About

Amanda L. Brewster is an Associate Professor of Health Policy and Management and co-Director of the Center for Health Management and Policy Research at the School of Public Health, University of California, Berkeley. Her research examines how management and inter-organizational relationships influence the performance of health care organizations. Her recent work focuses on identifying effective strategies for health care and social services to work together to address both medical and social determinants of health, including studies of cross-sector collaboration at the community level, partnerships between Area Agencies on Aging and health care organizations, and screening for social determinants of health in physician practices. Her work employs a range of methods, including qualitative and mixed-methods, organizational network analysis, and longitudinal analyses leveraging large survey-based and claims-based datasets. In addition to her research on relationships between health care and social services organizations, Dr. Brewster also studies quality improvement and organizational learning in health care organizations, including efforts to reduce readmissions and mortality from acute myocardial infarction.

Research topics

• Sociology
• Medicine
• Business
• Environmental health
• Nursing
• Gerontology
• Political Science
• Computer Science
• Economics
• Economic growth
• Marketing
• Finance
• Family medicine
• Actuarial science
• Emergency medicine
• Applied psychology
• Process management
• Psychology
• Public economics
• Public relations

Selected publications

• Defining case management success: a qualitative study of case manager perspectives from a large-scale health and social needs support program

  BMJ Open Quality · 2022 · 20 citations

  Senior authorCorresponding
  • Sociology
  • Political Science
  • Computer Science

  OBJECTIVE: Health systems are expanding efforts to address health and social risks, although the heterogeneity of early evidence indicates need for more nuanced exploration of how such programs work and how to holistically assess program success. This qualitative study aims to identify characteristics of success in a large-scale, health and social needs case management program from the perspective of interdisciplinary case managers. SETTING: Case management program for high-risk, complex patients run by an integrated, county-based public health system. PARTICIPANTS: 30 out of 70 case managers, purposively sampled to represent their interdisciplinary health and social work backgrounds. Interviews took place in March-November 2019. PRIMARY AND SECONDARY OUTCOME MEASURES: The analysis intended to identify characteristics of success working with patients. RESULTS: Case managers described three characteristics of success working with patients: (1) establishing trust; (2) observing change in patients' mindset or initiative and (3) promoting stability and independence. Cross-cutting these characteristics, case managers emphasised the importance of patients defining their own success, often demonstrated through individualised, incremental progress. Thus, moments of success commonly contrasted with external perceptions and operational or productivity metrics. CONCLUSIONS: Themes emphasise the importance of compassion for complexity in patients' lives, and success as a step-by-step process that is built over longitudinal relationships.

  DOI

• Effect of Social Needs Case Management on Hospital Use Among Adult Medicaid Beneficiaries

  Annals of Internal Medicine · 2022 · 41 citations

  Senior authorCorresponding
  • Medicine
  • Family medicine
  • Gerontology

  BACKGROUND: Case management programs assisting patients with social needs may improve health and avoid unnecessary health care use, but little is known about their effectiveness. OBJECTIVE: This large-scale study assessed the population-level impact of a case management program designed to address patients' social needs. DESIGN: Single-site randomized encouragement design with administrative enrollment from an eligible population and intention-to-treat analysis. Study participants were enrolled between August 2017 and December 2018 and followed for 1 year. (ClinicalTrials.gov: NCT04000074). SETTING: Contra Costa County, an economically and culturally diverse community in the San Francisco Bay Area. PARTICIPANTS: 57 972 randomized enrollments of adult Medicaid patients at elevated risk for health care use (top 15%) to the intervention or control group. INTERVENTION: Enrollees were offered 12 months of social needs case management, which provided more intensive services to patients with higher demonstrated needs. MEASUREMENTS: Medical use was measured via emergency department (ED) visits and inpatient admissions, some of which were classified as avoidable. RESULTS: Participants in the intervention group visited the ED at ratios of 0.96 (95% CI, 0.91 to 1.00) for all visits and 0.97 (CI, 0.92 to 1.03) for avoidable visits relative to the control group. The intervention group was hospitalized at ratios of 0.89 (CI, 0.81 to 0.98) for all admissions and 0.72 (CI, 0.55 to 0.88) for avoidable admissions. LIMITATIONS: Only 40% of the intervention group engaged with the program. The program was in continual development during the trial period. CONCLUSION: Although social needs case management programs may reduce health care use, these savings may not cover full program costs. More work is needed to identify ways to increase patient uptake and define characteristics of successful programs. PRIMARY FUNDING SOURCE: Contra Costa Health Services via the Medicaid waiver program.

  DOI

• Linking Health And Social Services Through Area Agencies On Aging Is Associated With Lower Health Care Use And Spending

  Health Affairs · 2020 · 33 citations

  1st authorCorresponding
  • Sociology
  • Business
  • Gerontology

  Area Agencies on Aging are increasingly partnering with health care organizations to address the health-related social needs of older adults and contribute to multisector coalitions that promote community health. Using survey data for the period 2008-13, we examined the potential health impacts of establishing such partnerships. Partnerships with hospitals located in an agency's service county were associated with a reduction of $136 in average annual Medicare spending per beneficiary, while partnerships with mental health organizations in an agency's service county saw potentially avoidable nursing home use fall by 0.5 percentage points. When agencies were funded participants in livable community initiatives-multisector coalitions to promote the well-being and health of older adults-potentially avoidable nursing home use fell by nearly 1 percentage point. Our results suggest that investments in health and human services partnerships through Area Agencies on Aging can yield health returns among older adults, in the form of reduced health care use and spending.

  DOI

• The Role of Value‐Based Payment in Promoting Innovation to Address Social Risks: A Cross‐Sectional Study of Social Risk Screening by US Physicians

  Milbank Quarterly · 2020 · 45 citations

  1st authorCorresponding
  • Business
  • Marketing
  • Actuarial science

  Policy Points One of the most important possibilities of value-based payment is its potential to spur innovation in upstream prevention, such as attention to social needs that lead to poor health. Screening patients for social risks such as housing instability and food insecurity represents an early step physician practices can take to address social needs. At present, adoption of social risk screening by physician practices is linked with having high innovation capacity and focusing on low-income populations, but not exposure to value-based payment. Expanding social risk screening by physician practices may require standardization and technical assistance for practices that have less innovative capacity. CONTEXT: One of the most important possibilities of value-based payment is its potential to spur innovation in upstream prevention, such as attention to social needs that lead to poor health. However, there is uncertainty about the conditions under which value-based payment will encourage health care providers to innovate to address upstream social risks. METHODS: We used the 2017-2018 National Survey of Healthcare Organizations and Systems (NSHOS), a nationally representative survey of physician practices (n = 2,178), to ascertain (1) the number of social risks for which practices systematically screen patients; (2) the extent of practices' participation in value-based payment models; and (3) measures of practices' capacity for innovation. We used multivariate regression models to examine predictors of social risk screening. FINDINGS: On average, physician practices systematically screened for 2.4 out of 7 (34%) social risks assessed by the survey. In the fully adjusted model, implementing social risk screening was not associated with the practices' overall exposure to value-based payment. Being in the top quartile on any of three innovation capacity scales, however, was associated with screening for 0.95 to 1.00 additional social risk (p < 0.001 for all three results) relative to the bottom quartile. In subanalysis examining specific payment models, participating in a Medicaid accountable care organization was associated with screening for 0.37 more social risks (p = 0.015). Expecting more exposure to accountable care in the future was associated with greater social risk screening, but the effect size was small compared with practices' capacity for innovation. CONCLUSIONS: Our results indicate that implementation of social risk screening-an initial step in enhancing awareness of social needs in health care-is not associated with overall exposure to value-based payment for physician practices. Expanding social risk screening by physician practices may require standardized approaches and implementation assistance to reduce the level of innovative capacity required.

  PublisherOA PDFDOI

Frequent coauthors

• Matthew Anderson

  Brigham Young University

  288 shared

• Jill R. Glassman

  Stanford University

  288 shared

• John Fick

  Atrium Health Wake Forest Baptist

  288 shared

• Amber L. Stephenson

  Clarkson University

  288 shared

• Lihua Dishman

  288 shared

• Abi Sriharan

  York University

  288 shared

• Amy Diehl

  Wilson College

  288 shared

• Erin E. Sullivan

  Suffolk University

  288 shared

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