Background: Care coordination services are provided by most primary care clinics in Minnesota as a requirement for certification as medical homes by the Minnesota Department of Health. Clinics can flexibly design their care coordination program, leading to two general approaches: one medically focused and usually led by nurses (Medical/Nursing) and one socially focused including a social worker on the team (Medical/Social). This study involved a collaboration among researchers, a state health department, a quality reporting organization, five large health plans, 42 care systems, and patients to compare these two approaches to care coordination.

Methods: Patients starting care coordination during 1/1/2021-12/31/2021 in up to 317 participating clinics were retrospectively identified and matched to medical record and claims-based care quality outcomes in the 12 months before and after their start date. The primary outcome was the percent of care quality outcomes meeting quality goals. Secondary measures included HbA1c, blood pressure, depression, and tobacco control and colorectal and breast cancer screening rates. Outcomes by care coordination model were compared using generalized linear mixed models that controlled for patient demographics, insurance status, and clinic contextual factors (urban/rural, organization size).

Results: 267 clinics with 7,657 patients were included in the analysis. Care quality goal achievement was 6% higher 12 months after starting care coordination (55% vs. 61%). However, there was little difference in this outcome between approaches with Medical/Nursing clinics improving 0.5% more than Medical/Social clinics (95% CI: -2.7%, 1.7%). Pre/post improvements were seen in some secondary outcomes (depression control, 4%; colorectal cancer screening, 4%; blood pressure control, 2%; breast cancer screening, 1%) but not others (HbA1c control, -1%; tobacco control, 0%).

Conclusions: Care coordination was associated with improvements in achieving care quality goals with little difference between these two approaches. Use of these findings by participating clinics may be enhanced by the multi-stakeholder engagement.