• Daniel M Brown, Elizabeth A Hernandez, Sara Levin, Mathijs De Vaan, Mi-Ok Kim, Chris Lynch, Anna Roth, and Amanda L Brewster.
• Contra Costa Health Services, Martinez, California (D.M.B., E.A.H., S.L., C.L., A.R.).
• Ann. Intern. Med. 2022 Aug 1; 175 (8): 1109-1117.

BackgroundCase management programs assisting patients with social needs may improve health and avoid unnecessary health care use, but little is known about their effectiveness.ObjectiveThis large-scale study assessed the population-level impact of a case management program designed to address patients' social needs.DesignSingle-site randomized encouragement design with administrative enrollment from an eligible population and intention-to-treat analysis. Study participants were enrolled between August 2017 and December 2018 and followed for 1 year. (ClinicalTrials.gov: NCT04000074).SettingContra Costa County, an economically and culturally diverse community in the San Francisco Bay Area.Participants57 972 randomized enrollments of adult Medicaid patients at elevated risk for health care use (top 15%) to the intervention or control group.InterventionEnrollees were offered 12 months of social needs case management, which provided more intensive services to patients with higher demonstrated needs.MeasurementsMedical use was measured via emergency department (ED) visits and inpatient admissions, some of which were classified as avoidable.ResultsParticipants in the intervention group visited the ED at ratios of 0.96 (95% CI, 0.91 to 1.00) for all visits and 0.97 (CI, 0.92 to 1.03) for avoidable visits relative to the control group. The intervention group was hospitalized at ratios of 0.89 (CI, 0.81 to 0.98) for all admissions and 0.72 (CI, 0.55 to 0.88) for avoidable admissions.LimitationsOnly 40% of the intervention group engaged with the program. The program was in continual development during the trial period.ConclusionAlthough social needs case management programs may reduce health care use, these savings may not cover full program costs. More work is needed to identify ways to increase patient uptake and define characteristics of successful programs.Primary Funding SourceContra Costa Health Services via the Medicaid waiver program.

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