Safaeinili Nadia, Chuang Emmeline, Fleming Mark, Ramanadhan Shoba, Pourat Nadereh, Brewster Amanda
School of Medicine, Stanford University, Palo Alto, California, USA.
School of Social Welfare, University of California, Berkeley, California, USA.
Health Serv Res. 2025 May;60 Suppl 3(Suppl 3):e14418. doi: 10.1111/1475-6773.14418. Epub 2024 Dec 12.
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.
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.
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).
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.
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.
评估多层次因素对26个社会护理试点项目可持续性的影响，这些试点项目为加利福尼亚州医疗补助计划参保者在新制定的医疗补助福利中整合医疗和社会服务。
这项定性研究评估了2016年至2021年期间实施的全人护理（WPC）试点项目的可持续性。试点项目（n = 26）覆盖了加利福尼亚州的大部分县。
主要定性数据于2021年6月至8月收集，包括对代表所有WPC试点项目的管理人员、中层管理人员和一线病例管理工作人员进行的58次时长为一小时的半结构化个人和小组访谈。我们采用混合归纳-演绎主题分析法来识别和分析影响可持续性的因素中的模式和异常值。演绎编码包括影响新项目可持续性的既定实施科学因素（如创新特征、能力、流程与互动以及背景）。
在26个WPC试点项目中，22个试点项目通过与医疗补助管理式医疗计划签约，将提供服务作为新制定的医疗补助福利的一部分，从而维持了WPC项目。三个试点项目在试点期结束前选择不再维持，一个试点项目在完成全面试点后决定不再维持。影响可持续性的因素包括：（1）项目的适应性和灵活性；（2）资金结构和报销要求；（3）与管理式医疗计划的共同领导；（4）试点项目是选择在内部构建项目基础设施，还是将核心组件外包给合作伙伴组织。许多试点项目，尤其是农村地区的试点项目，表明作为将试点服务过渡到医疗补助福利的一部分而引入的系统和政策变化降低了参与提供者的WPC项目的可持续性。
包括项目适应性、资金、领导力和构建基础设施能力在内的多层次因素影响了WPC试点项目的可持续性。这些发现对健康公平具有重要意义，因为随着时间的推移持续实施这些项目，可以支持服务、资源和福利的公平分配。
