A Formative Process Evaluation of Social Care Programming in a Health Care System Serving a Predominantly Rural State

Background and Purpose: In both the scientific literature and in the context of health services delivery, more attention is being paid to health-related social needs of patients and, more broadly, populations and communities. Because of the increased call to identify and address patients’ health-related social needs and population- and community-level social determinants of health in the delivery of health care services, more needs to be known about the design, implementation, and maintenance of health system-based social needs programming. This is especially true for health systems operating social need programming in rural and under-resourced contexts.

Methods: To learn more about the design, implementation, and maintenance of health system-based social needs programming in rural and under-resourced areas, a formative process evaluation case study of the largest health care system in a predominantly rural and under-resourced Southeastern state was undertaken. Data were collected from in-depth, semi-structured interviews with program administrators and front-line staff of social needs programming and triangulated with historical document review. Interviews were transcribed verbatim and analyzed following a deductive thematic analysis approach. Community-engaged research methodology was also employed to engage the community partner throughout the research process to maximize the immediate and practical translation of results for program refinement.

Results: Health system-based social care programming in the rural context was found to be designed using a person-centered lens at both the patient and provider levels. The initial implementation of this programming began as a small grant-funded program targeted to a patient population with high health-related social needs and subsequently grew across the continuum of health care services once measurable positive health outcomes and cost avoidance were appreciated. Social care programming is maintained financially through intricate shared savings contracts and grant funding mechanisms, and socially through substantial buy-in from traditional health care providers on the importance of addressing health-related social needs of patients and communities. Social care providers are challenged, however, by a general lack of understanding of their role on interprofessional health care teams and the availability of community-based resources to meet the identified health-related social needs of patients.

Conclusion and Implications: As health care systems continue to implement programming to identify and intervene on health-related social needs of patients and communities, lessons learned from this case study may translate to other health systems which serve predominantly rural and under-resourced communities. Due to a general lack of available community-based resources, health systems in these contexts may need to simultaneously engage in data-driven advocacy efforts calling to increase the amount and availability of resources to ultimately improve the health and wellbeing of patients and populations in rural and under-resourced contexts. This presents an opportunity for health systems to bridge the gap between micro- and macro- practice and more research is needed to better understand the integration of health and social care services as a multi-level mechanism to improve health equity.