ORIGINAL RESEARCH
Christine H. Lo, MPH; Margae J. Knox, PhD, MPH; Elizabeth A. Hernandez, MS; Amanda L. Brewster, PhD
Corresponding Author: Christine H. Lo, MPH; University of California, Berkeley School of Public Health
Email: christine.lo@berkeley.edu
DOI: 10.3122/jabfm.2023.230388R1
Keywords: California, Case Management. Logistic Regression, Medicaid, Patient Engagement, Population Health, Risk Factors, Social Determinants of Health
Dates: Submitted: 10-24-2023; Revised: 01-07-2024; Accepted: 01-17-2024
FINAL PUBLICATION: |HTML| |PDF|
INTRODUCTION: Many patients offered case management services to address their health and social needs choose not to engage. Factors that drive engagement remain unclear. We sought to understand patient characteristics associated with engagement in a social needs case management program and variability by case manager.
METHODS: Between August 2017 and February 2021, 43,347 Medicaid beneficiaries with an elevated risk of hospital or emergency department use were offered case management in Contra Costa County, California. Results were analyzed in 2022 using descriptive statistics and multilevel logistic regression models to examine 1) associations between patient engagement and patient characteristics and 2) variation in engagement attributable to case managers. Engagement was defined as responding to case manager outreach and documentation of at least one topic to mutually address. A sensitivity analysis was performed by stratifying the pre-COVID-19 and COVID-19 cohorts.
RESULTS: 16,811 (39%) of eligible patients engaged. Adjusted analyses indicate associations between higher patient engagement and female gender, age 40 and over, Black/African American race, Hispanic/Latino ethnicity, history of homelessness, and a medical history of certain chronic conditions and depressive disorder. The intraclass correlation coefficient indicates that 6% of the variation in engagement was explained at the case manager level.
CONCLUSIONS: Medicaid patients with a history of housing instability and specific medical conditions were more likely to enroll in case management services, consistent with prior evidence that patients with greater need are more receptive to assistance. Case managers accounted for a small percentage of variation in patient engagement.