The North Carolina Way: emerging healthcare system and faith community partnerships

ABSTRACT

United States healthcare policy has promoted the development of healthcare systems and community partnerships designed to decrease costs and readmissions, particularly for under-served populations. Typically, these partnerships are “hospital-centric”, focused on following in-house clinical costs into the community. Two contrasting large-scale community system models show results from development practices, integrating faith community partnerships that affect healthcare utilisation. This “community to hospital” focus is key to several such initiatives in the US. This article describes local implementation efforts in North Carolina, known as “the North Carolina Way”, and tests assumptions on implementation practices for creating robust faith-community and healthcare partnerships.

Aux États-Unis, la politique des soins de santé a promu le développement de partenariats entre les systèmes de santé et les communautés dans le but de réduire les coûts et le nombre de réadmissions, en particulier parmi les populations marginalisées. Généralement, ces partenariats sont « hôpitaux-centrés » et axés sur l'implication communautaire dans la gestion des coûts médicaux internes, inhérents aux soins administrés à la suite d'un séjour à l'hôpital. Deux modèles opposés de systèmes communautaires à grande échelle ont produit des résultats de leurs pratiques de développement, intégrant les partenariats avec des communautés confessionnelles qui ont un impact sur le recours aux soins de santé. Cette approche de la « communauté vers l'hôpital » est essentielle à plusieurs de ces initiatives aux États-Unis. Cet article décrit les efforts locaux de mise en œuvre de cette approche en Caroline du Nord, connus sous le nom de « The North Carolina Way », et examine les théories sur les pratiques de mise en œuvre visant à créer des partenariats solides entre communautés confessionnelles et soins de santé.

Las políticas implementadas en torno al cuidado de la salud en Estados Unidos han impulsado la creación de sistemas de salud y el establecimiento de alianzas comunitarias, cuyo objetivo es reducir costos y readmisiones, especialmente en los sectores más desatendidos de la población. Normalmente, estas alianzas están centradas en los hospitales y enfocadas en la participación comunitaria en la gestión de los costos médicos internos, implicados por los cuidados proporcionados después de una hospitalización. La existencia de dos modelos contrastantes de sistemas comunitarios a gran escala da cuenta de los resultados producidos por varias prácticas de desarrollo en las que se integran alianzas de comunidades confesionales que afectan el uso de los servicios de salud. El enfoque “de la comunidad al hospital” resulta fundamental para varias iniciativas adicionales en Estados Unidos. El presente artículo examina la operación de este enfoque a nivel local en Carolina del Norte, en el llamado “modelo de Carolina del Norte”, a la vez que comprueba supuestos relativos a la implementación de prácticas encaminadas a generar sólidas alianzas entre las comunidades de fe y el sector salud.

KEYWORDS:

• Civil society – Partnership
• Social sector – Health
• North America (exc. Mexico)

Acknowledgements

Huge credit is due to the KBR Fellows cohort, much of whose “on the ground work” is reflected in this article: Annika Archie, Dean Carter, Melanie Childress, Phillip Long, Lisa Marisiddaiah, Helen Milleson, and Dennis Stamper. We also thank WFBMC colleagues Emily Viverette (Director of FaithHealth Education) and Jeremy Moseley (Director of Community Engagement), as well as Memphis MLH colleague, Bobby Baker (Director of Faith and Community Partnerships) and Randolph Hospital Chaplain Barry Morris for their input. Chris Gambill (Cooperative Baptist Liaison) deserves special credit for the idea of the Connector role, while efforts of Liaisons Leland Kerr (North Carolina State Baptist Convention) and Anita Holmes (General Baptist Convention) are also deeply appreciated. All Connectors and Supporters’ work has been critical in building these networks and capturing data.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes on contributors

Teresa Cutts is Assistant Research Professor at the Wake Forest School of Medicine’s Public Health Sciences Division, Department of Social Sciences and Health Policy.

Rev. Gary Gunderson is Vice President of the FaithHealth Division at Wake Forest Baptist Medical Center and holds faculty appointments in the Wake Forest School of Medicine and Divinity School.

Notes

1. In the USA, the term “health system” usually describes a cluster of health facilities (as opposed to other articles in this special issue, where the term “health system” applies to the entire complex entity inclusive of all health-related facilities and actors).

2. At the time of writing, the ACA is currently under threat of being repealed with the change of political administration. Regardless, from a healthcare provider perspective, this ethos of community connection is likely to remain an imperative of the US health system – no matter the political configuration impacting health care delivery.

3. Charity care refers to:

   “The process whereby most hospitals offer care to some patients at no cost when they fit certain criteria. This is known as charity care. Bed debt, on the other hand, is when bills go unpaid because patients are unable or unwilling to pay  …  and arises in situations where patients have not requested or do not qualify for financial assistance.” (Value Healthcare Services 2013)

Additional information

Funding

We offer thanks to the Kate B. Reynolds Charitable Trust and The Duke Endowment, who funded parts of this work through grant-making, dedicated to more local health system evaluation. We thank the WFBMC Foundation Board for funding new staff positions, Forsyth and Davidson county Connector efforts, and formative evaluation. We also thank the Baptist State Convention of North Carolina, the Ministers’ Conference of Winston Salem and Vicinity, the United Methodist Church, and Moravian Church for their support of Connectors’ efforts.