4. Non-Medical Drivers of Health NC DHSS should increase resources in NCCARE360 and CBOs to ensure their ability to address non-medical drivers of health. Implementation: • NC DHHS should increase advertising and communication to community-based organizations on NCCARE360. • NC DHHS should invest in technical assistance and resources to communitybased organizations to incorporate NCCARE360 into their practice. • NC DHHS should set a community reinvestment requirement for PHPs. North Carolina Context
Many North Carolinians face conditions including food insecurity, housing instability, unmet transportation needs, and interpersonal violence, all of which impact their health and well-being. More specifically, over 1.2 million North Carolinians cannot find affordable housing; the state has the eighth highest rate of food insecurity; 47 percent of North Carolina women experience intimate partner violence; and nearly a quarter of North Carolina children have experienced adverse childhood experiences.138 Screening and identifying these unmet needs provide opportunities for intervention, to improve health outcomes and to generate cost savings. NC Medicaid is a leader in the country in its effort to integrate non-medical drivers of health into models of care. The state has taken several initiatives to address non-medical drivers, including creating a set of nine standard screening questions for providers to determine if Medicaid enrollees face barriers related to transportation, food, housing, or interpersonal safety and developing Healthy Opportunities
to improve screening for social needs, care coordination, and the provision of non-medical services to its Medicaid population.139 Furthermore, the state has created a statewide platform called NCCARE360, where providers can refer and connect patients to community-based organizations (CBOs). The coordinated care network was launched in 2019 and now boasts over 1,000 CBOs that connect people to resources they need in all 100 counties.140 However, one challenge has been a lack of widespread use of NCCARE360 by health care providers and community-based organizations.141 Stakeholder interviews indicated a need for greater awareness of NCCARE360 across provider networks as well as greater organizational capacity to implement it. CBOs cited a lack sufficient staff and technical training to implement NCCARE360 at a larger scale. The effectiveness of these programs to connect people to local services depends heavily on CBOs’ resources and ability address people’s needs. The COVID-19 pandemic has impacted nonprofits in the state; 87 percent of nonprofits report lower than usual revenue and 77 percent report higher demand than usual for services.142 Evidence
Non-medical drivers of health are particularly important for people with SCD, who are more likely to experience structural barriers and racial disparities that exacerbate the physical and behavioral health challenges associated with SCD and result in worse health outcomes.143 A study examining universal screening for social determinants in patients with SCD in a pediatric hematology clinic at the Boston Medical Center found that 66 percent of patients screened positive for at least one unmet socioeconomic need with an average of 2.1 unmet needs per patient (among patients with unmet needs). The most common unmet need was food insecurity, followed by difficulty paying utilities, a desire for more education, unemployment, transportation, housing, and childcare.144 The same study found that patients were proactive after being referred
34 Part I. Recommendations to Improve Both Sickle Cell Disease and Maternal Health Outcomes
