In 2019, the National Academy of Medicine (NAM) launched the Vital Directions for Health and Health Care initiative to draw insights on the status of health and health care in the United States from the state level. The initiative kicked off in the Research Triangle last fall, with a symposium focused on better understanding what states and localities can do to achieve more affordable, value-driven health care and health outcomes.
The NAM chose to launch this initiative in North Carolina because our state has been both an innovator in health care transformation and an example of some of the barriers to making major change in the delivery of and payment for health care.
The latest issue of the North Carolina Medical Journal draws from the proceedings of the Vital Directions symposium, focusing on innovations in health and health care in North Carolina and what the state can share with – and learn from – other states. Though the articles were written before the emergence of the COVID-19 pandemic, the priorities discussed during the symposium continue to be central to health reform in North Carolina, and in many ways have become more critical.
“Vital directions for health and health care were critical prior to the pandemic—COVID-19 has put our health system under additional burden, and needed reforms have never been more apparent,” write NAM President Victor J. Dzau, NC DHHHS Secretary Mandy Cohen, and NAM Senior Scholar J. Michael McGinnis in their issue brief.
Vital Directions for Health & Health Care: The North Carolina Experience by Victor J. Dzau, Mandy Cohen, J. Michael McGinnis
“The initiative presents recommendations for an optimized health system, along with a streamlined framework toward achieving three core goals for the nation: better health and well-being, high-value health care, and strong science and technology.”
Place Matters: From Health and Health Care Disparities to Equity and Liberation by Sharrelle Barber
“Place—a confluence of the social, economic, political, physical, and built environments—is fundamental to our understanding of health and health inequities among marginalized racial groups in the United States. Moreover, racism, defined as a system of structuring opportunity and assigning value based on the social interpretation of how one looks (i.e., race), has shaped the places people live in North Carolina.”
Investing in Whole Person Health: Working Toward an Integration of Physical, Behavioral, and Social Health by Elizabeth Cuervo Tilson, Amelia Muse, Kathy Colville, Alisahah Cole, Christopher F. Koller
“Best practices such as the collaborative care and primary care behavioral health models reduce inefficiencies and disparities by bringing together teams of primary care and behavioral health care providers.”
Toward a Health Data Strategy for North Carolina by Aaron McKethan, Annette DuBard
“North Carolina has attracted significant national attention due to numerous health care reforms underway across government and the private sector. These reforms encompass new incentives, new partnerships, and new models of delivering care, and collectively, they have important implications for health care data.”
Developing a Workforce for Health in North Carolina: Planning for the Future by Erin Fraher, Rukmini Balu, Peter Buerhaus, Julie George, Crystal Murillo, A. Eugene Washington
“Among the many trends influencing health and health care delivery over the next decade, three are particularly important: the transition to value-based care and increased focus on population health; the shift of care from acute to community-based settings; and addressing the vulnerability of rural health care systems in North Carolina.”
Sidebar: Moving Upstream to Impact Health – Building a Physician Workforce that Understands Social Determinants by Christine Petrin, Karen De Salvo
“More widespread action and attention by the health care system drives the need to train the next generation of physicians in the concepts and actions related to SDOH.”
North Carolina’s Health Care Transformation to Value: Progress to Date and Further Steps Needed by Hannah Crook, Rebecca Whitaker, Azalea Kim, Scott Heiser, Mark B. McClellan
“North Carolina has received national attention for its approach to health care payment and delivery reform. Importantly, payment reform alone is not enough to drive systematic changes in care delivery.”
Engaging the Power of Communities for Better Health by E. Benjamin Money, Josie Williams, Michael Zelek, Adaugo Amobi
“Authentically engaging community residents is necessary to impact social drivers of health. Acknowledging the value of residents’ lived experiences in the planning, implementation, and financial decisions of community engagement initiatives is key.”
Historical Geography and Health Equity: An Exploratory View of North Carolina Slavery and Sociohealth Factors by Nicole Dozier, William H. Munn
“Current health inequities are rooted in more than simple systems failures and inefficiencies. Historical legacy has corrupted health outcomes, and resolution requires both acknowledgment and intention.”
Why the ABCs Matter More than Ever in Medical Education by Julie Ann Freischlag, Katherine Files
“Addressing social drivers of health in medical education— through community engagement experiences—is essential for health equity and the development of future physicians.”
“With rising costs and below-average outcomes, North Carolina’s health care value proposition is upside down. It’s time for employers to lead transformative change.”
“To better the health of all North Carolinians, policymakers must come together to improve access to care, expand broadband, and close the coverage gap.”
Call to Action: Philanthropy in North Carolina Health Care by Lin B. Hollowell
“The conversation about how we create and maintain health has evolved. We have now clearly expanded our thinking beyond an exclusive focus on traditional medical care, and philanthropy can play an important role.”