NC State Transformation Collaborative Newsletter

Winter 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.

News and Updates

Duke Elevates Duke-Margolis to a University Health Policy Institute

Duke University advanced its commitment to improving health care quality, equity, and affordability through health policy by announcing the elevation of the Duke-Margolis Center for Health Policy to the Duke-Margolis Institute for Health Policy. The elevation of Duke-Margolis, one of the lead NC STC partners, to an Institute recognizes its impact on the health policy landscape and advances the University-wide efforts to have a transformative impact on the future of health and health care.

With this new Duke recognition, Duke-Margolis will continue to address timely health policy challenges; amplify Duke’s collective ability to support research and education that impacts health policy locally, nationally, and across the globe; and deepen Duke’s recruitment and retention of dynamic faculty and scholars who will lead, research, and explore the most pressing health care challenges of the future.

Launch of North Carolina’s Medicaid Expansion

On December 1, 2023, North Carolina expanded health care coverage to more people, now covering more residents ages 19 to 64 with higher incomes. In addition to expanding access to physical health services across the state, Medicaid expansion also expands access to behavioral health services, including mental health and substance use care. As of January 19, 2024, 318,977 North Carolinians have enrolled in Medicaid coverage under new eligibility guidelines. NCDHHS has launched an expansion dashboard, updated monthly with new enrollment data. Preliminary dashboard data shows that the majority of new Medicaid enrollees live in rural NC communities.

Investments in NC Behavioral Health Infrastructure and Resources

In October 2023, NCDHHS received a four-year $14.8 million grant from the Substance Abuse and Mental Health Services Administration (SAMHSA) to support behavioral health access for North Carolina children and families. This grant will support North Carolina’s System of Care, which connects children and families to mental health services across the state through evidence-based High-Fidelity Wraparound services.

In addition, the approved 2023-2025 NC state budget included an $835 million investment to support expanded behavioral health services. A few of the main provisions included in the budget are listed in the table below.

Funding Area	Specific Provision
Increasing rates for behavioral health providers, effective January 1, 2024	$220 million annually to increase Medicaid reimbursement rates for providers of mental health, substance use disorder (SUD), and intellectual/developmental disability (I/DD)-related services
Expanding access to behavioral health services through primary care integration	$5 million to continue to support and scale up the Collaborative Care Model which integrates behavioral and physical health into the same primary care modality via a team-based approach $2 million annually to support the NC Psychiatry Access Line (NC-PAL), a partnership between NCDHHS and the Duke Department of Psychiatry which provides behavioral health education and resources to clinical and social service providers in NC
Creating alternatives to Emergency Department care	$80 million over two years to create new mobile crisis teams and support respite facilities
Expanding workforce provisions	$40 million over two years to provide sign-on and retention bonuses for state mental health facility employees and $18 million to create a workforce training center $50 million over two years to expand the NC Loan Repayment Program with supplemental recruitment efforts by the North Carolina Area Health Education Center (AHEC) $20 million in grants over two years for telehealth equipment for rural providers
Supporting children and families	$80 million in community-based support for families and other caregivers of children with high behavioral health or other special needs to expand structured, intensive support systems

Recent Activities to Support NC STC Goals

Advancing Coordinated, Accountable Primary Care Models in NC: Completion of Making Care Primary Meeting Series

As NC Medicaid explores how the future of its primary care programs may potentially align with and build upon CMMI’s new multipayer Making Care Primary (MCP) model, NC Medicaid and the Duke-Margolis Institute for Health Policy (Duke-Margolis) hosted a series of convenings from October to December 2023 with the Medicaid Standard Plans, provider associations, and Clinically Integrated Networks (CINs) to solicit feedback. North Carolina is one of eight states chosen as sites for this 10.5-year model, launching on July 1, 2024. The feedback from these meetings will be used to inform the next steps and best approach for a potential NC Medicaid version of the MCP model. Given the NC STC’s shared goals to advance coordinated, accountable primary care, there is a unique opportunity to extend MCP beyond Medicare and Medicaid through the NC STC. Key themes emerged across the three MCP convenings and our ongoing NC STC work, including the need for:

Support for building on existing models in the state (e.g., NC Advanced Medical Home Model and other Medicare alternative payment models)
Data sharing through standardized, aligned, and automated data reporting mechanisms and the NC Health Information Exchange (NC HIE)
Aligned approaches in the movement towards primary care capitation
Efforts to reduce provider burden through multipayer alignment across all lines of business

Pursuing Measure Alignment, Data-Sharing, and Health Equity Goals: Convening the NC Health Care Transformation Workgroup

On November 9, 2023, Duke-Margolis convened the NC Health Care Transformation Workgroup (NC HCT) in collaboration with NC STC lead partners (NCDHHS, CMS, and the LAN), marking the group’s first ever in-person meeting. The stakeholders represented in the NC HCT are Standard Plans, commercial plans, provider associations, clinically integrated networks, the NC HIE, and NCDHHS. The goal of the meeting was to discuss and provide feedback on a draft NC STC Alignment Proposal, which constitutes a set of preliminary action steps to ultimately accelerate the adoption of advanced primary care and population-based payment models via measure alignment. These proposed actions were informed by previous Workgroup meetings, landscape analyses, and learning calls and support greater alignment with national efforts including CMMI’s Making Care Primary model and the HCP LAN’s nationwide STC initiative, building on top of the learnings of individual states like North Carolina. The NC STC Alignment Proposal is the first critical step in laying a pathway for ongoing alignment and innovation long-term with the ultimate goal of building a solid foundation to advance NC STC goals, which include aligning quality measures, improving data infrastructure, and enhancing health equity data to strengthen primary care, improve provider experience, and reduce cost. The positive feedback and recommendations received during the November discussion on the NC STC Alignment Proposal will shape the strategies for further advancing NC STC goals at the May 2024 public meeting.

Creating a Process Framework for Continued Alignment and Adoption of Value-Based Payment Models: Drafting the NC STC Alignment Proposal

To achieve progress across the NC STC’s goals and synthesize learnings and pain points shared at previous stakeholder convenings, Duke-Margolis drafted the NC STC Alignment Proposal, a proposed set of actions to implement the NC STC strategies: aligning quality measures, improving data infrastructure, and enhancing health equity data with the end goal of strengthening primary care. The NC STC Alignment Proposal focuses on a small set of priority quality measures commonly used in payer contracts to assess provider performance as a test case to reduce burden in the measurement process, improve disparities measurement, and facilitate data sharing.

Upcoming NC STC Activities

Continue to solicit feedback on the proposed action steps within the NC STC Alignment Proposal through ongoing stakeholder outreach.
Host the NC STC Data Sharing Workgroup meeting series in early 2024 in collaboration with NC STC lead partners, where the participants will discuss key pain points and solutions in data sharing practices allowing the decision points from that group to guide the next steps for alignment on our starter set of measures.
Establish the proposed Health Equity Data Workgroup in Summer 2024 to further identify specific alignment steps to enhance health equity data collection.
Convene the next public meeting on May 23, 2024, from 3-5 PM ET. This meeting will be hosted by Duke-Margolis in collaboration with NC STC lead partners at Duke University, with a virtual option available. We plan to provide additional details on the NC STC Alignment Proposal in advance of the public May meeting. More event details are forthcoming!

Next quarterly newsletter coming in Spring 2024!

Any Feedback, Comments, or Questions?

STC Engagement Opportunities

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.