Arons Abigail, Alban-Acuna Priscilla, Simon Melora, Whaley John, Fossier Nicole, Simon Amy, Rastogi Rohan, Fichtenberg Caroline
Division of General Internal Medicine at ZSFG, University of California San Francisco (UCSF), 2540 23rd St, San Francisco, CA, 94110, USA.
Division of General Pediatrics, UCSF, 550 16th Street, Fourth Floor, San Francisco, CA, 94158, USA.
BMC Public Health. 2025 Jul 2;25(1):2234. doi: 10.1186/s12889-025-23419-3.
To improve integration across health care and social needs, California's Medicaid transformation initiative, CalAIM, depends on partnerships between health care entities and social services organizations (SSOs). Given the potential for power imbalance both within the landscape of SSOs and between SSOs and healthcare entities, monitoring and elevating SSO perspectives during implementation is paramount.
We report the results of the SSO subgroup within a statewide survey conducted eighteen months into CalAIM implementation (July-September 2023, following CalAIM's January 2022 launch) among a diverse convenience sample of SSO respondents who were familiar with CalAIM. Results were analyzed using multivariable logistic regression models with CalAIM participation and six measures of perceived improvement as outcomes.
There were 355 SSO employee respondents representing 51 of 58 California counties, 66% of which worked in SSOs contracted as CalAIM providers. CalAIM participation was negatively associated with operating in a single county (OR 0.47, 95%CI 0.24-0.95), and positively associated with pilot participation (OR 6.4, 95% CI 2.5-16.4) and prior managed care contracting experience (OR 2.5, 95% CI 1.4-4.7); pilot participation was negatively associated with fewer employees and non-profit status, indicating a possible mediation effect. Across all six models with outcomes of perceived improvement in health care-social services integration, CalAIM participation was strongly associated with increased odds of perceived improvement (OR 2.28 to 4.97), as was being frontline staff or a manager compared to senior leadership (Manager OR 1.76 to 2.85; frontline OR 1.92-3.35), and being a housing services provider (OR 1.80 to 2.15).
Our analysis suggests that among SSOs familiar with CalAIM, smaller SSOs were less likely to be contracted CalAIM providers, possibly mediated by lower rates of prior Medicaid contracting experiences (e.g. pilot participation). Contracted SSOs perceived improvements in health care-social services integration at both the patient and organizational levels, suggesting CalAIM is functioning as intended in the perception of SSOs. We demonstrate a feasible method for ongoing monitoring of the SSO perspective that can inform near-term policy directions to ensure small SSOs with close community ties are fully included as partners in CalAIM.
为了加强医疗保健与社会需求之间的整合，加利福尼亚州的医疗补助转型计划（CalAIM）依赖于医疗保健实体与社会服务组织（SSO）之间的合作。鉴于SSO领域内部以及SSO与医疗保健实体之间存在权力失衡的可能性，在实施过程中监测并提升SSO的观点至关重要。
我们报告了在CalAIM实施18个月后（2023年7月至9月，自2022年1月CalAIM启动后）在全州范围内进行的一项调查中SSO子群体的结果，该调查对象是熟悉CalAIM的不同便利样本的SSO受访者。使用多变量逻辑回归模型对结果进行分析，以CalAIM参与情况和六项感知改善指标作为结果。
共有355名SSO员工受访者，代表加利福尼亚州58个县中的51个，其中66%在作为CalAIM提供者签约的SSO工作。CalAIM参与与在单个县运营呈负相关（OR 0.47，95%CI 0.24 - 0.95），与试点参与呈正相关（OR 6.4，95%CI 2.5 - 16.4）以及与先前的管理式医疗签约经验呈正相关（OR 2.5，95%CI 1.4 - 4.7）；试点参与与员工较少和非营利地位呈负相关，表明可能存在中介效应。在所有六个以医疗保健 - 社会服务整合感知改善为结果的模型中，CalAIM参与与感知改善几率增加密切相关（OR 2.28至4.97），与高级领导相比，一线员工或经理也是如此（经理OR 1.76至2.85；一线OR 1.92 - 3.35），以及作为住房服务提供者也是如此（OR 1.80至2.15）。
我们的分析表明，在熟悉CalAIM的SSO中，规模较小的SSO成为CalAIM签约提供者的可能性较小，这可能由先前医疗补助签约经验（如试点参与）的较低比率所介导。签约的SSO在患者和组织层面都感知到了医疗保健 - 社会服务整合的改善，这表明CalAIM在SSO的认知中按预期发挥作用。我们展示了一种可行的方法来持续监测SSO的观点，可为近期政策方向提供信息，以确保与社区联系紧密的小型SSO作为合作伙伴被充分纳入CalAIM。
