Inclusion Criteria:  Age 18 or older Historical Cohort: Receiving care coordination services in a participating clinic with a care coordination start date between January 2018 and February 2019 Primary Cohort: Receiving care coordination services in a participating clinic with a care coordination start date between January 2021 and December 2021 Currently insured by the MN Department of Human Services (DHS), Blue Cross Blue Shield MN (BCBS), UCare, or HealthPartners (HP) (for utilization outcomes only) Consents to participate in interview or responds to a survey (for those data collection events only)  Exclusion Criteria:  Cannot complete an interview in English (interviews only) Cannot complete a survey in English, Spanish, Somali, or Hmong (for interviews only, reflecting most prevalent languages in MN) On a known research exclusion list