North Carolina’s Healthy Opportunities Pilots (HOP) is the nation’s first comprehensive program aimed at addressing non-medical, health-related needs for qualifying Medicaid enrollees. Melinda Dutton, a partner at Manatt Health recently facilitated a fireside chat with North Carolina’s Secretary of Health and Human Services, Kody Kinsley, State Chief Medical Officer, Dr. Elizabeth Tilson, and partner entities on the ground about the launch and early results from HOP. During the session, Secretary Kinsley and Dr. Tilson provided an overview of how HOP is integral in supporting the Department’s goals of improving the health of all North Carolinians. An excerpt of that discussion was edited for clarity and can be found below. The full webinar discussion can be watched here.
Melinda Dutton: Thanks for joining us. Please tell us about HOP and why this work is so important to the State’s broader goals for a healthy, productive North Carolina?
Secretary Kinsley: HOP is a key innovation in the State’s efforts to give people access to the preventative care that they need to stay healthy. Because we know that prevention, such as for a major cardiovascular event, is a lot cheaper than ending up in the emergency department. Similarly, our investments in addressing health disparities can help make sure that we can bring solutions to communities that need them. HOP is all about investing in the right place to render value in the long run.
Dr. Tilson: When we think about our charge, it's to improve the health and well-being of people in North Carolina, and to do that, we have to think about whole person health. We know that means addressing people's physical and behavioral health, which is foundational for high-quality integrated healthcare. The recent expansion of Medicaid in North Carolina has been such a critical lever to get people access to that high quality, integrated clinical care, but what we're also learning is it isn't always sufficient. People need food, shelter, and safety/security. For us, the focus has been on being able to expand Medicaid and then really think about leveraging Medicaid as a means for addressing key social determinants of health that not only improve health but can decrease costs.
Melinda Dutton: As part of your 1115 waiver, where you received authority from the federal government to use Medicaid funding to help pay for services that address health related social needs, you also committed to an evaluation. I know the evaluation was a very high priority for your administration to understand what value is coming out of these investments. Could you talk a little bit about the early results from the evaluation?
Dr. Tilson: We have partnered with a third-party evaluator through the University of North Carolina to conduct a HOP evaluation and based on data through November 2023, we showed that we’ve effectively created a healthcare system that's connected to our social service systems.
We wanted to decrease people's social needs through services around food, housing, transportation and interpersonal violence. The evaluation found that these investments are reducing the number of social needs an individual has. We also looked at healthcare utilization from two angles - we want people to utilize primary care and to prevent people from unnecessary hospital care. We saw a decrease in emergency department utilization and a decrease in hospitalizations for our adult non-pregnant population.
Additionally, the evaluation found that HOP saves on average $85 per enrollee, per month. Another thing that we learned in the evaluation, which is very intuitive, is that the longer a person was enrolled, the better off they were, the lower the social risk, the more the cost savings were generated. We are absolutely thrilled with the evaluation results and that we're improving the health of people in North Carolina and decreasing health care costs.
Secretary Kinsley: I want to add some contextual elements here that are important to remember. HOP operates in some of our most rural communities in North Carolina. When we think about that, paired with the historic lack of insurance in North Carolina, the success that Dr. Tilson just outlined really underscores the power of this work and the importance of it.
The second thing is that as I think about my title Secretary of Health and Human Services, HOP is really about bringing those two pieces of the title together. We've been able to use these healthcare dollars to infuse funding into human services organizations, and what we hear back is that this resource allows them to build up their organizations to do more in a variety of ways. It's stabilizing, and it's a steady source of income that we think is really foundationally important in these communities.
Melinda Dutton: North Carolina is the first state to take on something of this scale, but there are many other states who have entered into this space as well and are standing up programs at various phases of maturity. What lessons learned and advice would you have for states who are looking to achieve the goals that you all are reaching?
Secretary Kinsley: I'm really glad that many other states are jumping into the space. I think it's important that we all maintain a spirit of piloting, right? I think we've learned a lot about how you build out the diverse networks of community-based organizations. We've learned a great deal about the information technology and the data exchange framework necessary to make this work.
Dr. Tilson: I think there are a couple other lessons learned too.
One was we didn't just have HOP in isolation. I think that would have been a mistake. We built an enabling ecosystem that got our systems, payers, and communities ready to invest in and care about addressing the social determinants of health. The 1115 waiver and the extra Medicaid dollars enhanced that. If we were just doing HOP, we wouldn't have had that ecosystem.
Second was that by using capacity building dollars from the 1115 waiver upfront, we were able to resource our Network Leads and our social service providers—the organizations bridging the gap between health care and human services, so they could get the technology and needed staff.
Third, our model was designed so that services are delivered by people in the communities. Our local community-based organizations really helped with the effectiveness of the program. It also helps to invest dollars into our local communities as well.
Melinda Dutton: Thank you, both and congratulations on your success.
The full webinar discussion, including commentary from the State’s on-the-ground partners operationalizing HOP, can be watched here.