This paper describes efforts to identify high users of healthcare in British Columbia, Alberta and Manitoba. British Columbia's Ministry of Health adopted a population segmentation approach that segments the province's population into 14 matrix populations. The approach has been used to inform strategic planning, especially for populations with frailty or chronic conditions. Alberta has pursued a similar but different population segmentation approach. A model capable of allocating healthcare costs to the individual level revealed that 5% of the population consumed approximately 66% of the allocated costs. Additional analysis of this 5% produced seven population profiles that have been used in planning. Manitoba's approach has focused on hospital inpatients and users of emergency departments (EDs). High users of hospitals were defined as the top 5% of users of days of inpatient care. Despite representing only 0.33% of the Manitoba population, this group received 45% of all days of hospital care. Using a threshold of seven or more ED visits annually, 2.2% of all ED patients were defined as frequent users, representing 13.5% of all visits. The paper demonstrates that common themes emerge from the approaches taken in each jurisdiction.