As state reimagines Medicaid, local nonprofits may have role to play

BY EVAN RICHARDSON AND CALVIN TOMKINS

This issue of Mountain Xpress highlights many of the wonderful nonprofits we have in Western North Carolina, and in terms of the community’s overall health, it couldn’t come at a better time. Although we’re more than 300 miles from North Carolina’s coast, we are experiencing a sea change in how we think about and address health.

Until recently, discussions about health care tended to focus mainly on care provided inside a doctor’s office, hospital or other medical facility. Most often, the talk was about treating people who were sick, injured or living with chronic illnesses.

Meanwhile, out in our communities, countless nonprofits have been steadfastly working to address the many factors that support well-being and prevent illness. Often partnering with their county public health agencies, these organizations aim to expand access to what are called the social determinants of health: safe, affordable housing; healthy food; child care; transportation; and educational and economic opportunities. Together, these factors influence and help predict how healthy an individual, family or community is likely to be.

For too many years, WNC nonprofits have been asked to do a lot with a little. Meanwhile, most of our resources have gone to providing care inside medical facilities, which explains why health care is one of the region’s and the nation’s biggest industries. Now, however, things are changing — and for the better.

Wading into the sea change

Here in North Carolina, we’re seeing a surge of change at the state level as we prepare for Medicaid transformation.

Health and Human Services Secretary Mandy Cohen emphasizes that our ability to achieve shared goals — such as ensuring that our children are ready for school, that our youths can realize the best possible future, and that all residents have access to economic opportunities — begins with healthy people.

Accordingly, North Carolina is investing heavily in new initiatives. Under the “Healthy Opportunities” umbrella, the state is rolling out programs designed to maximize residents’ prospects for optimal health.

When it’s fully implemented, perhaps by the end of next year, NCCARE360 will become the nation’s first statewide electronic platform for connecting individuals to the help they need. Built on the 211 platform, NCCARE360 will enable health care providers to quickly identify and make referrals to community resources — many of them nonprofits — that can help address patients’ nonmedical health issues. Likewise, community-based service providers will be able to refer clients to medical providers when needed. This online system will also help communities determine which services are most needed by revealing where gaps exist in the resources available to address those social determinants.

Healthy Opportunities pilots are another strategy for addressing social determinants and gauging their impact on both community health and health care costs. The state will select up to four pilot communities across North Carolina where networks of care providers, hospitals, community-based organizations and county-based public health and social service agencies will be created. Over five years, these pilot networks will receive up to $650 million in Medicaid funding to provide nonmedical services such as housing, transportation, food security and interpersonal safety. If rigorous analysis shows those interventions to be effective, these services would then be incorporated into the statewide Medicaid system.

What will care look like in one of these pilot communities? Someone with diabetes and limited access to healthy food could receive regular deliveries of fresh produce along with education on nutrition and meal preparation; a pregnant woman facing eviction could get housing assistance to ensure that she and her family have a home; a family in distress might be offered parenting support and stress management education.

Will WNC have a Healthy Opportunities pilot?

We certainly hope so. Thanks to our vibrant local network of nonprofits, public health and social service agencies, as well as organizations like Mission Health Partners, the Mountain Area Health Education Center and federally qualified health centers, we already have a strong foundation to support such a project.

Mission Health Partners is a physician-led network of hospitals, other health facilities, primary care providers and independent specialists working together to improve the quality and affordability of care by focusing on the social determinants of health. The program’s care management team screens patients for social determinant needs, connects them with community partners and ensures that those needs are met, whether it’s a question of legal problems, housing, food insecurity or medication assistance.

This approach has shown promising results and could become a national model for curbing health care costs. The program’s data indicates that connecting patients with critical, community-based services promotes health while reducing unnecessary care and its associated costs. Routing health care spending to those services enables medical care providers to spend more time on preventive approaches that improve health and reduce chronic illness.

Clearly, we already have both the expertise and the commitment to improve lives in our region. What we need is more funding and better coordination among our health care system, county public health and social service agencies, and nonprofit community partners. Whether our healthy opportunities come by way of the state or from within our own region, we believe Western North Carolina is ready to make the most of them.

Evan Richardson, a certified nurse midwife, is the director of community health integration at MAHEC, where she supports the integration of social determinants of health into the clinical space. Dr. Calvin Tomkins is the assistant medical director of Mission Health Partners and a practicing physician with Asheville Pediatric Associates.