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.
Below are summaries of past meetings held by Healthy Opportunities of the Piedmont or its partners. Archived materials can be accessed by clicking on the links.
5-23-2019 Healthy Opportunities of the Piedmont Meeting
Presenters gave an overview of Medicaid Transformation and the Healthy Opportunities Pilots to help area HSOs and other stakeholders understand what these initiatives may mean for their clients and staff.
4-18-2019 Healthy Opportunities of the Piedmont Meeting
Meeting participants considered projections for pilot enrollment, referral, and cash flow as well as attendant capacity building needs and how to incorporate those into upcoming budget cycles.
April 18th Meeting notes - PTRC Gathering Healthy Opportunities Pilots
4-03-2019 Healthy North Carolina 2030 - Greensboro Community Input Session
As part of its Healthy North Carolina 2030 project, NCIOM sought community input on select population health indicators to identify and prioritize those with the most pressing needs. Feedback from community input sessions will be used to develop a population health improvement plan with a common set of health indicators and targets for the state in the upcoming decade.
- HNC 2030 overview
- Advancing HNC 2030 Through Community Partnerships.
- The Final Report with recommendations for the Task Force on Accountable Care Communities is available HERE.
3-14-2019 Healthy Opportunities of the Piedmont Meeting
Kathy Colville of Cone Health briefed area stakeholders on NC DHHS and CMS’s vision for the Healthy Opportunities Pilots, contents of the Pilots RFI, and thoughts on how to prepare for the RFP. Ms. Colville also discussed the need to clarify the definition and goals of social determinants of health: to look beyond just providing discrete services for social needs and focusing instead on improving underlying socioeconomic conditions to achieve positive health outcomes.
3-01-2019 RFI Drops In
PTRC facilitated a widely attended “RFI Drop-In” session from 10:00am – 2:00pm within the large conference room at its Kernersville location. HSO partners were invited to sit with individual PTRC team members to work on their application via laptop computers. This approach felt to be very much in line with the role of an LPE as suggested in the “Proposed Design for Interested Stakeholders.”
PTRC designed a flexible approach that included (1) taking HSO input to submit within PTRC’s own response, (2) assembling HSO input into a response PTRC then submitted to NCDHHS on their behalf, and/or (3) contributing input into an HSO response they themselves submitted directly. We also shared our LPE RFI Language with our partners at Cone Health, Wake Forest Baptist Health, UNC Rockingham & Novant Health.
2-05-2019 Healthy Opportunities of the Piedmont Meeting
February’s meeting focused on the recently awarded PHP contracts and timelines for the managed care transition as well as current understanding about the pilot payment process, service definitions and pricing, and evaluations. Also highlighted was a national report by the Center for Health Care Strategies which recognized NC Medicaid’s integration of social determinants of health into managed care and its move toward value-based payments.
Risk Factor 1 - Housing Breakout Notes
1-22-2019 Healthy Opportunities of the Piedmont Meeting
Morgan Forrester, Community Engagement Manager with Unite US, helped lead a local strategy session about the NCCARE360 platform which will be used to connect social service and healthcare providers within and across NC communities. The platform launched in Guilford and Alamance counties. During the strategy session, Piedmont service providers received guidance and encouragement to become part of the network.
12-18-2018 Healthy Opportunities of the Piedmont Meeting
This meeting included a presentation on the key roles of Lead Pilot Entity, Prepaid Health Plans, and Human Services Organizations and their respective responsibilities in the Pilot. Participants also discussed the NCCARE360 platform in preparation for the “NCCARE360 Influencer Meeting” held in Greensboro on December 19.
12-03 & 12-04-2018 Remarkable Integration Conference
PTRC’s Area Agency on Aging held a conference on Remarkable Integration: Human Service and Health Care Partnerships. Presentations made during the conference offered opportunities and potential solutions to changes in human services, behavioral health, and healthcare brought on by federal and state legislation. Of special importance are the changes brought on by North Carolina Medicaid’s transition from fee-for-service to managed care.
11-27-2018 Healthy Opportunities of the Piedmont Meeting
Stakeholders discussed how to build on PTRC’s current network of providers and identify where capacity building may be needed to support the priority service domains and target populations identified as part of the Pilot.
Risk Factor 1 - Housing Breakout Notes
Risk Factor 2 - Nutrition Breakout Notes
Risk Factor 3 - Transportation Breakout Notes
Risk Factor 4 - Interpersonal Viiolence Breakout Notes
11-01-2018 Healthy Opportunities of the Piedmont Meeting
Stakeholders named their pilot initiative Healthy Opportunities of the Piedmont and designated PTRC as the Lead Pilot Entity. They chose to initiate pilot services in Forsyth, Guilford, and Rockingham counties.
10-17-2018 Healthy Opportunities of the Piedmont Meeting
Dr. Betsey Tilson (State Health Director and Chief Medical Officer of NC DHHS) spoke to area stakeholders about NC Medicaid’s transition from fee-for-service to managed care and the proposed regional pilots. Providers of human services, health systems and others from the Piedmont attended Dr. Tilson’s presentation and agreed to collaborate to address social drivers of health and apply to be one of the Medicaid regional pilots.
North Carolina’s Medicaid program is transitioning from fee-for-service payment model to Medicaid Managed Care in 2019, which is the most significant change to the NC program in over 40 years. Four statewide Managed Care plans will provide coverage for Medicaid beneficiaries.
In preparation for this transition, a Piedmont collaboration invited Dr. Betsey Tilson, North Carolina's State Health Director and DHHS's Chief Medical Officer, to Kernersville to speak about NC’s transformation to Medicaid Managed Care and proposed regional pilots. Providers of human services, health systems and others from across the Piedmont attended Dr. Tilson’s presentation and agreed to collaborate to address social drivers of health (called Healthy Opportunities) and apply to be one of the Medicaid regional pilots.
Under Medicaid’s transformation, 2-4 regional pilots will be chosen to deliver health services that address both medical and social needs of patients. These Pilots must address four categories of Healthy Opportunities: Housing, Transportation, Nutrition and Interpersonal Violence/Toxic Stress. Pilots will include a Lead Pilot Entity to serve as a backbone organization for the pilot initiative. Pilots should cumulatively serve 25,000-50,000 Medicaid beneficiaries and cover both urban and rural communities.
- NC DHHS Healthy Opportunities
- NC Resource Platform
- Medicaid Pilot Programs