All North Carolinians should have the opportunity for health. That opportunity begins where people live, learn, work and play; it begins with our families, neighborhoods and communities. By investing in the health and well-being of all North Carolinians, we are investing in the health and vitality of our state.
Health begins long before we need medical care, but our healthcare system is not designed to address the primary drivers of health.
Currently, 90 percent of health care spending in the United States is on medical care. While access to high-quality medical services is crucial to health, research shows that up to 80 percent of a person’s overall health is driven by other social and environmental factors and the behavior influenced by them— known as “social determinants of health” or SDOH.
DHHS’ mission is to improve the health, safety and well-being of all North Carolinians. To meet our mission, we must look beyond what is typically thought of as “healthcare” and invest more efficiently and strategically in health.
Conditions such as food insecurity, housing instability, unmet transportation needs and interpersonal violence not only have a deep impact on a person’s health, safety and well-being, but also on healthcare utilization and costs.
In North Carolina, people grapple with the impact of unmet health-related social needs every day.
- More than 1.2 million North Carolinians cannot find affordable housing and one in 28 of our state’s children under age 6 is homeless.
- North Carolina has the 8th highest rate of food insecurity in the United States, with more than one in five children living in food insecure households.
- In some North Carolina counties, one in three children live in food insecure households.
- Forty-seven percent of North Carolina women have experience intimate partner violence.
- Nearly a quarter of North Carolina children have experienced adverse childhood experiences (ACEs), including physical, sexual or emotional abuse or household dysfunction, like living with someone struggling with a substance use disorder.
Strategic interventions and investments in these initial core domains of food, housing, transportation and interpersonal safety, in partnership with local community groups and healthcare providers, will help us meet our mission of improving health, safety and well-being for all North Carolinians. It will also provide short and long-term cost savings and make our healthcare system more efficient.
In North Carolina, we are fortunate that our private sector has already begun developing innovative approaches for knitting together our healthcare system and communities. Our country’s healthcare system continues to move to alternative payment models and value-based payment, and there will be further incentives for healthcare providers and payers to drive value, not just volume. To do that they must look beyond the care they are able to provide within the four walls of a medical setting to the other factors that drive a person’s health and health care costs.
DHHS is committed to creating a statewide framework and infrastructure that can support the innovation in our private sector and promote opportunities for health for all North Carolinians through a combination of strategies, including:
- Creating an interactive statewide map of SDOH indicators that can guide community investment and prioritize resources.
- Developing a set of standardized screening questions to identify and assist patients with unmet health-related resource needs.
- Building a statewide resource platform to connect those with an identified need to community resources.
- Incorporating SDOH strategies throughout the Medicaid 1115 wavier.
- Developing Healthy Opportunities Pilots to test and evaluate the impact of providing select evidence-based, non-medical interventions related to housing, food, transportation and interpersonal safety to high-needs Medicaid enrollees.
- Building an infrastructure to develop and support a Community Health Worker Initiative.
- Examining better ways to streamline cross-enrollment in existing key benefit programs.
DHHS is not working on any of these strategies alone. Each of these initiatives bring together philanthropy, healthcare, community partners and the state in a private-public partnership. These initiatives have the potential to touch the lives and improve the health, safety and well-being of all North Carolinians, including the commercially insured, Medicare, Medicaid, uninsured, military and veteran populations.
We believe that together we can create a healthier, more educated and economically competitive North Carolina by providing all residents opportunities for health and well-being.
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