Timely Spending: North Carolina's Approach to Efficiently Utilizing Federal Funds

Some answers have been edited for clarity.

What policies, systems, or partnerships does the North Carolina Division of Public Health have in place to ensure spending?

SUSAN KANSAGRA:
In North Carolina, one of the ways we make sure we are spending our funding towards the highest priorities is by putting in place processes that enable us to fund based on the social vulnerability index. We look at how we fund our counties; counties that might have a greater need for funding may get more, but we also want to provide some baseline funding per capita for every county as well.

We use the same method of prioritizing when we consider bringing on vendors to do services. For example, we've been using a lot of this funding to support COVID-19 testing and vaccine-related services. We are really prioritizing the use of vendors and state resources in high-priority communities to focus on historically marginalized populations. And again, those places that we know have a higher social vulnerability index, so we can make sure we're targeting those resources to those that need them the most.

What specific improvements in your business processes did you make to expedite spending?

KANSAGRA:
One focus we had was certainly hiring. We know we've been fortunate to receive lots of funds and to hire additional staff at the department and the division of public health. In the past, we had to wait to have money in hand before we could start the hiring process. So, one of the ways we expedited that is by working with our leadership and additional folks across the department to make sure that we were able to start creating positions even though we didn't have the funding in hand. We started creating positions. Get those positions through our review and approval chain. And even get them to post before the funding has come in. So that really helped cut down on the process for HR and for getting some of the staff ready to be onboarded as soon as that money was in hand.

The other piece that we've been using is making sure that we are talking with our partners. Oftentimes, we hear about funding coming in through ASTHO and some of our other partners. As soon as we hear about those things, we make sure that we are having conversations with our communities or with other divisions across our department of health and human services that would be touched by that grant and start to formulate some plans. We might not know the specifics of the actual funding, but usually you know enough to start formulating plans and make those partnerships come together. We anticipate funding opportunities and these days they come with shorter timeframes to respond.

What efficient, expedited spending strategies are you currently using?

JENEEN PRECIOSE:
With our state of emergency and executive order, we've got additional capacity to contract and flexibility within our own procurement policies. To echo what Dr. Kansagra talked about with the use of our health departments and partnering with known entities, we've done a lot of partnering with our local health departments and districts, as well as nonprofits with proven track records of getting funding out.

Additionally, we've worked to create pools of pre-qualified vendors. So, when we needed to do COVID-19 testing or COVID-19 vaccination, we created a request for proposal process where we would pre-qualify vendors that could meet the state's requirements, and then we could issue a specific scope of work to those vendors and then work in a more expedited fashion as opposed to going out and procuring from start to finish every single need that we had. We’re trying to leverage key existing partnerships to give our state the most impact and with the least amount of risk.

How do you know if your strategies have been effective?

PRECIOSE:
We first look at our funding source. In some cases, that may be a federal grant. And specifically, with these COVID-19 supplements that have been coming in, CDC has been prescriptive around the metrics that the state needs to report back. So, we pass those same metrics down to all our sub-grantees.

With regard to our vendors, we also have very specific deliverables that we expect them to deliver on. Both sets of agreements have contract administrators and monitors in place. All our agreements are written with those measures in the contract. And we've got reports that are always due back to us from either our sub grantees or our vendors in order to support the work that they're doing and that we're paying for. So that the monitoring process is ongoing on a monthly or quarterly cadence.

In some cases, there are brand new initiatives, such as using incentives for folks to get vaccinated. North Carolina certainly used incentives, but they didn't have any sort of scientific data behind them. So, we contracted with one of our universities to conduct an evaluation of that program in order to help us measure its success.

Additionally, we continue to refine our processes so we can reduce the burden on our sub-recipients, especially for our local health departments, who are really bearing the brunt of the pandemic at the local level. To help streamline their reporting process, we've leveraged some technology called "smart sheets" to really give them a baseline for their reporting and a consistent way to report their metrics back to us on a regular basis.

What expedited strategies are you currently not able to use but are striving toward?

PRECIOSE:
We have a lot of flexibility right now, and we're looking ahead to when the emergency declaration is over. The state is in the middle of a process where we've released additional services out for a request for proposals in an effort to pre-qualify groups of vendors that can not only provide the standard goods and services like we've seen in the pandemic (e.g., PPE, COVID-19 testing, COVID-19 vaccine implementation), but also the sort of services that we've become really reliant upon, such as gathering our data. We’re creating that pool of vendors. And looking forward, I think it is really going to help. It has not been implemented yet, but we are working toward it.

We've also identified additional goods and services that are not on our state term contract and probably should be. So while our department is trying to pre-qualify vendors for us, we are also identifying things that haven't really come up before in a major way and that impacts all our agencies at the state level. We're giving recommendations to our statewide procurement offices about what we think really needs to be on state term contracts to make procurement easier.

And finally, information technology procurement is always the trickiest. We haven't figured out a solution for that because, while our procurement flexibility might be there, especially during the state of emergency, we don't have flexibility around the security requirements that our state deems absolutely critical. That is something that I feel we need to continue to work in partnership with our division IT department and our state IT in terms of developing a minimum threshold of what we need to be secure and get the work done that we absolutely need in a critical crisis like a COVID-19 pandemic.

What advice do you have for other state and territorial health agencies that may help them expedite spending?

KANSAGRA:
Well, I think the biggest thing is partnering with your finance teams, your procurement teams, and your HR teams to make sure they know from the beginning what you're intending to do with the funds that are coming in. Set up those governance teams early on so that you can plan collectively together and set yourself up for success as you receive the funding and go on to implement activities.

I'll also mention that in the beginning, when funding comes out, you get a lot of different community partners that are coming at you and wanting to know how they can work with you on the proposal and receive some of the funding as well. And so, we've used a mechanism where we create a menu of actions that local partners can do and then issue an RFA. That creates a level playing field and gives everybody the opportunity to apply for the funds where they can do one or more of those activities and that menu of action. And that's worked well for us to increase our number of partners and, again, create that level playing field from the beginning.