Impact of social needs case management on use of medical and behavioral health services: Secondary analysis of a randomized controlled trial

Background: Social needs case management is an increasingly common strategy used by health care organizations to address integrated health and social needs. These programs connect patients to resources such as food assistance, housing, transportation, or income benefits, in addition to facilitating access to health care and behavioral health services. One theory suggests these programs may benefit patients by increasing use of primary and preventive care and decreasing need for acute care. In 2017, Contra Costa Health Services in California implemented a large-scale, randomized study to evaluate the effect of social needs case management on acute care use. The trial showed an 11% reduction in hospitalizations among patients offered case management. Objective: To evaluate impacts of social needs case management intervention on use of outpatient health care, behavioral health services, and jail intakes. Methods and Findings: We conducted a secondary analysis of a randomized encouragement study that assigned Medicaid beneficiaries with high risk for acute care use to social needs case management or to be administratively observed in the control group from August 2017 through December 2018. Eligibility criteria included being 18 years or older, a resident of Contra Costa County, and enrolled in full-scope Medicaid. Patients could not be in a vegetative state, currently in detention for more than 30 days, or enrolled in duplicative case management services. Risk for avoidable health care use was designated by a predictive risk score based on demographic information, past health care utilization, and social risk factors.