oREgon medicaid policy, SOciaL serVices, and hEalth (RESOLVE) - Enter the text here that is the new abstract information for your application. This section must be no longer than 30 lines of text. The circumstances in which people are born, grow, live, and work—often referred to as social determinants of health (SDH)—have well-documented impacts on chronic disease outcomes. Stemming from this strong and compelling evidence linking SDH and chronic disease, healthcare organizations are increasingly integrating screening for select forms of social barriers to health such as food insecurity, followed by referrals to connect patients to local social services (community-clinical linkages (CCLs)). Although these activities are being widely promoted at both the national and state levels, robust evidence about their impacts on chronic disease prevalence and outcomes is lacking. Furthermore, there is not yet any evidence about policy levers to increase uptake of CCLs. The state of Oregon’s Medicaid environment offers a unique laboratory for studying both the impacts of policy levers on CCLs activities as well as the impacts of CCLs on chronic disease outcomes. In 2024 and 2025, the state is launching two new policies intended to increase CCLs, including a new “Health Related Social Needs” (HRSN) benefit covering 10 categories of non-medical services and Medicaid health plan quality measures related to social risk screening and social service referrals. We propose to conduct a quasi-experimental mixed-methods study that (1) evaluates the impacts of Oregon’s new Medicaid social care policies on social risk screening and related community-clinical linkages, and (2) evaluates the impacts of social risk screening and related community-clinical linkages on chronic disease outcomes and healthcare utilization. In the oREgon medicaid policy, SOciaL serVices, and hEalth (RESOLVE) study, we will create a novel, comprehensive dataset that includes information about social risk screening, referrals to social services, receipt of social services, and EHR and claims data from > 170,000 Medicaid members seen in community health centers (CHCs) across Oregon. We will use interrupted time series methods to examine whether and how the new Medicaid policies affect rates of social risk screening, social services referrals, and receipt of specific social services. We will also investigate the impacts of social care activities on key chronic disease risk factors, disease outcomes, receipt of preventive care, and healthcare utilization using instrumental variable analysis and sequential target trial emulation. In these analyses we will examine whether these policies benefit all Medicaid members. Qualitative interviews with healthcare and community-based organization leaders will inform our understanding of the policies’ influence on social care activities. Interviews with clinical delivery team members and Medicaid members will explore how community-clinical linkages influence chronic disease outcomes and how to maximize the impact of services to improve chronic disease outcomes. RESOLVE will provide critical evidence to inform social care policy efforts at both the state and national levels.
