Earlier this yr, the North Carolina Division of Well being and Human Companies introduced it was increasing its Medicaid Wholesome Alternatives Pilot (HOP) venture, which addresses folks’s social wants with companies like meals, housing, and transportation. Throughout a current webinar, Sarah Rideout, the chief of a corporation that bridges healthcare and social companies organizations for the initiative, described her group’s function.
Rideout is the HOP Program Director for one of many “community leads” in this system, the Group Care of Decrease Cape Worry. Community leads function native anchors to construct the capability of community-based organizations to take part in Medicaid, together with by distributing capacity-building funds and offering technical help and growing and managing a high-quality community of CBOs.
Talking throughout a September 2024 Manatt Well being webinar, Rideout mentioned that an essential objective in any group hub mannequin is to make sure you’re participating with organizations that mirror the members locally.
“You will have a small rural church or a meals pantry that is deeply rooted and trusted of their group and do nice issues, however possibly they’ve by no means been invited to the desk,” she mentioned. “Taking part in state- and federal-level grants or pilot applications requires a steep studying curve. There could also be organizations who suppose HOP or different SDOH-type fashions really feel insurmountable. A group hub group can actually assist carry them up and create glide paths to get them there.”
Rideout defined that the community leads present an area of training and assist, and be tailor-made to the wants of the organizations they work with. “Loads of our community-based organizations (CBOs) must turn into Medicaid distributors. They practice to make use of a closed-loop referral and invoicing system. They join with well being plan EFTs [electronic fund transfers] and must create reconciliation processes,” she mentioned. “Additionally they want to grasp compliance and information privateness and safety, budgeting and reporting. That is all along with constructing staffing fashions and utilizing capacity-building to fulfill these service supply wants whereas honing in on being sustainable.”
The community lead’s function is to coach CBOs on processes and coverage modifications. “We evaluation invoices to make sure they’re full and correct with all of the supporting documentation, and that is earlier than it goes to the well being plan,” Rideout mentioned. “Because the pilot evolves, you’ll be able to actually drive efficiency on your community. For instance, within the first yr you are getting your toes underneath you. You are studying processes, tackling boundaries, studying to collaborate throughout stakeholders who sometimes have by no means performed collectively earlier than. Because the community lead, a part of our function is to function a conduit and assist assist organizations work collaboratively. When you recover from that preliminary hump of implementation, a community lead can actually assist drive efficiency, and that assist CBOs create efficiencies and transfer the needle relating to assembly metrics or KPIs, after which, after all, optimizing member expertise.”
Along with being a bridge to well being plans, Group Care of Decrease Cape Worry additionally collaborates with clinically built-in networks and care administration entities. “We’re a really data-driven community lead, so all of us use lots of information to assist us perceive the place we’re and the way we may also help efficiency, and that features working with our care administration entities and our well being plan companions.”
Additionally talking in the course of the Manatt Well being webinar was Reverend Blake Hart, govt director of the Haywood Christian Ministry, which joined the Wholesome Alternatives Pilot program in November of 2022.
“I’ve by no means seen a program this efficient at getting assist into rural communities,” Hart mentioned, “Among the different applications that we now have taken half in, we’d be capable of supply meals help with $5,000 for a yr, or do weatherization for 5 households in a yr.” Then he gave a snapshot of his group’s present caseload with Wholesome Alternatives: “We’re providing case administration to 95 households for housing navigation and safety. Now we have 60 households that we’re both delivering meals bins to or meals to, and 193 produce prescriptions are popping out of us each single month,” Hart mentioned. “I used to speak concerning the rental help — first month’s deposits, utility deposits and funds, these type of issues. Since 2022 that interprets into simply over, $1 million of direct cash going into both dwelling repairs, buying wholesome items for households, buying produce prescriptions.”
He famous that they’ve a local-first coverage. “In order that’s not simply cash that is benefiting these households, but it surely’s going into our native economic system. In rural Western North Carolina, that is a big affect when a small produce stand has obtained about $20,000 to $30,000 of produce purchases from us since our inception into that program.
He instructed one story a few Hispanic household that mentioned in any other case would have been afraid to achieve out for any help. However by way of this program, they have been capable of attain out and get wholesome produce by way of the produce prescriptions into their family. Additionally they have been capable of get humidity management and mildew remediation to assist with their kids’s bronchial asthma of their dwelling. In the long run, they have been capable of finding higher housing that was extra satisfactory for his or her household measurement.
“One other case concerned a household we have been first providing meals bins, however then discovered that they have been dwelling out of their automobile,” Hart mentioned. “We labored with that household over the months that it takes to seek out inexpensive housing in our space, to lastly get them enrolled in Part 8 and to then get them right into a home that was each wholesome and protected for the dad and mom and the kid within the family.”
Elizabeth Tilson, M.D., State Well being Director and the Chief Medical Officer for North Carolina, mentioned, “One of many beauties of the 1115 Medicaid waiver was that we might use capacity-building {dollars} up entrance, so we have been capable of useful resource our community leads and our community-based organizations up entrance, so they may get the know-how and workers folks they wanted up entrance, so they may begin delivering companies. Capability constructing in our communities was large and actually, actually essential. We actually needed the companies delivered by our native, group based mostly organizations, When any person from our church is delivering the meals field to that individual, it’s creating that connectedness, it is pulling folks in, after which we will begin wrapping round extra of these companies.”
