Greater Covid‐19 vaccine uptake among enrollees offered health and social needs case management: Results from a randomized trial

Abstract

AbstractObjectiveTo investigate Covid‐19 vaccination as a potential secondary public health benefit of case management for Medicaid beneficiaries with health and social needs.Data Sources and Study SettingThe CommunityConnect case management program for Medicaid beneficiaries is run by Contra Costa Health, a county safety net health system in California. Program enrollment data were merged with comprehensive county vaccination records.Study DesignIndividuals with elevated risk of hospital and emergency department use were randomized each month to a case management intervention or usual care. Interdisciplinary case managers offered coaching, community referrals, healthcare connections, and other support based on enrollee interest and need. Using survival analysis with intent‐to‐treat assignment, we assessed rates of first‐dose Covid‐19 vaccination from December 2020 to September 2021. In exploratory sub‐analyses we also examined effect heterogeneity by gender, race/ethnicity, age, and primary language.Data Collection and Extraction MethodsData were extracted from county and program records as of September 2021, totaling 12,866 interventions and 25,761 control enrollments.Principal FindingsApproximately 58% of enrollees were female and 41% were under age 35. Enrollees were 23% White, 12% Asian/Pacific Islander, 20% Black/African American, and 36% Hispanic/Latino, and 10% other/unknown. Approximately 35% of the intervention group engaged with their case manager. Approximately 56% of all intervention and control enrollees were vaccinated after 9 months of analysis time. Intervention enrollees had a higher vaccination rate compared to control enrollees (adjusted hazard ratio [aHR]: 1.06; 95% confidence interval [CI]: 1.02–1.10). In sub‐analyses, the intervention was associated with stronger likelihood of vaccination among males and individuals under age 35.ConclusionsCase management infrastructure modestly improved Covid‐19 vaccine uptake in a population of Medicaid beneficiaries that over‐represents social groups with barriers to early Covid‐19 vaccination. Amidst mixed evidence on vaccination‐specific incentives, leveraging trusted case managers and existing case management programs may be a valuable prevention strategy.