Season 2, episode 7: WNC Healthy Opportunities Pilot

Use Medicaid dollars for social determinants of health? That is what the Healthy Opportunities Pilot, right here in Western North Carolina, is trying to do. Take a listen to this week's episode to hear Katlyn Moss, BSN interview the director of this new and innovative program, Dr. Laurie Stradley. Find out how  this program can benefit YOUR patients! 

Call HOP: 828-278-9900

https://impacthealth.org/healthy-opportunities-pilot/ 

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Transcript

Intro [00:00]: Hi everyone and welcome or welcome back to our podcast, just us before Birth and Beyond. We're so glad to have you here with us today. My name is Katlyn and I have been a nurse in Western North Carolina for the past 10 years and I am one of the hosts of this podcast, and today I'm here to give a little intro for our episode. Today we're covering an episode that I think is a hot topic in the maternity care world right now, which is social determinants of health and how much they affect patient care, and when I say social determinants of health, you know I'm talking about housing, food, transportations, the things that are going on outside of medical care in our patients' lives that affect their medical care, and today I'm talking to the director of the Healthy Opportunities pilot program, which is happening in Western North Carolina. And this program exists to try and address some of the issues with social determinants of health here in this part of the state. It's a really rich conversation. We get into some nitty gritty processes and procedures in order to get our patients connected to this program and I really hope that everyone walks away from this episode with some information on how to help their patients with these issues and how to get the word out on this program, so without further ado, I hope you enjoy

Katlyn  [01:25]: Welcome. Thank you so much for hanging out with us today on the Just us Before Birth and Beyond podcast. We're so glad to have you. I wanted to start off today with just some introductions. If you wouldn't mind sharing with us your name, your organization, your title within the organization, and just a little bit about yourself.

Lori Stradley [01:46]: Sure. My name is Lori Stradley. I use she; her pronouns and I serve as the executive director at Impact Health. We are a regional nonprofit that supports the health and wellness of the members of Western North Carolina. We have about an 18-county footprint and our main role right now is to serve as the network lead for the Healthy Opportunities demonstration project for Medicaid managed care members.

Katlyn [02:10]: Okay. So, Healthy Opportunities Pilot, am I right? And that's the title that everyone is using when referring to the program?

Lori Stradley [02:19]: Yes. Healthy Opportunities, healthy Opportunities, pilot, Hop, Hop, we get it all. It's a little bit of a mouthful sometimes.

Katlyn [02:26]: I kind of like Hop, especially because as we're recording this, we're getting closer and closer to Easter. It just makes me think of [Inaudible 02:31].

Lori Stradley [02:33]: I like it. Enjoy. Hop is a good, like a good movement.

Katlyn [02:37]: Right. Okay. So, tell us actually a little bit, sort of in a nutshell what Hop or the Healthy Opportunities Pilot is.

Lori Stradley [02:46]: Sure. The Healthy Opportunities Pilot came about as North Carolina started looking at Medicaid transformation in our state. How could we get better health outcomes while maintaining affordable care and getting folks access to the resources that most influence their health outcomes, and so North Carolina is the first of its kind in doing this work in partnership with the Center for Medicare and Medicaid Services CMS, though many other pilots are happening all over the country now. In fact, North Carolina is cited in many of those applications to do demonstration projects because the state was known for being innovative in healthcare and education. So, when we started to form this in North Carolina, it required approval from centers for Medicare Medicaid services. And when we received it, it was to kick off a five-year demonstration project to show that we could use medical dollars, Medicaid dollars to pay for those social needs that we know influence health outcomes long before anyone is in a doctor's office or a hospital.

Those are social needs so, the demonstration project allows us to set up a system where eligible Medicaid managed care members can access social services like housing support and transportation access to food in ways that help them get to a better, healthier, more stable life and in this, at the same time, potentially reduces healthcare costs and creates better health outcomes. So, the way that we set this up in North Carolina, there are a lot of folks that are getting involved, but I think my favorite thing about this pilot is that it was asset-based. It recognized that we have great people all over the state already doing this kind of work in communities. They just aren't connected to the medical system, and Impact Health serves as the network lead here in Western North Carolina. There are two other pilot sites in the state. Both are in the eastern part of the state, one is in the Northeastern part, one in the Southeastern, and Impact Health supports the 18 Westernmost counties in North Carolina, and then we get to contract with all these phenomenal human service organizations that are already doing good work in our region, and we provide training and technical assistance to make sure that those organizations are able to receive referrals, provide services, and then get paid for those services here in our region.

Katlyn [05:12]: Awesome. So, what I'm hearing is Impact Health, which is the, or the nonprofit organization you work for, that organization is the one that applied to implement these healthy opportunities program. Is that right?

Lori Stradley [05:26]: Almost. There are quite a few layers of application for this. So, the first one was that the state of North Carolina, our Department of Health and Human Services applied to centers for Medicare Medicaid services, CMS to get approval to do this demonstration here in North Carolina, and the reason we need approval is because it's a modification of the way Medicaid is intended to work in all of the states. States do have a lot of control over how Medicaid is implemented, but there are some approved expenditures that we are asking to flex around, and so social health needs are not typically paid for by Medicaid. So, the state applied first and when they receive support network leads around. So, we are one, impact Health is one of the network leads and then Access East is another network lead, and then Lower Cape Fear is another network lead.

So, we applied to the state for the privilege of being a part of this project and then we in turn reached out to the network of nonprofits, and human service organizations in our region to see who would be willing to do this work with us and to demonstrate that we could make this happen. So, those are all the layers of bringing stakeholders together, and then the last piece, not really the last, one of the biggest pieces is that Medicaid transformation in North Carolina meant that we were moving to a private model of managed care with private insurance companies. So, we also work with five prepaid health plans here in Western North Carolina that serve Medicaid managed care members as their insurance provider.

Katlyn [07:01]: Such amazing collaboration, you're talking Medicaid, you're talking a nonprofit organization and then again talking about other health service organizations already existing. So, really taking the time to leverage what ARDI exists in Western North Carolina, these sorts of upstream angles of health. I really just want to highlight that and commend you all for that amazing collaboration. Can you give us some examples of the health service organizations that already existed that you are leveraging through this pilot?

Lori Stradley [07:33]: Absolutely. We have a network of 52 organizations in our region that provide services so that it ensures that every individual in our region who is eligible will have access to services no matter where they live. So, we have an overlapping map of human service organizations who provide food access, transportation, housing services, some of the cross-functional or cross-domain groups here that provide areas of support that may draw from any number of those domains, and one example, for example, manna Food Bank is a support system for our entire region, and so they were an easy go-to partner that already had established services and relationships across the region all the way to some really incredible hyper-local groups like Neighbors Feeding Neighbors, which serves Yancy County and does food service delivery. So, even those folks who aren't coming into town are coming in to food pantries that are maybe available to them, this disrupts that need to also find transportation.

We also work with groups that really navigate all kinds of support systems. There is a relatively new group down in Rutherford called Eden of Abundance and they focus on a few different areas of support, but food access is one of theirs as well. And then really one of the things that I'll want to include in the notes is a link to all of the human service organizations that are involved because this was a pretty brave step for them as well. What we are asking them to do is pretty fundamentally change an aspect of the way that they work. One of the things about Medicaid is that it is needs tested. So, folks have to demonstrate their eligibility in order to receive these funded services, and many of our nonprofits don't function that way. They are very mission driven and they recognize that they can help anyone who I self identifies for need. But this does draw a new revenue streaming that allows them to serve more individuals in their communities and maintain their mission for as long as there's need in their backyards.

Katlyn [09:36]: So, you're not only providing technical assistance and maybe some programmatic assistance to these health service organizations, but there are actually dollars that are going to them to help bolster the work that they're doing. Is that right?

Lori Stradley [09:52]: That's right, and it's coming through in two different ways. There is recognition that there are startup costs associated with this. Folks need to onboard people resources, skills, upfront costs, and so one of the splices of funding that came with this Healthy Opportunities pilot is called Capacity Building Funds, and those dollars are matched 50/50 with investment from federal funding and investment here from our North Carolina legislature, which allocated funds for this, and so that first wave of funding is underway right now and at the end of May we will have distributed nearly 8 million in capacity building funds across those 52 HSO human service organizations in our region, and most of those funds go to startup costs like food delivery trucks and data platforms, computers and laptops that are required to make sure that they're complying with regulations associated with Medicaid dollars staff training and development and even staffing themselves.

Because our goal is to make this funding self-sustaining so that the costs of providing these services are reimbursed. But when you're just getting started, those costs are already present, and they aren't being fully offset by reimbursements yet. So, that first chunk of money is underway right now and is in invested and it actually supports almost 200 jobs in our region, either full or part-time. So, it's really an investment in an infrastructure in our region that we intend to make sure is here for a long time. That's always something that makes me nervous about the language of pilot is that folks feel like it may end, but our goal is to make sure that this work sustains because we really, we can't ever go back to a place where social health needs are not identified as critical as clinical care needs.

Katlyn [11:42]: Lori, all I can think about as you were talking right now, like I wish people could see us because I am gritting from ear to ear. First of all, the amount of money that you were talking about and the fact that it's coming directly into North Carolina really does excite me. I feel like a lot of times people forget that this giant 18 county portion of north of the state of North Carolina exists. But like hello, we are here. The state extends past Asheville and to know that your program is not only bringing dollars and Medicaid dollars into this part of the state but is supporting grassroots organizations like this is just so exciting and I'm so glad that this opportunity has come to this part of the state, and I think you said this was just one way that you're hoping to make this program sustainable. Are there any other things that the program is doing in the hopes of really building an infrastructure that can continue after the pilot?

Lori Stradley [12:45]: Yeah, I couldn't agree with you more about my excitement of around North Carolina being a leader, but Western North Carolina being center stage in this work that we're trying to do, there is so much good happening out here and sometimes it is hard to get folks to pay attention but they are certainly paying attention right now, and so the capacity building funds are just the start and what we're trying now and what is underway is ensuring that those are sustained because folks are getting referred for services that they need and that are supporting them, and then our nonprofits are getting reimbursed for those services direct with direct Medicaid dollars, and so as the capacity building dollars taper off, the services should be increasing, and so to date we have just been live and we have staggered our domains over time over the launch. So, food services have been opened the longest and then came transportation and then housing.

But we've already provided over 10,000 services in our region to families who have an identified need, and what that means is that we have also seen almost 1.5 million in reimbursements also flowing directly into those HSO's that are providing care, and what that means, we hope we intend to see those funds increased over time so that as the capacity building dollars taper off, they are replaced by direct fee for service pay for the work that they're doing, and we believe that healthy opportunities is just the start. It's really been an incredible investment in infrastructure in this part of the state and we think that infrastructure can be used for any number of approaches. We have a large number of uninsured individuals in our region that could really use support systems like this. So, if we can find another funding partner that wants to leverage this network in order to provide more systematic approach to providing those services and understanding the impact that we have, we think that we're going to be able to partner in that and really continue to support the people doing this work already in our region.

Katlyn [14:48]: And it sounds like you are doing a really great job of keeping up with where the dollars are going and who the organizations are touching. Are you guys tracking the counties that are being served as well as the patients? You know, is there a geographical component to the data that you're collecting?

Lori Stradley [15:08]: Absolutely. We have a couple of inputs and outputs that are really important to us. So, as we were launching this network, we needed to understand the estimated need by county so that we could create a network that meets that demand and the language we use all the time there is network adequacy, it's the same sort of clinical language you hear about numbers of physician practices and types of providers that are around the region. We needed to make sure that we had that structure in place to support the projected need for social support systems. So, we have set that up and we are starting, that data is available. But the research aspect of this pilot predominantly sits in the hands of two statewide evaluators that are contracted through the state and that's Duke Margolis Health Policy Institute and the SHEP Center at UNC Chapel Hill.

We are starting to get more access to data. One of the things that we do as often as possible is listening; we try to listen to the human service organizations about what's going on, and what's hard. This is meant to make mistakes, we're going to make them, we're going to learn from them, we're going to make the system better, and we learn from the members themselves as well. We have a lot of really exciting success stories about how this has worked for people and how we get our arms around a lot of that data for Real time quality improvement, and so that's a big area of focus for us right now. We're actually on boarding a new quality improvement and valuation specialist here at Impact Health in the next couple of weeks and hope to accelerate our ability to really dig into what's happening in our own region.

Katlyn [16:46]: Awesome. So, you mentioned resources for social determinants of health including food and housing and transportation. Can you and I believe you said that you launched in phases, which I think was a really great idea. I personally hear a lot about transportation needs in this part of the state, but often we don't actually have resources to connect patients to. So, can you tell me a little bit about how the Healthy Opportunities Pilot is addressing some of these social determinants of health when there is an organization that doesn't yet exist?

Lori Stradley [17:25]: That's a great area to dig into. For the most part, we've been able to work with human service organizations that are willing and able to expand their reach. So, in some cases we may have started working with a group that was singular, double county specific and have been able to expand their services. But transportation in under this demonstration site is a little bit different from how Medicaid has approached transportation in the past. Typically, they have been able to reimburse for medical related transportation and this approach broadens that. So, we can use hop dollars to support things like a trip to the grocery store. So, the reasons why we can access transportation differ and then how we do it is a little bit different as well. So, when there is transportation infrastructure, we can help to reimburse the costs associated with it where there isn't, we can reimburse for taxi and ride share.

Even things like Uber, and Lift where those exist again as we get more and more rural, those don't exist either, and we can reimburse for gas mileage if a family does have access to private transportation, and then even another layer is that we can support families in getting vehicle repairs. So, if they have a vehicle but need brake care or they need new tires, those sorts of things can be covered by a referral to one of the nonprofits in our regions that they can contract with a mechanic or with a repair shop. So, those are a couple of the unique ways that we're able to expand the definition that's been historically tied to medical based transportation.

Katlyn [19:05]: Such innovative solutions. I love that. So, of the health service organizations that you are working with, if there is another one say that's listening to this podcast and thinking, Ooh, we want to be a part of this or we feel like we could help or contribute to this, are you still taking on health service organizations or is there a limit to the ones that you're able to work with now that the pilot is underway? And you said you were going to answer it politically.

Lori Stradley [19:32]: Yeah, because I, in this kind of work, I can't say no that we don't need, but I will say that we are through the major thrust of recruitment where we really rapidly built up this network and now, we need enough referrals to sustain it. So, we want to make sure that we don't have so many organizations involved that they're all just doing a tiny slice and it's not sustainable. At the same time all my expectations are for growth. We expect to see more folks become eligible and as Medicaid expansion moves through our state legislature, it is very possible that we will have a significant growth and eligibility in the coming year, and we'll need more. So, right now my advice if we hear from a nonprofit who cares about this or wants to be involved is that we want to be connected with you and we want to understand what you could offer or how you could partner with us. And then long term, again, we don't think Medicaid will be the only payer for this work. We think that we will only continue to grow the network and grow the opportunity. So, while I don't expect to sign on any new HSO's in the next couple of weeks, we want to stay connected and we want to hear from you about how you're serving the region and how we can support you and support your sustainability.

Katlyn [20:48]: I love this outlook on growth and this focus on growth. I think that confidence and that mindset really makes such a difference in any kind of program that that you're trying to lead. So, kudos to you for that. Something else you mentioned just now was that keyword eligibility. So, taking a little bit of a shift, we've been talking about the health service organizations that are participating in the pilot and some of the logistics and operational standpoints of the program itself. So, I want to switch now to the patient side, and can you tell me starting out who is eligible for this program, and do they have to have Medicaid to be eligible?

Lori Stradley [21:31]: Yes, that's a really important question and probably the toughest part of this pilot is that there is a relatively narrow eligibility for this. The first big gap is Medicaid, but not just Medicaid. We still have Medicaid direct in the state and the eligibility for this pilot is limited to those who are participating in Medicaid managed care, and so that's the first gate Medicaid managed care. That means that if you look at your Medicaid card, it has a traditional private insurer's name, for example, healthy Blue would be a provider that would have some eligibility for this program, and then after Medicaid managed care eligibility, the next thing that we're looking for is that in this demonstration window we were identifying folks that already have some chronic condition that could be supported or could be prevented or reduced if folks had access to social health needs or were having those met.

So, if I could just give just a quick rundown, it's a little bit detailed, but I want to make sure that folks understand that they should be seeking out a screening to get access to these. So, for adults that are 21 plus, they need to have two or more identified chronic conditions and those could be any number of chronic conditions, but BMI over 25 diagnosed chronic cardiovascular disease, substance use disorder is another gateway into this chronic endocrine or cognitive conditions. So, there is a large number of conditions that open that second gate for you. And with adults who are 21 plus, they need two chronic conditions, for children and that's zero to 20 there's only a need for one identified chronic condition that could be improved with access to social needs. So, that's a wider area, and in addition to chronic conditions with young people, we're also interested in supporting folks who have experienced three or more identified adverse childhood experiences.

So, they may not already have a chronic condition, but we know that they're at higher risk for it if they are navigating those fundamental adverse childhood experiences, and then there's one that I know is really important to you and your listeners are also pregnant women. Their eligibility is a little broader so pregnant woman who has a history of any difficult, poor or negative birth outcome in history. So, maybe they have already had a preterm birth or a low weight birth if they are young. So, if they are a pregnant individual under the age of 15 or over the age of 40, that may increase their risk. If there's any history in pregnant individuals with drug or alcohol use, these are all reasons that we know if we could get them access, having social needs met that we may be able to support them in having a healthy pregnancy and healthy pregnancy outcomes.

And then with very young children, preterm birth is a gate all by itself. So, if a child comes early and is eligible for Medicaid managed care, they're immediately eligible for the support systems that come along with healthy opportunities, and that brings me to just one other piece that is about this pilot that is very near and dear to my heart is that most of these support systems are for the whole household. So, if you have one eligible member in your family that is identified as, for example food insecure, the food that is coming into the household is meant to support the entire household, not just the individual who is Medicaid managed Care eligible.

Katlyn [25:11]: Amazing. Thank you so much for that detail. We like detail on this podcast.

Lori Stradley [25:16]: Good.

Katlyn [25:17]: It's really helpful. I think a lot of times, especially depending on how much time you have with someone who is explaining a program, you don't always get the nitty gritty details, which is really why we wanted you here. So, we could go through that so I appreciate you laying that out and making it easier to understand eligibility for this program. In the same vein, so a patient comes to a doctor's office, the provider or birth worker there identifies them as someone who meets the eligibility criteria for the program, but the provider either wants to know if the patient is already enrolled or wants to be able to help this patient get enrolled. What are we doing? Are we going to the back of the patient's individual insurance card? Are we calling, is there a number through Impact Health that we should be giving our patients? How do we tangibly get our patients connected to this program?

Lori Stradley [26:16]: I am so glad you asked. If you hadn't, I would've made sure that we talked about this because one of the most important things about this is getting folks in the door. So, even when I give that sort of weedy definition of who is actually eligible, I think the main takeaway I want folks to have from that is at least get people to the pre-screening or screening stage. We don't want folks to self-select out because that sounded complicated, or they didn't hear their specific need identified. There is quite a bit of eligibility out there and we just want to get people connected. So, if you're a provider and you suspect that your patient or friend or family might be eligible for this program, there are a few different ways to get connected, and we refer to this as no wrong door. We want folks to come in a way that they feel trusted, seen and supported.

So, if that is in the space of their provider, if they feel safe and supported there, then the provider can make a a direct referral through their care manager access. So, if they're in into Advanced Medical Home, they have the care managers that are involved there, as you mentioned, there is a number on the back of their Medicaid card and they can call and connect with member services, which will loop them in again to their care manager, and then the last piece we have is really through the human service organization. So, if somebody is already connected to one of our HSO across the region, they feel supported and have a trusting relationship there, our HSO are now able to pre-screen them and connect them with a care manager to get broader services. So, let's say that you are a nonprofit that's doing food delivery already and you recognize that one of the folks that you're supporting is having a lot of trouble with their housing.

Maybe they're having trouble making rent or maybe they've had their utilities turned off. Then that human service organization can actually help get them screened into the program and get access to a broader set of resources. So, they may have come in the food access door, but now they can get support with housing, and then the other piece is that they can call us directly here at Impact Health, we have Care Navigators who can help support them getting in that right door. So, if they don't have a quick access to their provider or they're not already engaged in other ways, then we have a phone number, it's [828] 278-9900 and then they can also get on our website and do a pre-screening online so folks can self-select in and then that connects them so that they'll get outreach from a care manager to get these plans started.

Katlyn [28:54]: So, many options. I love how many I want to reiterate as Lori did earlier and as I do in most of our episodes, that we will have all this information linked in our show notes. So, if you're driving or you don't have access to a pen or a piece of paper, do not rest, we will have this information linked and have the number that Lori just shared available in the show notes below. Love all the different options to figure out eligibility and kind of get enrolled in the program. I think a lot of times it is hard as a provider or someone in an outpatient setting who is working with this population to always know the right person to call and to know that we can just call Impact Health directly and say here's our patient, where do they need to go? That's really helpful from the clinical perspective. So, I heard you mention care managers as well; we were talking about the eligibility. So, tell me a little bit about how they play a role in this network.

Lori Stradley [29:54]: They are another favorite part of the puzzle that came together as DHS was mapping this out for us. For our state care managers have always, or long term been a partner in achieving the best possible health outcomes for folks who are navigating complex needs, and so central to this model is recognizing that care managers have an opportunity to really spend time with individuals who are trying to navigate this healthcare world, and so historically they're navigating a specific healthcare issue. So, let's say someone's newly diagnosed with diabetes, they're going to help connect them with a care plan, they're going to lay it out and they're going to say, these are the types of medications, this is what testing is like, we're going to connect you with a diabetes educator. All of those pieces come through a care manager, but with this program we're allowed to expand that view and the care manager can start to inquire about and screen for social needs.

So, again, you can use that example of someone newly diagnosed with diabetes. Now, instead of saying you've got to get more fruits and vegetables in your menu, they can say, do you need help getting access to better food, to fruits and vegetables to fresh foods so that you can help to navigate this concern? Do you have a good refrigeration system in your household to keep your insulin cold and ready to be used? And so now the care management plan is really person-centered and thinks about all the needs and intersecting areas of support that can be put in place to make sure this individual and their family have the best possible health outcomes.

Katlyn [31:34]: That's an important layer I think to healthcare, and I know as a nurse and someone who works with providers a lot, we really love having any kind of care management service on staff because unfortunately there's not always time in a 15 minute slot, to get outside of the physical medicine part of the visit to get into some of the social determinants of health. So, I love that that Care managers are such a large part of this program. I think that's really important. So, I think we've touched on everything that I planned on touching on with you except for one. So, we love to wrap up our episodes with what you as a healthcare worker are grateful for in this work, and you are more than welcome to share just personally what you're grateful for or even you mentioned at the top of the episode some patient examples that you have maybe of someone who has really benefited from this program. So, what do you have for us?

Lori Stradley [32:36]: That's such a big good question. I think the thing that I'm grateful for every day that maybe feels a little less tangible is all of the people who are willing to try this. It's not a perfect plan. We didn't have all the answers when we kicked it off, but there are literally hundreds of people who are willing to be brave and test the waters and let us mess up and learn and fix it and do better. But that is hard to do when you are supporting people that have immediate social need right now it's to dedicate some time and energy so we can build this foundation and grow it long term. So, I have a huge amount of gratitude for all the incredible leadership that is big and small, formal and informal around our region to make this happen so that's the big one.

But I'd love to share a story with you about an organization. I mentioned them earlier and maybe you could share two stories since Neighbors Feeding Neighbors is a really amazing group and I think I said Yancy County before, but they're actually based in Mitchell County and they created this organization with one goal in mind to treat their neighbors like they would want to be treated themselves, and so they do their work with love, kindness, compassion, and a focus on meeting folks where they are, and so one of the areas or the the stories that I would share is that they've shared with us how partnering in this program and being able to be one of the providers of HOP is that they can now better meet their neighbors needs. They've discovered all of these new ways that other layers of this state also care about them.

I think in the same way that it sometimes feels like the state forgets about Western North Carolina, folks don't always feel seen in general. They don't feel seen by federal programs or government interventions because they don't always create them with our rural mountain neighbors and mind, and so this isn't just been a direct benefit, but it's helping other organizations in our regions feel seen, supported and connected. So, I think that is building relationships in a time where places and people can feel very far apart and very separated and this is really bringing people together, and then there's just one other story that this is the very first one success story that was shared with me as I was becoming a part of this organization and it's from a nonprofit called Macon Program for Progress, and they're an organization that is focused in some ways on many things but on food insecurity.

When they saw that rising in Macon County and saw more and more of their families in need, they started partnering with Manna Food Bank and their local senior center to distribute food around their region. But as they were able to partner with Healthy Opportunities pilot, they started delivering healthy food boxes and meals and then securing safe places for these folks to live, broadening the needs. So, l working into housing navigation services, move-in supports utility costs and home remediation so that folks can stay in their homes and stay safe, and this is another organization that has said this is a new way of doing business, doing the work that they do and sustaining it, and it's just they say, if I could just read a quote from their director for community services, it's rewarding to help folks find a place they can afford so they can stabilize their living situation and begin to build up some savings. Hearing that a food box helps someone get through the weekend or that a home repair allowed someone to focus on their health, it makes it all worthwhile, and that's really why we're doing this work and I just get my chill bumps every time I get to read one of those stories.

Katlyn [36:28]: Thank you so much for sharing. I'm glad that you did more than one story and I think I forgot Chill bombs. I as someone who has worked in Macon County for a few years now, again to echo the Mitchell County folks, I love hearing our stories represented. So, thank you so much for sharing your gratitude and your wonderful stories and your time with us today. I really appreciate it. I feel like I better understand the program and the great work that it's doing, and I really hope that this podcast helped get the word out and helps bring you all some eligible patience. Lori, we really appreciate your time. Thank you so much for being with us.

Lori Stradley [37:08]: Thank you for having me. I so appreciate the work that you're doing and the way that you connect with people where they are as well in places like this podcast.

Katlyn [37:16]: Thank you. Until next time.

Outro [37:19]: And there you have it, a program to help with social determinants of health in Western North Carolina. Such good stuff. Please remember that everything discussed in the episode will be linked in the show notes below. We also have in the show notes a link to a survey that we would love for you to take just five minutes to fill out for us. It reviews how you think we're doing on the episodes that you've listened to, as well as there is an opportunity at the bottom a question where you can suggest topics for future episodes. We would love to hear what you know you all want to hear about. So, if you don't mind, again, we would really appreciate your time to fill out that survey. It is linked in the show notes below. Also, if you want to take the time to subscribe and review the podcast, it will help us get the word out to the rest of the Western North Carolina provider and birth worker community working in maternal health. So, yeah, we really appreciate your time and until next time.