Buying Health For North Carolinians: Addressing Nonmedical Drivers Of Health At Scale

Health Aff (Millwood). 2020 Apr;39(4):649-654. doi: 10.1377/hlthaff.2019.01583.


Since 2017 the North Carolina Department of Health and Human Services has asked how its resources could be optimized to buy health, not only health care. This has led the department to incorporate whole-person care into all of its priorities, including building a statewide infrastructure and implementing incentives to address nonmedical drivers of health-focusing on food, housing, transportation, employment, and interpersonal safety/toxic stress. This article describes four interconnected initiatives that the department has implemented or is implementing to begin integrating medical and nonmedical drivers of health. This multifaceted effort involves many partners and includes financial incentives for commercial payers, Medicare, and Medicaid that are aligned with whole-person care; a standardized screening process to identify people with unmet social resource needs across all populations; NCCARE360, the first statewide network linking health care and human services providers to one another with a shared technology platform; and a large-scale Medicaid pilot to evaluate the impact of nonmedical health interventions on health outcomes and health care costs. North Carolina's interconnected initiatives can help inform efforts around the US and generate needed evidence on how to implement systems through public-private partnerships to address nonmedical drivers of health at scale.

Keywords: Costs and spending; Financial incentives; Food; Health care providers; Health policy; Housing; Medicaid; Medicaid managed care; Non-medical drivers of health; Payment; Social Determinants of Health; Stress; Systems of care; Whole-person health.

MeSH terms

  • Aged
  • Housing
  • Humans
  • Mass Screening
  • Medicaid*
  • Medicare*
  • North Carolina
  • United States