Buying Health, Not Just Health Care: North Carolina’s Pilot Effort

Buying Health, Not Just Health Care: North Carolina’s Pilot Effort
– The Commonwealth Fund

Prepared for To the Point, The Commonwealth Fund Blog

In late December, the North Carolina Department of Health and Human Services (NC DHHS) released a standardized fee schedule for health-related social services—including, for example, housing support and healthy food boxes—reimbursed by Medicaid under the state’s Healthy Opportunities Pilots. Part of North Carolina’s far-reaching efforts to “ buy health, not just healthcare,” the fee schedule sets pricing for services authorized under an 1115 waiver that allows Medicaid funds, as part of value-based payment arrangements, to pay for services in four domains: housing, interpersonal violence/toxic stress, food and transportation.

In a new blog post for The Commonwealth Fund, Manatt Health and the NC DHHS explain the fee schedule, which defines 29 interventions, selected based on their potential to improve health outcomes and/or lower healthcare costs and priced based on independent actuarial analysis, experience with existing Medicaid waiver services, and substantial stakeholder and expert input. Over time, as more data on cost and health outcomes become available, North Carolina will base payments for health-related social services on the value they provide.

While the fee schedule was designed for North Carolina, it has value well beyond the state, paving the way toward a systematic evaluation of the effectiveness and costs of social interventions. It also offers community-based organizations insight into potential revenue from providing social services, strengthening their ability to establish long-term partnerships with payers and providers.

Click here to read the full blog post.



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