Pilot program addresses social drivers of health

Good health depends on many factors.

A new Medicaid program called the Healthy Opportunities Pilot addresses the social factors involved in health. Developed by the N.C. Department of Health and Human Services, the pilot covers 18 counties and the Qualla Boundary in Western North Carolina (in addition to two regions in Eastern North Carolina). It’s the first pilot in the nation to “test and evaluate the impact of providing select evidence-based, nonmedical interventions,” according to NCDHHS.

Impact Health, a new nonprofit created by Dogwood Health Trust to manage the pilot, is serving as network lead for WNC.

One of the goals of the pilot is to identify which services both improve health and lower health care costs. This means addressing nutrition, housing, safety and transportation. In total, 29 potential interventions are available for reimbursement under the Healthy Opportunities Pilots fee schedule.

The Healthy Opportunities Pilot is part of North Carolina’s July 1 transition to Medicaid Managed Care health plans. According to Impact Health, the transition “essentially outsources the management and reimbursements of the state’s Medicaid system to private health plans.” The human service organizations selected will receive Medicaid reimbursements from the private insurance plans for the services they provide Medicaid enrollees. The federal government has authorized up to $650 million in Medicaid funds for the next five years, NCDHHS reports.

Impact Health opened the application process for human services organizations in September, and it announced the organizations that would serve in the pilot March 3.  In total, 46 human service organizations will participate in the network.

Some organizations focus on a singular domain, such as Bounty & Soul, a Black Mountain-based nonprofit that provides boxes of nourishing food to individuals. Others serve across multiple domains, such as Safelight, a Hendersonville-based nonprofit that provides services for cases of intimate partner violence as well as housing navigation and reimbursement for health-related public transportation.

The first phase of the pilot’s rollout began March 15 with an emphasis on food insecurity. Dionne Greenlee-Jones, interim executive director for Impact Health, says referrals began immediately.

“To find that we’ve already seen some reimbursements happen points to the fact that the pilot has successfully launched,” says Greenlee-Jones. Since the pilot began, there have been more than 35 referrals made for services from providers within the food domain.

Healthy Opportunities is rolling out two more phases this spring: housing and transportation on Sunday, May 1, and interpersonal violence services on Wednesday, June 15.

Social determinants of health

Social determinants of health, also called social drivers of health, have traditionally not received as much attention as in-office aspects of health care, such as vaccinations or bloodwork.

But those in the medical community have long known that their patients’ living conditions are a factor in their overall health. According to a 2018 survey of physicians in America, conducted by The Physicians Foundation, 88% of physicians said some, many or all of their patients experienced a social condition, like poverty, that impacted their health.

The Office of Disease Prevention and Health Promotion at the U.S. Department of Health and Human Services recognizes five domains for social determinants of health: economic stability, neighborhood and built environment, education access and quality, social and community context, and health care access and quality.

“A well-paying job, after-school programming for youth, trees in the neighborhood — all contribute to our physical, mental and emotional well-being, and can delay or reduce illness in individuals and populations,” writes Ameena Batada, a professor of health and wellness at UNC Asheville.

Ventures like Healthy Opportunities Pilot are laying the groundwork for larger structural changes to address health concerns, she indicates.

“Initiatives such as Healthy Opportunities, which create mechanisms to allocate funding outside of health care, have the potential to offer greater support to populations that have been historically, and continue to be, disenfranchised due to classism, racism, and other critical systemic problems,” she says.

Food first

The Healthy Opportunities Pilot is focusing on food insecurity in the first phase. “Food insecurity is a huge issue all throughout the state, but particularly in Western North Carolina,” explains Greenlee-Jones.

The U.S. Department of Agriculture defines food insecurity as “a household-level economic and social condition of limited or uncertain access to adequate food.” Low food security is considered to be “reduced quality, variety of desirability of diet,” while very low food security means “multiple indications of disrupted eating patterns and reduced food intake,” the USDA says.

In 2019, North Carolina’s food insecurity rate was 13.5%, according to Feeding America, a nonprofit that partners with the USDA on implementing federal nutrition programs. On a county level, Feeding America reports Buncombe County’s food insecurity rate was 13.5%, while Haywood County’s food insecurity rate was 14.9%. McDowell County had a rate of 16.5%, which was among the highest in the state.

MANNA FoodBank is a hunger relief organization in the pilot that services over 250 food pantries in the 16 WNC counties, says Glenn Wise, director of programs for MANNA FoodBank. “One of the reasons that the food domain was chosen to launch [the pilot] initially [is] because that’s a pretty strong network, and those networks exist across the state,” he explains.

North Carolina is permitting nine food-related services to be reimbursed under the pilot, Wise explains — “everything from healthy food boxes — both for pickup at a partner agency or delivered. Also healthy meals for pickup and delivery.” Evidence-based nutrition classes such as Cooking Matters and diabetes prevention programs also make the list.

Nineteen organizations in the food domain were part of the pilot at its launch, says Greenlee-Jones. As additional organizations join the pilot in future phases, more might be added, as some organizations serve multiple domains, she says.

Since the Healthy Opportunities Pilot is new, it remains to be seen which services move the needle on participants’ health the most. However, Wise tells Xpress he is particularly enthusiastic about the educational programs.

“Providing the actual food is only a part of what it’s going to take for someone to really improve their health or change behavior in a way that it improves their health outcome,” he explains.

It’s “absolutely critical,” he says, for people to understand how they can “adopt changes in their diet that ultimately reduce their risk of diabetes.”

Wise tells Xpress that the Healthy Opportunities Pilot has the potential to serve some of the most vulnerable among us. (Three in seven children in North Carolina are insured by Medicaid, according to 2019 data from Kaiser Family Foundation, a nationwide research and policy organization.)

“To be able to use Medicaid dollars to treat food insecurity for children and even some of those in their family is really pretty powerful,” Wise says.