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Ensuring the Most Opportunity in Healthy Opportunities

May 25, 2020

One of the many casualties of the COVID-19 pandemic is the North Carolina Department of Health and Human Services Healthy Opportunities Pilots, which have been delayed indefinitely. Healthy Opportunities, along with the department’s broader Medicaid transformation effort had the eyes of many on North Carolina.

While the overall net benefit of the Pilots and integration of community-based organizations will be positive, it will not be without side effects, primarily the strain on these organizations to adapt to the changes that coincide with this shift. There is risk of overwhelming these organizations to the point of unsustainability without implementation of essential capacity building and infrastructure supports.

Understanding these ramifications, we commissioned the Nonprofit Finance Fund to work with prospective Lead Pilot Entities (LPEs) to explore how they engaged human service and other community-based organizations to understand the greatest capacity building needs, as well as overall concerns and considerations for Pilot involvement.

The goal was to inform DHHS, local government leaders, philanthropy, prospective Pilot participants, and other community stakeholders as each considers its role. And while the future for the Pilots is unclear at this moment, there is value at this point in sharing these insights with the field of philanthropy and with all of those invested in success of this transformation.

 

For additional context on challenges facing community and human service organizations as part of Medicaid Transformation, included below is a letter to the editor that appeared in the March issue of the North Carolina Medical Journal, co-authored by Blue Cross NC Foundation President, Dr. John Lumpkin, and Dr. Laura Gerald, President of the Kate B. Reynolds Charitable Trust.

To the Editor

Thank you for highlighting Medicaid transformation in your September/October issue. The spotlight is upon North Carolina. How we address social needs and their impact on health through the Healthy Opportunities Pilots can have significant influence here and nationwide.

We've long known that housing, personal safety, access to healthy food, and other needs impact health at the individual level, and that some communities experience greater barriers to addressing these needs than others. To this end, paying community-based organizations (CBOs) for the services they provide is past due.

But such dramatic change to how we pay for health does not come without complications. CBOs need to build infrastructure to succeed in this new environment, or we risk overwhelming them to the point of unsustainability. We have a responsibility to build a bridge between health care and nonprofits, large and small, that decreases disparities rather than exacerbates them.

First, we must avoid imposing our current health care model onto the social service system. Nominal compensation for each bag of food delivered or each client housed is inadequate. We must instead strengthen our CBOs and incorporate their contributions into calculations about how we pay for value. And CBOs must be organized and understand their worth in a value-based health care system so that community service providers can approach discussions about cost and reimbursement with payers from a position of power. We applaud the North Carolina Department of Health and Human Services for funding capacity-building as part of the Healthy Opportunities Pilots. In addition to enhancing finance and programmatic capacity, efforts should support developing partnerships between community organizations, health care providers, and payers, recognizing that gains in the shift to value and paying for health will result from the health improvements generated in part by CBOs.

Second, it's vital to elevate the perspectives of those most impacted by Medicaid transformation as our experience with it evolves. This can be done by engaging with individuals directly or ensuring there are avenues for individuals to give input to health care providers and nonprofits that are providing services. Ensuring that the nonprofits most connected to beneficiaries participate in shaping the transformation effort is also critical.

And finally, while it's imperative that we embrace the role of CBOs in improving health, we must confront the historic inequities that create barriers to good health to begin with. While addressing social needs at the individual level is critical, policy and system-level changes that address social determinants at the population level are the only path to sustained improvement in health. By explicitly and intentionally addressing community conditions, rather than simply adjusting payments to recognize CBOs' contributions, we will move closer to our goal of a North Carolina where everyone has more opportunity to be healthy and thrive.

 

Image Credit: Nonprofit Finance Fund