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 Carolinas 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 Carolinas 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 states 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.