Utilization by High-Cost, High-Need Medicaid Patients Receiving Social Worker Care Coordination

OBJECTIVES: Office-based care coordination programs are increasingly utilizing social work-trained care coordinators to manage high-cost, high-need (HCHN) patients with increased psychosocial risk, including patients covered by Medicaid. Whether utilization of social worker care coordinators (SWCCs) with HCHN Medicaid patients impacts health care utilization is not clear, so we conducted a wait-list randomized controlled trial to test whether social worker care coordination decreases health care utilization and costs in HCHN Medicaid patients. STUDY DESIGN: Prospective enrollment with computer randomization 1:1 to an intervention group receiving SWCC office-based care coordination or to a control group. METHODS: HCHN patients (N = 252) were randomly assigned to enrollment in an office-based care coordination program with SWCC engagement or to a wait-list control group. Total numbers of emergency department (ED) visits and hospitalizations and total medical expenditure (TME) within the preceding 12 months were collected at baseline and then again at 1 year and 2 years after study group assignment. Health care utilization and costs were compared using mixed-effects models. RESULTS: Patients enrolled in an outpatient SWCC program had an increased number of hospitalizations compared with wait-listed control patients. There were no differences in the number of ED visits or in TME between groups. CONCLUSIONS: Enrollment for up to 2 years in an office-based social worker-led care coordination program did not reduce health care utilization or costs in HCHN Medicaid patients.