Lessons Learned Thus Far From North Carolina’s Healthy Opportunities Pilots

In March 2022, as part of a shift to Medicaid managed care, North Carolina became the first state to launch a comprehensive pilot program to provide evidence-based non-medical services, such as food distribution and transportation, to Medicaid beneficiaries, with the goal of improving overall health and well-being. This program, known as the Healthy Opportunities Pilots (HOP), also includes an evaluation process aimed at ensuring equitable participation and assessing the impact of the pilot program on health outcomes.

If paying for these non-medical services leads to better health outcomes, according to Amanda Van Vleet of the North Carolina Department of Health and Human Services (NC DHHS), the hope is that these services will become available for all Medicaid beneficiaries, and the infrastructure built during the HOP period will be expanded statewide.

On July 28, the Duke-Margolis Center for Health Policy and the North Carolina Institute of Medicine co-hosted a webinar featuring lessons learned from the Healthy Opportunities Pilots to date.

Initial Results

Sharing initial research conducted by the Margolis Center, Will Bleser, PhD, MSPH, shared that variation of program goals greatly affected the success of programs focused on social drivers of health (SDOH). Short-term sustainability, he said, requires creative and comprehensive evaluation.

Margolis Senior Research Director Robert Saunders, PhD, presented feedback from focus groups showing overwhelmingly positive experiences with the HOP food box rollout. Medicaid beneficiaries participating in the focus groups were happy with the process and with the food, and said they learned about the service from a Medicaid care manager. In addition, some said they learned about other benefits, such as SNAP, through this HOP interaction.

Early Experiences

NCCARE360 Program Director LaQuana Palmer, MPA, shared with webinar participants that one of the biggest challenges since the platform launched in 2021 has been responding to unique individual and community needs amid worsening health workforce shortages. But Ayana Simon, the HOP manager for Carolina Complete Health (a managed care prepaid health plan), said that NCCARE360 has helped streamline the process of making community-based referrals for CCH members. NCCARE360’s invoicing technology has also helped NCDHHS meet health services organizations where they are in terms of processing claims and invoices. LaQuana shared that NCCARE360 is currently working to respond to pilot user feedback about the platform, including requests for more training.

One of the first to provide HOP referrals for SDOH services was Impact Health, in Western North Carolina. Community Engagement Manager Dionne Greenlee-Jones noted the organization’s success with empowering small community organizations to provide services they may not have otherwise, adding a diversity of perspective and skill.

Seth Berkowitz, MD, MPH of the University of North Carolina at Chapel Hill, is leading the evaluation of the pilots, and added that a key philosophy of the HOP is flexibility. Individual communities know best how to address their communities’ needs, and evaluation of HOP will have to take into account that regional approaches will differ. So, why conduct rapid-cycle evaluations? Says Berkowitz: to learn what’s working so far, with plenty of time to make changes.

Advice for Other States: Trust Communities

A major focus of the HOP is to help ensure all North Carolinians have a fair chance for achieving optimal health. Panelists shared the following advice for other states looking to try something similar:

Berkowitz: Think beyond health programs only. Much inequity is the result of other social policies.
Simon: Understand your community’s specific gaps and needs.
Palmer: Invest in the infrastructure of your community organizations. They will be key partners.
Bleser: Key for North Carolina is that screening for and addressing SDOH needs is not something providers can do – it is something they must
Greenlee-Jones: Look at the capacity of not just health services organizations, but care managers and other stakeholders.
Sarah Ridout, MBA, SPHR (Community Care of the Lower Cape Fear): This is an opportunity to be innovative that requires a combination of being data-driven and administrative, and being collaborative and flexible.
Melissa Roupe, RN, MSN (Vidant Health, Access East): Intentionally gain knowledge of the community you’re serving, and intentionally collaborate with community partners early on.
Madlyn Morreale, JD, MPH (UNC, Legal Aid): Make an early estimate about the number of potential referrals expected. Take a quality improvement approach – there is a lot to lose if value isn’t shown.
Emilie Hart (Catholic Charities of the Diocese of Raleigh): Be flexible and creative, and share best practices with others doing the work.