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

Health and social care continue to integrate, but relatively little is known about how social care is designed, implemented, and maintained across the health care continuum. This is especially true for health systems serving rural and under-resourced communities. To fill these gaps, this dissertation project applied formative process evaluation methods to a single case study of the largest health care system serving a predominantly rural state and its integrated social care programming. Data were collected from in-depth, semi-structured interviews following a purposeful and snowball sampling method among key informants for the design, implementation, and maintenance of social care programming as well as with social care providers with lived experience navigating social care in the rural and under-resourced context. Interviews were recorded and transcribed verbatim and analyzed following a thematic analysis approach. Results indicate that social care was initially designed and implemented on a small scale, with program growth based on positive outcomes. Social care programming is maintained financially through intricate shared cost savings contracts with health insurers for patients who are insured and through grants for patients who are uninsured or underinsured. Social care programming is also maintained socially, evidenced by a theme of high buyin from traditional health care providers as well as patients and families on the value of providing social care. Participants identified challenges associated with social care in the rural context, including a general lack of available community-based resources and a reliance on informal resources, as well as opportunities associated with social care in the rural context, including engaging in a closed-loop referral process and moving social care even further upstream to address the causes of health-related social needs in a data-driven way. These results were presented to the community partner in the form of a technical report so that integrated social care programming can continue to evolve to better achieve the goals of improving health and health equity for patients and communities in the rural and under-resourced context.