A group of middle school-age students of different racial backgrounds have an animated conversation in a cafeteria

Why equitable health systems?

Inequities in health systems—by race, class and geography—must be eliminated.

Providing access to medical care by itself will not change historic health inequities. We support efforts to eliminate health disparities by helping communities and safety net providers adjust during Medicaid transformation, ensuring those most impacted are included in critical conversations. We’re supporting the state’s Healthy Opportunity Pilots to address the social determinants of health and ensuring that health care delivery systems are accountable to the communities they serve.

Our Goals

A mother, who is a person of color, holds her infant upright while a Black woman doctor tests their facial recognition ability

Utilize a value-based care environment to narrow systemic racial and ethnic inequities in health outcomes and facilitate health improvement.

What we know: Because the health care system is undergoing a sweeping shift driven by rising costs, poor outcomes, and federal reform, it is moving from traditional reimbursement methods to a concept called value-based care. Value-based care is meant to encourage population health improvement and keep people out of the hospital. In 2021, the state launched Medicaid managed care–the largest experiment implementing value-based care in NC–resulting in approximately 1.7 million people experiencing a change to their insurance.

What we do: We work to ensure that this change narrows racial disparities in health outcomes and improves the health of people whom the system has too often overlooked. We know the power is in community. Urban Institute research shows that the shift to Medicaid managed care has been confusing for beneficiaries, specifically around selecting health plans, finding providers, and accessing services. The Trust is funding advocacy efforts to try to increase direct connections to impacted residents.

A group of Black youth water and care for plant starters in a tunnel greenhouse

Work with health systems to improve health outcomes for Medicaid and uninsured populations by addressing social drivers of health and well-being.

What we know: Research increasingly shows us that social, economic, and environmental factors are much greater drivers of health than what happens in the clinic and hospital. In 2022, the state launched Healthy Opportunities Pilot regions to use Medicaid dollars to pay community-based organizations to provide services, such as housing and food, to address social determinants of health. Achieving greater equity in health outcomes will require genuine partnership between hospitals and health systems and the community organizations that are embedded in underserved areas or led by residents with low incomes.

What we do: We support efforts to better understand the social determinants of health, as well as innovative approaches, such as value-based care, to helping health systems address these underlying drivers. We helped the state build infrastructure for the pilots, including NCCARE360, which connects health providers and human service organizations. We are also investing in the capacity of community groups to participate in the pilots.

Doctor taking women's blood pressure

Ensure the viability of health care safety net systems including public health.

What we know: As the health system shifts to new payment models, we know that financially vulnerable residents, including the uninsured and underinsured, will suffer disproportionately from a lack of access to care. Given this transition and the COVID-19 pandemic, it is especially important to ensure the continued viability of the state’s health care safety net system.

What we do: During the implementation of value-based care in North Carolina, we are focused on ensuring safety net providers, including federally qualified health centers, free and charitable clinics, rural health centers, and public health departments, have the capacity to pivot with new payment systems. We also invested in the North Carolina Institute of Medicine’s Task Force on the Future of Local Public Health to better understand how our public health system can be strengthened moving forward.

Our Grantmaking Strategies

We leverage a variety of strategies to advance our goals, across all programs, initiatives, and bodies of work.

Activating Change With Our Values

We start by listening. Believe in communities. Engage unlikely partners. Employ a place-based approach. Believe equity is essential to everything we do. Focus on outcomes. Support scale and sustainability.

Funding Opportunities

Find out what we’re funding now.

Our Team

Senior Program Officer

Senior Program Officer

Grants Assistant