Wortman Zachary, Tilson Elizabeth Cuervo, Cohen Mandy Krauthamer
Zack Wortman ( zack. wortman@dhhs. nc. gov ) is the chief of staff and deputy chief data officer for the North Carolina Department of Health and Human Services (NCDHHS), in Raleigh.
Elizabeth Cuervo Tilson is the state health director and chief medical officer for the NCDHHS.
Health Aff (Millwood). 2020 Apr;39(4):649-654. doi: 10.1377/hlthaff.2019.01583.
Since 2017 the North Carolina Department of Health and Human Services has asked how its resources could be optimized to buy health, not only health care. This has led the department to incorporate whole-person care into all of its priorities, including building a statewide infrastructure and implementing incentives to address nonmedical drivers of health-focusing on food, housing, transportation, employment, and interpersonal safety/toxic stress. This article describes four interconnected initiatives that the department has implemented or is implementing to begin integrating medical and nonmedical drivers of health. This multifaceted effort involves many partners and includes financial incentives for commercial payers, Medicare, and Medicaid that are aligned with whole-person care; a standardized screening process to identify people with unmet social resource needs across all populations; NCCARE360, the first statewide network linking health care and human services providers to one another with a shared technology platform; and a large-scale Medicaid pilot to evaluate the impact of nonmedical health interventions on health outcomes and health care costs. North Carolina's interconnected initiatives can help inform efforts around the US and generate needed evidence on how to implement systems through public-private partnerships to address nonmedical drivers of health at scale.
自2017年以来，北卡罗来纳州卫生与公众服务部一直在探讨如何优化其资源配置，以促进健康，而非仅仅关注医疗保健。这使得该部门将全人护理纳入其所有工作重点，包括建立全州范围的基础设施，并实施激励措施，以应对影响健康的非医疗因素，重点关注食品、住房、交通、就业以及人际安全/毒性应激。本文介绍了该部门已经实施或正在实施的四项相互关联的举措，旨在开始整合影响健康的医疗和非医疗因素。这一多方面的努力涉及众多合作伙伴，包括针对商业医保支付方、医疗保险和医疗补助计划的财务激励措施，这些措施与全人护理保持一致；一个标准化的筛查流程，以识别所有人群中社会资源需求未得到满足的人群；NCCARE360，这是首个通过共享技术平台将医疗保健和人类服务提供者相互连接的全州范围网络；以及一项大规模的医疗补助试点项目，以评估非医疗健康干预措施对健康结果和医疗保健成本的影响。北卡罗来纳州相互关联的举措有助于为美国各地的相关工作提供参考，并为如何通过公私合作建立系统以大规模应对影响健康的非医疗因素提供所需的证据。
