A Great Opportunity for
Western North Carolina

The State’s new Healthy Opportunities Pilot

The North Carolina Department of Health and Human Services (DHHS) has a bold new plan for Medicaid services, and Dogwood Health Trust wants to see Western North Carolina be a part of it. In a nutshell, DHHS has created a new pilot program called Healthy Opportunities, that will make it possible for Medicaid dollars to fund much more than just clinical health care. Through Healthy Opportunities, organizations that provide services related to nutrition and food assistance, transportation, housing and domestic violence or toxic stress can receive payments for services they provide to Medicaid patients. The goal? To ultimately improve health and save millions on treatment of clinical illnesses or conditions by investing in evidence-based interventions before health becomes a problem. DHHS will support Healthy Opportunities pilots in 2 to 4 areas across the state. The formal Request for Proposals was released on November 1, 2019, and applications to the state are due January 21, 2020.

Here's How it Works

Healthy Opportunities in WNC
  1. Medicaid patients in selected pilot regions are enrolled in Healthy Opportunities.

  2. Health insurers (Prepaid Health Plans, or PHPs) work closely with physician offices and local health departments (Advanced Medical Homes, or AMHs) to identify non-clinical health needs of Medicaid patients.

  3. Communities select a Lead Pilot Entity (LPE) – an organization that can coordinate with health providers and the nonprofit organizations (called Human Service Organizations, or HSOs) that will provide the non-medical services included in Healthy Opportunities (food, housing, transportation, violence or toxic stress). The LPE makes sure that the process runs smoothly and pays the HSOs for their services. It also provides technical assistance to help HSOs deliver their services most effectively and efficiently.

  4. Care Managers work closely with AMHs and HSOs to ensure individual patients have what they need to maintain and improve health and prevent unnecessary trips to the doctor or the emergency department.

What is Western North Carolina Doing to Engage in Healthy Opportunities?

Creating partnerships. First, we need to respond to the application that was released from DHHS. That means we’ll need to identify which organizations will play the required roles in our region (the LPE, PHPs, AMHs, HSOs and care managers). Fortunately, there are many organizations in our region that have already been working on these questions, and Dogwood Health Trust is honored to join that conversation. We are continually engaging in conversations with partners throughout the region and expanding our networks – quickly but intentionally.

Tapping expertise. We are currently working with several partners to develop a regional response to the state’s RFP, and welcome others to join us. Dogwood Health Trust also has retained the services of Health Management Associates (HMA) to bring their considerable knowledge of Medicaid systems transformation to support the development of Western North Carolina’s proposal and ensure ours is the strongest in the state.

Creating a match. We also are exploring the best options for Dogwood Health Trust to provide matching funds in the region as part of the Healthy Opportunities pilot here. This funding might include:

  • We believe that Dogwood Health Trust can help the Healthy Opportunities pilot achieve the highest impact in WNC if we can provide start-up capital to build the strongest team. That means helping all of the county collaboratives involved in the pilot organize and create a strong, unified voice. It also can mean strengthening the four main service areas outlined in the pilot: housing, food insecurity, transportation, and interpersonal violence and toxic stress.

  • We know that the state will provide LPEs with capacity building support, but we also know there that will likely only cover some of the needs. Therefore, we may also offer additional capacity building for Healthy Opportunities partners in the region.

  • While the state has designed a robust online platform, NCCARES 360, to facilitate referrals from providers to human services organizations, there are several needs specific to WNC partners that the system does not address. We can invest in improvements to the NCCARES 360 platform that are tailored to our partners, strengthening the overall process, improving work flow, creating performance measures, and advancing its overall potential.

Conversations with partners across the region are still ongoing as we work together to create a Healthy Opportunities proposal that will not only win the state’s approval – but dramatically improve the health of Medicaid recipients throughout our region. To join in the discussion, contact Brian Myers, b.myers@dht.org.