Bridge to Health

The Bridge to Health model is a proactive, collaborative population health approach designed to engage the highest-need, most complex patients, reduce avoidable utilization, and improve outcomes and associated costs through community-driven care. This model demonstrates that meeting patients where they are — outside hospital walls, in the community — reduces costs, prevents suffering, and empowers patients. By leveraging data, collaboration, and innovative care models, health systems can improve outcomes, support payment reform, and build sustainable value-based care. Six sites across North Carolina have been funded by The Duke Endowment to pilot the Bridge to Health approach beginning in 2026.

NCHF provides implementation assistance to sites inclusive of a peer learning collaborative and trainings; site-specific performance coaching; data collection, reporting and evaluation support; implementation tools and resources; and guidance on sustainability and payment design.