4/19/22: Spotlight on North Carolina

Thank you for participating in this month’s Maternal Health Hub Learning Community session focusing on initiatives in North Carolina to address health equity and improve maternal health outcomes. Speakers included Amanda Van Vleet (North Carolina HHS), Dr. Sherma Morton and Rita Hanson-Bohl (Healthy Blue North Carolina), and Kelly Crosbie (North Carolina HHS).

View a recording of the meeting here. View slides here.

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Amanda Van Vleet, Associate Director of Innovation at North Carolina Medicaid, shared information about the department’s ‘Healthy Opportunities’ pilot initiative. The initiative is authorized by CMS through a 1115 waiver and allows the department to spend up to $650 million on regional pilots over a five-year period. Funding will go to providing Medicaid beneficiaries who meet the pilot criteria with evidence-based, non-medical services related to health status, including food, housing, transportation, and interpersonal safety. The funding will also go toward capacity building for the community-based organizations (CBOs) providing these services. To participate in the program, individuals must be enrolled in a Medicaid MCO, live in one of the three targeted areas, and display at least one physical/behavioral health criteria (of which having a high-risk pregnancy is one) and one social risk factor.

The pilot will rely on the infrastructure supported by NCCARE360, the state’s first statewide, closed-loop referral system, meaning it allows health care providers to refer patients to a CBO, and the CBO to respond to the referral. North Carolina Medicaid is working to build the NCCARE 360 capacity, including making the process easier for CBOs to submit claims.

Amanda shared several learnings from the pilot so far:

• Investing in building CBOs’ capacity is critical, and often requires external investment (i.e. outside of Medicaid) to support CBOs in building the capacity they need to operate effectively with medical systems.
• CBOs that have experience with the technology that allows for data sharing with health systems have an easier time integrating into the pilot.
• Building trusted relationships with CBOs and community leaders is imperative to get members of the community involved with the program.

Dr. Sherma Morton, OBGYN Medical Director at Healthy Blue NC, and Rita Hanson-Bohl, Director of Network Relations at Healthy Blue NC, shared innovations being undertaken at Healthy Blue, Blue Cross Blue Shield of North Carolina’s Medicaid Managed Care plan, to improve maternity care delivery and outcomes. Healthy Blue invests in care management for high-risk pregnancies; OB consultants to serve as a clinical liaison between OB providers and health plans; OB high risk rounds; the Healthy Blue perinatal program, a proactive care management program for all expectant mothers in GBD plans; My Advocate, an app that conducts outreach to pregnant members; prenatal packs; and postpartum packs (more information on slides 39-41).

Healthy Blue also has several initiatives in place to increase workforce diversity and access to doulas. Recognizing that only 2% of International Board-certified lactation consultants are Black, BCBS NC invested in training for lactation consultants at a Historically Black College and University. Further, Healthy Blue is developing a doula initiative based on evidence showing the positive effects doulas have on mothers. In this program, they intend to promote community-based doulas, who come with a greater understanding of the community served, versus private pay doulas.

The Healthy Blue team shared several challenges they have encountered in developing the doula program including how to engage doula organizations; billing issues, as doulas cannot bill Medicaid in North Carolina; setting sustainable reimbursement rates; preventing administrative burdens; and standardizing doula certification.

Moving forward, Healthy Blue is looking to CMS to make current value-added services permanent in standard care, address equity through standardized SDOH screening and measurement for maternal health, and utilize extended postpartum care to effectively impact preventative diseases.

Kelly Crosbie, Chief Quality Officer at North Carolina Medicaid, provided a population health and value-based payment perspective on NC Medicaid activities. From the very beginning, the department has placed an emphasis on stratifying data to elucidate areas of care – and identify populations – that need improvement and/or interventions. The state sets quality target improvements by requiring a 5% relative improvement per year for services. In areas with disparities (defined as any measure that has a 10% relative gap between a group of interest and reference group), the quality targets are on an accelerated track. The department shares data with all the state’s health plans and medical home practices to track improvements in quality.

North Carolina is also working to address health equity via value-based payment strategies. Recently, it was selected to be one of four states participating in the Health Care Payment Learning and Action Network’s (LAN) State Transformation Collaborative, under which it will develop strategies for multi-payer alignment in value-based care. North Carolina intends to look at this project through a lens of whole-person care.

Last, Kelly shared feedback from providers on the importance of incorporating social risk factors into standardized risk adjustment methodologies. Providers also would like to see support – both financial and technical – for providers serving historically marginalized communities.

NC Medicaid is now turning their attention to look at pediatrics and maternity care APMs.

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Thank you to all of our presenters!