Diabetes patients with unmet social needs (e.g., housing instability, food insecurity) may be less able to complete recommended processes of care than patients without these challenges. We examined survey data from a multi-state sample of Medicaid patients with diabetes (n=6,087) identified by UnitedHealthcare as high-cost, high-need based on utilization over the past year, who were enrolled in a comprehensive care coordination intervention by Optum. Before receiving any intervention services, patients reported whether they experienced housing instability, food insecurity, transportation problems, need for help with utilities, or feared for their interpersonal safety at baseline. We used data from administrative claims to measure whether these patients had 4 recommended processes of care completed within the last 18 months: 1) retinal exam, 2) ACE/ARB medication or nephropathy screening, 3) A1c testing, or 4) statin prescription ordered. We examined the cross-sectional association between unmet social needs and processes of care using multivariate logistic regression, controlling for clustering by zip code. The analytic sample was 50% White and 61% female, with 5.6 documented comorbidities on average. Overall, rates of unmet social need varied from 4% for concerns about interpersonal safety to 16% for transportation problems. Only 52% of patients had a retinal exam during the study window, 69% were prescribed a statin, 88% had their A1c checked, and 95% were taking an ACE/ARB medication or had nephropathy screening. In the regression analyses, we did not find statistically significant associations between any of the unmet social needs and the processes of care (all p values >0.05) . In this analysis of high-cost, high-need Medicaid patients, barriers other than unmet social needs may underpin difficulties with achieving recommended processes of care for diabetes, particularly retinal exams and statin use that are completed at lower rates.


O. Duru: None. A. M. Klomhaus: None. C. Mangione: n/a. T. Moin: None.


Centers for Disease Control and Prevention U18DP006128

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