North Carolina’s Healthy Opportunities initiative will provide up to $650 million in Medicaid funding for pilot services related to housing, food, transportation and other social needs in three regions of the state. Later this month, the program will begin using a new Social Care Payments solution from Unite Us. In a recent interview, Melissa Sherry, vice president of social care integration at Unite Us, spoke about what is involved in the roll-out and next steps.
New York-based Unite Us, whose platform connects health systems, payers and community-based organizations (CBOs), says this payment offering is a first-of-its-kind solution designed to bridge the gap between healthcare funders and community-based organizations (CBOs), enabling social care funding at scale. The company said it is the only end-to-end solution for social care that streamlines the implementation and management of paid social care programs for all healthcare funders, including health plans and managed-care organizations.
With the solution, payers can:
• Access a contracted network of community-based organizations;
• Streamline eligibility and authorization processes;
• Simplify invoicing and billing to reimburse community partners for services; and
• Measure the effectiveness of social care funding and reduce preventable medical costs with robust data and improved visibility.
Sherry came to Unite Us from a position as director of population health innovation and transformation for Johns Hopkins Healthcare in Baltimore, where her focus was on partnering with community-based organizations. I asked her if there were some lessons learned at Johns Hopkins that she brought to her new position.
“At Johns Hopkins, we were trying to figure out how to combine social care and healthcare to improve outcomes for high-risk Medicaid and Medicare individuals. We decided to stand up a community health worker intervention,” Sherry explained. “Initially, we decided to hire our own community health workers. We had some really brilliant community partners, however, who convinced us that they have resources that people in the community already use.” So instead, they contracted and worked closely with those community organizations.
“That taught me so much about the interesting divide between healthcare and social care,” she recalled. “We were trying to figure out how to get community-based organizations to participate in paid healthcare arrangements in a way that makes sense for them, and makes sense for us on the healthcare side. I learned a lot about what not to do. I think we made some valiant efforts in terms of trying to do the right thing. But I was a little bit schooled in what I didn't know, in a way that has led me to where I am today, trying to build the right thing.”
Sherry said she is grateful for those lessons learned. She also focused her Ph.D. work on how neighborhood factors affect the Medicaid spending, “because I really wanted to prove the ROI and show how much it matters to healthcare to invest in community resources. So when I ended up at Unite Us, it was the perfect intersection between taking all the lessons I'd learned at Hopkins, and also trying to figure out how to tell that story about ROI, to get more investment into communities to change healthcare outcomes.”
The Social Care Payments solution was designed so CBOs can tap sustainable funding streams without changing the way they operate.
When Sherry joined the company, it was thinking through what are the right technology mechanisms that allow CBOs to meaningfully get paid for their work instead of just receiving referrals. “I'm leading the payment side of the house — what are the technology and tools that we can build to support that bridge between healthcare and community-based organizations? And then how do we evaluate it and really tell the story and make sure that what we're doing has real healthcare outcome impact?”
I asked Sherry if that payment side of the equation is a lot more complicated than it might sound initially.
“Yes, 100 percent,” she said. “I think the really fascinating thing that we had to work through as a team is figuring out how do you make this work for both sides of the equation. Healthcare obviously is built on these really complex administrative billing structures, with claims and database systems built around it. Social care doesn't have those rules yet. That standardized language is not built out; the national provider ID may not exist for a community-based organization. So one of our principal challenges is how do we take all that complexity that healthcare needs to be able to pay but at the same time make it really simple for community-based partners? Because that was the biggest lesson I had learned: You can't be asking your community partners to go in and hire a clinical coder. You can't ask them to be doing a lot of that really complex documentation. It's not in their wheelhouse. What we were really focused on is how do we build the technology that takes a lot of that complexity and basically embedded it in the system so that healthcare gets what they need, but community-based organizations only have to do a few clicks, and everybody gets what they need.”
Another challenge, she added, was deciding who is this solution built for? Healthcare is a huge potential funder of this, obviously. “We're really focused on how do we enable healthcare to pay for this, but we also have other sectors who are interested in participating in paying for social care — education systems, the criminal justice system. The other complex part about thinking through this is how do we make a system that works for community-based organizations to receive funding from multiple sources in a way that makes sense for them, but also makes sense for each sector.”
Besides North Carolina, other states have Medicaid 1115 waivers to pay for social care. I asked Sherry if the lessons learned from the start-up in North Carolina are likely to lead to a scale-up of similar deployments in some of these other states, such as Oregon, California, Washington or Massachusetts.
“I think all eyes are on North Carolina,” she said. “The other cool thing about Medicaid 1115 waivers is they're done very differently in different states. All of the states are going to be learning very different lessons. The technology we built was designed to be flexible enough to support these different models. One of the keys that we always talk about is you need to have that standardized data collection, high-quality data to prove whether or not it worked. In North Carolina, what we're really focused on is how do we support those models in a way that gets them really robust person-level data to be able to evaluate the impact so that they can prove that investment in social care is worth continuing.”
Could large integrated health systems such as Kaiser Permanente or Intermountain be interested in a solution like this, even though they are not Medicaid managed care organizations?
“Absolutely,” she said. “What we're trying to do is just make it really simple to include social care as part of a benefit package. When you are thinking about things like closing quality gaps, we're seeing huge opportunities for health systems, in particular, to think about quality measures that they have to achieve and how social care factors contribute to those. We're seeing a lot of those systems thinking about how to start to pay for these basic needs, which tend to be a lot cheaper than medical care, in order to achieve quality outcomes and close quality gaps, like in the management of diabetes, for example. We're really excited about the opportunity for those innovative health systems and health plans to start paying for social care, like they do medical care and seeing the return on that.”
