Category: Education

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

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 (https://schs.dph.ncdhhs.gov/data/maternal/).

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 http://nciom.org/nc-health-data/guide-to-accountable-care-communities/

 

 

[1] https://www.ama-assn.org/about/ama-history/history-african-americans-and-organized-medicine

 

 

 

Does Prekindergarten Push against the Curve of Community Change?

What happens when a room full of county commissioners, school board members, and early childhood practitioners spend the day diving deep into the data on preschool education with the state’s leading child development researchers? They start digging into how prekindergarten programs for four year olds push against the curve of community change.

On September 25, 2017, the Thinking Big for Small People group gathered in Chapel Hill for a day of training and reflection. The broader context for this gathering was the North Carolina General Assembly’s decision to increase funding for the state’s standard pre-K program delivered in each county, known as “NC Pre-K,” in its budget for the next two years. Program attendees spanned a continuum of familiarity with pre-K. Some came from communities with a great deal of curiosity, but no consensus about whether they would expand pre-K. Other communities had already set a goal for granting universal access to pre-K.

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How Is the NC Pre-K Program Delivered in Each County?

NC Pre-K is a state-funded pre-kindergarten program administered by the Division of Child Development and Early Education within the North Carolina Department of Health and Human Services. The program serves eligible four-year-olds via classroom-based education in a variety of public and private settings governed by NC Child Care Rules. The state generally limits eligibility for NC Pre-K to children from families whose gross income is at or below 75 percent of North Carolina’s median income. In addition, up to 20 percent of the program can consist of children from families above the income ceiling who exhibit certain risk factors, such as limited English proficiency or a developmental disability. A later blog post will discuss the NC Pre-K program in more detail.

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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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