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Monday, April 6, 2020

Pilot program to test cost benefits of health-based social services


By John Breslin | Feb 14, 2020


Supporters of a North Carolina pilot program aimed at spending money on health rather than just health care believe the idea could spread well beyond the state's boundaries.

A piece posted by the Commonwealth Fund outlines details of the program, which aims to evaluate how dollars may be spent on health-related social services, and cut spending on care. The Commonwealth Fund, which began operating in the 1920s, has a mission to focus "on the challenges vulnerable populations face in receiving high-quality, safe, compassionate, coordinated and efficiently delivered care."

In a jointly authored piece posted on the foundation's site, Dr. Mandy Cohen, Dr. Elizabeth Cuervo Tilson, Melinda Dutton, Jocelyn Guyer, Melinda K. Abrams, and Dr. Laurie Zephyrin noted that the North Carolina Department of Health and Human Services (NC DHHS) released a standardized fee schedule for health-related social services. These may include, as an example, housing support and healthy food boxes that would be reimbursed by Medicaid under the state’s Healthy Opportunities Pilots, the authors said.

[It's part] "of the state’s far-reaching efforts to 'buy health, not just health care,'" with the fee schedule setting pricing as part of a "value-based payment arrangement, to pay for services in four domains: housing, interpersonal violence/toxic stress, food and transportation," the authors wrote. "For each intervention, the fee schedule outlines the unit of service, payment amount, anticipated frequency and duration of the service, setting, and the criteria a member would need to meet in order to receive it."

The fee schedule, they wrote, is a key plank of North Carolina’s Healthy Opportunities Pilots.

The program will assess the impact of this unique approach to the provision of these services over five years, including the health outcomes and costs of Medicaid recipients. Up to $650 million was authorized by the Centers for Medicare and Medicaid Services to fund the pilots, mostly to pay for services.

"While the fee schedule was designed for North Carolina, it is likely to be of interest well beyond the state," the authors argue. "Despite increasing consensus that social, economic and environmental factors have a substantial impact on health outcomes and costs, scalable efforts to address these social determinants of health have been hamstrung, partly by a lack of standardization in the definition and cost of services. The fee schedule offers an opportunity to help bridge this gap, paving the way to systematically evaluate the effectiveness and cost of such interventions."

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North Carolina Department of Health and Human Services

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