Vital Directions for Health and Health Care:
The North Carolina Experience 

In 2017, the National Academy of Medicine (NAM) released 19 priority issues that should be considered in guiding federal U.S. health policy in a collection of discussion papers called Vital Directions for Health and Health Care. In 2019, the NAM turned to the all-important state level to draw insights on the status of health and health care, understanding that many policy initiatives begin and take root at the state level. The NAM held a two-day symposium in North Carolina to bring together various stakeholders to better understand actions that states and localities are taking to achieve, and the barriers they face in pursuing, more affordable, value-driven, quality care and health outcomes. The NAM purposefully chose North Carolina, given that it has been at the forefront of health care transformation at the state level and illustrates the promise and the challenges facing health and health care nationally.

The priorities discussed during the symposium are further explored in a special issue of the North Carolina Medical Journal developed in collaboration with the NAM. This collection of manuscripts covers topics that resonate with the state’s activities within the context of the Vital Directions framework, ranging from connecting care through the integration of social, physical, and behavioral health to payer alignment through the advancement of new payment models. Like the first iteration of the Vital Directions initiative in 2017, the key aim of this collection of manuscripts is to draw attention to and stimulate action on issues that matter most to improving health. While national policies can have great influence on care delivery and outcomes, progress also depends on, and can be further propelled by, actions at the state and local level.

Victor J. Dzau (Co-Chair)
National Academy of Medicine

Mandy Cohen (Co-Chair)
N.C. Department of Health and Human Services

Adaugo Amobi
Rhode Island Department of Health, Harvard Medical School

Rukmini Balu
Duke University

Sharrelle Barber
Drexel University

Peter Buerhaus
Montana State University

Alisahah Cole
Atrium Health

Kathy Colville
Cone Health

Hannah Crook
Duke-Margolis Center for Health Policy

Elizabeth Cuervo Tilson
NC Department of Health and Human Services

Rep. Josh Dobson
North Carolina House of Representatives

Nicole Dozier
North Carolina Justice Center

Annette DuBard
Aledade

Katherine Files
Wake Forest Baptist Health

Erin Fraher
University of North Carolina at Chapel Hill

Julie Ann Freischlag
Wake Forest Baptist Health, Wake Forest University

Julie George
North Carolina Board of Nursing