, better outcomes and maximizing resources. After a 12-month pilot, the program has expanded to include 2 additional hospital partners including 2 emergency departments and 1 inpatient department. Favorable outcomes continue to grow, enabling a number of success stories.