Social Determinants of Health: Impact Health and the Healthy Opportunities Pilot - WNC Health Policy Podcast Ep. 6

The roots of our health are entangled in our everyday environment. Including factors such as our living environments, relationships, food, income, education, or communities, the non-medical domains that impact our health and wellbeing are called the Social Determinants of Health (SDOH). As public health workers look ‘upstream’ for ways to improve the health and wellbeing of our communities, addressing the SDOH is both effective and cheaper than ‘downstream’ health impacts like chronic illnesses. 


In North Carolina, public health workers identified a waiver that allows Medicaid funding to be directed towards SDOH programs. Currently manifesting across 3 regions of N.C., the Healthy Opportunities Pilots (HOP) is building organizational capacity, like funding for staff, for human service organizations that address the SDOH. To learn more about this innovative pilot, HPI Podcast host, Andrew Rainey, spoke with Dionne Greenlee-Jones, the HOP Senior Director of Innovation and Equity Development based in the WNC pilot, Impact Health.

Note: This podcast was originally recorded on November 1st of 2023, so many of the data and figures mentioned in the show have since changed/increased. You can view the updated information in this Impact Health/HOP slide show, which was presented on March 15 at the WNC HPI’s 2024 WNC Legislative Caucus event.

You can also learn more about HOP and SDOH in our previous blog post In The News: NC Medicaid’s Healthy Opportunities Pilot (published Oct 6, 2023).

Transcript

WNC HPI Podcast: Social Determinants of Health: Impact Health and the Healthy Opportunities Pilot

3/20/2024

AR: Andrew Rainey

DGJ: Dionne Greenlee-Jones

EB: Erin Braasch 

DGJ: What would happen if we were able to connect people to services’ around transportation and housing, and food throughout WNC, in order for us to be able to look at how we can prevent conditions from becoming more severe? So, N.C. is the first state in the country that’s doing this work- talk about innovation!

 

Introduction

AR: You're listening to the Western North Carolina Health Policy Initiative (HPI) podcast. I'm Andrew Rainey. In each installment we’ll speak about different public health strategies for improving health and well-being in Western North Carolina (WNC).

Recorded between the studios of AshevilleFM and the mountainous internet waves of Appalachia, in this installment, a conversation about the social determinants of health (SDOH) and the Healthy Opportunities Pilot in WNC.

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In this episode of the HPI podcast, we’ll be listening back to an interview record on November 1st of 2023. In it, we’ll learn about a pilot program that intersects with many of the challenges we’ve heard about in previous installments of the podcast: housing, food security, transportation, safety, the healthcare workforce, and the cost of resources. . .  Expected to be expanded in November of 2024, this pilot represents a new direction for healthcare funding in N.C., and may influence health policy nationwide. 

I’m privileged to be joined by the Senior Director of Innovation & Equity Development, Dionne Greenlee-Jones, from the Healthy Opportunities Pilot (HOP), Impact Health.  Dionne, thank you so much for joining me to speak about the SDOH and the Healthy Opportunities Pilot (HOP).

 

DGJ: Thank you so much for having me here, Andrew. We’re excited to share more information about Healthy Opportunities.

 

Social Determinants of Health (SDOH)

 

AR: Before we jump into what the HOP is, I wonder if you could break down a term that’s tied to this conversation. . .  and while it shows up regularly in public health, is kinda jargony for most folks. . .  

What are the SDOH and why are they important to talk about?

 

DGJ: When we think about social drivers or social determinants, they’re the nonmedical conditions, experiences, that help contribute to a person's whole wellbeing. So, it's actually about 80% (of factors contributing to your health), and we’re talking about things that shape someone’s life from day to day. Access to transportation, food, housing opportunities, and not just those, but also, economic development, systems that affect one’s life whether they’re great systems or not so great systems. When we’re talking about systemic racism, when we’re talking about educational opportunities. . . all of those nonmedical instances of systems that we just from day to day don’t think about. . .  we take them for granted. If you’ve had access to healthy foods all your life, or you’ve had access to housing, you haven’t experienced homelessness. . . those things that you have access to can shape your life positively or negatively. And those are all considered SDOH. They ultimately can affect our health outcomes and that’s why they're so important for us to talk about. . . 

 

AR: Could you walk us through an example?  

 

DGJ: If you have individuals who have not had access to some of the more favorable aspects of these determinants, then we’re seeing individuals have to go to the emergency room for care on a regular basis. Which is not a good thing. One,  if someone’s not seeing a primary care physician or care provider on a regular basis then the situation is really severe. So, it's not only that where you're looking at trying to halt something from getting worse, you’re also thinking about when it comes to ER visits, they’re very expensive. . . 

 

AR: It brings up that ‘ounce of prevention is a pound of cure’ sort of thing for the diseases and medical conditions we usually hear about. . . and, I guess that preventative care is also cheaper, right?  

 

DGJ: You are correct Andrew, particularly if they have a condition that’s become a chronic care condition, it means that they are not as healthy as they could’ve been if something was addressed previously or a long time ago and they had adequate transportation. They had transportation to get to a doctor’s appointment. . you know, if they had transportation  to go and get healthy foods. . .  so we’re talking about a lot of things that can influence one's health. . and the 80% of one’s health is actually along these social determinants. . .  the 20% is more what we talk about with medical issues with someone. . 

 

AR: For folks interested, you can see how those numbers were reached in a study published in 2016 by Carlyn Hood et al. that used data from the 2015 County Health Rankings (CHR) across the U.S. to see that relationship between health factors, like transportation, and outcomes, like heart disease.   

And we have data in WNC too. The WNC Health Network, for example, has data stories on many different health inequities in WNC. Here's their Executive Director, Erin Braasch:

 

EB: Income affects health in many ways. Our ability to purchase health care, the quality of the food we eat and homes we live in along with our level of education, and our work status all influence our health. We know that lower incomes are connected to poorer health outcomes. For example, compared to higher earners, our lower income neighbors in WNC are 3.6 times more likely to report being diagnosed with heart disease.

 

AR: In addition to heart disease, we know that poverty increases health risks across the board and impacts a lot of folks here. . .

 

EB: Over 1 in 10 adults live in poverty in western North Carolina.

 

AR: To learn more about the non-medical factors that influence health, also known as the SDOH, you can see the data stories of the WNC Health Network @ wnchn.org.

 

Healthy Opportunities Pilot (HOP): Impact Health

AR: Dionne, as y’all note on the Impact Health website, “ninety percent of U.S. healthcare spending goes to medical care, but 80% of what affects a person’s health happens outside of a medical setting,” being a SDOH. . .  And that’s where the pilot steps in, right? Can you walk us through what the HOP is and how it arrived in WNC?

 

DGJ: Well, it’s interesting about how the pilot’s idea kinda came about. Dr Mandy Cohen, who is now actually, the director of the CDC was here in NC directing a lot of initiatives, and I understand there were conversations that she had with individuals about ‘what would happen if we were able to connect people to some of these services’ in order for us to be able to look at how we can prevent conditions from becoming more severe. . And so then, the NC DHHS applied for this 1115 waiver. . . 

 

AR: A provision under the Social Security Act where states can make changes to Medicaid funding . .

 

DGJ: . . . which allowed the state to be able to say “how can we shift resources in order to cover non clinical needs for individuals- particularly for Medicaid Managed Care entities, which was almost just a pipe dream really. . .  people were like “are we really going to be able to do this?”  So, NC is the first state in the country that’s doing this kinda work- talk about innovation. 

So that means now that the Medicaid Managed Care individuals who are eligible for the pilot will now have access to nonmedical transportation, food, and several different service areas.

And so when we talk about that, we’re really going against some of the pitfalls, I guess what you would talk about, in the region. We know a lot of NC, and a lot of WNC is very rural. . .so we know that oftentimes there are issues with transportation needs. There are issues with people getting healthy food when we have several you know food deserts throughout the region because of the rural area. Are people able to get where they need to go? What about housing? Housing is a big need everywhere, but in WNC, it’s also a really strong need. So it's been a great way of saying particularly from us looking at data, and looking at the needs of WNC, and also the needs throughout the state. . what are the prevalent issues here, and how can we work to pivot to address some of these?

How do we make sure that our most vulnerable can receive services in SDOH, but also in a way that looks at how expensive it is, again, for people to rely on emergency rooms and urgent care facilities to get the help they need, and then still often were not being able to get needs addressed along social drivers. . . .

 

AR: Ok, so because we have a lot of health challenges connected to the SDOH here, folks in N.C. were wondering how to fund them, and then found this creative way to use this waiver with Medicaid! And with that waiver, now it's possible to use Medicaid money to cover health challenge areas like food, housing, and transportation . . .

 

DGJ: The Center for Medicare and Medicaid was able to grant N.C. access to millions of dollars to be able to address this. With that being a strategy, it meant then that N.C., all of a sudden, was a part of this grand, and we think successful, experiment to address these needs. . . .using Medicaid money that came down from the federal government through the state, the NCDHHS, and then each network lead would get an allocation of that. . .

It’s a part of N.C.’s Medicaid Transformation strategy, and again, with the granting of the 1115 waiver, it meant that Medicaid funds could address nonmedical drivers in a way that has not been done before. . . And so when that happened, it opened up the opportunity in 3 different regions in N.C.. . . With WNC, we’re in 18 counties and the Qualla Boundary; Impact Health is referred to as a network lead. . In the other part of the state, the eastern part, there are 2 more regions that are smaller than what we’re looking at county-wise in WNC. . . 

 

AR: So it starts with this waiver, which gives Medicaid dollars to fund these pilots. And Impact Health is the version of the pilot found here. . .  How is it that these SDOH services are being provided?

 

DGJ: We actually have about 52 organizations that are participating in the WNC network that are offering all of these service types. . . 36,000 services to date in the last year and a half have been provided to WNC residents. . . 

 

AR: This interview was recorded on November 1st, 2023, since then these numbers have grown substantially! You can visit Impact Health’s website wnc-hop.org/impact for a more recent snapshot.

So organizations are connected to Impact Health to offer SDOH supports. We’ve heard other guests remark that organizational collaborations are a regional strength. That really seems true for the pilot as well to have that many different groups. ..

 

DGJ: Yes, we’re just excited that organizations are willing to come together to address those domains. . .and when it comes to resources, we know, and I guess this is an old adage, its like stone soup: the more that all of us come together with our talents and resources, the better the outcomes are going to be. . we’ve learned that. So, it is positive to have organizations that are really willing to work with each other.

I like to refer to it as strong relationship capital. WNC has such a great number of nonprofit organizations, human service organizations (HSOs), and that’s exciting. . and the fact that we’re able to work with many strategic partners in the region that have deep roots in WNC. . . When we’re talking about MAHEC, when we’re talking about MANNA foodbank, when we’re talking about the Mission Health System and other. . .  the health departments throughout WNC. There are organizations that are just really committed to partnering within every county about how can we work together to improve and make better health outcomes and that’s great, because you just don’t always see this spirit of collaboration to the extent that you see in WNC.  

 

AR:. Could you talk some more about how that Medicaid funding makes it to these organizations from the pilots?

 

DGJ: HSOs through this pilot become somewhat like a billing entity- there's a fee schedule of those services that are covered, they’re able to provide those services and then through Impact Health, send invoices that go to private health plans, health plans, and then they get reimbursed for that work. Again, something just totally unheard of: you say, “What? Insurance companies are helping by reimbursing nonprofits and HSOs?” Yes. And so, again, another strategy that you didn’t see a lot of until you saw Healthy Opportunities.

 

AR: And so the HSOs get reimbursed for the SDOH services they offer. . .to Medicaid recipients. . . because the needs are high, what happens when the organizations that are offering good services can’t meet the demand?

 

DGJ:  The pilot offers the opportunity to bring resources and capacity building money to support nonprofits that are doing this work in the network. Becoming a member of our network means that you would have the ability to access capacity building dollars if you need it.

There are over $12 million invested to build HSO capacity through capacity-building funds, and particularly to help support staff needs of our nonprofit members. . . and that’s a big one! 

AR: The $12 million dollars invested was as of November 1st of 2023. As of March of 2024, this number had grown to at least $14M in capacity building funds and over $20M in reimbursable income for WNC nonprofits providing pilot services. While over $43M invested in WNC’s social safety net at the time of this podcast's release in total, you’ll have to visit Impact Health’s website wnc-hop.org/impact for even more recent figures. 

DGJ: You know, we hear that nonprofits are on the ground, doing all this work, but the reality is sometimes, just like a lot of other industries, and we saw more of this even during COVID, that the workforce needed support within these nonprofits. . . .So they’ve been able to ask for this capacity-building money and it's been able to go towards funding that, as well as other needs that relate to the pilot. . .

And then, what’s great is we’ve seen individuals be employed using these capacity-building funds, and so that’s powerful because then it also means we’re addressing workforce issues in WNC, we’re not only supporting with capacity building funds the staffing issues that nonprofits, HSOs, may have. . .  but individuals part time and full time are being able to continue this work and that’s something that we’re really proud of. .

 

AR:  So we’ve heard that food, transportation, housing, and safety are the 4 specific domains Impact Health is supporting with Medicaid funding. Could you walk us through how those were picked, and what that support looks like?

 

DGJ: There were lots of studies and honestly, in the early days, when the DHHS were really trying to identify what the greatest needs were with the state. There were focus groups with medical providers, community organizations, where they really wanted to listen, and these were the 4 domains that came to the top when it came to where our greatest needs were.

  1.  So, along the lines of food insecurity, are we talking about healthy food boxes? Are we talking about food prescriptions that people would be able to get actual prescription-like opportunities to have those filled with healthy food?

  2.  Transportation. And it wasn’t just transportation to nonmedical appointments, but also, how do we see support for helping people to purchase vehicles, whether they’re nonprofits, or organizations that maybe needed a refrigerated truck? Or were there families that had a vehicle that needed a repair, and they weren’t able to afford the repairs?

  3. When we look at housing, we know that housing is complicated wherever you go in NC, but particularly when we talk about housing, are there deposits that people might need to have access to? What if there is a home repair? Maybe someone has mold that’s growing in their home. And again, as a Medicaid managed care recipient, could be able to get access. . .  or someone might be in need of a ramp, if they’re elderly or qualified, then they might need something like that added to their home to make it more accessible.

  4.  And then, for personal safety: are there toxic environments that families have been in? Were there counseling services that were needed? Were there IPV domestic violence or interpersonal violence incidents where people would need help with dealing with those?


So the groups looked at those 4 domains rising to the top and then applying fee schedules to those service types. .  So, if a nonprofit or Human Service Organization, or HSO, was able to provide housing, they could be reimbursed for that. And so, it's just grown! It's taken off from this initial group of experts and community members coming together and saying “this is what’s happening in these communities,” there being continued work around how do we address those, and then, really discovering that this is what’s needed.

 

AR: As a recap, NC is trying something new. Because the SDOH, the nonmedical things that affect our wellbeing, have such a big impact on our health, the state has gotten approval to use Medicaid funding to run some pilots addressing them. Dionne’s organization, Impact Health, is one of 3 of these pilot tests, and is based right here in WNC. As a result, Medicaid managed care folks can get support by Medicaid to take care of 4 areas: food, housing, transportation, and personal safety. It also means that our local organizations offering these services can get reimbursed by Medicaid!

After the break, we’ll be back with Dionne to learn more about how the HOP is working in WNC.

 

BREAK

 

Hi everyone, Andrew here on the WNC Health Policy Initiative Podcast, the show that looks at public health strategies to improve health in WNC. We’ve been listening to an interview recorded back in Nov. of 2023, where I speak with Impact Health’s Senior Director of Innovation & Equity Development, Dionne Greenlee-Jones, about the SDOH and the HOP.

Be sure to check our website at www.wnchealthpolicy.org for the transcript or to listen again. We’ll return to my conversation with Dionne in just a moment. . . .

That was Asheville-based Appalachian ballad singer, Saro Lynch-Thomason, humming the old shape note styled ballad ‘Lady Margaret.’ You can learn more about her work and regional music traditions at sarosings.com. And now back to the show:

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In the first part of the show, we heard about the SDOH. . . . as well as how, over the past few years, an innovative pilot called Healthy Opportunities has been able to use Medicaid funding to get those kinds of services covered in WNC. . .  

Dionne, as the central agency for local organizations getting reimbursements for SDOH services, you all offer a lot of capacity building funds for example for staffing. Does Impact Health also bring any of those organizations together? Whether it's to tag-team similar services or learn from each other?

 

DGJ: Yes, one of the things that the pilot really helps support is that interagency county by county communication, particularly when its following an individual. . .  and so maybe you’re able to see Mr. Smith maybe getting assistance in Buncombe County, but then maybe through his travels he also is able to get some support in Swain County, and as a part of NCCARE360 Unite Us, the platform, you’re able to track an individual’s journey. And so that’s really positive again to see the connection of care providers in a platform. . .  that also means that you might be able to address some of the gaps that you might see with Mr. Smith’s healthcare needs. So that’s something that’s come across when we’re looking at how important it is for providers to be able to have a way to communicate. .   when sometimes, a client or patient may not feel comfortable sharing information with every new practitioner they might have to work with. So, to be able to see this, where it's a more streamlined process, where people can fill in the gaps of information through the platform, it's helping to paint a fuller picture of the deeds of an individual and that’s positive.

 

AR: From a systemic point of view, the HOP is addressing some forms of health inequities by investing in local human service infrastructure and expanding access to Medicaid recipients. However, because systems are entrenched and inequities are a part of that, it's a dynamic process to address. As Senior Director of Innovation & Equity Development, could you talk about how the pilot addresses inequities?

 

DGJ: Well, we are really intentional about our efforts in order to address inequity- health inequity, in particular. And this is broader than most people think. . .we’re talking about language justice, we’re talking about any systemic racism, we’re talking about access or the inability to  connect to resources that in some places you’d have a greater chance of doing that. . . So part of what we do is try to make sure people get connected to the resources they need, again along those social determinants. How do we address those so that they have access to resources, they have access to care? They become aware of resources that perhaps they didn’t know they had access to . . so when it comes to health equity, how can we make things overall more equitable for individuals who are experiencing any kind of disenfranchisement. . . 

It's critical to the work we do, whether it’s creating a space for people to feel trust with our organization and the nonprofits that are working with our network. . . whether it's us providing technical assistance and training in order to help educate nonprofits organizations in our network, to help them get them to where they want to be. . .  We also ask all of our organizations what they feel their needs are when it comes to becoming a more equitable organization in their day-to-day operations. . .  So, we kind of look at this as a big family that we’re all trying to become better organizations at doing this health equity work.

And one of my major roles is ‘how do we look at that?’ And then create some innovative opportunities, for example, working on a Community Health Worker (CHW) initiative. We know that CHWs are really critical to providing trustworthy connections in communities all through WNC. How do we empower organizations that work with CHWs so that they can continue to do the work, and how can we help contribute to that success, in partnership? So it's a big conversation, and we always try to consider the factors around inequity, and how can we work together in partnership throughout WNC to address any of those. . .

 

AR:  We’ve gotten to hear some about CHWs in several other HPI podcast installments and how essential they are to healthcare access. If I’m hearing you right, the workforce promotion that y'all are offering with capacity building funds is also supporting this part of our regional workforce.

 

DGJ: Yes, we’re actually currently working on an initiative now that will help organizations that  are working with CHWs- that are hosting them or they are staff of our HSOs. We are working on an initiative now that would provide an opportunity for organizations to apply for additional support in order to support the work that CHWs are doing with their organizations, and so that’s exciting.

 

AR: In 2024, Impact Health is providing up to 6 organizations with $50,000 each to invest in their current CHW workforce to increase access to the HOP and other resources that address critical health-related social needs.

For listeners interested to learn more about CHWs, the NCCHW Culture of Results team created some videos on their website that show off some of the ways that CHWs really create a bridge between resources and community members. We also used some of the audio from that in a recent HPI podcast on language access. And we’ll hear more about CHWs in an upcoming episode.

 

DGJ: CHWs have really done an amazing job of building trust in communities in ways where there was a lack of trust. And we're talking about multiple different community members in different communities that may have different reasons for not trusting systems in general or organizations saying that they wish to help. Being able to have a CHW Guide, and kind of bridge those trust issues is just pivotal for people to really get some of the care they need and maybe they had given up. . maybe you had a bad experience as a community member trying to go in and see a provider about some service you needed and, for whatever the reason, weren’t comfortable.

CHWs have proven, time and time again, to help make those connections and so we’re excited with Impact Health to support the work and elevate the work that CHWs are doing across the state, but especially in WNC

 

AR: As CHWs are bridges between community members and providers, it almost sounds like Impact Health serves a similar role between Medicaid and community organizations. .

 

DGJ: We try to be a connector organization. . .  and the fact that organizations around the state may have really good intentions, but if we're not all connecting on the very basic levels, for us to be able to pool our resources, for us to be able to communicate. . . and you know, We have regular meetings with insurance companies with care managers, with providers about where they’re seeing the needs, because we may not always there to see it, but collectively, we have a better opportunity of addressing needs that are expressed, and so that’s another great part of the pilot, is that we’re able to communicate it in a way that we, I feel, that we probably were not communicating as well previously. . . .  and I think with any pilot, some of it is going to be how we establish and maintain trust. . .  how we work together, collaboratively. . . how we take into consideration the voices that would benefit from having access to these services. . .  that goes a long way. .  

 

AR: As the HOP is near the end of its first few years, are there any strategies you’d like to see used moving forward?

 

DGJ: What we are looking at is a lot of different strategies. . One, just general information- how do we reach out to potential partnership organizations that may not become official members of our network but who have access to numbers of clients that they see could possibly be eligible? We’re working with outreach strategies- How can we work with local health departments? How can we provide information that practices want and need to be able give information to their patients?

We’ve been able to, after the first couple years since launch, with the first domain being food, the most prevalent launching last year in March, we’ve been able to make adjustments and offer suggestions to the DHHS as they’re looking to apply for another 1115 waiver to continue this work, which is an exciting time for us as well. . . .

 

AR: Given this is a new pilot, you have a lot of eyes looking at how it’s working. As you were saying, NC is the first state that’s using those waivers to apply Medicaid funding a little bit differently, and that other states might follow suit depending on how it goes here. . 

Because data is an important tool for tracking just that, how are y'all thinking about data?

 

DGJ : There are hopes and dreams that the data and the impacts that we’re seeing with healthier outcomes will convince everyone that this is something here to stay. What’s exciting, Andrew, is that other states throughout the country are looking at what NC and WNC, what we’re doing, and they’re now applying for the same kind of waivers, which means the momentum is growing. . .  When people are looking at and organizations in other states, if I’m not mistaken, New York is applying for one as we speak, South Carolina is doing a lot of research, and had asked many of us to come down and actually talk about what we were seeing in N.C. I know that Gov. Cooper is interested in this pilot expanding throughout the entire state of N.C. Again, you still have the Triangle, the Triad, and the Charlotte metro area- those are not part of the pilot; We understand that he's interested in the entire state being covered. So, the dream is. . .  and I’m just gonna claim it's going to be a reality. . .  that this is going to continue to grow, and as it continues, we’ll be able to see the success of it.

What’s important to acknowledge is that sometimes, we have to also have a conversation about what success looks like- it's not always about, you know, the numbers of people that receive benefits, but the impact of that one person receiving a benefit. If a young person is a Medicaid Managed Care recipient beneficiary, a food box may impact that entire family. So we have to have conversations also about the impact of individuals being within Healthy Opportunities, within this pilot, or being qualified as a member within this pilot, because then, we’re looking at how this is positively affecting whole families. . . . And if you looked at the numbers of families in a neighborhood that might have been Medicaid Managed Care eligible, how we can see that this is much greater than just us counting individuals, but rather how do we look at the impact of this and that’s what’s really amazing when we look at, you know, qualitative vs quantitative reviews of the pilot, and how they go together to paint a more complete picture than just us counting the number of individuals alone.

 

AR: So the impact here, as yall have seen and heard from others, is big, but I'm hearing that typical data measures don’t always capture that success cause it may be looking in the wrong places, when they focus on the individual, rather than a family or community. . . .  Regardless of what data is collected, are there any external evaluations of how the pilot is going?

 

DGJ:. Duke Margolis is one of the evaluating organizations and they’ve done a great job, and will continue to monitor and ask questions at convenings, and we’re partnering organizations within all of the 3 network lead areas will have convenings where they get to ask what they think? What do you see? and I think that’s going to be critical to continue with the pilot.

So some would say that it’s really early at this point to see how much money was saved, but the wisdom here is that sometimes, it takes a little longer to see outcomes, you know, this wasn’t an overnight situation, it's going to take some time to work with organizations collectively to affect change. . .  and so we know that some movements, I call this a movement in health equity, it takes time for those movements to really take hold- and that’s a big lesson, that we can't rush this. In a pilot format we have an opportunity to make incremental changes and ask questions, and partner with the DHHS. We meet with them on a weekly basis, they’re meeting with the other networks on a weekly basis, and tons of other meetings, but the whole purpose behind that is ‘what can we do better?’ ‘What are you noticing?’ ‘What changes do we need to make?’ And the exciting thing is this is a pilot so we should be able to take advantage of that to continue to grow this and make it a better initiative.

 

AR: Are there any other lessons from your time at Impact Health that you’d like to share with listeners about this pilot and the SDOH?   

 

DGJ: I think that there are lots of lessons. . . there's something to be said for listening to communal voices and communal wisdom. . you know, again, the qualitative aspect of data collection listening, having conversations with stakeholders, conversations with HSO staff members and community members about what they're seeing and what they would love to have help with. . .  but we also know that these domains are still at critical levels when it comes to the need around transportation, housing, and food throughout WNC. How do we continue to make sure that information flow is great and we’re not operating in silos, that we’re able to leverage our resources in a way that everyone benefits a little more perhaps than they did originally. . . and that's exciting.

 

RESOURCES

 

AR: For any listeners out there who happen to be a part of a HSO that offers support on SDOH, how might they get their organization involved so that they can get capacity to some of that capacity-building funding?

 

DGJ: If you are a provider that’s interested in learning more, the team at Impact Health, any of us definitively would be able to come and speak to your staff or at meetings or community engagement opportunities. We’d love to help educate the public as to what’s available here.

We have only begun to look at some of these larger opportunities for partnership. And so, individuals could always go to impacthealth.org and my contact information is there: Dionne Greenlee-Jones, and I’d love for people to reach out if they're interested in us collaborating or explore an opportunity for partnership. There's so many different ways we could partner and I'd love to have conversations with organizations who are interested in helping us move this forward.

And so we’d love to have those opportunities. We’re just waiting on your contacting us.

 

AR: And of course, how can individuals get access to these supports for the SDOH?

 

DGJ: If they are Medicaid managed care recipients or eligible, then they can get screened, they can go to wnc-hop.org, they can call the HOP Help Line at  828-278-9900, and actually get someone to speak with on the phone to help direct them, and then also care managers, they generally have the ability on the back of their Medicaid card- there should be some information there on how to connect to a care manager. They can call those individuals and also have a conversation. . .  so that there are multiple ways for people to connect. If they can go to that website and can actually fill out a form. That’s a short form, but it would allow the connection also to individuals to ask questions, so there are many opportunities for people who are interested in discovering if they are eligible to receive some of the benefits, because, you know, there may be some individuals in a family that are not eligible, but there might be a whole lot of individuals in one’s family that are, and again, that means that the entire family benefits from these resources.

And so, if individuals have additional questions about Healthy Opportunities or Impact Health, I just would encourage them to call us or reach out to us in whichever way they feel most comfortable so that we can have the opportunity to answer any questions and point people in the right direction..

 

AR: On this edition of the HPI Podcast, we’ve been speaking with Dionne Greenlee-Jones, the Senior Director of Innovation & Equity Development at WNC’s HOP, Impact Health. You can visit Impact Health’s website for a current snapshot of their impact in WNC @ wnc-hop.org.

Dionne, thank you so much for spending this time with me, talking about the HOP and the SDOH!  

 

DGJ: Thank you so much, this has been a pleasure, and again we’re just waiting to answer any questions and then see how we can work to help individuals get access to the services, if eligible, that they are seeking, so again it's been a pleasure today, Andrew, to have this time to share. . .

 

OUTRO

AR: You've been listening to the WNC Health Policy Initiative Podcast through the NC Center for Health and Wellness at UNCA. To listen again or learn more about public health issues in WNC, check out the website @ wnchealthpolicy.org. To find some of the resources mentioned in this show about the HOP and SDOH, head to the blog section at the top of the website where you’ll find additional show notes.

If there’s a WNC health issue that you’d like to hear more about, speak about, or comments about anything you’ve heard on an HPI podcast, feel free to send us an email at info@wnchealthpolicy.org.

A big thanks to the AshevilleFM Studios where this installment was recorded.

You can visit Impact Health’s website for further updated information on services and collaborations, as well as opportunities to connect yourself or your organization to their work addressing the SDOH in WNC. Visit wnc-hop.org to learn more. 

For listeners looking for data, here’s a quick PSA from one of this show’s contributors:

EB: This is Erin Braasch, executive director with WNC Health Network. Every three years, our organization develops a comprehensive regional dataset to understand health challenges and strengths in our communities. This dataset is the foundation that launches local and regional community health needs assessments for our public health agencies and hospitals.

Data is an important tool to help people and organizations improve community health and well-being across Western North Carolina. To learn more, visit: www.wnchn.org/wnc-data.

AR: A big thanks to Erin Braasch and the Health Network team for all the resources on their website!

To find more information about CHWs, see the North Carolina Center for Health & Wellness’s 2023 Community Health Worker Evaluation, as well as the North Carolina Community Health Worker Association’s website.

Another big thanks to Asheville-based Appalachian ballad singer Saro Lynch-Thomason for humming the old shape note styled ballad Lady Margaret in the mid show break. You can learn more about her work and regional music traditions @ sarosings.com.

Other music included in the podcast includes old ballad, Little Margaret, performed on banjo by Cath and Phil Tyler. Found on the FreeMusicArchive, it’s licensed under an Attribution- Noncommercial-Share Alike 3.0 United States License.

Additional music on the podcast included the tracks Some Nights End, Night Music, The Silver Hatch, Great is the Contessa,  Lover’s Leap, Apple Spice, Talens Bal, A Catalog of Seasons & Night Watch by the Blue Dot Sessions; These tracks are found on the FreeMusicArchive under license attribution international CC BY 4.0.

Be sure to check the website for more HPI podcast episodes and other resources @ wnchealthpolicy.org. Thanks for listening.

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Language Access Part 2: Language Access in WNC - WNC Health Policy Podcast Ep. 5