Spring 2024

Welcome to the quarterly NC STC newsletter. These newsletters will keep you updated on NC STC activities and provide you with related resources and opportunities.

What is the NC STC?  

The North Carolina State Transformation Collaborative (NC STC) is a public-private partnership designed to advance value-based and person-centered care through multi-stakeholder alignment, with federal engagement (CMS) and state leadership (NCDHHS). North Carolina is one of four states—along with Colorado, California, and Arkansas—selected to participate in this initiative operated by the Health Care Payment Learning & Action Network (LAN). Duke-Margolis, in partnership with the NCDHHS Division of Health Benefits and the LAN, is establishing technical working groups and gathering strategic feedback to build a path forward to advance the NC STC goals across key priority areas: aligning quality measurement, strengthening coordinated and accountable primary care, enhancing health equity data, and improving data exchange.  

To achieve progress across the NC STC’s goals of improving population health, advancing health equity, enhancing patient experience, relieving provider burden, and reducing cost, the Duke-Margolis Institute for Health Policy drafted the Alignment Proposal for the NC STC, which describes a pathway toward implementing NC STC strategies—aligning quality measures, improving data infrastructure, and enhancing health equity data to enable advanced, coordinated care models, starting with primary care. The proposal addresses common challenges experienced across stakeholder groups when pursuing whole-person care.

Through a series of convenings with the NC Health Care Transformation Workgroup (a strategic and technical advisory group for the NC STC that includes health system representatives, health care providers, health plans, clinically integrated networks, employers, and state government entities such as NC Medicaid and the NC Health Information Exchange Authority), interviews with stakeholders, and research over the last year, the NC STC identified “pain points” and areas of opportunity to reduce the sources of administrative burden that often distract from providing the best care for patients. Variability in performance measures included in value-based care contracts, inconsistencies in the application of measure specifications, and variation in measure collection and reporting all distract from the adoption of advanced primary care. The NC Health Care Transformation Workgroup expressed strong support for streamlining the measurement process and consistently applying Healthcare Effectiveness Data and Information Set (HEDIS) specifications to a few priority, evidence-based measures which include:

• Childhood Immunization Status (CBE #0038)
• Glycemic Status Assessment for Patients with Diabetes (GSD) (CBE #0575) (previously known as Hemoglobin A1c Control for Patients with Diabetes)
• Controlling High Blood Pressure (CBE #0018)

Following convenings with the NC Health Care Transformation Workgroup, the NC STC convened a technical NC STC Data Sharing Workgroup comprised of technical data experts in early 2024 to identify key pain points for each measure and discuss potential alignment actions for the starter measure set. The Alignment Proposal for the NC STC illustrates a use case for how alignment on a small set of measures can help establish a process for implementation across a wide variety of measures in the longer term. 

NC STC Roadmap to Advance Progress Toward Whole-Person Care

The roadmap above outlines the NC STC efforts since the February 2023 launch and describes next steps in the year ahead. Lead partners will continue to engage stakeholders and collect feedback on the identified action areas. The Alignment Proposal will then be updated to incorporate feedback and include an implementation and evaluation plan that organizations can voluntarily adopt to help build organizational capacity for advancing the NC STC goals. The evaluation plan will help measure and track progress on NC STC strategies and goals.

NC STC Highlights Progress and Shared Goals at May 2024 Public Meeting

The NC STC and lead partners successfully hosted a public meeting on May 23, 2024, at Duke University. In attendance were state, local, and federal partners and collaborators, including NC Health Care Transformation Workgroup and NC STC Data Sharing Workgroup members.

The NC STC May Public Meeting’s objectives included:



• Sharing progress on key goals of the NC STC, which include improving population health, advancing health equity, enhancing patient experience, relieving provider burden, and reducing costs.
• Providing an overview of the Alignment Proposal for the NC STC, a set of preliminary action steps to strengthen accountable primary care.
• Hearing feedback from stakeholders on the current and future work and discussing ways to make progress as a state on key goals for the NC STC over the next year.
• Continuing to advance momentum for multi-stakeholder alignment and highlighting opportunities to scale.
• Fostering relationship building to further work on key goals of the NC STC.

• Continue to gather stakeholder feedback on the action steps outlined in the Alignment Proposal for the NC STC.
• Establish the proposed Health Equity Data Workgroup in the Summer of 2024 to further identify specific alignment steps to enhance health equity data collection, sharing, and use.
• Stay on the lookout for the Special Edition Newsletter with additional details about the May 23^rd meeting on Advancing Whole-Person Care through the NC STC and outlining the key action areas and strategies of the Alignment Proposal for the NC STC.

NCDHHS Releases Proposed Approach for Making Care Primary Payment Model and Requests Feedback by June 28, 2024

In June 2023, NC was selected as one of eight states to participate in the Making Care Primary (MCP) Model, a new CMS primary care model utilizing multi-payer alignment to strengthen primary care through payment reform, quality measures and incentives, data sharing, and learning systems. NCDHHS and Duke-Margolis convened community partners in the Fall and Winter of 2023 to discuss alignment opportunities between the existing Advanced Medical Home (AMH) program and the MCP Model. On May 21, NCDHHS released their proposed approach for the aligned MCP Model titled “Proposed Approach: Aligning and Standardizing AMH Incentives”, and is requesting feedback from community partners by June 28, 2024. The NC STC is focused on driving alignment on quality measures, while improving data sharing and infrastructure and enhancing health equity data. There are opportunities to extend the work of the NC STC to MCP and further the state's goals around multi-payer alignment.

NCDHHS Announces New Children and Families Specialty Plan Supporting Whole-Person Behavioral Health Approaches for Families with Complex Needs

NCDHHS issued a revised Children and Families Specialty Plan (CFSP) policy paper, detailing CFSP’S updated design, aiming to support Medicaid-enrolled children, youth, and families served by the NC child welfare system in receiving seamless, integrated, and coordinated health services across the full spectrum of health. The CFSP will provide members with access to state-wide, integrated physical health services, in addition to behavioral health, pharmacy services, long-term services and supports, Intellectual/Developmental Disabilities (I/DD) care, and health-related social needs (HRSN) support, aligning with the NC STC’s whole-person health goals.

NC Medicaid Expansion is Making Significant Progress on Enrollment Goals

North Carolina Medicaid enrollment surpassed 400,000 enrollees in its first five months of implementation with more than 450,000 enrollees receiving coverage as of May 2024. NCDHHS predicted that 600,000 North Carolinians would become newly eligible for expanded health services and aimed to enroll that total population in the first two years of implementation. NC Medicaid is currently averaging 1,000 new enrollees per day, marking significant progress on statewide expansion enrollment goals.

The Healthy Opportunities Pilots Celebrate Two-Years of Providing Health-Related Social Needs Services

On April 3^rd, 2024, the North Carolina Healthy Opportunities Pilots celebrated two-years of providing more than 288,000 food, housing, transportation and other health-related social needs services to over 20,000 enrolled NC Medicaid beneficiaries. Preliminary findings show reductions in emergency department visits, per-beneficiary spending, risk of food insecurity, housing instability, and lack of access to transportation. While the program was originally authorized to run through October 2024, a recent Section 1115 Demonstration Waiver renewal application from NC Medicaid has requested to expand services to the entire state for five additional years.

NCDHHS Continues their Landmark Investments in Behavioral Health

NCDHHS has invested additional funding to support the state’s ongoing whole-person behavioral health transformation goals. It announced a $22 million investment to expand peer respite care and community crisis centers state-wide. They will also distribute $6.25 million to support the implementation of youth and young adult substance use prevention programs in seven NC counties. Finally, they plan on investing $1.35 million to begin piloting trauma-informed mobile crisis and crisis co-responder services trained in responding to individuals experiencing behavioral health emergencies.

NCDHHS Prepares to Launch Behavioral Health and Intellectual/Developmental Disabilities Tailored Plans

On July 1, 2024, the new NCDHHS Tailored Plans are scheduled to launch, and will serve approximately 210,000 beneficiaries with a serious mental illness, serious emotional disturbance, a severe substance use disorder, an Intellectual or Developmental Disability, or a traumatic brain injury (TBI). The plans will cover doctor visits, prescription drugs, services for mental health, substance use, I/DD, and TBI along with services that support well-being such as food, transportation, and housing.

The Centers for Medicare and Medicaid Services (CMS) Announced a Notice of Funding for the New Transforming Maternal Health (TMaH) Model in Spring of 2024

Aiming to reduce disparities in access and quality of maternal care while decreasing overall Medicaid expenditures, the Transforming Maternal Health (TMaH) model highlights national efforts to enable states to develop a value-based alternative payment model for maternity care services. The TMaH model emphasizes access to care, infrastructure, and workforce capacity while also prioritizing multistakeholder alignment by including critical partners such as Managed Care Organizations, Perinatal Quality Collaboratives, hospitals, birth centers, health centers and rural health clinical, maternity-care providers, and community-based organizations, highlighting alignment with the NC STC’s multistakeholder efforts across lines of business.

The Centers for Medicare and Medicaid Services (CMS) Announced a Notice of Funding for the New ACO Primary Care Flex Model

The ACO Primary Care Flex Model utilizes prospective primary care payments (PPCPs) and increased funding for primary care in Accountable Care Organizations (ACO) to improve health outcomes, quality, and costs of care. The model focuses on increasing funding and other resources in the Medicare Shared Savings Program. The ACO Primary Care Flex Model utilizes a flexible payment design to empower ACOs and their primary care providers to use more innovative, team-based, person-centered, and proactive approaches to care. Basing PPCPs on county primary care spend data versus historical experience supports increased payments for ACOs serving underserved populations facing historical barriers to care, emphasizing equity as a core component of the model and alignment with the NC STC goals.

The Centers for Medicare and Medicaid Services (CMS) Announced a Notice of Funding for the Innovation in Behavioral Health Model

Focused on community-based behavioral health practices that treat Medicaid and Medicare beneficiaries, the Innovation in Behavioral Health Model (IBH) aims to improve outcomes for people with moderate to severe mental health conditions and substance use disorders through person-centered, integrated care. IBH integrates care by supporting practices in developing Behavioral Health programs which include interprofessional care teams. Additionally, the model aligns with the NC STC strategies to improve data sharing and infrastructure and enhance health equity data by supporting the expansion of health information technology and the development of health equity plans.

NC General Assembly Legislative Updates

North Carolina Primary Care Payment Reform Task Force

The Primary Care Payment Reform Task Force submitted its report on North Carolina’s current state of primary care and associated spending to the Joint Legislative Oversight Committee on Medicaid. Legislated in 2023 in SL 2023-134 to create a working definition of primary care and make actionable recommendations to the State to improve NC’s quality and cost of primary care, the Primary Care Payment Reform Taskforce met five times between January and March 2024 and submitted the final report in April 2024.

In its report to the legislature, the Task Force provided a working definition of primary care, including types of core primary care services, types of providers, and locations where primary care services are rendered. This definition excludes additional settings that do not provide continuous, longitudinal care such as care delivered in inpatient settings, emergency rooms, urgent cares, and retail clinics. Obstetric and gynecological services were included in the definition as well as behavioral health services and providers.



The Task Force also outlined the following findings and recommendations in its report:

For more information, see the Task Force webpage.

The NC STC can play an important role in supporting implementation of various reform initiatives ongoing at the state and federal level while also pursuing the strategies outlined in its Alignment Proposal around aligning quality measures, improving data sharing infrastructure, and enhancing health equity data in order to reduce administrative burden and increase impact.  

The next special edition newsletter is coming in Summer 2024.

Contact us using this form on the STC web page:

Scroll down to “Stakeholder Engagement Opportunities through NC STC.”

In these discussions, “alignment” is defined to mean the application of evidence and experience to assess and identify measures, administrative components, and data that would be impactful and practical for potential use to improve performance in the provision of value-based health care. These measures, components, and data concepts, combined with evidence, will be made available to the public as a resource for consideration and use by any interested stakeholders to further the Workgroup’s goals of reducing complexity for clinicians and advancing high-quality care for all patients.