Goldman, AnnaHerscovitz, HayaSukserm, Thidarath2025-10-292025-10-292024https://hdl.handle.net/2144/516782024INTRODUCTION: Medicaid Accountable Care Organizations (ACOs) are a payment model that aims to better community health, improve patient experience, and lower the cost of care. These systems place a greater emphasis on provider involvement in patient care, addressing patients’ health related social needs, and have been shown to improve health outcomes in some cases. Many patients with serious mental illness (SMI) receive care within ACOs, but there is little evidence on quality of care or SMI patient experiences in these models. Social determinants of health (SDOH) coordinators (i.e., case managers, community wellness advocates, community health workers, and social workers) are largely responsible for balancing a patients’ medical needs with their social needs. Understanding coordinator perspectives and experiences can provide insight into the impact of the ACO model and current SDOH systems on patients with serious mental illness. OBJECTIVE: To understand SDOH coordinator perspectives on health care experiences of patients with serious mental illness receiving care in ACOs. METHODS: A qualitative study was conducted using semi-structured conversational Zoom interviews with SDOH coordinators from ACOs in the greater Boston area. Perspectives on experiences with care quality, potential areas of improved care with ACOs, challenges when navigating SMI patient care, SDOH coordinator burnout, and social determinants of health were evaluated. RESULTS: Medicaid ACOs were identified as having only partially improved the delivery and accessibility of resources for patients with serious mental illness. SDOH coordinators reported housing as being the most challenging social determinant of health to navigate. Barriers in transportation, food insecurity, and insurance followed closely behind. Coordinators generally reported considerable levels of stress and burnout caused by their work. Most continued to stay in their positions, but some have expressed thoughts about leaving their roles. CONCLUSIONS: SDOH coordinators reported significant challenges regarding accessibility for medical care and SDOH resources for patients with serious mental illness. Many patients with serious mental illness were found to have extreme difficulties securing adequate housing, transportation, food, and health insurance. This was due in major part to the flawed nature of the U.S. healthcare system. Most of the data suggested that ACOs have not been making marginal improvements in increasing accessibility for social determinants of health, especially for patients with serious mental illness. High levels of stress and burnout among SDOH coordinators were often attributed to a lack of resources for themselves and their patients, feelings of hopelessness, and the structure of the U.S. healthcare system hindering quality patient care.en-USPublic healthMedicinePublic policyACOBurnoutHealthcare systemMental healthMental illnessSocial determinants of healthThesis/Dissertation2025-10-28