TY - JOUR
AU - N. Safaeinili
AU - E. Chuang
AU - M. Fleming
AU - S. Ramanadhan
AU - N. Pourat
AU - A. Brewster
A1 - 
AB - OBJECTIVE: To assess multi-level factors influencing the sustainability of 26 social care pilots integrating medical and social services for Medicaid enrollees across California in newly developed Medicaid benefits. STUDY SETTING AND DESIGN: This qualitative study assessed the sustainability of Whole Person Care (WPC) pilots implemented between 2016 and 2021. Pilots (n = 26) represented a majority of counties in California. DATA SOURCES AND ANALYTIC SAMPLE: Primary qualitative data were collected between June and August 2021 and included 58 hour-long, semi-structured individual and group interviews with administrators, middle managers, and frontline case management staff representing all WPC pilots. We used hybrid inductive-deductive thematic analysis to identify and analyze patterns, and outliers, in factors influencing sustainment. Deductive codes included established implementation science factors influencing the sustainability of new programs (e.g., innovation characteristics, capacity, processes and interactions, and context). PRINCIPAL FINDINGS: Of 26 WPC pilots, 22 pilots sustained WPC by contracting with Medicaid managed care plans to provide services as part of newly developed Medicaid benefits. Three pilots chose not to sustain before the pilot period ended and one pilot decided not to sustain following completion of the full pilot. Factors influencing sustainability included: (1) program adaptability and flexibility; (2) funding structure and reimbursement requirements; (3) shared leadership with managed care plans; and (4) whether pilots chose to build out program infrastructure internally or contracted out core components to partner organizations. Many pilots, particularly those in rural areas, indicated that system and policy changes introduced as part of transitioning pilot services into Medicaid benefits reduced the sustainability of WPC for participating providers. CONCLUSIONS: Multi-level factors including program adaptability, funding, leadership, and capacity to build out infrastructure influenced the sustainability of WPC pilots. These findings have significant implications for health equity as equitable distribution of services, resources, and benefits from these programs can be supported through sustained implementation over time.
AD - School of Medicine, Stanford University, Palo Alto, California, USA.; School of Social Welfare, University of California, Berkeley, California, USA.; School of Public Health, University of California, Berkeley, California, USA.; University of California Los Angeles, Los Angeles, California, USA.; Center for Health Policy Research, University of California Los Angeles, Los Angeles, California, USA.
AN - 39668622
BT - Health Serv Res
C5 - Healthcare Policy; Financing & Sustainability
CP - Suppl 3
DA - May
DO - 10.1111/1475-6773.14418
DP - NLM
ET - 20241212
IS - Suppl 3
JF - Health Serv Res
LA - eng
N2 - OBJECTIVE: To assess multi-level factors influencing the sustainability of 26 social care pilots integrating medical and social services for Medicaid enrollees across California in newly developed Medicaid benefits. STUDY SETTING AND DESIGN: This qualitative study assessed the sustainability of Whole Person Care (WPC) pilots implemented between 2016 and 2021. Pilots (n = 26) represented a majority of counties in California. DATA SOURCES AND ANALYTIC SAMPLE: Primary qualitative data were collected between June and August 2021 and included 58 hour-long, semi-structured individual and group interviews with administrators, middle managers, and frontline case management staff representing all WPC pilots. We used hybrid inductive-deductive thematic analysis to identify and analyze patterns, and outliers, in factors influencing sustainment. Deductive codes included established implementation science factors influencing the sustainability of new programs (e.g., innovation characteristics, capacity, processes and interactions, and context). PRINCIPAL FINDINGS: Of 26 WPC pilots, 22 pilots sustained WPC by contracting with Medicaid managed care plans to provide services as part of newly developed Medicaid benefits. Three pilots chose not to sustain before the pilot period ended and one pilot decided not to sustain following completion of the full pilot. Factors influencing sustainability included: (1) program adaptability and flexibility; (2) funding structure and reimbursement requirements; (3) shared leadership with managed care plans; and (4) whether pilots chose to build out program infrastructure internally or contracted out core components to partner organizations. Many pilots, particularly those in rural areas, indicated that system and policy changes introduced as part of transitioning pilot services into Medicaid benefits reduced the sustainability of WPC for participating providers. CONCLUSIONS: Multi-level factors including program adaptability, funding, leadership, and capacity to build out infrastructure influenced the sustainability of WPC pilots. These findings have significant implications for health equity as equitable distribution of services, resources, and benefits from these programs can be supported through sustained implementation over time.
PY - 2025
SN - 0017-9124 (Print); 0017-9124
SP - e14418
ST - Sustainability of California's Whole Person Care pilots integrating medical and social services for Medicaid enrollees via newly developed Medicaid benefits
T1 - Sustainability of California's Whole Person Care pilots integrating medical and social services for Medicaid enrollees via newly developed Medicaid benefits
T2 - Health Serv Res
TI - Sustainability of California's Whole Person Care pilots integrating medical and social services for Medicaid enrollees via newly developed Medicaid benefits
U1 - Healthcare Policy; Financing & Sustainability
U3 - 10.1111/1475-6773.14418
VL - 60 Suppl 3
VO - 0017-9124 (Print); 0017-9124
Y1 - 2025
ER -