Duke-Margolis completed preliminary interviews and convenings to identify priority areas for multi-stakeholder alignment in payment and delivery reforms. Through the combination of stakeholder feedback and additional research, Duke-Margolis developed strategies and potential actions to guide the NC STC.

The NC STC has made significant progress on the agreed-upon goals by leveraging multi-stakeholder collaboration and building out the key strategies outlined in the NC STC Framework. Health care leaders from clinically integrated networks, NC Medicaid Standard Health Plans, commercial payers and purchasers, primary care providers, federally-qualified health centers, pharmacy groups, and health systems have contributed to the NC STC’s alignment initiatives through learning calls, workgroup meetings, convenings, and other efforts to determine actionable alignment areas that can help relieve provider burden, enhance patient experience, advance health equity, reduce costs, and improve population health. The NC STC relies on collaboration with diverse stakeholders, organizations, and individuals working together toward equitable and high-quality, whole-person care. 

See below to learn more about stakeholder engagement opportunities through the NC STC

Stakeholders involved in NC STC efforts:

NC STC FAQ released October 2024

NC STC launch event on Feb 2, 2023

May 2024 annual public event

Alignment Proposal for the NC STC released May 2024

NC STC one pager released June 2024

NC STC press release released May 2024

Hea!thcare Innovation Article published May 2024

On February 2, 2023, the NCDHHS Division of Health Benefits, HCP-LAN, CMS, and Duke-Margolis formally launched the NC STC. At the public meeting, stakeholders discussed the NC STC vision, impact of State Transformation Collaboratives on national policy reforms, and strategies for advancing whole-person health through the NC STC. Additionally, attendees provided feedback on key priorities and next steps for the NC STC.

The NC STC is guided by the lead partners and the North Carolina Health Care Transformation (HCT) Workgroup, an existing multi-stakeholder group convened by Duke-Margolis to provide strategic and technical guidance on cross-sector health care transformation in North Carolina. The HCT Workgroup is a multistakeholder group of health system representatives, health care providers, health plans, clinically integrated networks, employers, and state government entities such as NC Medicaid and the NC Health Information Exchange Authority. Due to the significant administrative burden associated with performance measure proliferation and variation, the HCT Workgroup expressed strong support for streamlining the measurement process and consistently applying Healthcare Effectiveness Data and Information Set (HEDIS) specifications to a few priority, evidence-based measures which include: 

• Childhood Immunization Status (CBE #0038) 
• Hemoglobin A1c Control for Patients with Diabetes (CBE #0575) (Previously known as Hemoglobin A1c Control for Patients with Diabetes)
• Controlling High Blood Pressure (CBE #0018) 

By focusing on streamlining the measurement process on a few key measures, the NC STC can help establish a process for implementation across a wide variety of measures in the longer term.

In early 2024, Duke-Margolis collaborated with NC STC partners to convene the NC STC Data Sharing Workgroup to identify key pain points for each chosen measure and discuss potential areas of opportunity for alignment within the starter measure set. Variability in performance measures included in value-based care contracts, inconsistencies in the application of measure specifications, and variation in measure collection and reporting all distract from the adoption of advanced primary care. The Workgroup was comprised of technical data experts from NC Medicaid, health plans, provider organizations, pharmacy groups, the NC Health Information Exchange Authority, and clinically integrated networks. The learnings from these convenings informed the Alignment Proposal for the NC STC and were presented at the May 2024 annual public meeting.

The Alignment Proposal for the NC STC outlines a set of actions to address shared challenges across key NC STC strategies – aligning quality measures, improving data infrastructure, and enhancing health equity data to enable advanced, coordinated care models, starting with primary care. This document, released by Duke-Margolis in preparation for the May public meeting, details next steps to further progress toward better health care delivery in the short- and long-term, specifically prioritizing key primary care and prevention clinical areas. The Alignment Proposal identifies areas in need of improvement, such as diabetes, childhood immunization status, and heart disease, and the data tools to facilitate the right care, at the right time, for the right patient.

The NC STC and lead partners hosted a public meeting on May 23, 2024, at Duke University. In attendance were state, local, and federal partners and collaborators, including the NC Health Care Transformation Workgroup and NC STC Data Sharing Workgroup members. During this meeting, stakeholders reflected on the Alignment Proposal and discussed how it could help streamline health reform programs to support capacity-building for whole-person care and reduce administrative burden for providers. Health care leaders also highlighted the need to address long-standing health disparities in North Carolina through improved collection, use, and sharing of data. 

In September 2024, Duke-Margolis will collaborate with NC STC partners to convene the NC STC Health Disparities Data Workgroup to establish guiding principles for the equitable collection, sharing, and use of health equity-related data. The workgroup will apply these guiding principles to identify and prioritize multistakeholder opportunities to improve health equity data within and across organizations. Variation in how organizations collect, share, and use health equity data creates challenges for directing resources and interventions to address identified health disparities across North Carolina. The workgroup will engage researchers, health care providers, health plans, health systems, state leaders, and community-based organizations who work alongside underserved and historically marginalized populations and have expertise in health equity-related data use for impact on the health and well-being of North Carolinians.  The learnings from this convening will inform the Alignment Proposal for the NC STC and be shared with stakeholders for consideration.

Action Area: Establishing a Starter Set for Multi-stakeholder Alignment in Measure Implementation

The NC STC identified a few priority, evidence-based measures as a starting point for reducing performance measurement burden through aligned measure implementation. These measures include:

• Childhood Immunization Status (CBE #0038) 
• Glycemic Status Assessment for Patients with Diabetes (GSD) (CBE #0575) (previously known as Hemoglobin A1c Control for Patients with Diabetes)
• Controlling High Blood Pressure (CBE #0018) 
   

The NC Health Care Transformation Workgroup selected these measures because they are clinically significant, known to be associated with persistent disparities across populations groups, and common across measure sets and value-based payment (VBP) contracts.

Action Area: Identify Data Strategies to Operationalize Alignment through the NC STC Data Sharing Workgroup

Using the three priority, evidence-based measures outlined above—Childhood Immunization Status, Glycemic Status Assessment for Patients with Diabetes (GSD), and Controlling High Blood Pressure—as use-cases for aligned implementation and to increase the adoption of national data interoperability standards, the NC STC convened the technical NC STC Data Sharing Workgroup. The Workgroup identified key pain points for each measure and discussed potential alignment actions for the starter measure set, including establishing standard data-sharing formats, strategies to enhance automated reports within the NC HIEA, and approaches to improving data sharing among practices, labs, pharmacies, and payers using Bulk FHIR (Fast Healthcare Interoperability Resources) standards. The lack of data interoperability across stakeholders and lines of business acts as a major source of administrative burden in value-based payment contracts, presenting challenges for care coordination, population health management, and performance measurement. The NC STC has proposed short- and long-term alignment steps to improve data sharing infrastructure.

Short-term alignment steps (6 months-2 years)

• Streamline supplemental data submissions for performance measurement
• Identify ways to move toward national interoperability standards

Long-Term Alignment Steps (2-5 years)

• Build a robust ecosystem to support data sharing in North Carolina

Action Area: Identifying Guiding Principles and Establishing Foundational Steps to Measure and Track Disparities with the NC STC Health Disparities Data Workgroup

Variation in how organizations collect, share, and use health equity data (e.g., race, ethnicity, language, disability, rurality and health-related social needs (HRSN)) creates challenges for directing resources and interventions to address identified health disparities across North Carolina. To address these issues, Duke-Margolis, in collaboration with NC STC lead partners, will convene a Health Disparities Data Workgroup to establish guiding principles to streamline the collection, sharing, and use of data.

If you are interested in learning more about the strategies and key action areas, you can find details in the Alignment Proposal for the STC. Please click here to read more.

If you are interested in learning about stakeholder involvement opportunities within the NC STC, or would like additional information, please complete the form below.  

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Special Edition - May Public Meeting and the Alignment Proposal for the NC STC