September 13, 2019 at 8:30 am, High Point University Community Center at Oak Hollow Mall
At our next meeting for Healthy Opportunities of the Piedmont, national experts from the Nonprofit Finance Fund (NFF) will discuss what level of commitment may be required by organizations interested in participating in the Medicaid Pilots.
In preparation for this pivotal event, interested HSOs are asked to talk with their board members, decision makers, and other stakeholders about their desire to participate in the Medicaid Pilot.
08/22/2019: Healthy Opportunities of the Piedmont Meeting at PTRC
NC DHHS anticipates releasing the Lead Pilot Entity RFP in fall 2019. At our August meeting, attendees were asked to consider their organization’s current concerns and level of interest around participating in the Medicaid Pilot.
The attached presentation provides background on NC’s Medicaid Transformation and an overview of the role pilots will play in the state’s efforts to improve health outcomes.
The attached Tip Sheet was designed to help HSOs talk with their Boards and other stakeholders about whether they are prepared to broaden their scope and be part of the Healthy Opportunities Pilot.
07/15/2019: NC DHHS releases updated guidance on Pilot Services and Pricing
In a lead-up to the Lead Pilot Entity RFP, DHHS released on July 15, 2019, two technical documents for stakeholder feedback related to the Pilots.
- Healthy Opportunities Pilots Service Definitions and Pricing Methodology: Interested stakeholders (especially frontline human services providers) were asked to provide feedback by August 2, 2019, on detailed Pilot service definitions, provider descriptions, payment approaches, and pricing inputs.
- Healthy Opportunities Lead Pilot Entity (LPE) Statement of Interest and Supplementary Guidance: Organizations interested in serving as an LPE were asked to submit a voluntary, non-binding Statement of Interest (SOI) by August 12, 2019. Those who respond are not obligated to respond to the LPE RFP. This document also provides information about roles, responsibilities, governance, and organizations eligible to be Lead Pilot Entity.
- Responses to the SOI were posted to the Healthy Opportunities Pilots website in August 2019 to encourage collaboration among interested organizations.
06/19/2019: Healthy Opportunities of the Piedmont Meeting at PTRC
At the June meeting, an expert panel of healthcare industry leaders discussed the benefits and challenges afforded by the Healthy Opportunities Pilots.
Panel members included:
- Kevin Moore, Vice President, Policy–Health and Human Services, UnitedHealthcare, Wisconsin
- Ted Rooney, Healthcare Quality Consulting, Maine
- Chris Esguerra, Senior Medical Director, Blue California, California (Member of the NC Medicaid Pilot Advisory Panel)
- Brieanne Lyda-McDonald, Project Director, NC Institute of Medicine
Below are some key takeaways from the panelists’ presentations:
Social Determinants of Health: The U.S. spends more on healthcare (or medical needs) and not as much on social needs but with poorer health outcomes compared to other developed nations. NC DHHS initiatives around Healthy Opportunities help expand the definition and ecosystem of healthcare. Integrating social determinants of health and value-based payment models into care management while also addressing health equity hold the promise of improved health outcomes and reduced healthcare costs.
Measuring Data: Demonstrating improved health outcomes and reduced healthcare costs requires capturing and measuring the right data to determine what interventions work and to justify funding for the most effective, evidence-based interventions.
HSO Collaboration and Relationship-Building: The fragility of the HSO ecosystem requires more effective collaboration and relationship-building across organizations and sectors as providers listen to one another, learn each other’s languages, and build trust. More effective relationship-building between the health systems (healthcare providers, care managers, HSOs) will better position providers to work together as a team to address patients’ needs.
Empathy and Cultural Competence: Care managers and providers must employ empathy, cultural competence, and relationship-building to gain the trust of high-needs beneficiaries so they can be properly motivated to make changes in behavioral health that will yield improved health outcomes.
Accountable Care Communities: Like the state’s Healthy Opportunities initiatives, the Accountable Care Communities (ACC) health model brings together cross-sector stakeholders (including community members) to collectively address social determinants of health as part of value-based care from a community perspective.
The framework DHHS created for Healthy Opportunities will help build the infrastructure needed for ACCs. The ACC model holds the potential to benefit all community members regardless of socioeconomic status but is especially promising for those who are just above the threshold to receive Medicaid.