DHHS announces three regions for Medicaid healthy opportunities pilots — A major milestone for Nation’s first comprehensive Medicaid program to address non-medical drivers of health
RALEIGH — The North Carolina Department of Health and Human Services today announced the selection of organizations to serve three regions of the state, marking a major milestone towards launching the nation’s first comprehensive program to test evidence-based, non-medical interventions designed to reduce costs and improve the health of Medicaid beneficiaries. The groundbreaking program will create a systematic approach to integrating and financing non-medical services that address housing stability, transportation access, food security and interpersonal safety into the delivery of health care.
Following a competitive selection process, the following organizations will reach three regions, two in eastern North Carolina and one in western North Carolina.
Access East Inc.: Beaufort, Bertie, Chowan, Edgecombe, Halifax, Hertford, Martin, Northampton, Pitt
Community Care of the Lower Cape Fear: Bladen, Brunswick, Columbus, New Hanover, Onslow, Pender
Dogwood Health Trust: Avery, Buncombe, Burke, Cherokee, Clay, Graham, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Polk, Rutherford, Swain, Transylvania, Yancey
The program, known as the Healthy Opportunities Pilots, was hailed by Seema Verma, the former director of the Centers for Medicare and Medicaid Services (CMS), as an "innovative" and "groundbreaking" new approach. She wrote, "As we seek to create a health care system that truly rewards value, we must consider the impact that factors beyond medical care have in driving up health costs." CMS approved the Healthy Opportunities Pilots in 2018 as part of the state’s waiver to transition to Medicaid managed care.
"North Carolina continues to lead in innovative approaches to build a well-coordinated system of care that addresses both the medical and non-medical drivers of health," said DHHS Secretary Mandy K. Cohen, M.D. "The Healthy Opportunities Pilot will integrate the services that address these non-medical drivers of health and build the evidence base to identify which services are most effective at improving a person’s health and lowering their health care costs."
To be eligible for and receive pilot services, NC Medicaid Managed Care members must live in one of the three selected regions, have at least one qualifying physical or behavioral health condition, and have one qualifying social risk factor.
The federal government has authorized up to $650 million in Medicaid funding for the pilots, which will cover the cost of delivering the non-medical services and, in the first two years, support capacity building for Human Service Organizations needed to effectively deliver non-medical services in a health care context. The department will work with the Healthy Opportunities Network Leads (formerly referred to as Lead Pilot Entities), Prepaid Health Plans (PHPs), care management entities and Human Service Organizations to implement the pilot program. Human Service Organizations are community-based organizations and social services agencies that will deliver pilot services and be overseen by Healthy Opportunities Network Leads.
Goals of the pilots are to:
Evaluate the effectiveness of select, evidence-based, non-medical interventions and the role of the Network Leads in improving health outcomes and reducing health care costs for high-risk NC Medicaid Managed Care members.
Leverage evaluation findings to embed cost-effective interventions that improve health outcomes into the Medicaid program statewide, furthering the department’s goals for a sustainable Medicaid program.
Support the sustainability of delivering non-medical services identified as effective through the evaluation, including by strengthening the capabilities of Human Service Organizations and partnerships with health care payers and providers.
Healthy Opportunities Network Leads will spend the upcoming months building their network of Human Service Organizations and developing their capacity and that of their HSOs to participate in the pilots. The department anticipates that pilot service delivery will begin in the spring of 2022.
For more information about Healthy Opportunities, please visit https://www.ncdhhs.gov/about/department-initiatives/healthy-opportunities.
