How Providers, Health System Leaders, and States Can Work Together to Align Disparate Policy Efforts to Address Health-Related Social Needs: Learning from North Carolina

Nationally, there is progress and interest across health payers and policymakers in using health payment and delivery reforms to address unmet health-related social needs (HRSNs) to improve whole-person health. Social drivers of health (SDoH) affect health utilization, access to health and social services, and health outcomes. Addressing individual unmet HRSNs is one whole-person strategy, with historic federal investments, authorities, and requirements, that can potentially improve costs, outcomes, and equity in health and social service sectors (sometimes with a financial return-on-investment).

In this paper, by examining North Carolina’s HRSN landscape, we aim to draw implications for provider, health system, and state leadership looking to expand and align disparate health policy-led efforts to address HRSNs. North Carolina has the most expansive Section 1115 waiver program in the country to address HRSNs, the Healthy Opportunities Pilots (Pilots). North Carolina also built one of the most expansive programs to address pandemic-related HRSNs. Some argue that North Carolina is a national leader in addressing HRSNs across all payers beyond Medicaid.

But still, many of these efforts are disconnected, affording opportunities to think through how providers, health system leaders, and state policymakers can work together to coordinate and align different efforts while fostering innovation in those that are market-driven. Examining North Carolina as a state provides a holistic look at what major mechanisms can be used to address HRSNs and provides an opportunity to share challenges that cut across disparate health policy efforts.

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