Northampton County July 2023

When the Extra Miles Tour traveled to the Northampton County Cultural and Wellness Center, many memorable and friendly faces greeted the team when we entered. The roundtable discussion began with a welcome from Dr. Patrena Elliot, president of Halifax Community College. Dr. Elliot has the unique experience of returning to her home county after spending over 30 years working elsewhere. To set the tone of the discussion, she introduced Tina Dixon, another Northampton native, who has taken charge of improving access to health and wellness in the community.

Leading the Access East Healthy Opportunities Pilot (HOP), Dixon brought to the table other key stakeholders and leaders of the community. The HOP program is a national effort to tackle the social determinants of health, driven by the understanding that to have a healthy community requires more than just doctor appointments and medicine. Good health depends on access to food, transportation and many non-medical factors, which many North Carolinians in rural areas have difficulty acquiring. The Access East HOP serves the northeast section of North Carolina. Serving nine counties and with only 22 employees, this organization works hard to connect community members with resources.

Dixon set the stage with a staggering statistic: Across her nine counties, there are 35,000 residents eligible to receive HOP support, but less than 2,000 enrolled. The barriers to enrollment include a lack of awareness, difficulties with registering and mistrust of the health care system. Throughout the conversation, leaders and community health workers shared the same sentiments: Residents don’t know what resources are available to them. Many in the community need transportation to appointments and daily activities but are unaware that they can secure a ride through Family Solutions and Support Services, a local agency that provides non-medical transportation to eligible HOP participants. Others have had difficulties with the customer service representatives or are unsure of what HOP is and how to enroll.

The conversation also explored the challenges of engaging residents. Although there are many people in the region who are eligible to receive support through HOP, there is no central platform to determine who they are. While community health workers do their best to find and educate them, the 45-minute to one-hour call required to complete the eligibility screening and application process often deters participants. To expedite the process, Access East’s Barry White and other community members have adopted the No Wrong Door Program, which allows residents to give their information and have it sent to the insurers to determine eligibility. This cuts down the process to five minutes.

While this has been a great asset in allowing more community members to be enrolled in HOP, there is still the issue of mistrust. This problem is not unique to HOP. Dixon emphasized that the same skepticism over providers and medical authorities more broadly also impacts HOP enrollment. The enrollment process requires residents to share personal information over the phone. The impersonal nature of the phone and the perceived lack of security causes residents to leave the call without completing the enrollment process and without getting access to the resources HOP can offer. The community health workers associated with HOP have taken the issue head-on: They still continue to engage and educate the community, but now they’re going door-to-door instead of relying on phone calls. Meeting people face-to-face instills a level of trust.

HOP relies on the participation of community-based organizations to provide resources that address non-medical factors – in the Access East HOP, Green Rural Redevelopment Organization (GRRO) offers access to fresh, healthy food. Serving five northeastern counties, GRRO is an expansive food hub that pools resources with a focus on grassroots solutions to poverty, chronic disease and food security. Because they work with organizations that have direct access to truck drivers who deliver food, they have established a relationship with the community. Not only do they deliver food, but they provide education and reliability to the 450 clients they serve. They are hopeful that as HOP continues to expand, along with No Wrong Door, they will be able to provide their truck drivers with devices that can also enroll residents, growing the pilot and supporting residents.

Looking forward to growing HOP and encouraging resident health, the county is hopeful for stronger relationships with provider plans, making the process seamless across all levels. They will continue to build relationships with the community to make whole-person care accessible in Northampton County and the surrounding region.

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U39702, 8/23