Two things are worth separating. The first is the published evidence on California’s Enhanced Care Management benefit as a whole. The second is what Institute on Aging’s own Acute Care Transitions program has produced. Both are on this page, with sources.
Peer-reviewed and state evaluations show that Enhanced Care Management lowers acute care use, improves mental health, and pays for itself.
fewer emergency department visits
fewer inpatient hospital stays
more outpatient and preventive visits
drop in PHQ-9 depression score
Community Supports already proven cost-effective, with net cost reductions up to roughly 80% versus institutional care
members served by ECM statewide in Q3 2025 alone, up 59% year over year
576 participants enrolled through Acute Care Transitions, July 1, 2025 to May 31, 2026.
of referred patients enroll
stayed engaged beyond the first 30 days
completed a full episode of care
acute care settings
ACT participants are not the population most people picture when they hear “aging services.” They are working-age and older adults whose health is being shaped by housing, behavioral health, and repeated acute episodes.
Institute on Aging evaluates ACT using the RE-AIM framework, which measures reach, effectiveness, adoption, implementation, and maintenance. The evaluation runs across three aims.
Aim 1. Utilization, engagement, and housing
Thirty-day readmissions, avoidable emergency department use, engagement, and time to housing, compared against concurrent non-enrolled clients, a pre-implementation group, and community-referral ECM clients.
Aim 2. Client and care team experience
Interviews with enrolled and non-participating clients, plus surveys and interviews with care teams and partners on workflow, fidelity, and partnership.
Aim 3. Cost-effectiveness
Program costs weighed against inpatient, emergency department, and observation utilization at standardized rates, with cost-effectiveness ratios, return on investment, and sensitivity testing.
Lu D, et al. Journal of General Internal Medicine. 2026;41(5):1222–1228.
California Department of Health Care Services, Cost-Effectiveness of Medi-Cal Community Supports Fact Sheet (2026).
California Department of Health Care Services, New Data Reinforce California’s Commitment to Whole-Person Medi-Cal Care (2025).
Jencks SF, Williams MV, Coleman EA. New England Journal of Medicine. 2009;360(14):1418–1428.
AHRQ HCUP Statistical Brief #304 (2023).
Institute on Aging, Characteristics of ECM Acute Care Participants (CaseWorthy records), July 1, 2025 to May 31, 2026. Percentages may not total 100 due to rounding.
