The Healthy Opportunities Pilot is one of many innovative approaches the North Carolina Department of Health and Human Services (NCDHHS) has taken in the last few years in its commitment to developing a system suited to improve the health and wellbeing of North Carolinians. Research shows that while quality medical care is critical, up to 80% of a person’s health is determined by social and environmental factors. The Healthy Opportunities pilot aims to implement a series of well researched, coordinated, and evidenced-based methods to address both the medical and non-medical drivers of health for high-risk NC Medicaid Members. This week the pilot launched the first of a select set of interventions aimed to address food, housing, transportation, interpersonal violence, and toxic stress. The first of these interventions the pilot aims to address is food insecurity for individuals identified as being food insecure in pilot regions.
To identify these needs, Prepaid Health Plans (PHPs)—which launched in July 2021 as a part of Medicaid Transformation—have implemented the use of a standardized screening tool to assess the non-medical drivers of health for their members. The Social Determinants of Health (SDOH) screening tool was developed and rolled out by the department in 2019. The goal of the tool is to supply a guide to both mental and behavioral health providers on how to assess for external factors affecting health. To support departmental efforts and continue to uphold best practice standards Benchmarks has been requiring the use of the SDOH tool in our Trauma intensive Comprehensive Clinical Assessments (TiCCAs) which are used in our Standardized Assessment Protocol (SAP) and Partnering for Excellence (PFE) projects. Incorporation of the tools into these assessments has encouraged clinicians to consider and that many of the conditions underlining the traumatic experiences of children and their families are often rooted in SDOH factors. While intuitive to many of us involved in this work, the knowledge that social, environmental, and toxic stress factors are such large determinants of overall health is a new concept for many. Moreover, the fact our state has developed a way to pilot a system to operationalize that intuition is promising.
We are so excited for the opportunity this work presents and continue to be optimistic and encouraged by the efforts our state, members, and partners make daily to improve the lives of North Carolinians.
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