Vital Directions for Health & Health Care: The North Carolina Experience

Abstract

In 2019, the National Academy of Medicine (NAM) turned to the all-important state level to draw insights on the status of health and health care within the context of the NAM Vital Directions for Health and Health Care initiative. The NAM held a two-day symposium in the Research Triangle to bring together various stakeholders to better understand actions that states and localities are taking to achieve—and the barriers they face in pursuing—more affordable, value-driven quality care and health outcomes. The NAM purposefully chose to pivot to the state level with North Carolina given that it has been at the forefront of health care transformation and illustrates the promise but also the challenges facing US health and health care nationally. A 19-member planning committee, cochaired by NAM President Victor Dzau and Secretary Mandy Cohen of the North Carolina Department of Health and Human Services, selected topics that resonate with the state’s activities within the context of the Vital Directions framework, ranging from empowering people and connecting care through the integration of social, physical, and behavioral health to payer alignment though the advancement of new payment models (Figure 1). The priorities discussed during the symposium continue to be central to health reform in North Carolina and are further explored in the commentaries in this issue. Note from authors: The World Health Organization declared COVID-19 a global pandemic on March 11, 2020, while this issue was undergoing preparations for publication. The issues covered in the symposium that inspired the papers that compose this issue are not only relevant in the context of the COVID-19 pandemic—they become even more critical. Identifying and addressing health disparities are critical aspects of combating the pandemic, as evidence emerges that black and Latinx communities have significantly higher case fatality rates than their white peers. Integrating physical, behavioral, and social health becomes vital as lower-income individuals are more likely to be “essential” workers who are more frequently exposed to COVID-19 than those individuals who are able to work from home and shelter in place. Emerging evidence also supports that many Americans are suffering from mental health distress during the pandemic, and mental health access was challenging to access for many individuals even before COVID-19. Data sharing has never been more vital. We are completely dependent upon our 21st century health workforce, members of which are working tirelessly under extreme conditions to care for those who are ill. Vital directions for health and health care were critical prior to the pandemic—COVID-19 has put our health system under additional burden, and needed reforms have never been more apparent.