Despite pharmaceutical companies’ claims that addiction to opioids was nothing to worry about, opioid abuse continues to cause destruction throughout the United States.

Some states have brought lawsuits against big pharmaceutical companies like Johnson & Johnson and Purdue Pharma, arguing deceptive marketing campaigns overselling the benefits of opioid use and downplaying risks.

North Carolina is one of several states that is in the process of settling with pharmaceutical companies. North Carolina plans on using its settlement funds to implement evidence-informed strategies designed to address the opioid epidemic and is expected to receive and distribute $850 million over the next 18 years to support state and local efforts.

While the funding itself appears more than ample, the size of the settlement reflects the costs incurred by the wide range of strategies and programs needed to combat opioid addiction.

Some of the endorsed programs in the North Carolina Memorandum of Agreement (NC MOA) (the agreement between North Carolina and its counties outlining settlement distribution) include addiction treatment for incarcerated persons, criminal justice diversion programs, specialized treatment for pregnant women and parents, early-intervention programs, employment services, evidence-based addiction treatment, post-overdose response, prescription misuse prevention, recovery housing, recovery support, societal reentry support for recently incarcerated persons, syringe service programs, Naloxone distribution, and syringe service programs. The need for and variety of services certainly warrants the size of the settlement.

Accountability of opioid settlement distribution expenditures will be a significant focus in implementing the above programs in North Carolina and likely other states receiving similar funds. NC MOA Accountability requirements, of which there are many, will determine whether local North Carolina municipalities will be eligible to receive funds. This Memorandum will offer transparency into how local governments will use funds. It also requires specific measures such as special revenue funds, annual financial and impact reports, and the use of public dashboards.

In a nutshell, accountability requirements will involve extensive audits, compliance, and reporting measures. Counties will be subject to financial audits of fund expenditures and access to personnel and records. Counties will also have to create annual financial reports for every year they receive, hold, or spend opioid settlement funds. Finally, the counties must submit contributory information to a “statewide opioid settlement dashboard,” AND utilize their own public dashboard.

Dashboard data contributions may be the most challenging requirement yet, as impact reporting is arguably more complex and nuanced than financial reporting. Ultimately, municipalities must “report impact information for each strategy that it funded with Opioid Settlement Funds during that fiscal year.” Luckily, the NC MOA outlines nine critical pieces of information to be submitted, including (but not limited to):

• A progress report,
• a success story,
• process measures (how much activity did they do?),
• quality measures (how well did they do these activities?),
• outcomes measures (what was the impact of the activities?), and
• demographic information of program participants.

Additionally, counties’ impact strategies may include the use of public dashboards to share reports, recommendations, or plans. For further context, the agreement states that the dashboard must show how the municipality is “using settlement funds to address the epidemic.” However, there isn’t much more context provided in the actual NC MOA text.

For some, these requirements might be overwhelming or even vague. Confusion about where to begin and doubts about whether counties can even achieve the accountability stipulations may, unfortunately, impact whether they even decide to request funds. Luckily, some helpful software tools and frameworks perfectly fit in helping North Carolina and its counties simplify processes and meet accountability requirements.

First, the nine statewide public dashboard data requirements mentioned above are strongly reminiscent of the Results-Based Accountability (RBA) framework for social change and performance improvement. Of particular note are the three types of required measures (process, quality, and outcomes), which mirror RBA’s three types of performance measures (how much did we do? how well did we do it? and was anyone better off?). Furthermore, organizations and agencies worldwide use RBA’s signature exercise (Turn the Curve process) to develop strategies, progress reports, and success stories. North Carolina counties should consider looking into RBA for a simple, proven way to consolidate their planning, strategy implementation, results-based budgeting, and opioid settlement reporting.

In regards to each county’s individual (as opposed to the statewide) public dashboard (or data dashboard), these should not be viewed as an additional expense, challenge, or training headache, because they will actually simplify the entire reporting process, inform effective strategy and improve public communication. When used effectively, they will also provide much or all of the data needed for the statewide dashboard. North Carolina counties should easily be able to use opioid settlement funds to cover the cost of public dashboard systems for many years. This will provide long-term value to the agencies, who can utilize the systems to inform strategies outside the realm of opioid addiction.

But what exactly is a public data dashboard? And what should it be able to do to meet the accountability requirements of the NC MOA? The NC MOA presents several functionalities that a public dashboard system should provide. These functionalities should allow North Carolina counties to do the following:

• Show how Opioid Settlement Funds have been spent;
• report program or strategy outcomes;
• track, share or visualize key opioid-related or health-related indicators, and
• support collaborative statewide, regional, local, or community processes. 

It may sound like a no-brainer, but the most important part of a public dashboard is that it can easily be shared with the public – either by embedding it on a webpage or sharing links to it via email, social media, text message, etc. Many organizations of all persuasions are utilizing public dashboards to enhance transparency and accountability – especially in the health and healthcare sectors, as donor retention and stewardship are a significant concern.

In essence, counties should look for public dashboard software systems that allow them to track performance and outcome-level data, visualize and analyze that data, provide all the necessary context behind the data, engage in strategy and planning, and communicate with partners, stakeholders, and the public. Additionally, if they aren’t already using one, counties should utilize a data-collection or case management software to track program-level participant information and outcomes that is compatible and integrated with the public data dashboard.

When it comes to creating authentic, measurable impact and progress on the opioid epidemic, the NC MOA accountability requirements reflect the efficacy of results-based strategizing, data-based decision making, results-based budgeting, and transparent communication. North Carolina counties should be relieved that many tools, methodologies, and solutions can help simplify the entire funding process and maximize their impact.

If you are a North Carolina county considering or in the process of receiving opioid settlement funds, Clear Impact can help. Consider meeting with one of our friendly staff to help push you in the right direction utilizing our suite of online data collection and reporting tools specially designed for public health departments.