By Brieanne Lyda-McDonald

Stakeholders in the American health care system are beginning to take on a more wholistic approach, supporting overall well-being beyond the traditional provision of health care services. This has resulted in a turn toward value-based care and attention to the great impact that social determinants of health (SDOH) have on health outcomes.

In light of this, the North Carolina Department of Health and Human Services (NC DHHS) has a vision for optimizing health by “effectively stewarding resources that bridge our communities and our healthcare system [1].” The agency has created a statewide framework for healthy opportunities that includes:

• Developing a standardized screening for unmet resource needs
• Supporting the development of the State Resource Platform
• Mapping social drivers of health indicators
• Implementing Medicaid Transformation through Medicaid Managed Care
• Testing regional public-private pilots of Accountable Care Community (ACC)-style models focused on Medicaid beneficiaries [1]

This blog post explores the first and second activities on this list and how they can be used in the development of ACCs throughout North Carolina.

An NC DHHS Technical Advisory Group developed a standardized set of screening questions for health-related resource needs designed for use by any organization, but mandated for use by Prepaid Health Plans serving Medicaid beneficiaries [2]. The questions include:

• Primary screening over 4 domains: food, housing/utilities, transportation, and interpersonal safety [possible fifth domain of employment]
• Secondary assessments to gather greater detail about housing needs intimate partner violence
• Supplemental questions to evaluate: community safety, housing quality, health care/medicine, mental health/substance use, family and social supports, child care, emotional wellness, education, health literacy, employment, income, immigration, and legal/correctional issues.

The screening questions have undergone a public review process and will soon be field tested in 21 clinical sites throughout the state [3].

NC DHHS encourages adoption of the screening questions in combination with the new State Resource Platform, which will be developed by NCCARE360 under a public-private partnership led by The Foundation for Health Leadership and Innovation. The platform will be a tool “to make it easier for providers, insurers and community-based organizations to connect people with the community resources they need to be healthy [4].”

The platform will be available at no cost in all communities statewide and will integrate the standardized screening questions, a community resource identification and referral system, and tracking of referral status. With the goal of a coordinated, no-wrong-door style system, individuals will be able to access information about community resources and even start the referral process on their own. All referrals through the platform will require consent by the individual, which can be made via a variety of methods (e.g., pen and paper, voice recording, text message) [5].

Taken together, the standardized screening questions and the State Resource Platform will be exciting tools for local ACC models to incorporate into their work. Communities that apply these tools to their ACC model will:

• Save the time and money that would be required to develop individual systems,
• Have more time to focus on localized efforts to address needs unique to their community, and
• Be part of a consistent approach to screening and referral for SDOH needs throughout the state.

[1] Tilson, B. “North Carolina Department of Health and Human Services’ Vision for Buying Health.” Presentation to the North Carolina Institute of Medicine Task Force on Accountable Care Communities. March 5, 2018. https://nciom.org/wp-content/uploads/2018/03/Tilson_NC-DHHS_Presentation_3.5.2018.pdf

[2] North Carolina Department of Health and Human Services. Using Standardized Social Determinants of Health Screening Questions to Identify and Assist Patients with Unment Health-Related Resource Needs in North Carolina. April 5, 2018. https://files.nc.gov/ncdhhs/documents/SDOH-Screening-Tool_Paper_FINAL_20180405.pdf

[3] Tilson, B. “Update on DHHS Resources for Healthy Opportunities.” Presentation to the North Carolina Institute of Medicine Task Force on Accountable Care Communities. August 23, 2018. https://nciom.org/wp-content/uploads/2018/08/1_Tilson_screening_ACC-Task-Force_8.23.2018.pdf

[4] The Foundation for Health Leadership and Innovation. “NCCARE360 Selected to Build a New Tool for a Healthier North Carolina – The NC Resource Platform” Blog Post. August 21, 2018. https://foundationhli.org/2018/08/21/ncccare360-selected-to-build-a-new-tool-for-a-healthier-north-carolina-the-nc-resource-platform/

[5] Expound, Unite Us, and United Way of North Carolina. “A New Tool for a Healthier North Carolina.” Presentation to the North Carolina Institute of Medicine Task Force on Accountable Care Communities. August 23, 2018. https://nciom.org/wp-content/uploads/2018/08/3_-Vendor_Platform_ACC-Task-Force_8.23.2018_2.pdf