Category: Community and Economic Development

Accountable Care Communities Offer An Opportunity to Address Healthcare Disparities at the Systems Level

In a previous blog post, which you can find here, ncIMPACT shared information around NCCARE 360, an interdisciplinary referral tool being implemented in the state of North Carolina’s medical care systems. As we continue to research impacts of the health of a community, we find it increasingly important to look at the way data around how changes become integrated with existing cultural norms and daily lives of community members in North Carolina. NCCARE 360 is part of an effort to implement a model of Accountable Care Communities (ACCs).


ACCs aim to address health at the community level through addressing the social drivers of health and looks at health on a systems level to better coordinate healthcare with a wide variety of stakeholders within a community. This coordination includes involving non-traditional partners in health initiatives, such as faith communities and academic researchers. ACCs have an underlying value of authentic community engagement. In the context of the ACC model, it is not enough to go into communities and give out information. Stakeholders must work alongside communities to create a power dynamic that gives community members agency and self-determination. Under the ACC model, the goal is to elevate the voices of community members who are most impacted by health disparities. For example, specific race groups are more likely to experience disparities within population health–those voices need to be amplified within this model.



Health Inequities by Race

In fact, the data suggests that many health initiatives have historically neglected or taken advantage of specific race populations, such as the Native American and African American communities (see Black-White Disparities in Health Care Report, released by the American Medical Association[1]). Racial disparities in health begin even at the stage of conception. African American babies are more than twice as likely to die during childbirth than white or Hispanic babies in North Carolina. While white babies die at a rate of 5.4% in North Carolina (comparable to the Hispanic rate of 5.5%), Black babies die at a rate of 12.4% (see figure below from NCDHHS).



Maternal mortality rates are alarming in general, but when analyzed by race, it is evident that Black mothers have a totally different experience during pregnancy and childbirth than their racial counterparts. In 2013, in the state of North Carolina, the maternal mortality rates for Black and white women was almost the same, with the white racial category making a large jump up in rates and the Black racial category briefly falling. However, since then, the numbers have since diverged once more. Today, a Black woman in North Carolina is 3x as likely to die from giving birth than a white woman. From 1999-2013, Black women accounted for 49% of the deaths due to childbirth in the state of North Carolina, while African Americans make up 22% of the state’s population (

While working with the Kate B. Reynolds Charitable Trust on their targeted health strategies, our interviews with experts repeatedly brought up the importance of cultural competency at the systems level to address disparity. For example, one anonymous interviewee we spoke with mentions struggles with healthcare perceptions for older African American men:

“He grew up in a time where he knew studies were being done on Black people. Telling him he needs to go to the doctor brings up distrust for him. Entering into those large facilities, he’s not inclined to do that. He needs a provider that looks like him and be able to come to a place that feels safe.”


These disparities are alarming and to begin addressing these health inequalities, research and reports indicate that strategically culturally appropriate care, community capacity building, and homegrown community leader involvement will all need to be present as a start to making the state’s health system more culturally appropriate. These non-traditional partnerships implemented in Accountable Care Communities will require a breaking down of walls for everyone involved–silos will need to be removed for an integrated community care system.

For more guidance on implementing the ACC model, please see the following guide, provided by Kate B. Reynolds Charitable Trust and Duke Endowment, visit







ncIMPACT Town Hall on the Economic Impact of Outdoor Recreation


The broadcast will also air on the NC Channel on June 27th at 9pm and will on June 30th at 2pm.

The ncIMPACT Initiative at the UNC School of Government partnered with Western Carolina University, Mountain Biz Works, UNC-TV, and Civic Federal Credit Union to highlight efforts in Southwestern NC to leverage natural resources for economic development. The broadcast will offer a great way to help leaders in other regions of our state better understand the outdoor economy in Southwestern NC by covering the economic impact of outdoor recreation, stewardship of natural resources, and strategies to stimulate the outdoor economy.

“The outdoor economy refers to the money that is made and spent around activities that take place in nature.”

Panelists for the ncIMPACT Town Hall at Western Carolina University include:

  • Jeremy Hyatt, Eastern Band of the Cherokee Indians
  • Barry Jones, U.S. Forest Service
  • Lisa Leatherman, Duke Energy
  • Cory McCall, Outdoor 76
  • Arthur Salido, Western Carolina University
  • Sarah Thompson, Southwestern Commission

“People underestimate the size and scale of the industry,” according to panelist Arthur Salido, executive director for community and economic engagement and innovation at Western Carolina University. “[F]or hundreds of years Western North Carolina was the playground for the Southeast…now it’s really a national and international destination.”

Read more from Blue Ridge Outdoors:

“Outfitters have sprouted from the pastoral banks of the North Fork to urban stretches of the French Broad. Mountain communities are reinventing themselves to attract hikers, mountain bikers, and climbers. Revamped downtowns across the region are complete with microbreweries and Airbnbs. And the region’s national forests and state parks are being reimagined not just as weekend getaways but as economic support systems for small towns and entire states alike…A recent report by the Outdoor Alliance found that the Nantahala and Pisgah National Forests—just two of more than ten national forests across the larger Appalachian region—host 4.6 million visitors annually and plug $115 million into local economies each year.”

These ongoing statewide ncIMPACT Town Hall events enhance the weekly ncIMPACT series. Just as we take ncIMPACT into communities, tackling problems head on by meeting with bold, positive change agents, the ncIMPACT town halls serve as a convening for a region’s residents, businesses, non-profits and government organizations to share their stories, ideas and solutions.

ncIMPACT is designed to get North Carolinians excited about these opportunities for creating positive change in their communities and in North Carolina. In addition to over-the-air broadcasts, explore ncIMPACT online anytime at The site features individual episodes, segments and web extras.


Decreasing Cost and Increasing Quality: Value-Based Care Could Improve Communities

Co-Author: David Brown

According to the America’s Health Rankings by United Healthcare, North Carolina ranks 33rd in the country. As the ncIMPACT Initiative works alongside North Carolina stakeholders to solve complex problems, we increasingly hear concerns about how the state’s health outcomes affect community economic vitality. It is important to fit these conversations into the context of the changing health systems around us. As a patient, citizen, and community member, you may hear a repetitive term in this context: value-based care. What is it? What solutions does it promise, and what potential problems could it cause?


What is Value-Based Care?

In a granular sense, value-based care refers to health care programs based on incentives: care providers should have a financial stake in basing their care on patient outcomes rather than the number of tests, procedures, or other interventions (sometimes called volume-based care). In the case of Medicare, where the transition to value-based care is occurring most prominently, the federal government hopes that aligning provider reimbursements more closely to health outcomes will ultimately result in better care for individuals, better health for populations, and lower costs for everyone. Other valued-based reimbursement programs administered by the federal government include the Skilled Nursing Facility Value- Based Purchasing Program and the Home Health Value-Based Purchasing Model. This is part of a steady transition toward value-based care at the national level.


The Challenge of Health Costs

Everyone knows – often from experience – that health care can be costly. Some drivers of health care costs are obvious: investments in highly trained personnel and highly specialized equipment; the chronic nature of some diseases; and the willingness to spend almost any amount to prolong life and avoid pain. Little can be done about these cost drivers in our current system. However, much can be done to control costs by incentivizing preventive care, minimizing complications from chronic diseases, modernizing medical record-keeping to avoid unnecessary tests and procedures, and treating diseases and other ailments that tend to occur together as a single health problem, rather than as multiple.

Transitioning to a system where health outcomes are prioritized over the number of appointments and procedures makes intuitive sense, but there are pitfalls to avoid on the road to value-based care. Measuring health outcomes is complicated and lacks an agreed-upon methodology across providers. Further, a system that dis-incentivizes proliferating appointments and tests runs the risk of denying aggressive care to patients for whom it may be appropriate. In addition, there may be a long learning curve as everyone from major hospitals and insurers to small private practices adjusts to the new world of value-based care. Finally, any change that increases reporting requirements is likely to divert providers’ time away from more patient-focused tasks.

Further, hand-offs between specialists as part of a comprehensive care plan are more likely to be successful than if the patient has to seek out each provider on his own. The ultimate goal of improved health means fewer hospital stays and, in the case of a Medicare or Medicaid recipient, lower costs for the government. And if provider reimbursements are tied to improved health, rather than the number of interventions, the incentives for the provider might be higher for patients with a higher likelihood of improved health outcomes.


The Potential for a Promising Response: NCCARE 360

Advanced medical record keeping will become increasingly important with the move to value-based care. NCCARE 360 is a new statewide coordinated care effort that will electronically track, connect, and refer patients through an accountable care  network. This is a person-centered approach in which community members and providers in North Carolina will have access to:

  • A statewide resource directory
  • A community resource repository
  • A referral platform

Experts have recently established that while around 20% of health determinants are around access to healthcare, the other 80% are referred to as the Social Determinants of Health (SDOH). NCCARE 360 will allow for a team of providers and social organizations to track health outcomes of a patient together, with a comprehensive care plan that works in real time. Not only will the patient be a part of an accountable care community, they will also have access to services not typically associated with medical care: housing services, access to healthy foods, domestic violence services, and other SDOH resources.

Image result for social determinants of health graphic

The promise of cost savings, greater efficiency, and better health outcomes will speed the adoption of value-based care in the coming years, as will legislation and regulations that require it. But providers and patients alike will need to be vigilant to ensure that the dollar-related outcomes are not prioritized over those related to patient health and well-being. NCCARE 360 gives an opportunity to impact health outcomes from a person-centered, community approach, creating accountability. NCCARE 360 will be implemented in every county in North Carolina by the end of 2020.


For more information, visit:


Image result for nccare 360


Sticky Floors Impede Economic Mobility in North Carolina

The ncIMPACT Initiative recently completed a project examining poverty in Forsyth County for the Kate B. Reynolds Charitable Trust. Our focus quickly narrowed to the related issue of economic mobility – the ability of low-income Forsyth residents to significantly change their income or wealth over their lifetimes or the generations that follow. Of course, such examinations of economic mobility are inextricably tied to measures of an economy’s inclusiveness.

At the differing levels of city, county and country, global voices are increasingly raising important questions about the adequacy of old economic productivity measures to tell us what we need to know about the inclusiveness of economies. Think tanks and other advocates increasingly point out that commonly used measures, such as Gross Domestic Product, for instance, fail to consider the inequalities that lie beneath usual measures of well-being.

We found those critiques useful as we did our work in Forsyth County. The economy is transitioning from its historical reliance on tobacco and textiles, and the county is creating an impressive number of new economy jobs. However, a significant percentage of the local labor force does not have the skills required for this new economy. ncIMPACT’s research revealed that, for too many Forsyth County residents, the barriers to jobs that pay a living wage seem insurmountable. In essence, the local economy is not inclusive.

One of the ways in which economic mobility typically occurs is through advancing one’s educational status. Although our study found a clear desire for more education and training opportunities, barriers remain. Participants express the needs that must be met for this to happen. The most common need, expressed by respondents at a rate of 60%, is affordable education supports (e.g. transportation, childcare). Developing skills for available jobs often requires formal training and education. Providing additional resources to those who need additional support for advancement is one way an economy can become more inclusive.

ncIMPACT is not the first group to notice that Forsyth County’s economic inclusion measures lag behind its economic growth and prosperity numbers. In 2017, the Brookings Institution evaluated the nation’s 100 largest metropolitan areas along three dimensions: growth, prosperity, and inclusion. Based on the indicators used and composite scores generated, the Winston-Salem metropolitan area ranked 79th for growth, 73rd for prosperity, and 85th for inclusion.

The authors of the Brookings report explain, “Inclusion indicators measure how the benefits of growth and prosperity in a metropolitan economy—specifically, changes in employment and income—are distributed among individuals. Inclusive growth enables more people to invest in their skills and to purchase more goods and services.”  Similarly, the Rockefeller Foundation recently defined an inclusive economy as one that provides expanded opportunities for a more broadly shared prosperity, especially for those facing the greatest barriers to advancing their well-being. Simply stated, an inclusive economy offers more opportunities for more people based on five interrelated characteristics:

  1. People are able to participate fully in economic life and have a meaningful say over their community’s future.
  2. True opportunities are available to enable upward mobility for all groups of people.
  3. The local economy produces enough goods and services to enable broad gains in well-being and opportunity.
  4. Individuals, communities, businesses, and governments have a sufficient degree of confidence in their future and an increased ability to predict the outcome of their economic decisions.
  5. Economic and social wealth is sustained over time, thus maintaining intergenerational well-being.

For more information on inclusive economies or ncIMPACT’s findings in Forsyth County, see


ncIMPACT Top Tweets on Inclusive Economy

  1. @uncsog professor Jonathan Morgan @sog_ced provides great summary of work on #inclusive #economicdevelopment @IEDCtweets @EconomicPolicy @CenterOnBudget @AtlFedComDev @urbaninstitute @pewresearch @BrookingsInst @leagueofcities
  2. From @publicmediaNC & @uncsog Education is Key to #economicmobility & #inclusiveeconomy – with insights from @InmarInc @KateBReynolds @WSSURAMS about efforts in @ForsythCountyNC
  3. Building #socialcapital strengthens #inclusiveeconomy & #economicmobility efforts in @ForsythCountyNC according to @CityofWS @anita4nc @NCWorks_PTriad @PTRC_NC @KateBReynolds @davidsonccc @publicmediaNC @uncsog
  4. In 1940, 90% of children grew up to earn more than parents. Now that number is half. How can we best prepare children for #economicmobility and build #inclusiveeconomy? @anita4nc asks #community experts from @ForsythCountyNC @publicmediaNC @uncsog
  5. As defined by @RockefellerFdn, #inclusiveeconomy provides opportunities for broadly shared prosperity, especially for those facing greatest barriers to advancing well-being. 5 characteristics: #equity #participation #growth #Sustainability #stability
  6. In 2017 @BrookingsInst evaluated 100 largest #metropolitan areas along dimensions of #growth, #prosperity & #inclusion. See how @CityofWS @RaleighGov @greensborocity @CLTgov regions & others fared:
    @NCLeague @NCACC @Metromayors @LeadNC @uncsog @sog_ced
  7. Efforts to help #cities & #regions achieve #inclusiveeconomy need to recognize local differences as @berubea1 @BrookingsInst describes. 5 characteristics: #equity #participation #growth #Sustainability #stability
    @NCLeague @NCACC @uncsog @sog_ced
  8. @DukeSanford report describes #skillsgap challenge that must be overcome for #inclusiveeconomy. #Jobs go unfilled b/c employers can­’t find workers with right skills. #MiddleSkill jobs represent 56% of NC labor market @SkillsCoalition @LeadNC @uncsog


9. Consider using these #InclusiveEconomy #indicators to evaluate your #community @EverettProgram @USCDornsife @RockefellerFdn @NCLeague @NCACC @Metromayors @LeadNC @uncsog @sog_ced @NCRuralCenter @urbaninstitute

10. Which #strategy do you think would best support #youth & young adults in efforts to build #InclusiveEconomy?
@NCLeague @NCACC @Metromayors @LeadNC @uncsog @sog_ced @NCRuralCenter @emergingissues @myFutureNC @EducationNC #nced #ncpol @ncawdb @ncworkforce

Survey options:

  1. Improve job information available
  2. Provide high-demand skills training
  3. Increase work-based learning opportunities
  4. Invest in business ideas of youth


Women in Construction

When more residents thrive, communities thrive.

Talent is essential for growth and competitiveness. When the potential of women is not fully harnessed, companies and communities lose out on skills, ideas, and perspectives that are critical for addressing challenges and maximizing new opportunities.

This reality is proving especially true in the construction sector for the greater Triangle industry, and communities are responding in innovative ways.

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Best Practices in Place-Based Grantmaking

Nathalie Santos is a student in the UNC School of Government’s Master of Public Administration program and a researcher for ncIMPACT. A graduate of Temple University,  she worked for a variety of education-focused nonprofits in the U.S. and Malaysia before coming to UNC. This is her first blog post for ncIMPACT. 

Much like Future Ready Communities, place-based grantmaking focuses on a location or place instead of a specific program or service. The Aspen Institute and Council on Foundations offer various strategies for place-based grantmaking that can also inform efforts toward ensuring a community is future-ready. Read on for their recommendations and best practices.

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What You Told Us in the ncIMPACT Planning Survey

We launched ncIMPACT in 2017 to help public officials in North Carolina navigate critical policy challenges across a wide range of topics, including health, education, economic development, criminal justice, public finance, and the environment. As we planned this new initiative, we wanted to hear from practitioners and other citizens about the most vexing policy issues in their community and in the state as a whole, and what we could do to help. As such, in January 2017 we drafted an online survey and distributed it with the assistance of various peer associations and a targeted Twitter campaign. Over the course of two months, we received 154 responses to our survey. Please read on for an analysis of our results.

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Welcome to the ncIMPACT blog, where we feature posts on the following topics:

  • Community and Economic Development
  • Criminal Justice
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  • Public Finance
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