How Providers, Health System Leaders, and States Can Work Together to Align Disparate Policy Efforts to Address Health-Related Social Needs: Learning from North Carolina

BACKGROUND Under the Biden Administration, policy authorities and programs working to address health-related social needs (HRSNs) expanded across the United States. Despite major investments and initiatives to address HRSNs, they are still largely disparate from one another. METHODS We conducted qualitative research to study North Carolina’s HRSN landscape from 2020 to 2023, drawing on interviews with 22 individuals from 10 local HRSN initiatives and previous research collected on the service provision of North Carolina’s Medicaid waiver demonstration pilot program to address HRSNs. RESULTS For all states, payers, health systems, and providers, North Carolina demonstrates the archetypes of major policy authorities and programs that can and are being used to address HRSNs. However, we identify challenges that cut across them, including sustainability, operational barriers, and silos between sectors, and we draw implications for providers, health system leaders, and state policymakers looking to expand and align disparate health policy efforts to address HRSNs. LIMITATIONS We acknowledge several limitations. First, participants in our qualitative research study did not represent all HRSN initiatives in North Carolina; however, we made significant efforts to capture diverse perspectives and major initiatives in the state. Second, we examined one state’s approach to addressing HRSNs, which has lessons for other states; therefore, the generalizability of our findings depends on other states’ contexts. CONCLUSIONS As many states are currently prioritizing a whole-person approach to care for their residents, learning from North Carolina is critical to building a more effective and financially sustainable approach to address HRSNs.

Duke Scholars

Author Michelle Jacqueline Lyn Family Medicine and Community Health, Community Health

Author Andrea Thoumi  

Author Rebecca Garr Whitaker Duke-Margolis Institute for Health Policy