Value-Based Payment & Incentive Models
While there is no current value-based payment model in California, there are opportunities to apply the learnings from the North Carolina’s Healthy Opportunities Pilots.
North Carolina’s Healthy Opportunities Pilots (HOP) was a Section 1115 Medicaid demonstration1 designed to test whether Medicaid could pay for evidence-based, non-medical services addressing health-related social needs, including interpersonal violence and toxic stress. The model operated through Medicaid managed care, community-based Human Service Organizations (HSOs), Network Lead organizations, and the statewide NCCARE360 referral infrastructure.
For IPV, North Carolina established reimbursable services including IPV case management and violence intervention services, with payment rates established through the HOP fee schedule.2 The model supported services such as safety planning, advocacy, connection to legal and behavioral health resources, housing and transportation coordination, and other survivor-centered supports.
North Carolina also identified CUES—Confidentiality, Universal Education and Empowerment, and Support—as an evidence-based intervention for IPV, emphasizing that universal education can reach people who do not disclose abuse when asked directly.3
How the Model Translates to California
| North Carolina lesson | California MCP opportunity |
|---|---|
| Universal education and safe disclosure | Make CUES the standard upstream intervention, rather than making disclosure the prerequisite for receiving information or support. |
| Medicaid-funded IPV services | Combine provider payment/incentives + MCP care-management funding + sustainable CBO payment for IPV response and linkage. |
| Network Leads and HSOs | Build formal MCP partnerships with IPV-specialized CBOs, including readiness and administrative support. |
| NCCARE360 referral infrastructure | Use CalAIM Closed-Loop Referral (CLR) infrastructure to track, support, and monitor referrals to ECM and Community Supports when applicable. |
| Care management integration | Use ECM and other PHM infrastructure to support members with complex needs rather than creating a separate IPV program. |
| Measure health outcomes, not disclosure alone | Connect IPV strategy to existing MCAS/HEDIS measures and downstream utilization, experience, and population-health outcomes. |
Key Takeaways: Applying the Learnings from the North Carolina Model
North Carolina’s experience suggests that the value proposition for IPV is not “screen more.” Rather, it emphasizes:
Give every member an opportunity to receive CUES → create a safe pathway for disclosure or self-identification → ensure a funded, survivor-centered response → close the referral loop → connect the intervention to existing PHM, ECM and MCAS infrastructure → evaluate value through quality, experience, utilization, and population-health outcomes.
This approach fits naturally within California’s CalAIM Population Health Management strategy, which emphasizes risk stratification, targeted interventions, care coordination and measurement, while leveraging an existing managed-care infrastructure rather than creating a stand-alone IPV program. The figure below illustrates the end-to-end model.
- North Carolina Department of Health and Human Services. Healthy Opportunities Pilots. Overview of the Medicaid 1115 demonstration and its evidence-based non-medical interventions, including interpersonal violence. NCDHHS Healthy Opportunities Pilots(opens in new tab) ↩︎
- North Carolina Department of Health and Human Services. Healthy Opportunities Pilot Fee Schedule and Service Definitions. Includes the IPV Case Management and Violence Intervention payment structure. HOP Fee Schedule and Service Definitions(opens in new tab) ↩︎
- North Carolina Department of Health and Human Services. HOP Evidence Base Roundtable: Intimate Partner Violence. Includes CUES as an evidence-based IPV intervention and describes the confidentiality/universal education/support model. NCDHHS IPV Evidence Base Roundtable ↩︎