UC Berkeley

Implementation science provides frameworks, theories, models, strategies, and mechanisms to support researchers and practitioners in translating evidence-based interventions into practice and improving the effectiveness of these interventions. However, until recently most implementation science studies did not attend to factors related to health equity. Arguably, the fields of implementation science and health equity research and practice often seek to meet similar outcomes including widespread access to services and resources, improved quality of services delivered, and generalizable benefits from evidence-based intervention implementation.

This dissertation evaluates equitable implementation and sustainment of California’s Whole Person Care initiative, which tested whether provision of care coordination, housing assistance, and other social services could improve cost and outcomes of care for high-risk, high-need Medicaid enrollees. Health systems increasingly use case management programs to integrate social and medical services to support health equity for high-risk, high-need patients. Limited evidence exists about key components of integrated case management program implementation and sustainability, especially from a health equity perspective.

Chapter 1 is a thematic analysis exploring how a single WPC pilot integrating medical and social services for high-risk, high-need patients addressed health equity through pilot design and implementation. Chapter 2 applies a mixed methods approach to identify key individual, interpersonal, and organizational factors associated with case manager job satisfaction and intention to leave their role among a sample of Whole Person Care frontline case management staff. Chapter 3 applies a thematic analysis approach to identify multi-level factors hindering or supporting equitable sustainability of Whole Person Care pilot components beyond the pilot phase. Combined, these analyses provide a blueprint for assessing equity research and practice leveraging the strengths of implementation science, while also offering pragmatic findings to inform future efforts to design, implement, and evaluate integrated case management models broadly.