Access to Primary Care

Goal

By 2025, improve North Carolina’s health care safety net, thus increasing by 50 percent the number of financially disadvantaged residents who regularly visit an affordable, quality health care provider.

The Kate B. Reynolds Charitable Trust is working to grow the number of financially disadvantaged North Carolinians, especially those living in rural areas, who are insured and have access to quality primary health care by investing in infrastructure and insurance coverage programs.

Nearly one in five North Carolinians were uninsured in 2014, and of those, nearly half are adults working full time. Lack of insurance often translates to a lack of primary care and a consistent, ongoing relationship with a primary care physician. Those with better access to primary care document earlier diagnoses and lower mortality rates for certain cancers, fewer cases of infant mortality and low birth weight, and lower overall mortality rates, among other positive health outcomes.

Low-income, minority, and uninsured populations are disproportionately affected by barriers to care and the lack of access to primary and preventative care, known as a ‘medical home.’ The medical home model is patient and family centered and proven to yield better health outcomes, remove barriers to care, and minimize health disparities. Medical homes have also been shown to reduce the need for avoidable, costly care, such as emergency department visits or hospitalizations, thus lowering overall costs. Expansion of medical homes is even more effective when coupled with the expansion of insurance coverage.

As of October 1, 2013, many uninsured North Carolinians became eligible for new coverage options through the federally facilitated health insurance marketplace, one of the provisions of the Patient Protection and Affordable Care Act (ACA). Although North Carolina has not expanded Medicaid under ACA, many individuals who are eligible under the existing criteria are seeking coverage. And more than 550,000 people selected a health insurance plan as of January 2015. Many of these individuals were previously uninsured, although some had prior health insurance coverage and switched to marketplace plans because they were more affordable or comprehensive.

To tackle the challenges of access and affordability, the Trust is working with local, regional, statewide, and national partners to support efforts designed to address the health care needs of North Carolina’s underserved communities.

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Closing The Gap

INCREASING HEALTH CARE COVERAGE

Advocating around efforts to increase insurance coverage, supporting enrollment efforts designed for disadvantaged rural and vulnerable populations, and supporting outreach models that target North Carolinians ineligible for existing insurance programs.

Investments in Action

  • Care Share Health Alliance  Statewide infrastructure to support outreach, education, and enrollment efforts connected to ACA.
  • North Carolina Justice Center  Rural county advocacy and education concerning the importance of Medicaid expansion.

PROVIDING A MEDICAL HOME

Improving patient access by supporting safety net providers, which offer coordinated primary care within an affordable, accessible medical home.

Investments in Action

  • North Carolina PACE Association  Establishment of a statewide association to support the successful implementation of Program of All-inclusive Care for the Elderly (PACE) sites throughout the state.