August 28, 2020

Faculty at the UNC Gillings School of Global Public Health have entered into a $2.5 million contract for the current year with the North Carolina Department of Health and Human Services (NC DHHS). The School will serve as the official evaluation center for the state’s landmark Medicaid transformation — a partnership that will have an incredible impact on public health in the state.

Dr. Marisa Domino

Dr. Marisa Domino

Marisa Domino, PhD, professor of health policy and management, will lead the efforts for the Gillings School, which will include participation from a number of faculty and students. Also providing leadership is Professor Mark Holmes, PhD, and Professor of the Practice Sandra Greene, DrPH, who also teaches in the School’s health policy and management department.

“This is a terrific opportunity for Gillings,” Domino says. “We have quite a large group of faculty involved in various capacities with this project. This kind of evaluation is exactly what our faculty have expertise in, and we’re delighted to be involved in such a major part of this milestone for the state.”

Dr. Mark Holmes

In August 2019, The New York Times called North Carolina’s proposal for Medicaid change “one of the country’s most ambitious efforts to transform how health care is defined and paid for.”

Now, Gillings School faculty will evaluate the success of the state’s new era of Medicaid, which includes the switch from the state’s typical fee-for-service model — which pays providers for each office visit — to managed-care groups where providers are paid based on improved health outcomes. This approach incentivizes the increased use of health-improvement measures, screenings and tools to keep patients well.

The new plan also includes enhanced coverage for substance use disorders, as the state has been heavily impacted by the nation’s growing opioid crisis. The federal government approved funding for a pilot program that covers non-medical interventions for social determinants of health such as unsafe housing or food insecurity. In addressing these issues, which contribute directly to poor health outcomes, the goal is to reduce hospital and emergency room visits while increasing the overall health of North Carolina’s most vulnerable citizens.

Dr. Sandra Greene

Dr. Sandra Greene

Known as the Healthy Opportunities Pilot, the $650 million program will start running in select parts of the state, with the potential to expand to all 100 counties.

“Dr. Mandy Cohen [secretary of NC DHHS] gives the example of a child with severe asthma who visits the emergency room often, returning after each visit to a home that has mold in the carpet. This program would pay to replace that carpet in hopes that the child would have fewer visits to the emergency room,” Domino explains.

Evaluators also will be charged with monitoring the quantitative metrics they receive from Medicaid data to determine which services are working best, what costs are associated with the services and what kinds of treatments and medications enrollees are receiving.

“We’ll take that data and monitor quality and access metrics such as who went to the ER and who got a cancer screening,” says Domino. “We’ll look at the data we have from the period prior to this transformation and track any improvements or changes.”

The collaborators also will evaluate health care providers’ participation and satisfaction with Medicaid. Medicaid patients often have health complications and risk factors that leave some providers reluctant to include them in their practices. The data those providers share with the evaluators will add context to any trends found in the data.

“Our overarching goal is to provide a thoughtful, independent evaluation that helps the state improve the Medicaid model and monitors the care Medicaid enrollees are receiving in North Carolina,” Domino says.

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