MAHEC 2022 Annual Report

ANNUAL REPORT 2022

On the Cover

MAHEC’s Innovation Team: Ashley Steward, MBA, Program Director; Jacqueline Donnelly, PhD, Preawards Grant Manager; Ellen McAngus-Jones, LCSW, Grants Manager; Meredith King, MPhil, Project Manager

About the vignettes in the Annual Report Full articles can be found online at mahec.net/about-us/readourstories

MAHEC Board of Directors

Chair Alan D. Stiles, MD; Vice Chair Casey Cooper; W. Louis Bissette, Jr.; Robert A. Blouin, PharmD; Carol Burton, PhD; Bruce Deighton, PhD; David P. Franklin, MD; William R. Hathaway, MD; James M. Kirby, II; Paul McDowell; Danielle Mahaffey, MD; Alfred J. Mina, MD; Joseph A. Pino, MD, MHA; Lindsey Rhoden, AIA; Laurie Stradley, PhD; Darin Waters, PhD

UNC Health Sciences at MAHEC Oversight Board

Voting members: UNC Provost and Executive Vice Chancellor Christopher Clemens, PhD; UNC School of Medicine Executive Dean Cristy Page, MD, MPH; UNC School of Medicine Interim Vice Dean of Academic Affairs Jennifer Wu, MD; UNC Gillings School of Global Public Health Senior Associate Dean Laura Linnan, ScD; UNC Eshelman School of Pharmacy Dean Angela Kashuba, PharmD; UNC Adams School of Dentistry Dean Janet Guthmiller, DDS, PhD; UNC Board of Governors Former Chair and MAHEC Board Representative W. Louis Bissette, Jr.; Cherokee Indian Hospital CEO Casey Cooper; and MAHEC CEO William R. Hathaway, MD

Non-voting members: Chief Academic Officer of UNC Health Sciences at MAHEC Robyn Latessa, MD; MAHEC CFO Zach Levin; UNC School of Medicine CFO Michael Sledge; UNC Asheville Chancellor Nancy J. Cable, PhD

Dear Friends:

What a year we have experienced! I know for me personally there have been a significant number of major milestones – new job, first grandchild, and I celebrate my 60th birthday in November. Much the same can be said for MAHEC and we hope to highlight many of these milestones in this 2021-2022 annual report.

First and foremost, a heartfelt and sincere thanks is warranted for the service that Dr. Jeff Heck brought to MAHEC prior to his retirement. Jeff first joined MAHEC in 2004 as chair of the Department of Family Medicine. His 10-year tenure at the helm as CEO starting in 2012 saw unprecedented growth across all departments. Under Dr. Heck’s leadership our annual operating budget increased from $30 to $100 million. In 2015 MAHEC had 537 employees, a number that now stands at more than 1,000 – a doubling in seven years! Under his leadership our GME programs expanded by five, adding surgery, psychiatry, rural medicine, addiction medicine and internal medicine. He also led the partnership with UNC Health Sciences to create the MAHEC campus and the acquisition of sustainable funding through state appropriations that have allowed us to fulfill our mission and vision as the people’s organization. Jeff’s impact and imprint is not only visible on MAHEC, but on all of Western North Carolina because of the work that MAHEC does each and every day. If you see Jeff, please share with him your thanks and appreciation.

This past year was also the second of the COVID-19 pandemic, a previously unimaginable event which oddly has allowed MAHEC to showcase its greatest strengths. Our teams rallied to meet the needs of our community in many ways at the onset of COVID including the creation of an acute care clinic for COVID patients, and we continued our work to end the pandemic last year serving as a monoclonal antibody infusion site for Buncombe County. MAHEC was at the ready to assist the community through both action and leadership as multiple organizations collaborated to combat the pandemic. Heroes do work at MAHEC – my sincere thanks to all who played and continue to play a role.

We are pleased to have received designation as a Federally Qualified Health Center look-alike this year. This was no small task and the process itself took more than a year to complete. My thanks to the myriad of team members involved in this application, which will be critical to our long term sustainability. This status affords us enhanced reimbursement from Medicare and Medicaid because we willingly care for an underserved population. It also allows us to participate in the 340B Pharmacy Program that will greatly benefit our patients. We are honored by the designation and look forward to partnering with the other FQHCs in the region.

And throughout all of this, we have attended to our core mission: the education and training of healthcare workers of all disciplines and caring for patients. My expectations of who MAHEC is and what MAHEC does prior to my arrival in February have not only been met, but have in fact been wildly exceeded. It is with pride that I say I work at MAHEC and I look forward to the coming year as we continue to serve Western North Carolina in so many ways.

Sincerely, Chief Executive Officer MAHEC

Access to Care for Opioid Use Disorder

Thanks to generous grant funded support, we’ve been able to increase access to care for individuals in WNC who are uninsured and at highest risk for overdose death. This support includes life-saving, evidence-based medication treatment, behavioral health counseling, and peer support services (PSS).

Safer Together: This grant funded access to care project provides care including medication for opioid use disorder (MOUD), medical and behavioral health visits, and PSS for uninsured individuals with OUD up to a year at no cost

Buncombe Bridge to Care: Partnering with Buncombe County EMS Post Overdose Response Team (PORT), we launched a post-overdose buprenorphine induction pilot. In this innovative pilot (one of only a few across the country), individuals are provided PSS and buprenorphine initiation via paramedicine professionals in the field post-overdose. Then, individuals are connected to MAHEC to continue treatment.

Expanding Access to Care and Treatment (EXACT): Awarded a two year grant from the North Carolina Department of Health and Human Services (NCDHHS) to expand evidence-based treatment services for 130 patients with OUD.

Project CARA has continued to provide vital medical and substance use disorder services to more than 200 pregnant and postpartum people affected by substance use disorders across western using an integrated care approach. Project CARA’s contingency management program (an evidence-based intervention that has shown success as a treatment method for people with methamphetamine use disorder) has served over 167 unduplicated patients who have participated in the program over 678 times.

Education

One of the greatest barriers to treatment access is education and through innovative grant funded work we are able to train new providers in the region and state on life saving care.

• 115 education programs across all opioid and SUD grants/projects

• 5th Annual Perinatal Substance Exposure Summit moved from regional to statewide where 250 individuals attended from 51 counties

Training Providers at Community Health Centers

NC STAR Network: In collaboration with UNC Chapel Hill through a grant funded by NCDHHS, our statewide Hub and Spokes addiction treatment network continues to engage with 15 community health center spokes across the state from 43 counties.

Training the Next Generation of Providers

Increasing Workforce Capacity to Treat OUD in Residencies and Advanced Practice Programs: With funding from NC DHHS, our team supported 340 learners across 38 residencies and advanced practice programs in NC with a comprehensive package to sustainably embed MOUD education into curricula.

Improving Access to Opioid Use Disorder Treatment in NC from the “Pipeline to the Frontline” –Oak Foundation:

• Cultivated workforce of 23 approved teachers by PCSS to train more prescribers

• Expanded Project Cara Hub and Spokes to six new WNC counties

• Trained 202 providers to prescribe medications for OUD

Supporting Individuals with OUD in the Criminal Justice System

Buncombe Bridge to Care: 26 patients inducted in care via EMS referral

679 patients with OUD treated at MAHEC 48% (328) of whom are in an underserved category

MAHEC is continuing to partner with UNC Formerly Incarcerated Transition (FIT) Program and the Division of PrisonsAdult Corrections to develop a MAT administration and reentry program

Susan McDowell, MD at a Rural Community Opioid Response Program (RCORP) event in Haywood County. Cherokee, Graham and Clay counties are also part of the grant to provide opioid education to providers and the community.

Safer Together: 91 patients at MAHEC provided medication for OUD through this program

This project continues to have a 70% retention in care rate.

4091 participants (49% increase in participant numbers from FY21)

Current and New

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• Maternal Fetal

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Adolescent

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GRADUATE MEDICAL

Training Programs Updates

complement of 20

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a total complement of four;

From

Amadeo Valdez, DMD

in

to clinical

San Francisco, and then to clinical practice in North Carolina, Dr. Valdez

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focused

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health. He sees oral

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care, something that is very much needed in the community.

Residency, he not only teaches clinical skills but also how to take care of one’s community.

director of the General

The MAHEC Innovations team was created to eliminate the gap between idea generation and execution. This specialized team partners with all departments at MAHEC in the pre-award phase of sponsored programs to help transform the abstract into the actionable. This includes creating/implementing clinic initiatives, designing pro formas, searching for funding for innovative principal investigators, and applying for particular funding.

Guide

Ashley Steward, MBA

Ashley Steward, MBA, has worn many hats during her healthcare career. She’s been an office manager and a consulting analyst, and she also worked in clinical informatics and finance. Ashley’s passion for making healthcare accessible has been a driving force throughout her career.

“I believe that healthcare is a right for everyone, and I wanted to do my part in ensuring that this idea

a reality,” Ashley said.

She was the first member of the Innovations Team and has worked hard to build it from the ground up.

Early Wins and Key Innovations

• Implementation of Post-Acute COVID-19 Clinic with Internal Medicine –this was our first clinic initiative and a major success for MAHEC

• HRSA: THC GME Resident Expansion – expansion of Family Medicine and Ob/Gyn residents by one each

• 100% HRSA rating for the HRSA: THC GME Family Medicine Expansion

• CCBHC award to help expand and continue our CCBHC in Psychiatry –completed in less than 14 days

• ORH Community Health Grant for three years to support our CHW Family Medicine and HBPC Program

• Support for Buncombe County BRIDGE – this was our first community-led

“The innovations team is at the heart of bringing meaningful change to fruition. The manner in which they partner throughout the organization to move great ideas from their inception to reality, allows the organization to stay forward facing as a leader in healthcare innovation.”

– Bryan Hodge, DO

KEY IMPACT

• 58 programs supported

• Total budgets: $20,393,500

• Total awarded so far: $9,395,550

• Currently working with 12 MAHEC departments

CREATING HEALTH EQUITY

North Carolina’s Healthy Opportunities Pilot (HOP) is an innovative new strategy to use $650 million in Medicaid funding to test the impact of paying for services that influence our health: transportation, nutrition, housing, and support for those experiencing interpersonal violence or adverse childhood experiences in addition to chronic disease or behavioral health diagnoses.

MAHEC is providing training to Impact Health (network lead for the WNC HOP), human service organizations, and care management entities. Since funding began in May 2022, MAHEC has:

• Developed a training and technical assistance plan

• Identified challenges and needs for training and network development with key stakeholders

• Created two resource handouts and an online training module to promote best practices

• Started developing six new training modules

WNC Community Health Worker Initiative expanded with funding from Dogwood Health Trust to provide training and technical assistance to 12 partners providing CHW services to reduce the prevalence of common chronic health diseases in disproportionately affected communities.

In addition to capturing key data, MAHEC has hosted monthly WNC CHW Coalition meetings with 50+ attendees. Each session provides networking and capacity building for regional partners covering topics such as regional collaboration, building teams to support CHWs, and strengthening CHW education through the certification process now being offered by NC community colleges.

• 14 CHWs trained by MAHEC monthly

• 23 partner technical assistance meetings funded by Dogwood Health Trust

• 4,747 people served at outreach events

• 1,983 people served through individual service (74% at or below 200% of federal poverty, 41% have self-reported high blood pressure or heart disease, and 30% selfreported pre-diabetes or diabetes)

Kevin Mahoney, CPSS, CHW

Before moving to Asheville, Kevin was a personal translator for the Air Force for 20 years. “There’s a lot of inherent trauma and vicarious trauma working in combat and high pressure situations. When I came out of the military, I was really unfit for civilian life. I was homeless for five years. I was mentally ill and abused substances,” Kevin said.

All of the experiences in Kevin Mahoney’s life that most people would see as setbacks, Kevin sees as an opportunity to help more people.

RURAL HEALTH INITIATIVES

LEADING THE DEVELOPMENT OF A RURAL WORKFORCE

MAHEC’s Rural Health Initiatives have been promoting access in rural areas through collaborative workforce development, interprofessional training, and innovation.

In order to create pathways that promote an equitable regional workforce to serve Western North Carolina, the Rural Health Initiative team partners across the region to expand health professional opportunities. This means comprehensively developing programs and mentoring that support individuals from middle school to their professional career.

Rural Fellowships Provide Immediate Access to Care and a Future Commitment to Community

Our rural fellowship programming recruits, enhances training, and leads to a retained rural provider workforce in the region. The Rural Fellowship has supported six interdisciplinary rural fellows who are providing full-spectrum care in five different rural WNC counties.

PREPROFESSIONAL UNDERGRADUATE PROGRAMSRURAL AND BIPOC COMMUNITIES

Eastern Band of the Cherokee Nation

Rural Teaching Practices, including our newest partnership with the Cherokee Indian Hospital, continue to provide a learning environment for various types of learners including medical residents and pharmacy students.

HIGH SCHOOL PROGRAMS

Maternal Health

PROFESSIONAL PROGRAMS

Ruslan Garcia, MD

Originally from Cuba, and having lived and trained in Miami and New York City, Dr. Garcia arrived in WNC to practice in Murphy, NC.

He was the first Internal Medicine Rural Fellow (2020 -2021) and then followed that with a second year as a Rural Innovations Fellow (2021 -2022).

Over the past two years, Dr. Garcia has helped transform Appalachian Mountain Community Health Center from a general practice that served basic primary care needs to an integrated practice that supports patients with opioid use disorder and hepatitis C. The practice now has one of the most robust diabetic clinics in the area.

For those who thought he wouldn’t last long, Dr. Garcia is still going strong and loving his work.

The first OB Rural Fellow, Dr. Amelia Cline, is practicing in Franklin. She is creating additional access to maternal services in the setting of regional labor and deliery.

With the loss of hospitals that provide labor and delivery services, so too went the care-providers. Our Rural Fellowship program helped to place needed additional access in Macon County. Dr. Cline represents a future where women in Franklin can still get services close to home.

KEY IMPACT DATA

• In 2021-2022, supported six interdisciplinary rural fellows who are providing full-spectrum care in five different rural WNC counties

• Since 2017, 24 rural fellows have been placed in every corner of WNC

• 100% of our fellows are still practicing rural medicine today

• 92% remain in WNC

CENTER FOR HEALTH PROFESSIONS

The Workforce Development Team creates a robust, diverse pipeline of learners and future healthcare providers in WNC. Minority and rural focused health careers programs provide student learners with experiences designed to increase their knowledge base and to inspire them to return to practice in WNC. Rural provider shortages persist, prompting increased health careers programming to high school and undergraduate students in rural counties.

RURAL TEACHING PRACTICES

RURAL FELLOWSHIPS

RESIDENCY

Annually, MAHEC provides more than 6,500 hours of primarily clinical training for Western Carolina University students.

Current WCU students rotating at MAHEC:

• FNP scholars

• Summer OB rotations

• RNs in primary care including acute care and psychiatry

• Behavioral health intern – social work

• Dietetic interns

• Psychology doctoral candidates

Interprofessional Education and Practice focuses on bringing learners and healthcare providers across all disciplines together to learn and practice in a spirit of collaboration. Over the past year, health sciences students from UNC and WCU have gathered for interprofessional case discussions. An average of 40 students regularly participated in interprofessional case discussions, representing seven different disciplines and two universities.

For the seventh year, rural scholars representing medicine, dental, and pharmacy participated in their unique collaboration of a leadership-focused curriculum, with faculty representation from each program.

KEY IMPACT DATA

Naomi Llamas

Naomi knew from a young age that she wanted to pursue a career in healthcare. To reach her goal, she has been in the health careers pathway at MAHEC since middle school.

In 2014 she attended the MAHEC/WCU Health Careers Summer Camp. While a senior at Erwin High School, she was an intern in the Minority Medical Mentoring Program. Now Naomi is a junior at Mars Hill University and in her first year of nursing school. She’s also in her first year of another MAHEC program, AHEC Scholars.

Naomi couldn’t help but notice the lack of Hispanic people working in healthcare. That lack of representation is another motivating factor in Naomi’s career choice. “We’re a minority in the healthcare field, and I always wanted to see someone who looks like me”.

• AHEC Scholars accepted 13 new students into Cohort 4 (2021-2023) and graduated 16 students in Cohort 3 (2020-2022)

• 18 summer interns (2022) in the MAHECXplorer, WNCHEART and UNCA internships

• Summer interns collectively performed more than 1,000 hours of clinical shadowing at MAHEC clinics and in the region while also contributing to 17 organizational/community projects

CENTER

Inspiring Practice in WNC

TEAM Health Careers Club: Teen Education, Awareness, and Mentoring is for 9th to 12th grade students in Western North Carolina. TEAM is a unique enrichment program that introduces them to the countless possibilities in the health field and to professionals within that field. Students will gain crucial leadership skills while learning about careers in the fields of pharmacy, family medicine, dentistry, public health, and more.

TEAM monthly meetings provide virtual opportunites for high school students in all 16 counties to explore various health careers by featuring presentations from a variety of healthcare professionals.

TEAM meetings have drawn more than 70 students from five WNC counties.

Health Careers Summer Camp provides a rich learning experience with an interest in learning more about potential health careers pathways.

More than 75% of the participatants are first generation students and approximately 90% plan to provide direct patient care as a health professional in the future.

Summer Camp 2022: 30 high school students from nine counties

The Minority Medical Mentoring Program continues to provide semester-long, in-depth shadowing and development experiences.

Since the program started, 93 BIPOC high school students have been mentored and encouraged to turn their healthcare career professional dreams into reality.

Honoring and Continuing a Legacy

Jacquelyn Hallum, MBA, MHA, Director of Health Careers and Diversity Education, was celebrated for her career with MAHEC by receiving the Suzanne DeFerie Lifetime Achievement Award at this year’s annual WomanUP Celebration hosted by the Asheville Chamber of Commerce.

The lifetime achievement award recognizes WNC women who have excelled in their careers, fostered the growth and development of other women, and improved our community by sharing their time and talents.

With more than 1,000 interactions with high school students interested in health careers, programming has now expanded to the middle school students.

UNC

SCIENCES AT

UNC SCHOOL OF MEDICINE ASHEVILLE CAMPUS

Key Programs and Initiatives

Curricular innovation/adaptation:

• We hosted a very successful virtual open house with more than 40 MS1 students participating, followed by several individual site visits, resulting in successful recruitment of 33 students who will join our campus for the 2023-24 academic year

• UNC implemented mandatory wellness days into the third year curriculum where students are free from clinical and nonclinical duties to focus on their personal wellbeing; Asheville Campus has four dates built into the calendar

• Impact sessions were designed and developed for students by our EDI lead and Advisor, Dr. Michelle Boose; the eight one-hour sessions give students an opportunity to discuss and reflect upon topics addressing social justice, equity, diversity, and inclusion, in medicine

• In partnership with MAHEC Simulation Center, we are able to return to in person testing onsite for OSCEs (Objective Structured Clinical Examinations)

New and Expanded Rotations

• Added two new courses for MS4s: Emergency Medicine Ultrasound and Wound Care

• Expanded our inpatient medicine service weeks from two to four weeks for all MS3s in partnership with MAHEC Internal Medicine; only now do we have the capacity to meet this much requested need

• Eight MS3s completed their outpatient IM rotation at MAHEC IM, and have expanded that to 11 MS3s for the current academic year

• Two FIRST students are on an accelerated path in Application Phase; one student will join the MAHEC Psychiatry Residency Programs

Faculty and Preceptors

• Dr. Ginger Poulton joined the Asheville Campus team as FM site directoradditionally, she is the lead for Quality Improvement and Wellness initiatives for our campus

• 399 UNC SOM faculty appointments

• 25 students graduated in 2022; 189 students have graduated since the program’s inception

• 35 MS3s completed Asheville Campus in 2022; 232 since inception

• MS3s and MS4s completed rotations in 14 WNC counties

• Four students matched to MAHEC residencies in 2022 (FMH-2, Psychiatry-1, IM-1)

• 33 students will join our campus for the 2023-24 academic year

Katie Leiner, MS4

As a Davidson Impact Fellow at MAHEC, Katie focused on addiction. She was so inspired, she stayed on for a year after her fellowship to work with MAHEC’s perinatal substance use treatment program, Project CARA. As the program’s rural practice coordinator, Katie contributed to research on perinatal substance use and helped rural medical practices support birthing people with substance use treatment needs.

Currently, Katie is a student in the UNC School of Medicine Asheville Campus. She has been honored with induction into Alpha Omega Alpha, an honor given to only a handful of medical students from across UNC’s four campuses each year.

UNC HEALTH SCIENCES AT MAHEC

ADAMS SCHOOL OF DENTISTRY

The Adams Rural Oral Health and Wellness Scholars (AROWS) Program is a partnership with the UNC Adams School of Dentistry and MAHEC’s Dental Department. It is a track of educational and clinical experiences within the UNC ASOD curriculum that is completed through MAHEC.

The AROWS program recruits students who identify as wanting to serve in rural and/or safety net areas. The goal of the program is for graduates to start/join dental practices that see a wide variety of patient populations including but not limited to: Medicaid, self-pay, FQHCs, and Community Health Centers.

Since 2020

graduated from the program;

UNC ESHELMAN SCHOOL OF PHARMACY

The UNC Eshelman School of Pharmacy Asheville Campus offers two unique programs that foster development of future pharmacy leaders:

• The Rural Pharmacy Health Scholars Program emphasizes the importance of social determinants of health, community engagement, and interprofessional practice in small and rural communities

• The Ambulatory Care Scholars Program prepares student pharmacists to serve as leaders in the development of new clinical pharmacy services in primary care

UNC Eshelman School of Pharmacy and MAHEC have strengthened their partnership to advance pharmacy practice and improve health in WNC.

The new Department of Pharmacotherapy has three strategic initiatives:

• Providing clinical pharmacy services throughout the organization

• Establishing a 340B pharmacy to better serve vulnerable patients in the FQHC look-alike model

• Increase research impact

To achieve these goals, clinical pharmacist practitioners (CPP) are embedded in family medicine, geriatric, internal medicine, Ob/Gyn and psychiatry to provide team-based comprehensive medication management services and a new pharmacy technician workforce has been established.

A recently awarded five-year Patient-Centered Outcomes Research Institute (PCORI) grant will compare usual care with CPP-managed hypertension, and a project funded by the Dogwood Trust will perform a patient-centered needs assessment of patients in WNC to optimize medication use.

“We are thrilled to build upon a decades-long partnership with MAHEC that will allow us to continue preparing leaders and innovators to solve the world’s most pressing healthcare challenges.”

Angela Kashuba, PharmD Dean, UNC Eshelman School of Pharmacy

patients seen

AROW Scholar, Shadoe Stewart, examines a patient

UNC HEALTH SCIENCES AT MAHEC

ASHEVILLE - UNC GILLINGS MASTER OF PUBLIC HEALTH PROGRAM

Highlights

In November, the UNC Board of Governors approved the UNC Asheville - UNC Gillings MPH Program as a joint degree. It has been accepted as an applicant for accreditation and will be the first joint program between a liberal arts university and a school of public health that the Council for Education in Public Health has accredited. UNCA faculty and administrators have been instrumental to the creation and operation of the MPH from the beginning; this joint status provides a new funding model to sustain the program.

Community members have supported our program throughout its development. As we move into this new phase as a joint program, a Stewarding Group is being formalized with representatives from across Western North Carolina to assure that the program is responsive to public health priorities in the region.

The program is now partnering with the Center for Native Health to build and deepen relationships with the Eastern Band of Cherokee Indians (EBCI) with a mutually beneficial approach.

MPH faculty Sarah Thach was selected as a National Rural Health Association Rural Health Policy Fellow and MPH faculty and MAHEC’s Director of Health Equity and Policy, Tamarie Macon, was appointed by the City of Asheville to the Community Reparations Commission.

“Since graduation, I’ve had the pleasure of working with six universities and colleges in our WNC region, [helping them] stay in class during the COVID-19 pandemic. Our systems course taught me the foundations that I’m using every single day in my role, managing team dynamics, building real relationships, garnering respect in the community, focusing on the impact you can make long term, and showing that impact statistically.”

Kol Gold, MPH 2020 graduate

• 17 students started in fall 2021

• 34 graduates since the start of the program; 32 retained in WNC

• 45 community partner organizations precepting in 13 WNC counties plus Qualla Boundary and 11 MAHEC departments; three alumni now serve as preceptors

• Scholarly activity this year: Six conference presentations and five articles; students involved in two presentations and five articles

School of Public Health faculty and staff celebrate with the Class of 2022

Rongrong Fan, MD works with two Ob/Gyn residents in the Simulation Center

Continuing Professional Development continues to meet the needs of our learners and presenters by producing novel programs during a year where COVID continued to challenge us. The online programs expanded to include the topics of substance use; diversity equity and inclusion; Medicaid transformation; community health workers; and COVID. We welcomed back limited inperson participants safely and successfully.

Project ECHO® for Geriatric Care has been fully funded by a community partner (Advent Health) for the first time

2022 Women’s Recovery Conference had a record attendance of 350 participants and drew providers from several surrounding states

5th Annual Perinatal Substance Exposure Summit was expanded from regional to statewide, reaching a multidisciplinary audience of more than 250 participants across North Carolina

Substance Use Education for Western North Carolina Educators has reached an audience of approximately 700 educators across the Western North Carolina region to date

KEY IMPACT DATA

• 947 events

• 31,564 participants

• 9,942 unique participants

• Participants from 99 of the 100 NC counties

• Participants from 37 states

Transgender Health Summit

The NC AHEC Diversity, Equity and Inclusion for Primary Care Clinical Providers and Non-clinical Staff touches on all aspects of health inequities on a deeper level than other programs

“The best conference I’ve ever been to based on all the audience interaction.”

— Jennifer Abbott, MD

Tori Cooper and conference attendees

CNA to MA Pathways Program

24 participants completed the training and study portions of the program in partnership with Blue Ridge Community College.

23 have passed the National Health Careers certification exam.

Through the Pathways Program, MAHEC contributes to the healthcare workforce by providing opportunities for nursing assistants to train and study to become certified clinical medical assistants.

Medical assistants are critical members of the healthcare team and are qualified to perform multiple tasks while ensuring quality patient care. Demand for medical assistants is projected to grow as the U.S. population ages and primary care services expand.

Bryanna has attended multiple MAHEC programs since her first Health Careers Summer Camp when she was in sixth grade.

Recently, she completed the CNA to MA Pathways program and is now the first pathways graduate working at MAHEC Ob/Gyn Specialists.

In August, Bryanna will embark on the next stage of her journey when she begins the physician assistant program at the Emory University School of Medicine.

DENTISTRY & ORAL HEALTH School Smiles Program

The MAHEC School Smiles (MSS) program was developed with the Medical University of South Carolina and East Carolina University and is funded by the generosity of The Duke Endowment. The program aims to provide preventative and basic dental treatment services for under-resourced children in Buncombe and McDowell County schools. The program sees children grades K-2 during the school day.

During the 2021-2022 school year we completed services at one elementary school after COVID restrictions were reduced in spring 2022.

The MSS team treated 10 children, and provided 38 preventative and treatment services mostly to students without a way to access dental services otherwise.

The program will resume and expand in the 2022-2023 school year.

Bryanna Williams, CCMA

Beverly Haney, CDA; Katherine Jowers, DDS; and Ron Fagan with the School Smiles van

Key Initiatives

• Acute Care Clinic continued through the year to meet the demands as COVID surged throughout the community.

• Next Step Clinic continues to expand to provide best practice hepatitis C and HIV care for patients in Western North Carolina. Since its inception, the interprofessional teaching clinic has touched 424 patients living with hepatitis C and treated 214. Screening efforts continue to expand with new collaborations with Ob/Gyn and Internal Medicine. In the past year, 4,266 unique patients were screened for HIV and 5,114 for hepatitis C.

• Safe Prescribing Clinic focuses on treating patients with both chronic pain and substance use disorders in a patient-centered manner.

905 monoclonal antibody infusions for patients infected with COVID

Laura Bailey, the first pharmacy technician at MAHEC, runs the Medication Access Program. She has connected more than 380 patients with medications, at no charge, that are valued at $2.7 million. Some medications are ones that patients would not have been able to get without her assistance.

INTERNAL MEDICINE

Key Accomplishments

Clinical Initiatives:

• Geriatrics Consultation Clinic— complex multimorbidity and geriatric syndrome consultations

• Hospital Follow Up Clinic— post-hospitalization care within two weeks of hospital discharge, increased access for primary care

• ACCESS Clinic— same -day visit access

• Post-Acute COVID Clinic (PACC)— accepts regional referrals to provide focused care for patients with long-COVID symptoms

• Procedure Clinic— dedicated procedure focus and expertise for patient safety and convenience as well as education

Education:

• Second successful match year— 15 interns

• Well-being in residents— measured burn-out rates more than 40% below the national average

• Above national average for specialty in all areas assessed in April 2022 ACGME survey

• Successful accreditation site visit

Collaborations:

• Pharmacist-led medication reconciliation training

• Embedded pharmacist provided training and tools to increase medication knowledge for clinical staff

• Project ECHO weekly seminar with Center for Psychiatry and Mental Wellness focuses on preparing physicians to effectively care for patients with depression and anxiety in primary care

Family Health Center at Enka/Candler opened at their new location in October 2021

“With collaborative care [IMPACT model], I have seen my patients with depression and anxiety get better more often and more quickly. I also learn tips from the counselors and psychiatrists about how to improve my care for future patients. What a great model!”

— Nancy Kubiak, MD Medical Director, Internal Medicine

Keelan Dorn, FNP, prepares for an infusion

Work-life balance is a priority for the Internal Medicine department

PSYCHIATRY

MAHEC’s Psychiatry Department was funded by a Certified Community Behavioral Health Center (CCBHC) Expansion grant from SAMHSA from May 1, 2020 to July 31, 2022. On July 1, 2022 we received an additional CCBHC grant from NC DHHS to increase access to mental health and substance use care, particularly for vulnerable and underserved populations.

The number of patients almost doubled between July 2021 and June 2022. There were 31,042 visits to the Center for Psychiatry and Mental Wellness this fiscal year, up 92.8% from 16,095 visits last fiscal year.

New Programs

• The MAHEC Intensive Outpatient Program began serving patients at the end of June

• The Addiction Psychiatry Fellowship was created to train clinical psychiatrists in preventing, recognizing, and treating addictive disorders. This fellowship is the only one of its kind in North Carolina and one of fewer than 50 across the United States

Existing Programs

• School-based therapy

17 school-based therapists provided services to more than 600 students

• Transcranial Magnetic Stimulation

36 patients treated across 1,296 treatment sessions 80% had a positive response to the treatment and 58% achieved full depression remission

• Peer Support Services

543 patients served in a total of 2455 encounters

Several MAHEC peer support specialists are completing cross-training to be certified community health workers

OBSTETRICS & GYNECOLOGY

Increased Access to Care in Rural Counties

MAHEC Ob/Gyn opened two satellite offices to ensure women can receive obstetrical and gynecological care closer to home: Franklin NC opened January 2021, and Brevard NC opened June 2021.

Research

PCORI: Patient-Centered Outcomes Research Institute

• Development of a racial equity curriculum based on the Accountability for Cancer Care through Undoing Racism and Equity (ACCURE) model that includes patient simulations and case-based discussions

Highlights

• 40 practice sites to be recruited by the ACCURE4Moms team at UNC Chapel Hill to implement REI training; there are 37 practices currently recruited across North Carolina

• Video simulations underway of patient-provider/staff encounters in the healthcare setting that highlight examples of/opportunities to recognize implicit biases

Brian Barrow, MD

When Brian Barrow began his first Ob/Gyn rotation while at University of Florida College of Medicine, he was hooked by day three. He enjoyed the people he worked with, the variety each day held, and the fast pace of moving between routine patient care, surgery, and labor and delivery.

A chance encounter during residency would set the course of his career as a rural physician.

Now Dr. Barrow and MAHEC Women’s Care at Brevard help build the pipeline of welltrained physicians for rural and medically unserved communities.

Mother-Dyad Study sponsored by the National Institutes of Health, examines the different characteristics between pregnant people with OUD who choose medically supervised withdrawal versus opioid agonist treatment. Both research studies aim to discover more information about best practices and treatment for pregnant people with OUD.

Community Opioid Response and Evaluation (CORE) funded by PEW Charitable Trust

MAHEC Ob/Gyn was selected as one of the sites nationally for this award. The research team evaluated the impact of Project CARA and to better understand needs of pregnant and postpartum people in WNC who use opioids, with the goal of improving access to quality perinatal substance use disorder treatment

• Conducted a mixed methods evaluation across WNC

• Results will guide the expansion of the Project CARA to other sites across WNC

• 3,501 ultrasounds read by our Maternal Fetal Medicine Specialists for HCA and all their outlying hospitals

• Nine doulas trained - 114 clients served by SistasCaring4Sistas

CENTER FOR HEALTHY AGING

Home-Based Primary Care

The Center for Healthy Aging (CHA) received funding from WNC Bridge Foundation and Buncombe County’s Home and Community Care Block Grant to continue its Home-Based Primary Care (HBPC) program for a third year. This program supports Buncombe County’s aging population to age in place safely. HBPC incorporated initiatives on diversity, equity, and inclusion, instituting a Community Member Advisory Board comprising BIPOC community leaders to help guide HBPC’s programming and reach into underserved communities, and ensuring access to Racial Equity Institute’s groundwater training for program staff.

HBPC also partnered with Buncombe County to connect adults referred by Adult Protective Services (APS) with primary care and the Social Bridging Project (a UNCA/MAHEC partnership initiative) to provide telephonic support to socially isolated older adults.

Educational Programing

• Hosted the annual Suzanne Landis Geriatric Summit in partnership with Continuing Professional Development 87 attendees, including aging services providers and an array of healthcare providers

• Hosted Geriatric ECHO sessions attended by 206 clinicians from across North Carolina Topics included: cognitive screening, cognitive management, polypharmacy and deprescribing, LGBTQIA elders, diabetes in the older adult, case management/social determinants of health, osteoporosis, urinary incontinence, advance care planning, fall prevention

• Funded enrollment in racial equity training for seven HBPC program staff and partners

• Cared for 139 Buncombe County residents in home-based primary care

• Incorporated a community health worker (CHW) from Asheville Buncombe Institute of Parity Achievement (ABIPA)

KEY IMPACT DATA

Referred 12 individuals for CHW services

• 73 patients received services from the Council on Aging of Buncombe County

• 17 patients received occupational therapy services

• 17 patients were referred to the Social Bridging Project

• Connected 15 APS-referred patients with primary care services

MATERNAL-CHILD HEALTH

• Funding and program availability has expanded into 17 of counties across WNC

• Approximately 5,000 area children and 2,300 caregivers have received direct program services and support

MAHEC is one of 10 support hubs across North Carolina tasked with the systematic scaling of the evidence-based parenting program Triple P (Positive Parenting Program)

• 45 service delivery agencies across a variety of sectors in WNC offer programs to local families

Safe Kids WNC works with community partners to address the most prevalent childhood injuries in Western North Carolina

• 128 newly certified child passenger safety technicians and 62 attendees reinstating their CPS certification via National Child Passenger Safety (CPS) Certification Classes provided

• 329 new car seats distributed to children in need, along with education on installation and proper car seat use; an additional 26 car seats distributed to children with special healthcare needs

• 848 attendees at six community safety events

• The PNOC and MHI teams joined forces to launch the first season of the “Just Us: Before, Birth, and Beyond Podcast”

• 128 OB telemedicine appointments

• Three OB Hemorrhage Simulations training funded by PNOC with 68 participants

• 122 participants in MHI Learning Collaborative Webinars, focused on “Doing Better Together to Equitably and Innovatively Advance Reproductive Health and Healthcare with a Focus on Human Rights, Quality Improvement, and Inter-professional Collaboration.”

Key Initiatives

•

• Worked with

• Recruited

•

•

a

(CHWs)

needs

Unhealthy (STUN) Alcohol Use Now project to aid practices in implementing

with the North Carolina HIE to utilize bidirectional

including SDOH screenings,

attribution strategies to ensure

• Assisted practices in preparation for Tailored

prepared them for site reviews in the successful achievement of AMH+ or CMA status

of Medicaid transformation

The CHW Integration and Optimization

practices across the state, including MAHEC.

The three

sites

collaborative

participating

discuss

an

and/or optimizing a CHW program in a primary

Health Equity Training for Practice Support Coaches

CHASM (Community Healing through Activism & Strategic Mobilization) is providing health

coaches.

•

The Practice Support team in December 2021

Strategic support for conducting research

MAHEC welcomed Edward C. Jauch, MD, MS FAHA as the new Chair of the Department of Research.

Al Kopak, PhD joined the Research team, bringing expertise in understanding the connections between substance use disorders and criminal justice-related outcomes.

Brandy Tiernan, PhD joined MAHEC in 2022 as the Director of the Institutional Review Board and Human Subject Protections Administrator.

Dr. Tiernan will build MAHEC’s new Institutional Review Board— a mission-based human subjects research program. It will enable MAHEC faculty, learners, staff, and community partners to make longlasting connections and meaningful contributions to equitable health care.

52

and scholarly articles published

Full list at https://ncahec.libguides.com/MAHEC/publications

library service interactions

28th Annual Research Day

Featured three plenary presentations and 11 poster presentations

SCIENCE

46% of search requests were for patient care, teaching and professional development

54% of search requests were for research, grants, publication, program development

What is the evidence for this new diagnostic tool compared to the gold standard?

Will this usage violate any license or copyright law?

Have others implemented a patient care program like this?

How do I properly cite this practice guideline in my presentation?

Has anyone else conducted a study on this before?

What is the incidence of this disease?

How can I share this article?

Where should I submit my article for publication?

Dr. Jauch listens to a poster presentation during Research Day

121 Hendersonville Rd | Asheville NC 28803 | 828-257-4400 www.mahec.net