Background

Because the health care system is undergoing a sweeping shift driven by rising costs, poor outcomes, and federal reform, it is moving away from traditional reimbursement methods built on individual payments for each medical service to a concept called value-based care. Value-based care is meant to encourage population health improvement and keep people out of the hospital.

The movement toward value-based care takes many forms in North Carolina. Networks called Accountable Care Organizations work to integrate groups of doctors, hospitals, and other health care providers to deliver high quality, coordinated care to a defined patient population such as Medicare recipients. Attempts to transform the health system also are reaching into neighborhoods to coordinate clinical care with social services and community-based organizations. This model is referred to as Accountable Care Communities. Accountable Care Communities aim to address some of the underlying drivers of poor health outcomes such as food insecurity, substandard housing, inadequate transportation, and interpersonal violence.

The Trust has an overarching goal of achieving equitable health outcomes. During the implementation of value-based care over the next several years, we want to ensure that populations traditionally suffering the worst health outcomes, especially low-income people and racial minorities, are directly engaged in reform efforts and have an equitable opportunity to enjoy improved health and well-being.

The largest experiment implementing value-based care in North Carolina that most impacts low-income communities is the remaking of the state’s Medicaid program. Medicaid is a joint state and federal program that pays for the care of approximately 2 million North Carolinians, or about 20 percent of the state’s population. Most Medicaid recipients are children, pregnant women, seniors, and people with disabilities. Value-based care and Medicaid reform hold the promise to provide better care at lower costs. But a change of this size and scale also can reproduce or exacerbate the deficiencies and disparities of the current structure.

Opportunity Details

The Trust is interested in hearing from applicants that can help educate and inform concerned residents, community-based organizations, safety net providers, and other key stakeholders about Medicaid reform and the transition to value-based care. This public education work could include large convenings, regional forums, or community conversations. We want to ensure that local groups, including nonprofits, safety net providers, and marginalized populations, have a better understanding of how they can engage with the health system and value-based care collaboratives to collectively improve the community conditions that contribute to poor health. The Trust may fund several organizations to reach target populations or geographic areas.

Future Funding Opportunities

As Medicaid reform and value-based care take shape in North Carolina, the Trust envisions opening future opportunities. Please check this section as we build a strategy around what we are learning about how the health system is changing. If you have ideas or expertise to offer about approaches that leverage value-based care to achieve equitable health outcomes for financially disadvantaged North Carolinians, please contact us so that we can collect information for potential partnerships and funding announcements.