Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.