NC Family Physician - Summer 2020

Volume 16 Issue 3 • Summer 2020

The North Carolina

Family Physician Quarterly News in North Carolina Family Medicine

COVID-19 Spurs Unexpected Medical Student Experiences P. 20

Inside Summer 2020

Could COVID Be the Positive Tipping Point for Primary Care P. 24

PRESIDENT’S MESSAGE

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A Time for Reflection and a Time for Action

ADVOCACY

8

2020 Legislative Session in Review

PROFESSIONAL DEVELOPMENT

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The 2020 Winter Family Physicians Weekend: A Family Tradition with a Twist

RESIDENTS & NEW PHYSICIANS

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North Carolina Residents and Medical Students Selected for Emerging Leaders Program

CHAPTER AFFAIRS

12 Payment Reform & Reduced

PRACTICE MANAGEMENT

Administrative Burdens

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Could COVID Be the Positive Tipping Point for Primary Care?

DEPARTMENTS

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President’s Message 4 Advocacy 8 Chapter Affairs 12 Professional Development 16 t 919.833.2110 •

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Residents & New Physicians 18 Medical Student Programs 20 Practice Management 24

919.833.1801 • ncafp.com

Managing Editor, Design & Production Peter T. Graber, NCAFP Communications

Have a news item we missed? NCAFP members may send news items to the NCAFP Communications Department for publishing consideration. Please email items to pgraber@ncafp.com.

PRESIDENT’S MESSAGE to Members

By Dr. David Rinehart 2019–2020 NCAFP President

~ 2020 TODAY ~

A Time for Reflection, and a Time for Action The past several months, and especially the past several weeks, have caused all of us to focus on societal and healthcare issues that are challenging and at times uncomfortable, embarrassing, frustrating, and intolerable. We have witnessed a sweeping pandemic that has made us feel inadequate, sometimes helpless, and sometimes personally vulnerable. Inequities and disparities in healthcare and in our communities have been made apparent and obvious. We have witnessed horrific videos of brutality, violence, and racism against our Black community members. We struggled to identify, fight against, and understand our own implicit biases. We ask ourselves about how we might help each other find the right direction on the moral compass to rid our society of the inequities of opportunity, disparities of outcome, and racism that exists.

There has been much to think about.

As we reflect, we are also swept up in the swirling current that calls for action. It does not seem like the right time to wring our hands and form another task force. We are called to be healers, and our communities have deep wounds and serious disease that require active treatment.

We must act first by becoming informed and humble. We need to spend time learning about and under-

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Dr. Rinehart attended the University of Virginia and earned his BA in 1978 (Phi Beta Kappa) and his MD in 1982 (Alpha Omega Alpha). He completed his residency in Family Medicine at Charlotte Memorial Hospital in 1985 and was recognized as a national Mead Johnson Outstanding Resident. Dr. Rinehart has enjoyed 34 years of community-based Family Medicine practice with South Point Family Practice in Belmont, NC, 22 years as an independent group practice and 12 years as part of CaroMont Health. Dr. Rinehart lives in Belmont with his wife of 40 years and has three grown children and two grandchildren.

standing the implicit biases we all harbor, speak with and read about people and cultures that are not of our own experience. We must try to see the world through the perspective of another person to further develop our own. We must continue to uncover and quantify disparities as we work to better understand the social determinants of health. These social determinants must be prominent and explicit in our thinking as we advocate for health equity.

We are trained to focus on family, on community, and on our environment as determinants of health. Let us support community groups such as mental health agencies, faith-based groups, literacy councils, housing agencies, food banks, youth and senior programs, childcare agencies and others as they provide threads that together weave the fabric of a healthy community.

Some of us will heed the call to be leaders and prominent voices in the struggle to bring equity in justice to our laws, policies, and systems of healthcare. Many will join in advocacy for just housing, just wages, equal educational opportunity, and equal healthcare access.

See ‘Reflection’ on Page 6

The North Carolina Family Physician

NCAFP STATEMENT AGAINST RACISM AND DISCRIMINATION

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he North Carolina Academy of Family Physicians has a long-held belief, reflected in policy, that discrimination for any reason is unacceptable. Considering recent events, it is clear that our state and nation have a long way to go before discrimination and racism have finally ended. Family physicians across North Carolina and our country are grieving with and for their communities. One of our past presidents, Dr. Karen Smith, attended the memorial service for Mr. George Floyd in his home county, Hoke County, in southeastern North Carolina. We join with all our members in speaking out against discrimination and institutional racism.

To reiterate AAFP’s position, the NCAFP considers racism a public health crisis. The elimination of health disparities will not be achieved without first acknowledging racism’s contribution to health and social inequalities. This includes inequitable access to quality health care services. Our members see the negative health outcomes of racism in their patients who are often at an increased risk of heart disease, stroke, diabetes, low birth weight, premature birth, and infant mortality. And we have seen it in the incidence of COVID-19 in minority populations in our state. As of early July, 33 percent of the COVID-19 related deaths in North Carolina had occurred in the African American community, a significant and disproportionate number compared to the population of our state.

The mission of our organization centers around providing our current and future members the tools to provide exceptional care to their patients and communities. We know that social determinants of health matter. We support family physicians in their efforts to actively dismantle implicit racist and discriminatory practices in their institutions and their communities.

Here are some ways you can take action personally: Challenge Bias and Racism: If you see something, say something. Conversations matter, even if it’s one person and one conversation at a time, whether it’s your friends, your family, or your co-workers.

Support Your Colleagues: Minority physicians remain under-represented in medicine and face their own unique obstacles in the workplace. Start by supporting them.

Educate Yourself: Take some time to learn about our country’s history with racism, and the impacts that we still see today. Even if you already know a lot, we can always learn more. Here’s one North Carolina resource, The Racial Equity Institute - www.racialequityinstitute.com, to get you started.

The NCAFP will continue to use our organization’s platform and voice to advance the conversation and act against racial injustice.

As AAFP previously said, it is incumbent upon all of us to engage in an honest discussion about how to ensure that health outcomes and personal safety are not determined by the color of a person’s skin. We stand ready to continue this conversation at both the local and state level.

David A. Rinehart, MD, FAAFP NCAFP President, and on behalf of the NC Academy of Family Physicians Board of Directors

Summer 2020

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REFLECTION from page 4 But the first and most important call to action for each one of us is in our daily patient care. When that exam room door closes, and we are face-to-face with a patient, this is when we as family physicians will practice true and honest health equity. We

will see that patient, regardless of their skin color, age, gender, culture, or ethnicity, as a valuable person and not as a member of a stereotyped group. We will embrace and celebrate their differences. We

Health Equity Resources – THE AAFP EVERYONE PROJECT The AAFP EveryONE Project is designed to help family physicians take action and confront health disparities head on. The project focuses on providing family physicians and their practice teams with education and resources, advocating for health equity, promoting workforce diversity, and collaborating with other disciplines and organizations to advance health equity. As part of the project, the AAFP developed a toolkit to help family physicians address social determinants of health in their practices and communities, to improve their patients’ lives and help them thrive in a multitude of ways. Some of the resources in the toolkit include: • • • •

Implicit Bias Training Materials on practice leadership for health equity Social needs screening tools for patients Health Equity issue briefs and more

Search for the “EveryONE Project” at www.AAFP.org.

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CULTURALLY AND LINGUISTICALLY APPROPRIATE SERVICES IN HEALTH CARE (CLAS) STANDARDS From 2006 through the summer of 2011, the NCAFP Foundation undertook an extensive grant-funded initiative to reduce health disparities in our state. One of the key components of the grant was to teach primary care physicians about the federal Culturally and Linguistically Appropriate Services (CLAS) standards. During the grant, physician knowledge and implementation of the standards increased greatly. For example, the percentage of surveyed members that had a process to resolve conflicts and patient complaints that included simple forms in preferred languages increased by nearly 50 percent. The grant also included numerous clinical presentations with specific information about health disparities in various disease states. Since that time, the federal government has updated and revised the CLAS standards and developed additional materials. This information can be found at www.thinkculturalhealth.hhs.gov, and includes:

The North Carolina Family Physician

2019-2020

NCAFP Board of Directors

will learn some of the story of their life, their fears and successes, their goals and their relationships. We will see them as valuable members of an inclusive community of equally important persons.

We will care for them. We will care about them. We are family physicians.

Executive Officers President

David R. Rinehart, MD

President-Elect

Jessica Triche, MD

Secretary/Treasurer

Dimitrios “Takie” P. Hondros, MD

Immediate Past President Executive Vice President

Alisa C. Nance, MD, RPh Gregory K. Griggs, MPA, CAE

At-Large Directors Talia M. Aron, MD Elizabeth B. Baltaro, MD Jewell P. Carr, MD Garett R. Franklin, MD Shauna L. Guthrie, MD, MPH Brian McCollough, MD Mark McNeill, MD Ying Vang, MD

• A Physician’s Practical Guide to Culturally Component Care – updated online educational program.

• An overview of the CLAS Standards • Information on Health Care and Civil Rights • Health Equity Resources and more.

Academic Position Mark L. Higdon, DO (Novant FMR)

Resident Director Elizabeth Ferruzzi, MD (Novant)

Resident Director-Elect Clayton Cooper, MD, MBA (Duke)

Student Director Katelyn Turlington (WFSOM)

Student Director-Elect Hannah Smith (ECU)

AAFP Delegates & Alternates AAFP Delegate

Michelle F. Jones, MD

AAFP Delegate

Karen L. Smith, MD

AAFP Alternate

Richard W. Lord, Jr., MD, MA

AAFP Alternate

Robert L. Rich, Jr., MD

2501 Blue Ridge Road, Suite 120, Raleigh, North Carolina 27607

Summer 2020

www.ncafp.com

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ADVOCACY

By Gregory K. Griggs, MPA, CAE NCAFP Executive Vice President

~ ACADEMY IN ACTION ~

2020 Legislative Session in Review In mid-July, the 2020 Session of the North Carolina General Assembly came to a close, well, sort of a close. The General Assembly will technically return in early September to address additional financial issues related to the coronavirus. However, several important bills were finalized during the 2020 legislative session. Key bills are summarized below.

Medicaid Transformation – Senate Bill 808 A bill designed to move Medicaid Transformation forward and fully fund Medicaid’s fiscal needs over the next year passed both chambers of the General Assembly and was signed into law by the Governor.

Senate Bill 808 sets July 1, 2021, as the go live date for Medicaid to move to the managed care model.

The bill also sets aside funding for a new Department of Health and Human Services headquarters in Wake County (the legislature had previously threatened to move DHHS out of Raleigh), fully funds the Medicaid rebase, provides additional funding to the Department to assist in managing the COVID-19 pandemic, and provides additional resources needed to implement Medicaid Transformation. Originally, the bill required penalty payments to the managed care plans if transformation does not go live by July 1st of next year. Those penalties were eliminated, but the legislation does direct the Department to move the

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The North Carolina Family Physician

additional managed care contracts from three years to four years, acknowledging that the delay has impacted those companies who won contracts as managed care plans.

NEW WEBSITE!!!

The legislation is particularly crucial to primary care practices because it eliminated the possibility of steep Medicaid rate cuts at a time when primary care practices are already hurting fiscally due to COVID-19. Without an adequate rebase to fund Medicaid, the Department would have been forced to implement substantial provider rate cuts. The move to managed care had been delayed due to a budget impasse. Beyond Medicaid Transformation, the bill added $100 million for COVID-19 testing, contact tracing, and trends tracking and analysis, and appropriates $20 million for early childhood health initiatives. The NCAFP supported this legislation and worked to successfully modify a few initial provisions that proved problematic.

Direct Primary Care Practices – House Bill 471

www.ncafp.com

House Bill 471 clarifies that Direct Primary Care agreements are not subject to regulation by the State Insurance Commissioner nor subject to the provisions of Chapter 58. The bill does establish minimal standards for agreements between a Direct Primary Care practice and the patients they serve. The Governor signed this bill into law July 1. The NCAFP generally supported this legislation.

Step Therapy Reform – Senate Bill 361 After a nearly five-year effort, the General Assembly passed step therapy reform in North Carolina as part of a larger bill, Senate Bill 361. The bill requires insurance companies to have a Pharmacy and Therapeutics Committee to review any restrictions on access to covered prescription drugs or devices, and establishes an exception process for prescribers to provide nonformulary drugs or devices if it is determined to be medically necessary and appropriate for the patient. The bill requires insurers to grant an exception request if there is sufSee ‘Review’ on page 10

Summer 2020

A Family Medicine Community Podcast ~ Hosted by NCAFP ~ www.ncafp.com/ncfmtoday 9

REVIEW from page 9

Pediatric Society), opposed several provisions in House Bill 918. All of the organizations were concerned that ficient documentation that any of the following apply: provisions in the bill could result in pregnant women the patient has tried alternate drugs while covered by not seeking prenatal care, could pose challenges for rethe current or previous health plan; the alternate drugs unification of foster children and further exacerbate the have been ineffective in the treatment of the disease shortage of foster homes. While the or condition; the alternate drugs bill passed the General Assembly, it are expected to cause a harmful or was a very close vote, and all the adverse clinical reaction; the drug organizations wrote letters asking has been approved as an exception We have been told by legislathe Governor to veto the bill. The to the clinical protocol pursuant to tive leaders that assistance to Governor formally vetoed the bill the insurer’s exception procedure; on July 2nd. or the prescriber certifies in writall types of independent ing that the patient has previously physician practices is still used an alternative nonrestricted being considered, dependWork Still Outstanding access drug and it has been detrimental to the patient’s health or ing on tax revenue and how The NCAFP and the NC Pediatric ineffective in treating the same Congress says the remaining Society fought hard to secure addicondition and is likely to be dettional fiscal relief for independent rimental or ineffective in treating funds can be utilized. primary care practices adversethe condition again. However, prily impacted by the COVID-19 or authorization processes may still pandemic. North Carolina reapply. The Governor signed this ceived substantial fiscal assistance bill into law July 1. The NCAFP from the federal government for various impacts of supported the Step Therapy Reform effort.

COVID-19. Some of the funding was passed on to hospitals and health systems. However, no funds have been allocated from the state to independent practices.

Miscellaneous Healthcare The General Assembly did not allocate 100 percent of Appropriations the federal funding the state received, vying to wait to see what July tax collections looked like due to the ecoSeveral bills had key appropriations for healthcare. nomic downturn, as well as for further direction from For example, House Bill 1023 allocates $4.8 million Congress on how the funds to the state may be able to for UNC School of Medicine Asheville Campus joint be used. The General Assembly is also waiting to see program for COVID-19 related response activities and if there is additional assistance forthcoming from the $2.6 million for the NC HealthConnex health inforfederal government. We have been told by legislative mation exchange network for certain COVID-19 releaders that assistance to all types of independent phylated improvements and operations. House Bill 1087 sician practices is still being considered, depending on allocates $9 million to the Southern Regional Area tax revenue and how Congress says the remaining funds Health Education Center in Fayetteville. can be utilized. We are continuing to advocate that independent practices receive some of this support and hope the General Assembly will appropriate funding Expedite Permanency/DHHS Report – for this purpose in September.

House Bill 918 The NCAFP, along with several other medical organizations (NC Medical Society, NC Ob/Gyn Society, NC

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The North Carolina Family Physician

ADVERTORIAL

Physician Well-Being During the COVID-19 Crisis: Leadership in the Time of COVID-19

By Jason Horay, Manager of Health Strategy and Well-Being, Curi Physicians and their practices across the country feel the impact of COVID-19 every day, and the decisions physician leaders make now in the face of the pandemic will impact their future success. To be an effective leader for your practice during times of crisis, it’s important to have a reliable toolbox of habits and identified character strengths to draw from.

As a leader, it’s important that you communicate across the organization clearly and frequently, explain your decisions, and tie them back to your organization’s mission, vision, and values. Here are five recommendations from healthcare consultant Paul DeChant to mitigate workforce burnout and help navigate employees through an unsettling world:

• • •

•

•

Be visible. Break out of committee meetings and conference rooms as much as possible to spend more time in clinical areas observing the work and communicating with clinicians. This face time can go a long way toward mitigating doubt and building trust.

Provide resources. Do everything you can to provide your clinicians the staffing, equipment, and supplies they need now and will need later. As you work to anticipate clinician needs and follow through with fulfilling them, your leadership shows.

Empower decision-making at the point of care. Rein in micromanaging. While at times you may feel out of control, enforcing tight control can demoralize your clinicians and result in bad decisions. People in the midst of chaos often have more insight into problems than leaders do, and they typically have great solutions. Trust them.

Express gratitude. Take every opportunity to thank your teams; anything from a quick handwritten card to broad public acknowledgement can do the trick. Your people are going way above and beyond, risking their health and potentially their families’ health to serve their patients. Showing your gratitude will further establish and maintain their respect, loyalty, and determination.

Anticipate short- and long-term changes. Pull back from the immediate crisis to look around and begin identifying and assessing next steps. It’s not too early. Looking to next week, next month, and next year is smart and can instill a sense of confidence and control.

Another way to reinforce leadership and problem-solving abilities is to identify your character strengths.

Character strengths are positive parts of your personality that impact how you think, feel, and behave, and according to the VIA Institute on Character, scientists have identified 24 character strengths that we all have the capacity to express. Knowing and applying your dominant character strengths is the key to you being your best self, which in turn can reinforce your abilities to lead and problem solve. Visit viacharacter.org to take the institute’s character strength survey and discover your unique character strengths profile and lean on those strengths in crisis times.

Much rides on how well your organization comes out of this volatile environment. Workforces are challenged by exhaustion and waning morale, and they’re looking to you for leadership. Be ready to spend more time and effort supporting your clinicians, communicating, providing resources, empowering decision making, expressing thanks, and strategizing next steps. Discover your character strengths for handling stress and developing relationships with those who matter most, including your employees.

While disruption and uncertainty could break an organization, they can be opportunities to nimbly pivot to a successful recovery. The strength and effectiveness of your leadership could make all the difference.

If you have questions about these strategies or how we can support the well-being of your employees further, please contact me at jason.horay@curi.com.

© Copyright 2020 Curi

800-662-7917 | curi.com

CHAPTER AFFAIRS

By Gregory K. Griggs, MPA, CAE NCAFP Executive Vice President

~ FIGHTING FOR YOU ~

Payment Reform and Reduced Administrative Burdens Over the past few years, the NCAFP has enhanced its efforts to improve investment in primary care and reduce the administrative burden faced by family physicians. These goals were set as a direct result of feedback you, our members, provided in an extensive survey in early 2018. The fruits of these efforts are now beginning to be seen.

For example, in late June, Blue Cross & Blue Shield of NC (Blue Cross NC) announced their “Accelerate to Value” program. Independent primary care practices that choose to participate will receive supplemental payments to stabilize pre-COVID-19 revenue from Blue Cross NC. The design of the program is to “true up” practice revenue for core primary care services in 2020 and 2021 to what an average practice would have earned in 2019.

However, to participate, practices are required to join a Blue Premier program that provides an opportunity for shared savings and quality improvement bonuses.

It also provides a glide path to (but does not require participation in) a prospective primary care capitation program that Blue Cross NC hopes to begin offering in 2022. The capitation program will pay a fixed monthly payment for a core basket of primary care services for all Blue Cross NC members attributed to a practice. Blue Cross did not require practices to make a commitment to accept PCP capitation this year but believes that it may be an attractive payment model in the future.

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In reaction to the Accelerate to Value Program, members of the NCAFP Executive Committee noted: “NCAFP appreciates the efforts of Blue Cross NC to move beyond our traditional fee-for-service delivery system to one based on value that truly recognizes the crucial and fundamental role of primary care in improving quality and lowering healthcare cost.”

Both AAFP and NCAFP have advocated for an alternative for fee for service payment that truly invests in primary care. In fact, earlier this year the NCAFP and many other organizations began calling for a “Marshall Plan” for primary care, noting that the COVID-19 pandemic had exposed the systemic underinvestment in primary care and public health.

An op/ed that ran in the News and Observer and Charlotte Observer co-signed by our President, Dr. David A. Rinehart called for the following: • A change in primary care payment from fee-forservice to a system rewarding prevention and care management; • Accelerating the use of telemedicine in primary care, rather than only incentivizing it during a time of crisis; • And expanding the number of family physicians by forgiving medical school tuition for graduates who choose primary care.

The editorial noted that the pandemic is an unprecedented crisis, but also provides an unprecedented opportunity for us to fix our healthcare system by strengthening its foundation: primary care.

A prospective primary care capitation payment model, such as Blue Cross NC is proposing, has the potential to reshape primary care in our state and nation by paying for keeping patients healthy versus payment for episodic sick care. It would let the physician decide, in conjunction with the patient, how care would be delivered to truly achieve healthy outcomes.

But we must remain at the table to make sure the details of the plan are done in a way that improves the See ‘Payment’ on page 14

The North Carolina Family Physician

New AAFP Website and Mobile App Confirm Your Account Login Email Address The launch of the new aafp.org and AAFP mobile app is the Academy’s first step in building a user experience that’s seamless across computers and mobile devices so members can easily use the wide array of AAFP tools to serve patients, manage practices, receive CME credit, succeed in medical school and residency, and advocate for themselves and their patients.

These upgrades brought changes to the login process for both the website and app, which switched to use the email address on file with the AAFP as each member’s default username.

If you have not confirmed your preferred email address with AAFP, please email the AAFP Member Resource Center at aafp@aafp.org or call 1-800-274-2237 x 0.

Because each member will need their own username, it’s important to note that those with shared email addresses, such as generic practice addresses, will need to update their information as well.

Visitors to the new website will find: • easier access to all their AAFP needs, whether on a mobile device or a desktop; • expandable mega-menus that allow visitors to find what they want more quickly; and • content prioritized for different types of members -practicing family physicians, residents and students.

The AAFP app switched to the new version for those who set their mobile apps to update automatically or it can be updated manually. It will offer: • a simpler interface for a better user experience; • everything in one place, including leading journal content from American Family Physician and FPM; • improved audio functionality for mobile learning; • new members-only audio content; and • in-app purchasing for select AAFP products.

Download the AAFP’s free mobile app on iTunes(itunes. apple.com) or Google Play(play.google.com).

For questions about any of these changes, please contact the AAFP at 1-800-274-2237 x 0 or email aafp@aafp.org.

NCAFP’s Virtual Sports Medicine Symposium a Success The NCAFP held a virtual, half-day Sports Medicine Symposium in early August that drew 184 registered attendees and a great lineup of speakers. Based on preliminary conference survey figures, over 97 percent of attendees rated the conference as excellent or very good, with 94 percent saying they are interested in additional virtual learning opportunities. Even more promising was that for 19 percent of attendees, it was the first time they had attended an NCAFP continuing medical education event.

The Academy would like to extend a huge ‘thank

Summer 2020

you’ to Dr. Bert Fields for putting together a great group of speakers.

Speakers included Drs. Kevin Burroughs, Timothy Draper, Dominic McKinley, Sara Neal, and Dr. Fields himself.

In addition to the plenary sessions, the Academy Board of Directors also met and completed a full agenda which included the review of committee meetings held earlier this summer on payer and system advocacy, membership satisfaction and practice environment, and workforce pipeline.

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PAYMENT from page 12 investment in primary care providing you additional tools to assist your patients. I expressed that desire in a recent phone conversation with the new President of Blue Cross NC, Dr. Tunde Sotunde.

Our advocacy efforts with Blue Cross have gotten us to the precipice of a new paradigm for primary care, but we must remain vigilant to make sure the details are done correctly.

This isn’t our only victory with some of the major payers in our state. Beyond Blue Cross, recent decisions by UnitedHealthcare and Humana have shown a greater commitment to reducing the administrative burdens our members face every day.

As each of you know so well, choosing the most cost-effective medication for a treatment plan poses difficulty due to different drug formularies that are payer dependent, constant formulary changes, and cost transparency to name a few. However, payers are beginning to put forth innovative solutions, including tools that integrate plan-specific information into Electronic Medical Records (EMR).

Humana is working to alleviate some of these burdens by incorporating technology into point-of-care decision making. The company developed a proprietary IntelligentRx solution that integrates with a physician’s EMR’s e-prescribing workflow. This gives the physician the ability to see a Humana member’s prescription cost and coverage at the point-of-care while using the patient’s preferred pharmacy as its source. The tool is meant to improve transparency between physicians and patients during a medical visit.

Also referred to as real-time benefit check (RTBC), Humana’s IntelligentRx solution can present up to three low-cost formulary alternatives when the medication is not covered or has coverage restrictions. The software also helps with prior authorizations by incorporating the medication exception process into the EMR workflow.

UnitedHealthcare is also working to simplify the health care system and reduce administrative burden

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by using new technology. United has just announced a new technology called Point of Care Assist™. It allows for real-time patient information — including clinical, pharmacy, labs, prior authorization, eligibility, and cost transparency — to integrate with existing EMRs. The goal is to make it easier for physicians to understand what UnitedHealthcare members need at the point-of-care. The company is paying to integrate this tool into various Electronic Medical Record platforms to eliminate any cost to participating practices. UnitedHealthcare also hopes to partner with other insurers to broaden the scope of their technology.

Point of Care Assist integrates patients’ UnitedHealthcare data within the EMR to provide real-time insights of their care needs, aligned to the specific patient’s plan benefits and costs. This makes it easier for practices to see potential gaps in care, select labs, estimate costs, and check prior authorization requirements — including benefit eligibility and coverage details. The program provides point-of-care information about what pharmaceutical benefits are included in the patient’s health plan, including possible lower cost alternatives. The technology also helps identify lower-cost, high-quality sub-specialty referrals by indicating what out of pocket costs a patient will have for various in network sub-specialists by utilizing UnitedHealth Premium Care subspecialists who have met quality and cost-efficient care criteria.

While none of these developments represent a cure all for the problems of Family Medicine, combined they do show that our advocacy efforts are making a difference. We want to continue to work with insurers to convince them to invest more in primary care while reducing administrative burden.

As these various technologies are rolled out and new payment models developed, we look forward to receiving your feedback. We can best advocate for you when you let us know what is working and what is not. The key areas of greater investment in primary care and reducing administrative burden remain two of our top priorities as we work to improve the lives of our state’s family physicians every day.

The North Carolina Family Physician

Achieve healthier outcomes—for everyone.

• Bu partn • En and

In its first major development for The EveryONE Project, the AAFP compiled an in-depth toolkit to help physicians recognize and respond to social factors that impact the health of patients.

The EveryONE Project toolkit is validated, intuitive, action oriented, and free. Utilize it to: • Raise awareness about the effects of social determinants of health.

• Discover specific health risks in patients of all backgrounds.

• Understand and manage potential biases that may exist.

• Connect patients with essential resources in their area.

Reveal and address the unseen health hurdles your patients face every day. Start using The EveryONE Project toolkit now.

aafp.org/EveryONE/tools

The EveryONE Project Advancing health equity in every community

17101839 Everyone Full Page.indd 1

12/11/17 11:20 AM

PROFESSIONAL DEVELOPMENT

By Kathryn Atkinson, CMP Manager, NCAFP Meetings & Events

~ UPCOMING EVENTS ~

The 2020 Winter Family Physicians Weekend: A Family Tradition with a Twist Due to the ongoing concerns of Covid-19, the 2020 Winter Family Physicians Weekend will be hosted via a fantastic two-day live webcast instead of the usual in-person conference at the Omni Grove Park Inn. While we will certainly miss seeing you in person, and the smell of gingerbread wafting through the air, the NCAFP CME team embraces this opportunity to delight you with an engaging and interactive virtual-only experience this December.

Mark your calendars now and make plans to join us virtually, from the comfort and safety of your preferred location, on Friday, December 4th, from approximately 1:00 pm to 8:00 pm, and on Saturday, December 5th, from approximately 8:00 am to 4:15 pm. For those interested, plan to join us for a pre-conference virtual KSA opportunity on Palliative Care on the evening of Thursday, December 3rd, from 6:00 pm to 9:30 pm. This revised schedule of high-quality programming means attendees can anticipate earning approximately 20+ CME credits by their participation in the pre-conference KSA workshop and the main stage general sessions. It is important to note; the CME sessions will only be available over the conference dates. The virtual sessions will

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not be recorded for later on-demand viewing.

With this fresh new approach to everyone’s favorite annual tradition, we are committed to providing you with the same informative and inspiring conference experience that has always made this capstone event so popular. Count on our trademark of timely general sessions, led by first-rate faculty, complete with real-time audience polling, and live Q&A sessions each day. Program Chair Victoria Kaprielian, MD, and Vice-Program Chair, Jay Patel, MD, have selected a slate of topics that is guaranteed to support your commitment to providing the best possible care to your patients. Tentative topics include HCV, osteoarthritis and low back pain, diabetic kidney disease, obesity management, depression, chronic heart failure, migraine, HPV, reproductive health, pediatric asthma, lung cancer, and much more.

Because the serendipitous conversations with your colleagues and friends are often the best parts of this

The North Carolina Family Physician

December 3rd through Sunday, December 6th, 2020. Imagine waking up in your guest room at the Grove Park Inn, opening the curtains to those beautiful mountain views, ordering room service, and logging in on your laptop to join our fantastic virtual CME sessions; while relaxing in a Grove Park Inn bathrobe! If this sounds like your perfect virtual CME conference weekend, consider reserving your sleeping room early by calling the Grove Park Inn at 800-438-5800 and requesting the NCAFP Winter Weekend Room Block. Rooms are limited, and the block will likely sell out before the cutoff date of Tuesday, Nov. 3rd, 2020.

annual tradition, we are working to provide fun, creative ways for members to still engage with one another during the virtual conference. We are also exploring exciting exhibit hall and sponsor platforms that will allow you to connect and network with other industry professionals. Watch our conference website at www. ncafp.com/wfpw and your email for exciting updates coming soon.

We realize that gathering with family and friends at the Omni Grove Park Inn for the Winter Weekend each December is a long-standing tradition. For many, it is hard to imagine a December that does not include relaxing in rocking chairs and sipping gourmet hot chocolate in the hotel’s Great Hall after a fun day of informative and engaging CME. Well, if December without a visit to the Grove Park Inn seems unbearable to you, we have great news! The Omni Grove Park Inn has graciously agreed to provide a small block of rooms at the NCAFP’s discounted rate of $260 - $320 per night (depending on room type) beginning Thursday,

Summer 2020

The NCAFP is committed to providing you with the best meeting experience possible during this year’s cyber-conference. We are confident that this year’s annual “family tradition with a twist” is still the one CME opportunity that you will not want to miss. If you have never attended the Winter Weekend because of travel concerns, budget restrictions, or scheduling conflicts, this is the perfect opportunity to join us for our brand of timely and engaging CME from wherever you are. Visit our conference site at www.ncafp. com/wfpw for discounted attendee rates, online registration, schedule information, and other important conference updates. Online registration is scheduled to open in mid-September, 2020.

On behalf of the NCAFP, thank you for what you continue to do every day within your communities. We miss gathering with you in-person, but we remain optimistic that better days are coming soon. Please continue to be safe and stay healthy. We appreciate you, and we cannot wait to see you again. Please contact Kathryn Atkinson, CMP, Manager of Meetings & Events, at katkinson@ncafp.com, with any questions you may have about this year’s virtual Winter Family Physicians Weekend.

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RESIDENTS & NEW PHYSICIANS

By Tracie Hazelett NCAFP Manager, Medical Student and Residency Relations

North Carolina Residents and Students Selected as AAFP Emerging Leaders

Development of an Integrated Electronic Referral System to Local Diabetes Prevention Programs Within a Family Medicine Clinic.

Dr. Scherr is passionate about making a positive difference in people’s lives, whether as a physician or personally, in the community she has grown to love. She not only strives to provide excellent patient care and but also to use her knowledge and skills to empower people, families and communities to live healthier lives. Dr. Scherr is completing her Family Medicine residency at Duke Community and Family Medicine where she is a third-year resident and was recently selected as co-chief.

Gabriela Plasencia, MD, MAS

The AAFP Foundation’s competitive leadership development program has selected two residents and one medical student from North Carolina to participate in the Family Medicine Leads’ Emerging Leader Institute.

Karen Scherr, MD, PhD Dr. Scherr obtained her undergraduate degree at Texas Tech in 2009 prior to relocating to North Carolina. She went on to complete her medical degree at Duke University School of Medicine where she also completed her doctorate as part of the Duke Medical Scientist Training Program. Dr. Scherr has also been a teaching assistant for courses in Duke’s Sanford School of Public Policy and The Fuqua School of Business. In addition to being selected for the Emerging Leader Institute, the research and poster she co-authored with fellow Duke resident, Matthew Geisz, MD, PGY-2, was selected as one of the winners in the Community Project category for inclusion in the (virtual) AAFP National Conference of Family Medicine Residents and Medical Students:

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Dr. Plasencia completed her undergraduate degree at the University of Florida, followed by her Masters in Applied Science in Population Health Management at Johns Hopkins University. Dr. Plasencia then completed her medical degree at the Loyola University Chicago Stritch School of Medicine.

Plasencia’s career goals are to continue her work in population health, using health management strategies to decrease health disparities, especially in older adult populations, and to promote research in primary care, particularly in Family Medicine. Dr. Plasencia is completing her Family Medicine residency at Duke Community and Family Medicine where she was drawn because of their focus on social justice, community engagement and primary care research. She is excited to offer her skills in community-based participatory research experience, masters training and fluency in Spanish to the community. Plasencia is a second-year resident, and during the recent virtual graduation ceremony for Duke residents, was selected as the recipient of the Thomas Matheson, M.D. Award.

The North Carolina Family Physician

NORTH CAROLINA’S Benjamin Kaplan, MPH Benjamin Kaplan, MPH, hails from New York City.

He completed his undergraduate degree at Columbia University then moved to North Carolina five years ago to enroll at the University of North Carolina School of Medicine. In addition to being selected for the Emerging Leader Institute, the research poster he submitted was selected as a one of the winners in the Education category for inclusion in the AAFP National Conference of Family Medicine Residents and Medical Students: I Know Me: A Pilot Feasibility Study of Photovoice With Complex Care Patients.

Ben completed his Master’s in Public Health from the Gillings School of Public Health in June. He is now a fourth-year medical student, beginning the application process for Family Medicine residency programs. Ben looks forward to his career as a family physician, splitting his time between community-based primary care, health equity research, and medical education. He is passionate about increasing access to primary care, particularly for individuals living with chronic illness.

Mr. Kaplan and Drs. Plasencia and Scherr are among the 30 scholars selected nationwide to participate in the program’s sixth cohort. Scholars participated in the virtual AAFP National Conference July 30 – August 1, followed by two days of training led by the AAFP Foundation. Post conference, the scholars will develop a project based on one of three tracks: Policy & Public Health Leadership, Personal & Practice Leadership or Philanthropic & Mission-Driven Leadership; with Project Award recipients returning to present at the 2021 National Conference. A complete list of the 2020 FML Emerging Leader Institute Scholars is available (www.aafpfoundation.org). Congratulations!

Summer 2020

2020

Resident & Student Research Poster Presentation The NCAFP Foundation’s twenty-seventh annual Research Poster Presentation will be held at the Academy’s Virtual Winter Family Physicians Weekend

The Foundation is interested in showcasing practice-based research, but poster presentations may address any topic relevant to Family Medicine.

Works-in-progress may also be submitted, but submissions must be of original work not yet published. Projects previously presented at medical schools’ or student “Research Days” are acceptable, as are concurrent submissions to other conferences such as NAPCRG and STFM.

Posters will be judged for awards with winners announced at the Virtual Annual Meeting. For complete details and link to submission form, please visit www.ncafp.com Please direct questions to Tracie Hazelett at thazelett@ncafp.com or 919-980-5357.

Resident and Student members interested in participating must submit their application and all corresponding materials (including final PDF of poster) by October 1st, 2020.

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STUDENT INTEREST & INITIATIVES

By Tracie Hazelett NCAFP Manager, Medical Student & Residency Relations

COVID-19 Spurs Unexpected Medical Student Experiences

Participation was widespread among students on campus, however it is no surprise that students involved in these activities are also active members of their Family Medicine Interest Group (FMIG) on campus. A true representation of the spirit and heart of a Family Physician!

Meeting Widespread Community Needs As is the case with the spectrum of Family Medicine, activities at the Brody School of Medicine ranged from working with the very young to the elderly. Students provided childcare for essential workers, stepping up when schools and daycare centers closed. Medical students helped children learn and adapt to their new normal, and parents were able to continue to serve the needs of their community in their essential roles.

Parents felt safe and reassured, knowing their children were supported academically and socially.

The medical school year 2019-20 ended like no other for medical students around the country. FaculBrody students have also worked in coordination with ty created new curriculum and students adapted to Meals on Wheels, delivering fresh quality food to sevirtual learning in record time, with the impact felt niors that need this nutritional support and benefit by all. Students completing rotations have had their from the social aspect of the face to face contact each educational experiences most directly impacted, but day. Many of the regularly scheduled volunteers are in whether a first-year on campus, or a fourth-year a vulnerable population group themselves and therewhose graduation celebration took place in a way fore have been forced to step back from volunteering never imagined, no one has been unaffected. Studuring this time for their own safety. These frienddents are left feeling anxious, nervous, angry and ly mask-wearing frustrated at how their medical education student faces have and approach to applying to residencies has helped to ensure sebeen forced to change.

“It gave me an opportunity to niors in their comexpand my creativity and remunity are safe and Those feelings aside, most have chosen to see minded me what it feels like to cared for during this the silver lining and make the most of time be a 12-year old again!” time of crisis. unexpectedly available. While maintaining

academics virtually, North Carolina medi— Hannah, M4 Other Brody stucal students found creative and useful ways dents worked to to meet the needs of those around them. create a fundraising platform to provide support to The activities that follow are only a sampling of the local businesses and eateries that were negatively afacts of service and kindness students performed; we fected by COVID. This effort simultaneously proknow there are many more! There isn’t enough space vided support to healthcare staff that were impacted here to share all that has been done by each school, by increased work hours and demands. A variety of so a few things specific to their respective universifamily style meals were purchased from locally owned ties are noted in this article.

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restaurants and were delivered to the hospital’s emergency department and intensive care units.

Two of Brody’s FMIG leaders who also happen to be Albert Schweitzer Fellows, completely pivoted their Schweitzer project when seeing the strain placed on individuals who use opioids and utilize harm reduction programs. In May 2020, there were 828 ED visits for opioid overdoses across NC, which is up from 658 visits in May 2019. The pandemic has challenged syringe exchanges to adapt to this new climate and maintain access to harm reduction supplies. Students partnered with a program in Greenville to address transportation barriers by delivering clean harm reduction supplies to clients’ homes.

They have slowly reopened the in-person exchange and are closely adhering to social distancing requirements. A Facebook group has been created to improve communication with those served to stay updated on changes and ask questions.

Necessary stay-at-home orders may be obscuring rates of opioid abuse and overdoses across the nation, therefore accessibility to harm reduction supplies and adapting to change is crucial for reducing overdoses and infectious disease during this challenging time.

Supporting Senior Citizens One population particularly touched the hearts of Campbell students— those in long-term care facilities. Everyone has been faced with new challenges, but life for the elderly changed dramatically when restrictions on visitors from family and friends were implemented. Many of these individuals struggle with health issues, but there are also those who have cognitive

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Summer 2020

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conditions that add confusion to their daily battles. This has been a distressing time for many. The disruptions in routines, restrictions on visitors and other preventative measures have left many residents in long term care centers feeling lonely, confused, worried and uncertain about what is happening and what is to come. This prompted students with Campbell’s FMIG to initiate a letter writing campaign with residents at Emerald Health and Rehab Center in Lillington. These letters of encouragement to the residents demonstrated care and kindness and let them know they have not been forgotten. The letters were a reminder of the good in their community and served as a welcome distraction for recipients.

ly sourced produce and shelf-stable items to food insecure patients young and old. Many community partners have been involved in these efforts.

Referrals to the program are made by clinicians affiliated with the Duke Outpatient Clinic and the Duke Healthy Lifestyles Clinic. Many patients have multiple chronic health conditions that make them particularly vulnerable to unstable food access. Root Causes also partnered with the student led Hotspotting Initiative at Duke Outpatient Clinic to deliver non-food essentials such as hand sanitizers, soap, disinfecting wipes, and sanitary pads. The partnership with Healthy Lifestyles Clinic also provided for delivery of Grow-It-Yourself Home Garden Box projects for pediatric patients.

Food Insecurity on the Rise

“Growing up in Pitt County and

Supplies, Access and Behavioral Health

Duke students have been inwatching different restaurants open UNC students traversed volved in a variety of efforts, but up and develop Greenville, and the community to collect one dynamic partnership that has seeing them struggle, made me think donated supplies for deflourished has been with memcritically about ways to support livery to those in need, bers of the FMIG team and the including citizens in the Root Causes Fresh Produce Prothem throughout the quarantine.” community and healthgram. The weekly fresh produce —Sydney, M4 care workers. Students delivery program is an effort assembled boxes of face that needs volunteers to call pashields and in the end tients, coordinate food sourcing, distributed several thousand to healthcare facilipack food bags, and make touch-free home delivties in the Charlotte area. In another effort to help eries to patients in the Durham community. Even manage supplies, students started a PPE monitoring before COVID-19, food insecurity was a signifiprogram in the Emergency Department. They ascant issue in Durham County, with 1 in 5 residents sisted ED staff with proper utilization of PPE and struggling with food security. The economic impact limited the number of times personnel had to enter of COVID-19 has exacerbated food insecurity for and leave patient rooms by providing needed assismany low-income Durham residents by decreasing tance or obtaining more help if needed. Students financial stability, job security, and safe access to also helped the ED initiate their reusable respirator public transportation. For those with chronic health program where staff were issued elastomeric N-100 conditions, the idea of getting food has become masks that are reusable. This included cleaning and risky, scary, and uncertain. Getting food has become storing masks to help minimize the use of disposmore complicated because of COVID-19 transmisable N-95s in the ED. sion risk and grocery stores running out of stock on numerous food and non-food essentials.

Several FMIG leaders were involved in other community outreach activities too, one of which is the This program has worked closely with amazing Zero Suicide Program. The intent of the program community partners to package and deliver local-

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The North Carolina Family Physician

is to provide regular non-clinical, well-being phone check-ups and social support to patients who were recently hospitalized for suicidality. The goal is that with additional contact and support, it will help to decrease future suicidality.

Additional efforts included supporting the Atrium community paramedics Virtual Hospital Program. Through the virtual hospital, students joined community paramedics to deliver kits with blood pressure cuffs, pulse-oximeters, thermometers, and medications to patients who were experiencing symptoms, or had tested positive for COVID-19, and were in quarantine in their home. When supplies were delivered, students also assisted the provider to conduct a virtual visit and perform recommended therapies such as a nebulizer treatment, draw labs, or give IV fluids.

Students worked at the NC Poison Control Call Center and helped operate the Coronavirus Hotline to answer questions people from across the state had related to the COVID-19 pandemic. Students were able to guide callers to local services and supports, the CDC or NC Department of Health & Human Services resources and in some cases direct the individual to call 911 or their hospital.

“It was rewarding to speak with people and help them stay informed so they could make the safest decisions related to employment issues, accessing financial assistance, food supplementation, or healthcare”. Rob, M4 Homelessness Student members of the FMIG at Wake Forest SOM have immersed themselves in a medical outreach project in Winston Salem. In April, a local nonprofit organization working to end homelessness in the Winston Salem community partnered with local shelters to quarantine medically fragile adults, who have high-risk co-morbidities, in an area hotel. Student volunteers visit the hotel multiple times each week to assist with COVID-19 symptom screening questions and temperature checks. Students perform a wide

Summer 2020

variety of support during the visit. They provide basic consultation and triage new medical concerns, assist individuals with medication reconciliation, offer support and guidance to adhere to their treatment plans and assist in scheduling future healthcare appointments. The students strive to listen with compassion and connect vulnerable individuals to resources for consistent, longitudinal care. Numerous hotel patients have now been established with their own personal primary care physician, with the first step for many being in the Department of Family and Community Medicine.

Gleaning motivational interviewing experience and developing clinical skills in a resource-limited setting will undoubtedly serve future Family Physicians. The students involved in this project continue to be inspired by the resiliency of the patients, dedication of the entire care team, and support from faculty.

“As an aspiring Family Medicine physician involved in this project, Dr. Shauna Guthrie’s recent NCFM Today podcast resonated with me in terms of her hopes for continued positivity for the medical community, the inherent overlap(s) between holistic primary care and public health, and the importance of partnerships with local health departments. Many of the resources we are connecting patients with have been sourced through partnerships with the local health department.” Collette, M2 As students begin the next academic year, it is clear there is anxiety about the upcoming application and interview season. There have also been many sleepless nights resulting from rescheduled Board exams, cancelled acting internships and challenges to complete labs and learn in the new virtual world.

However, it is also obvious that medical students are a resilient group and Pandemic or not, these individuals know they are fortunate to be in pursuit of a profession that is admirable, respected and in high demand. They have a bright future indeed.

In addition to their community service and support, special thanks to NC FMIG leaders for their contributions to this article.

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PRACTICE MANAGEMENT

By Brent Hazelett, MPA, CAE NCAFP Vice President & Chief Operating Officer

Could COVID Be the Positive Tipping Point for Primary Care?

For years we have all been patiently waiting while the world has been telling us that the move to value was coming like a freight train and we better all get on board or get run over. It appears all it might have taken is a pandemic and the worst economic downturn in our lifetime. Both private and public payers are scrambling to implement changes seemingly overnight that normally would take years. NCAFP leaders have been in countless conversations with payers, both during this pandemic and before, and these conversations are resulting in a better understanding of just how much damage this healthcare system has done to primary care, which has only been exacerbated during this pandemic.

There is no doubt that practices relying on fee-for-service revenue during COVID have been hurt the most, while those with substantive value-based care contracts in place have fared much better. Our goal as an Academy continues to be to provide our members with the resources they need to not just survive but thrive in today’s healthcare environment. Our work on your behalf continues and we are buoyed by ongoing changes in the marketplace that are increasingly recognizing the immense value family medicine plays in reducing cost and increasing quality.

Telemedicine, long underpaid (when paid at all) is finally being recognized as a viable means of effectively providing primary care in certain circumstances. No 24

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doubt telemedicine is here to stay and NCAFP will be fighting to ensure payment for these services remains at a level that compensates your care accordingly.

Blue Cross recently announced their new “Accelerate to Value” platform for independent practices, whereby the payer seeks to support independent practices through financial stabilization, a transition to value-based care, and the possibility of a capitated payment for a core group of primary care services. The NCAFP has been in many conversations with BCBS leaders over the past several years, espousing the importance of supporting primary care and the value you provide to their policy holders every single day.

These conversations with payers, one of the key tenets of the NCAFP Payer and System Advocacy Committee, are making a difference. Whether you believe this latest payer program is ideal or not – certainly, there are imperfections – the NCAFP believes these changes are moves in the right direction. Payers that are placing more value and resources into primary care are payers we want to work with on your behalf.

Additionally, NCAFP leaders have been working closely with the Duke Margolis Center for Health Policy, an organization at the forefront of the healthcare policy discussion both at the state and national level. The Margolis Center is dedicated to the transformation of healthcare and no doubt has played an increasing role bringing the key stakeholders in North Carolina together for meaningful discussion and action. Stay tuned as your Academy works with other organizations to improve healthcare for the citizens of NC, and create a positive and rewarding working environment for family physicians that allows you to thrive, and paves the way for future medical students to choose the best specialty in medicine.

We are proud to work on your behalf and welcome any feedback you have to help us more effectively work for you.

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PRACTICE BRIEFS

Booster Dose of Meningococcal Conjugate Vaccine now required for Students Entering 12th Grade Effective Aug. 1, 2020, a booster dose of meningococcal conjugant vaccine (MenACWY) is required for students entering the 12th grade in public, private or religious schools in North Carolina. Students who do not meet this requirement may not be allowed to attend school until they receive the booster dose.

“The MenACWY vaccine is the best protection against meningococcal disease, which most often affects young people,” said Kelly Kimple, M.D., M.P.H., Chief of the Women’s and Children’s Health Section of the N.C. Division of Public Health. “It is vital that children and adolescents continue to receive all their immunizations on schedule to ensure they are fully protected against all vaccine-preventable diseases, including some of the major causes of meningitis.”

Recognizing the importance of immunization, Governor Roy Cooper has proclaimed July as Adolescent Immunization Awareness Month in North Carolina. Now, more than ever, public health reminds us of the importance of continued routine vaccination to keep children healthy and avoid the risk of vaccine-preventable disease.

Office Signage and Material on COVID-19 Prevention Available from NC DHHS The NC Department of Health and Human Services has a whole host of materials available for healthcare providers to use in educating patients and the public about how to prevent COVID-19. Some of the materials include: • A Social Medial Tool Kit • A Prevent and Protect Medical Tool Kit • And a Know Your Ws: Wear, Wait and Wash Tool Kit. • Available in English and Spanish This toolkit contains signage of various sizes for physician offices, video Public Service Announcements, and even messaging for your E-Mail signature. You can find the key materials about the 3Ws at https://covid19.ncdhhs.gov/ materials-resources/know-your-ws-wear-wait-wash#wait

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