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A First Look at North Carolina’s Section 1115 Medicaid Waiver’s Healthy Opportunities Pilots

Medicaid funds typically cannot be used to pay for non-medical interventions that target the social determinants of health. However, in October 2018, CMS approved North Carolina’s Section 1115 waiver which provides financing for a new pilot program, called “Healthy Opportunities Pilots,” to cover evidence-based non-medical services that address specific social needs linked to health/health outcomes. The pilots will address housing instability, transportation insecurity, food insecurity, and interpersonal violence and toxic stress for a limited number of high-need Medicaid enrollees. This brief summarizes key features of the pilots.

Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity

Research demonstrates that improving population health and achieving health equity will require broad approaches that address social, economic, and environmental factors that influence health. This brief provides an overview of the broad factors that influence health and describes efforts to address them, including initiatives within Medicaid.

“What is CMMI?” and 11 other FAQs about the CMS Innovation Center

The Center for Medicare and Medicaid Innovation (CMMI), also known as the “Innovation Center,” was authorized under the Affordable Care Act with the goals of designing, implementing, and testing new payment and delivery system reform models to address concerns about rising costs, quality of care, and inefficient spending. These FAQs provide an overview of the Innovation Center, as well as details on model performance, beneficiary involvement, and more.

8 FAQs: Medicare Accountable Care Organizations (ACO)

ACOs are groups of doctors, hospitals, and other health care providers who voluntarily form partnerships to collaborate and share accountability for the quality and cost of care delivered to their patients. These FAQs describe the ACO models in Medicare and answer questions pertaining to spending and quality results, where models are located, and how many beneficiaries are involved. These Medicare accountable care organization (ACO) FAQs are part of the Medicare Delivery System Reform Evidence Link.

8 FAQs: Medicare Medical Home Models

Medical homes are typically team-based primary care practices that provide the majority of their patients’ health care needs either directly, or through coordination with other providers. These FAQs describe the medical home models in Medicare, and answer questions pertaining to spending and quality results, where models are located, and how many beneficiaries are involved. These Medicare medical home FAQs are part of the Medicare Delivery System Reform Evidence Link.

8 FAQs: Medicare Bundled Payment Models

Bundled payment models are a way for Medicare to establish a total budget for all services provided to a beneficiary throughout an episode of care. These FAQs describe the different types of Medicare bundled payment models, and answer questions pertaining to spending and quality results, where models are located, and how many beneficiaries are involved. These Medicare bundled payment FAQs are part of the Medicare Delivery System Reform Evidence Link.

Medicare Delivery System Reform: The Evidence Link

The Kaiser Family Foundation’s Evidence Link is an interactive resource that pulls together the latest available evidence on Medicare payment and delivery system reform models, with an initial focus on accountable care organization (ACO), medical home, and bundled payment models. Through FAQs and side-by-side comparison tables, the Evidence Link synthesizes the most up-to-date information on savings and quality results, and describes key design features of each Medicare model, such as how providers are paid, the number of beneficiaries receiving care under each model, where models are being tested, and timelines for evaluations.

The Evidence Link: Contact Us

Use this contact form to provide comments, suggestions, and/or questions about the Medicare Delivery System Reform Evidence Link, or to sign up for Medicare email alerts.

The Evidence Link: A Tutorial

This tutorial walks users through the Medicare Delivery System Reform Evidence Link, including its FAQs and side-by-side comparison tables on Medicare accountable care organization (ACO), medical home, and bundled payment models.