Duke-Margolis completed preliminary interviews and convenings to identify priority areas for multistakeholder 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 multistakeholder 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, address health disparities, reduce costs, and improve population health. The NC STC relies on collaboration with diverse stakeholders, organizations, and individuals working together toward 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, updated June 2025

NC STC launch event on Feb 2, 2023

May 2024 annual public event

Alignment Proposal for the NC STC released May 2024, updated June 2025

NC STC one pager released June 2024, updated June 2025

NC STC press release released May 2024

Hea!thcare Innovation Article published May 2024

North Carolina is one of four states participating in the STC initiative, initially launched by the Health Care Payment Learning and Action Network (HCP-LAN) and the Centers for Medicare & Medicaid Services (CMS). In North Carolina, the STC is financially supported by the North Carolina Department of Health and Human Services (NCDHHS) with Duke-Margolis serving as the neutral convener. The NC STC was launched on February 2, 2023 at a public meeting of stakeholders, including representatives from the NCDHHS Division of Health Benefits (NC Medicaid), HCP-LAN, CMS, and Duke-Margolis. 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 multistakeholder 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: 

• 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 disparities 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, high-blood pressure, and heart disease, and the data tools to facilitate the right care, at the right time, for the right patient.

On Tuesday, June 24th, Duke-Margolis will gather health policy leaders to discuss the progress of the NC State Transformation Collaborative (NC STC) on reducing provider burden and advancing value-based primary care in North Carolina. In February 2023, the NC State Transformation Collaborative (NC STC) was launched to promote high-value and whole-person care through multistakeholder partnerships. North Carolina is one of four states participating in the STC initiative, initially launched by the Health Care Payment Learning and Action Network (HCP-LAN) and the Centers for Medicare & Medicaid Services (CMS). In North Carolina, the STC is financially supported by the North Carolina Department of Health and Human Services (NCDHHS) with the Duke-Margolis Institute for Health Policy (Duke-Margolis) serving as the neutral convener.

During this event, speakers will:

• Highlight the importance of multistakeholder alignment initiatives to advance value-based and whole-person care, especially with a rapidly evolving policy landscape.
• Share NC STC's progress on key activities including aligning performance measures, improving data sharing, and enhancing health disparities data to enable advanced coordinated primary care models.
• Hear NC STC impact by featuring stories and perspectives from organizations who have signed on to the NC STC Alignment Proposal.
• Discuss future efforts for the NC STC leveraging the foundation built since the launch of the initiative.

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

Action Area: Establishing a Starter Set for Multistakeholder 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:

• 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—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 disparities data (data that enable the examination of health differences between populations and their causes) 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, convened a Health Disparities Data Workgroup (HDDWG) 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.  

Subscribe to the newsletter here.

Read the latest issues of the Collaborative's newsletter below:

February 2023 Meeting Summary 

Spring 2023

Fall 2023

Winter 2023

Spring 2024

Special Edition Summer 2024 - May Public Meeting and the Alignment Proposal for the NC STC

Fall 2024

Spring 2025