Bush, M. (2018). Addressing the root cause: Rising health care costs and social determinants of health. North Carolina Medicine Journal, 79(1), 26-29.

Year: 2018


This article describes how North Carolina plans to use its Medicaid expansion to address social determinants of health. The expanded Medicaid is designed to convert North Carolina’s fee-for-service program into a managed care health delivery system, with managed care organizations (MCOs) controlling costs by managing overall population health for beneficiaries through lump sum payments that provide a flat fee per beneficiary per month. MCOs have the flexibility to provide various incentives to providers or “in lieu of” services that may be less expensive than traditional medical services covered by Medicaid. It is a cost-saving lever that MCOs could employ to manage costs under a capitated payment structure and could potentially avoid more expensive treatment costs. North Carolina also has an opportunity to link health care plans with community-based organizations that can address social determinants. Building on existing efforts, North Carolina will map community needs and resources at the county and zip code level and collect data on areas with the highest disparities to better target resources and enhancements. Health plans will also link providers with community-based organizations, track referrals to community resources, and follow up to ensure unmet needs were addressed. Finally, North Carolina wants to encourage community partners to test initiatives that address unmet needs with focused investments that will ultimately be wiser in the long run than ever-increasing health care costs. Referral and navigation services, co-located and embedded services, and the the use of flexible supports are some of the evidence-based interventions the North Carolina Department of Health and Human Services (NC DHHS) is prepared to support.

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