Systemic barriers to care coordination for marginalized and vulnerable populations

ABSTRACT

Care coordination can improve patient outcomes, increase continuity of care, and reduce healthcare utilization. This study explores the effectiveness and limitations of care coordination as a strategy for meeting vulnerable patients’ needs. The study team conducted a qualitative, multi-site, collective case study of four sites providing care coordination for vulnerable and marginalized populations. Data were gathered via individual patient interviews (n = 69) and staff focus groups (82 participants) and analyzed using a matrix template to code data and identify common themes. Addressing patients’ needs required coordination across behavioral, medical, and social service providers. This was most effective when it included social needs and built on trusting relationships between patients and staff. However, sites faced shared challenges from systemic barriers that limited their effectiveness. For vulnerable and marginalized populations, evidence-based care coordination can only address some needs, and benefits are often undermined by deeply entrenched structural deficits. Future care coordination programs must include an assessment of structural barriers and incorporate concurrent efforts to address them.

KEYWORDS:

• Vulnerable populations
• social determinants of health
• healthcare disparities
• case management
• qualitative research

Acknowledgements

The authors would like to thank the Massachusetts Health Policy Commission for commissioning this case study as part of the evaluation of its Targeted Cost Challenge Investment initiative.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the Massachusetts Health Policy Commission under procurement reference number 2018-HPC-001-TCCIEval.

Notes on contributors

Palmira Santos

Palmira Santos, PhD, is a research and evaluation scientist at Brandeis University’s Schneider Institutes for Health Policy and Research, where she specializes in delivery system transformation, population health, and vulnerable and marginalized populations.

Kristen Faughnan

Kristen Faughnan, MPA, is a research associate at Brandeis University’s Schneider Institutes for Health Policy and Research, where she specializes in delivery system transformation, health disparities, and care coordination.

Carol Prost

Carol Prost, MA, is a research associate at Brandeis University’s Schneider Institutes for Health Policy and Research, where she specializes in qualitative research involving vulnerable and high-risk populations in urban, suburban, rural, and tribal settings.

Cynthia A. Tschampl

Cynthia A. Tschampl, PhD, is a research and evaluation scientist at Brandeis University’s Schneider Institutes for Health Policy and Research, where she specializes in health and public health systems research, economic evaluations, infectious disease, and vulnerable populations.