Practical, Timely Lessons for Advancing and Aligning North Carolina's Health Care Transformation Leadership to Address Social Needs

Practical, Timely Lessons for Advancing and Aligning North Carolina's Health Care Transformation Leadership to Address Social Needs


 In October 2018, CMS approved North Carolina’s 1115 waiver to move the state’s Medicaid system from fee-for-service to a managed care program. A key part of this 1115 waiver is a groundbreaking demonstration project, the Healthy Opportunities Pilots, to pay for and deliver services to address unmet social needs in three regions across North Carolina. In the program, each pilot region’s Network Lead organization—with support from managed care plans in identifying patients, assessing needs, collecting data, and managing budgets—will oversee a network of local human service organizations to pay for and deliver evidence-based interventions that address unmet needs in food, housing, transportation, interpersonal safety and toxic stress. In July 2021, the Pilots officially began its capacity-building phase where $100 million is supporting the Network Leads to do things like establishing policies, hiring staff, and building their network of human service organizations. Service delivery started in early 2022 and will continue through October 2024. 

Project Overview

Given the substantial challenges that exist for integrating health and social services, however, there is need for timely and practical guidance. This project’s objective is to understand early real-world experiences in preparing for and implementing the Healthy Opportunities Pilots, in order to generate learnings and insights to improve the implementation of the Pilots, North Carolina’s broader Medicaid transformation, and similar initiatives by other states or payers to address social needs.

Following two expert stakeholder guiding committee convenings in the first year of the project with over 50 key stakeholders locally and nationally to guide our work, we are in the process of conducting our research. In June 2021, our team moderated a policy roundtable at the 2021 AcademyHealth Annual Research Meeting to discuss the Pilots, our work, and work occurring across the nation to address social needs through Medicaid. For the first stage of our work, we studied North Carolina’s COVID-19 Support Services Program—developed during the COVID-19 public health emergency to address multiple pandemic-related social needs—as it is informally seen as a smaller-scale preview of Pilots due to similarities in design and service provision. We partnered with one of the program’s largest grantees to analyze their program survey data and we completed interviews with 16 experts involved in every level of the COVID-19 Support Services Program statewide. We published findings in a policy brief with Milbank Memorial Fund in March 2022. By Summer 2022, we: will finish conducting all interviews about planning, building capacity, and early administration of the Pilots; will hold a focus group with NC Medicaid enrollees in the Pilots program; and will develop a summative, cross-cutting manuscript of findings for local and national policymakers.  

The first phase of our project was funded as part of the Robert Wood Johnson Foundation’s “Research in Transforming Health and Health Care Systems” program, which sought to build the evidence base on the potential effects of policies or policy changes intended to transform health and health care systems.

The second phase of our project, which is funded by the Kate B. Reynolds Charitable Trust, will extend our work into the first two years of service provision of the Healthy Opportunities Pilots (2022-2024) and will allow us to generate insights and lessons learned from NC health care stakeholders conducting innovative work to address social needs outside of the Pilots. Throughout this multi-year project, we are coordinating with the NC Department of Health and Human Services.

Pilots Webinar Graphic

North Carolina’s Healthy Opportunities Pilots: A Medicaid Managed Care Program to Address Social Needs

Webinar - July 2022

This webinar provided an overview of practical cross-cutting themes from the planning, capacity-building, and early implementation periods of the Healthy Opportunities Pilots, including successes, lessons learned, challenges encountered, and innovative solutions for overcoming challenges. Policymakers, researchers, evaluators, implementation leaders, and frontline providers shared their experiences over the past two years, thoughts on the future of the program, and lessons for similar programs.

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Fact Sheet

North Carolina Healthy Opportunities Focus Group Findings

Fact Sheet - July 2022

This fact sheet describes key takeaways from focus groups conducted to assess the initial awareness of and access to the Healthy Opportunities Pilots services in North Carolina. 

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North Carolina’s COVID-19 Support Services Program: Lessons for Health Policy Programs to Address Social Needs

North Carolina’s COVID-19 Support Services Program: Lessons for Health Policy Programs to Address Social Needs

Policy Brief - March 2022

The North Carolina Department of Health and Human Services launched its COVID-19 Support Services Program in August 2020 to address multiple pandemic-related social needs in counties with COVID-19 hot spots in four target regions of the state. Lessons from the COVID-19 Support Services Program can inform other states’ and payers’ efforts to address social needs, as well as North Carolina’s soon-to-launch $650 million Healthy Opportunities Pilots, which will pay for and provide social services through Medicaid managed care programs. We offer key recommendations to health policymakers (e.g., state health officials, commercial payers) creating or administering health policy programs to address social needs in local populations; our findings are also relevant to frontline implementers of such programs.

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Duke-Margolis Team

Robert Saunders

Robert Saunders, PhD

Senior Research Director, Health Care Transformation
Adjunct Associate Professor
Senior Team Member
Margolis Core Faculty

William K. Bleser - Margolis headhot

William K. Bleser, PhD, MSPH

Assistant Research Director, Health Care Transformation for Population Health, Social Needs, and Health Equity
Senior Team Member
Anti-Racism and Equity Committee Member

Rebecca Whitaker Headshot

Rebecca Whitaker, PhD, MSPH

Research Director, North Carolina Health Care Transformation
Senior Team Member
Anti-Racism and Equity Committee Member

Katie Huber

Katie Huber, MPH

Senior Policy Analyst

Andrea Thoumi

Andrea Thoumi, MPP, MSc

Health Equity Policy Fellow
Faculty Director of Health Equity Educational Programming
Senior Team Member
Anti-Racism and Equity Committee Member
Core Faculty Member
Adjunct Assistant Professor
2020 Intern Mentor

Yolande Pokam Tchuisseu

Yolande Pokam Tchuisseu, MSc

Senior Policy Analyst

James Zheng

James Zheng

2020 Margolis Intern
2021 Margolis Intern

Picture of Jasmine Masand

Jasmine Masand, (MPP '21)

Anti-Racism and Equity Committee Member

Margolis Summer Experience

Karina Vasudeva

2022 Margolis Intern

Additional Collaborators

Hannah Crook (former Duke-Margolis Staff member)

Michelle Lyn (Assistant Professor in Family Medicine and Community Health at Duke University)

Raman Nohria (Family Medicine Physician and Medical Instructor at the Duke Department of Family Medicine and Community Health)