Evaluation of a National Care Coordination Program to Reduce Utilization Among High-Cost, High-Need Medicaid Beneficiaries with Diabetes

O. Kenrik Duru
Jessica Harwood
Tannaz Moin
Nicholas J Jackson
Susan L Ettner
Arseniy Vasilyev
David G Mosley
Donna L O'Shea
Sam Ho
Carol M Mangione
Peer-Reviewed Article
June 2020

Low-income individuals with diabetes who experience unstable housing and food insecurity are likely to have increased emergency department (ED) visits and hospitalizations. This study evaluated the impact of a national care coordination intervention for high-cost, high-need Medicaid beneficiaries with diabetes — implemented by UnitedHealthcare and Optum — on rates of ED visits and hospitalizations. The intervention provided whole-person care with integrated medical, behavioral, and social supports at a community level to address unmet social needs.

After 12 months in the care coordination program, individuals enrolled in Medicaid through the Supplemental Security Income (SSI) program had larger reductions in ED visits, and those enrolled through Medicaid expansion had fewer hospitalizations, when compared to a control group in a less-intensive intervention. For people enrolled in Medicaid through Temporary Assistance to Needy Families and those who were dually eligible for Medicare and Medicaid, there was no evidence of reduced utilization among the intervention and comparison groups.

These findings highlight the potential benefits of care coordination interventions for particular beneficiary subgroups, including adults receiving Medicaid SSI, who may have more behavioral health and social needs than other Medicaid beneficiaries and thus, may have more poorly coordinated care. In addition, the results suggest that enrollment in a care coordination program may not be sufficient to lead to reduced ED and hospital utilization. Identifying scalable approaches to addressing medical, behavioral, and social issues is key for improving health outcomes for high-cost, high-need patients.

Posted to The Playbook on