NC Family Physician - Winter 2019 by NCAFP

Volume 15 Issue 1 â&#x20AC;˘ Winter 2019

The North Carolina

Family Physician Quarterly News in North Carolina Family Medicine

Dr. Alisa Nance 2018-2019 NCAFP President

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Inside Winter 2019

Dr. Ken Yang Named 2018 NC Family Physician of the Year P. 12

PRESIDENT’S MESSAGE

PROFESSIONAL DEVELOPMENT

20 Meeting Your CME Needs and Exceeding Your Expectations

The 2018-2019 Inaugural Address

HEALTH POLICY & ADVOCACY

Primary Care Wins Key Advocacy Victory

CHAPTER AFFAIRS

Change is the Operative Word

22 Global Primary Care is Alive and Thriving PRACTICE MANAGEMENT

28 Building Relationships with Health System Executives

DEPARTMENTS

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RESIDENTS & NEW PHYSICIANS

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Managing Editor & Production Peter T. Graber, NCAFP Communications

President’s Message 4 Health Policy & Advocacy 8 Membership 12 Chapter Affairs 18

Professional Development 20 Residents & New FPs 22 Student Interest 26 Practice Management 28

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. Alisa Nance, RPh 2018–2019 NCAFP President

~ The 2018 Inaugural Address ~

Your Gloves Await These are trying times. Medicine is not what it used to be. Check boxes and quality scores may get more attention than the patient sitting right in front of you. EHRs and computers often take center stage as human touch and human emotion take the backseat. Diagnostic tests now trump clinical intuition and physical diagnosis. The date was July 17th, 2017. No alarm rings at 5:45 am. No lengthy schedule of patients. No packed in-box on the computer. The elusive medical diagnosis had taken me out of commission. I faced a medical disability as a medical provider. While I was fighting to keep my patients working, I couldn’t help my own self. Doctors aren’t supposed to get sick, or have burnout, or commit suicide. BUT, WE DO! Today I stand before you as a fighter! Not just for myself but for you---not as a patient, but as a colleague and mentor. I was born in North Carolina and went to a rural high school. I did my undergraduate education and medical school in North Carolina. I returned home after residency to practice 18-years in my hometown, giving back to the community that so graciously supported and nurtured me. My role models have been my parents who taught me humble beginnings can lead to success with determination and drive. And luckily, I have been blessed with “step” parents who also have encouraged me. My sister, Elaine, was my first cheerleader and critic, who taught me to stand tall and hold my own, if not she would see to it that others around me would hear from her! And I also want to recognize my in-laws, since I have had 4

them in my life longer than I have lived without them; they are my other parents. Professionally, the late Dr. Ed Campbell, with his quiet demeanor, gave me my first gig and was my first agent-- all my respect goes to him. As far as the NCAFP, Dr. Tom White was my talent scout. And as I have said numerous times, he discovered me when I didn’t know I was discoverable. His patient, true concern for me personally and professionally has pushed me to be better, better at being a doctor and better at being a leader. Of all the GREATS —Dr. Tommy Newton, Dr. Michelle Jones, Dr. Maureen Murphy, Dr. Rich Lord, Dr. Chuck Rich, Dr. Karen Smith and Dr. Jim Jones -- all of the Greatest of All Times -- showed me long-term experienced coaching is the best. With them, you can just watch and learn to do things great! Dr. Shannon Dowler taught me about boldness. Dr. Bill Dennis, with his dry wit, taught me how it’s possible to reinvent yourself to be successful even in a second career. Dr. Rhett Brown taught me how to appreciate diversity and feel true love as unconditional. Dr. Charlie Rhodes showed me how to humbly serve others as a Gentle Giant (soft spoken yet full of experience and knowledge). And Dr. Tamieka Howell, how awesome it’s been to watch her lead, as she kept the Main Thing, the Main Thing -- helping each other through our personal trials yet still finding a way to get the job done. Now you all know Greg Griggs, but I guess now he’s my bookie. He will schedule me for the appropriate gigs and coach me on the words and correct delivery of information for the audiences I will stand before and represent you. I would be remiss if I left out my fan club and support system of friends. They have kept me sane and smiling during my down time. I am thankful for them all. And last but definitely not least, I need to tell you about my cut men. You see cut men are those skilled and compassionate individuals that stand patiently in the corner of the ring until the cuts and bruises are tearing the fighter down. They are the ones that bandage, soothe, mend and uplift the boxer, to get them back in the ring. They are the true supporters, the ones who know your weaknesses and failures, but become your props -- even when you cannot stand -- literally! To my loving husband, Tommy and my

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2018-2019

NCAFP Board of Directors handsome, brave sons (who by the way have my same medical condition), I owe much more than a thank you. I can never repay their love and encouragement, but I promise I will continue to try. I truly love them! You see, I was left with the inability to stand without passing out. I had to leave practice; I became the patient. But family physicians are resilient! In our personal and professional lives, we stretch beyond even our own expectations. We know a lot about a lot. We care for the new babies starting their lives’ journey and console and transition the dying elderly. We hand hold the new mother-to-be, as the cycle begins again. We research and juggle multiple diagnoses in a patient, along with our other non-physician responsibilities. And recognize that a patient’s illness deserves our complete attention. Our compassion and passion to care drive us -- making us the most trusted medical professionals to Americans on large national surveys. But, we must RISE UP. Our state is struggling. We have growing rates of obesity and diabetes. Nearly 8 percent of North Carolinians have diabetes and thirty-two percent are Obese.[1,2] Childhood obesity and diabetes rates are the highest they have been. Obesity in eastern North Carolina children is at an all-time high.[3] We are now the 11th highest in high school children obesity in the nation.[4] And our opioid epidemic has claimed many of the lives of our patients and our friends. North Carolina has had a 73% spike in opioid related deaths since 2005.[5] Historically, prescription drugs have been a major driver of this epidemic. However, illicit drugs are also contributing to this problem in increasing numbers. Heroin or other synthetic narcotics (like fentanyl) were involved in over 60 percent of unintentional opioid deaths in 2016. And in 2017, naloxone was administered 15,000 times by EMS. Related to the opioid crisis, there has been a 900% increase in Hepatitis C in the last 10 years.[6] Burnout is another challenge we are facing. Nationally, Family Medicine is the 3rd highest specialty in medicine with physician burnout. More than 1 in 3 physician suffers from burnout. Look on either side of you now, if you don’t see someone burned out, it’s maybe YOU who is. From the 2018 Medscape Survey, 47% of family physician respondents suffered from burnout. Bureaucratic tasks, long working hours, and lack of respect from employers, colleagues and staff make up the top reasons for increasing burnout. And despite resources available, most physicians do not seek professional help.[7] We must RISE UP. Physician suicide is on the upswing. Although physicians globally have a lower mortality risk from cancer and heart disease relative to the general population, they have a significantly higher risk of dying from suicide, the end stage of an eminently treatable disease process. Depression is as common in the medical profession as in the general population, affecting an estimated 12% of males and up to 19.5% of females. Depression is even more common in medical students and residents, with 15-30% of them screening positive for depressive symptoms. Because of their greater knowledge of and better access Continues on next page

Winter 2019

Executive Officers President President-Elect Secretary/Treasurer Immediate Past President Executive Vice President

Alisa C. Nance, MD, RPh David R. Rinehart, MD Jessica Triche, MD Tamieka M.L. Howell, MD Gregory K. Griggs, MPA, CAE

At-Large Directors Talia M. Aron, MD Jewell P. Carr, MD Garett R. Franklin, MD Shauna L. Guthrie, MD, MPH Dimitrios “Taki” P. Hondros, MD Jennifer Mullendore, MD Mackenzie Smith, MD Ying Vang, MD Slade A. Suchecki, DO Brian McCollough, MD Elizabeth B. Baltaro, MD Family Medicine Residency Directors Mark L. Higdon, MD (Novant FMR) Resident Director David S. Baker, MD (MAHEC-A) Resident Director-Elect Elizabeth Ferruzzi, MD (Novant) Student Director Cameron G. Smith (Campbell) Student Director-Elect Katelyn Turlington (WFSOM)

Medical School Representatives & Alternates Chair (ECU) Alternate (Campbell) Alternate (Duke) Alternate (UNC) Alternate (Wake)

Chelley K. Alexander, MD Nicholas Pennings, DO Anthony J. Viera, MD, MPH Cristen P. Page, MD Richard W. Lord, Jr., MD, MA

AAFP Delegates & Alternates AAFP Delegate AAFP Delegate AAFP Alternate AAFP Alternate

Michelle F. Jones, MD Karen L. Smith, MD, FAAFP Richard W. Lord, Jr., MD, MA Robert L. Rich, Jr., MD

2501 Blue Ridge Road, Suite 120, Raleigh, North Carolina 27607 www.ncafp.com

to lethal means, physicians have from 1.4-2.3 times higher suicide completion rates than the general population.[8] It’s time to RISE UP. Some physicians are having their scope of practice limited. Others face decisions to leave their current practice style and look for other practice models. In the 2016 study titled, “Wide Gap between Preparation and Scope of Practice of Early Career Family Physicians,” a substantial gap exists between the training and preparation Family Medicine residents receive and the services they deliver in practice. Those gaps are greatest with maternity and newborn care. Much of this shift has occurred as approximately 70% of family physicians are now employed by healthcare systems. “Once children, OB, procedures, urgent care, and in-patient care are removed, many family physicians have become outpatient-only managers of adult chronic disease.”[9] We need to RISE UP! Family physicians need to find leadership roles. We need to be at the table. Whether we sit on our employers’ boards or hospital committees, in the offices of our legislators, or in our communities active as volunteers, we need to make our voice heard. In our country, we have more patients with insurance but still not every patient has access to care. Healthcare has been considered a human right, yet many go without care. Physicians are unable to care for all the need that exists. The workforce deficit is worse with burnout and suicide we have discussed. We also face the encroachment of other health professionals wanting to fill that gap, even with less training and experience. We must RISE UP and fight for more opportunities to train, more spots for residents and students, and we need to find ways to retain those leaving practice prematurely. We need to encourage systems, payers and others in North Carolina to incentivize teaching and mentoring. We also need to develop opportunities for our members to provide education to school-age children, college students and medical students about Family Medicine, with an emphasis on underserved areas. Our pipeline is our future. We need your help! We need everyone to be involved. The NCAFP has organized a new strategic plan. We have formed new committees:

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1) Member Satisfaction and Practice Environment Committee 2) Payer and System Advocacy Committee 3) Workforce Pipeline Committee These will help address our needs and the challenges we face. Be on the lookout through our website and email bi-weekly additions of NCAFPNotes for resources and updates on ways to participate and stay informed. We must RISE UP! We all are responsible to bring back the love of Family Medicine. The love of practicing and diagnosing! We can feel the energy again— the energy that ignites and unites us! The lyrics of the song Rise Up by Andra Day say it best. You’re broken down and tired Of living life on a merry-go-round. And you can’t find a fighter But I see it in YOU So, we gonna walk it out. And move mountains We gonna walk it out And move mountains. And we’ll rise up, High like the waves. We’ll rise up In spite of the ache. We’ll rise up And do it a thousand times again. For you, For you, For you, For you. YOUR GLOVES AWAIT!

REFERENCES: 1. https://stateofobesity.org/diabetes/ 2. https://stateofobesity.org/adult-obesity/ 3. Lee JM and Villamor E. JAMA Pediatr. 2013;167(1):87-88 4. https://stateofobesity.org/states/nc/ 5. https://governor.nc.gov/news/county-county-figures-opioid-crisis-north-carolina 6. https://injuryfreenc.ncdhhs.gov/DataSurveillance/StatewideOverdoseSurveillanceReports/ForPartners-IVPB-CoreOverdoseSlideSet-071318.pptx 7. https://www.medscape.com/slideshow/2018-lifestyle-burnout-depression-6009235#27 8. https://emedicine.medscape.com/article/806779-overview 9. https://www.aafp.org/news/practice-professional-issues/20180418scope. html

Winter 2019

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

Primary Care Wins Key Advocacy Victory Significant Payment Increase for Medicaid Visits

or June of this year. However, the increase will be retroactive to January 1st, so practices will receive additional revenue for any claims paid between January 1 and the date that claims can be processed at the new rate. A few years ago, the General Assembly gave the NC Department of Health and Human Services the authority to implement targeted rate increases as long as they can do so under existing budget constraints. Due to ongoing efforts to improve quality and control costs at all levels (including efforts by primary care physicians, the Department of Health and Human Services and the CCNC care management infrastructure), as well as favorable economic conditions, the Department had enough funding to implement the increases now. These new rates will become the base for primary care as Medicaid managed care is implemented beginning in November of this year.

As the holidays began and the calendar flipped from 2018 to 2019, primary care received a great holiday surprise, and it wasn’t a lump of coal in your Christmas stocking. Instead, the state Medicaid program announced a significant increase in North Carolina Medicaid rates for primary care Evaluation & Management codes.

Under the Affordable Care Act, the federal government increased primary care rates to parity with Medicare for two years: 2013 and 2014. Although federal funding for increased rates was not renewed nationwide beyond 2014, several states chose to partially extend the bump or permanently extend Medicaid-to Medicare parity. Several studies showed increase in access to care and greater availability of Medicaid appointments during the time that the federal government increased rates. Over the past 18 to 24 months, the NCAFP had focused on improving Medicaid rates for our members as a key policy priority culminating in the state’s announcement on December 21st.

For over a year, your NCAFP Advocacy Team, along with our counterparts from the NC Pediatric Society, have advocated for a rate increase for primary care physicians. We know primary care is key to the success of the state’s Medicaid program, particularly as the program moves toward Medicaid managed care in late 2019 and early 2020. And the state Department of Health and Human Services agrees.

The timing for the rate increase is crucial since it will now become a permanent rate floor as the state implements Medicaid managed care. The Department understood that primary care will inevitably face additional administrative burden with the move from one payer under the current Medicaid fee-for-service system to multiple health plans in the Medicaid managed care environment that will begin on November 1st.

“This change is recognition of how important primary care physicians are to ensuring Medicaid beneficiaries receive the best care possible,” said NC DHHS Deputy Secretary Dave Richard. “As we are in the process of Medicaid transformation, we want to make sure we have a healthy primary care base.”

Overall, 2018 rates for primary care Evaluation and Management codes had been approximately 75 percent of Medicare rates for the same codes. The 2019 increase will put these rates on par with Medicare.

The increase, which will put over $100 million additional dollars into primary care during each state fiscal year, will be retroactive to January 1st, 2019. The rate increase impacts Evaluation and Management codes for primary care physicians (including Family Physicians, Pediatricians and Ob/Gyns), nurse practitioners and physician assistants, as defined in the Affordable Care Act. The increase should put primary care Medicaid rates at or near 2019 Medicare rates for the same services.

We would like to take this opportunity to personally thank NC DHHS Secretary Dr. Mandy Cohen, Deputy Secretary Dave Richard, Assistant Secretary Jay Ludlam, and many others in the Department for their work on this important rate increase. The increase shows how important they believe primary care is today and will be as the state moves forward. Look for ongoing updates in NCAFPNotes relevant to rates for specific E&M codes, as well as final implementation plans.

Because of the process for final federal approval and re-programming needed, the rates will likely not increase until around May

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As a Physician in the U.S. Air Force, you’ll have one job: treat patients. You won’t manage finances, wrangle insurance red tape or worry about overhead expenses. We’ll give you all the support you need—from personnel to equipment—so you can be the doctor you were meant to be. For more information, contact MSgt Joshua L Humble, USAF Recruiter Email: joshua.humble@us.af.mil Phone: 919-799-0761

PRACTICE ADVOCACY

Update on Medicaid Managed Care Implementation By the time you read this article, the NC Department of Health and Human Services (NCDHHS) will have announced the organizations that will offer Medicaid Managed Care health plans in North Carolina. The announcement, slated for February 4th, was after the deadline for this magazine. However, the NCAFP will keep you updated on that process through electronic communications. But there’s much more to know about Medicaid Managed Care, and here are just a few of the things to help you prepare for the change in how Medicaid patients will be handled in North Carolina. First and foremost, primary care will be paid, at a minimum, at or near Medicare rates. The increased primary care rates, which are currently being implemented by the state (see article on page 8), will become the rate floor for Medicaid Managed Care. And that’s good news. That will be your beginning negotiating point with any health plan you choose to accept. Additional income for care management and quality could be available depending on what Tier of Advanced Medical Home (AMH) your practice ultimately becomes. However, the NCDHHS should have been notified by January 31st, on your practice’s intent relevant to AMH Tier status. Let’s first review the timeline for Managed Care:

plans to determine which plans to accept. Practices should also determine if they will work with a Clinically Integrated Network to meet AMH requirements and finalize those contracts. • November 1st: One or two regions of the state will go live with Managed Care. • February 1, 2020: The remaining regions of the state will go live with Managed Care. Centralized Credentialing Vendor Selected for NC Medicaid To minimize the administrative burden on providers as NC Medicaid transitions to managed care, the state Department of Health and Human Services has awarded a contract to Wipro Infocrossing to serve as the Provider Data Contractor (PDC). Wipro will supplement the state’s existing provider credentialing data to support health plans’ ability to make quality determinations during provider Medicaid Managed Care network contracting activities. The Health Plans will rely upon the provider credentialing information to determine if a provider meets their minimum quality standards and should be allowed to participate in the plan’s provider network. This streamlined process will facilitate providers enrolling with a plan for the first time, as well as providers currently participating in NC Medicaid or NC Health Choice. For more information and details, please visit NC Medicaid’s website at https://ncdhhs.gov/NC-medicaid-transformation.

• February 4th: Likely announcement of health plans selected to cover Medicaid recipients in North Carolina. • Winter/Spring: Practices negotiate with health

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MEMBERSHIP By Peter T. Graber NCAFP Communications Services

- AWARDS -

Dr. Ken Yang Named 2018 NC Family Physician of the Year Luck, timing or just plain fate have put many of us on life paths we never dreamed of. North Carolina’s 2018 Family Physician of the Year, Dr. Ken T. Yang of Clinton, NC, is a textbook example of an outstanding family physician who found his calling in Family Medicine as if by chance. But in doing so, Dr. Yang has developed into one of the state’s leading family physicians whose clinical knowledge, compassion, leadership talents, and exhaustive energy make him a role model for the entire specialty. When Dr. Yang first began undergraduate studies at Tufts University outside Boston, medical school wasn’t even on the radar. With his sights set on becoming an English teacher and swimming coach, he had a clear plan. But then he enrolled in Asian American Literature and forgot his textbook one day. After meeting his future wife who was on an academic scholarship by simply asking to look on with her, it all changed. According to Dr. Yang, his grades rose as they spent countless hours together in the library. And although teaching was still a great option, the courtship pushed him to complete the necessary pre-med requirements to keep his options open. Dr. Yang and his future wife, Dr. Grace Ho, both went

on to medical school at NY Medical College and completed residency training together at Tufts University-Beverly Hospital Family Medicine Residency. Living in Boston, they were looking to settle in someplace new after residency. Yearning to get away from the bustling pace of suburban north Boston where doctors are seemingly on every corner, they had set their sights on migrating south and were eager to put their full-scope training to work. “We thought that if we were going to leave Massachusetts, let’s go someplace warm,” Dr. Yang described. “We liked the Carolinas.” Aside from the attractions of a milder climate and the quality of schools compared to other states, the only catch was finding an opportunity where they could both practice medicine. They sought something akin to a couple’s post-residency ‘match.’ “We were looking for a place that could take two doctors at a time, both full scope,” recalled Dr. Yang in describing their plans. “But we also wanted to go where the need was.” Dr. Yang proceeded to contact the rural health offices in several states. As luck would have it, Clinton Medical Clinic’s founding partner, Dr. Frank Leak, was working for the Kate B. Reynolds Foundation helping the North Carolina Office of Rural Health attract physicians to underserved areas. The office of rural health invited them to come visit the practice. “It turned out the we had setup four places to interview, and we never talked to anyone else,” Dr. Yang recalled in telling the story. He and his wife began practicing

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with Clinton Medical Clinic in 1998 and have never looked back. Dr. Ho subsequently transitioned out of practice as the couple grew their family. Since arriving in North Carolina, Dr. Yang has thrived at Clinton Medical Clinic. He attributes a large part of his success to the longstanding excellence in patient care and advocacy the practice is known for. “We are all strong advocates for our patients and work hard,” described Yang. “We all just think of our patients as family. You see it everywhere and it’s hard for it not to rub off.” Dr. Yang noted that patient advocacy and service have been a staple of the Clinton Medical’s care process since the very beginning. For example, care has never been denied on any basis; it was the first area practice to offer full bilingual support, and that contributing within the community is a common thread among its providers. Practicing in this environment has shaped Dr. Yang’s

Winter 2019

care process in innumerable ways. It’s provided him with the opportunity to practice alongside some of the state’s most outstanding family physicians and physician leaders, but to influence the next generation of physicians as well. Of all these direct influences, Dr. Yang was quick to acknowledge that his wife Grace has had the most profound impact on him as a physician, a father, and a person. “My wife has impacted me the most. When she was practicing medicine, she showed me the power of patient advocacy. Then as a parent to our children, she taught me that raising children also teaches one to become a better physician than a textbook or residency program,” Yang described. “Most importantly, when she retired to raise the children, she is living proof that a successful practice would be very difficult without the unpaid support from a stay at home spouse or partner.” Continues on next page

In the Community Dr. Yang is active in Clinton, across Sampson County, and has been the go-to-guy for several community sports initiatives. His work and volunteerism have played a leading role in helping establish a USA Swimming-affiliated swim team in the community, a job he loves with a true passion. Yang currently coaches the high schools’ swim teams for Clinton, Midway, and Hobbton, as well as the Sampson Middle School girls’ soccer team. He has coached as many as four youth soccer teams at once in the past. His efforts within swimming, for instance, have enabled four of the Sampson County high schools to have swim teams; a luxury normally only afforded to students from larger suburban or urban communities. He takes pride in the rewards of his service. “To see young people who start out unable to even put their face in the water, to swimming over two miles in practice is very cool. Not only is swimming great for fitness and sport, but it is a life- saving skill,” Yang noted. Dr. Yang shared a story about two of his former swimmers, aged 10 and 11, who were vacationing in Mexico visiting relatives. While none of their cousins or the other familial adults could swim, one cousin drifted out into the ocean and began to drown. With no lifeguards, the two sisters swam out and rescued their cousin. Just as impressive as Dr. Yang’s community involvement are his efforts in mentoring and recruiting Clinton’s next generation of family physicians. At a time where many areas of need – especially those in rural and underserved areas – face strong headwinds in at-

tracting doctors, his efforts in spearheading a unique physician pipeline initiative is expected to pay huge dividends for Clinton in the years and decades to come. Yang has been an instrumental force in the growth of a unique scholarship/loan repayment program offered by Clinton Medical designed to attract young family physicians to the practice. Named after one of Clinton Medical’s founding partners, Dr. John Nance, the program offers future physicians a graduated incentive to joining the practice. The program begins as early as a student’s acceptance into medical school and follows them through their National Board passage and contract signing. Dr. Yang’s efforts have already yielded outstanding results, including one new physician expected to join the practice in 2020, and two others who are just completing their first year of medical school. In addition to workforce, Dr. Yang has also contributed greatly to the development and training of medical students. He has been lauded for developing a comprehensive training curriculum for students that has been formally recognized by Wake Forest School of Medicine. He was awarded the NCAFP Community Teaching award in 2014. As part time faculty at the Sampson Regional Medical Center Family Practice Residency program, he runs the outpatient pediatric and geriatric rotation. For students, Dr. Yang offers simple advice: let passion be your guide. “Study what gives you passion and joy. Don’t be afraid to change course in life if what you do doesn’t give you joy. Life is too short to be miserable.” Dr. Yang resides in Clinton with his wife and four children.

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www.ncafp.com The North Carolina Family Physician

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NCAFP

Sights & Scenes

Winter 2019

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

- EXECUTIVE’S MESSAGE -

Change is the Operative Word If you don’t believe change is happening in the healthcare world, you likely missed three significant stories that happened in mid-January in North Carolina, as well as numerous other stories that will drive healthcare in North Carolina in 2019 and beyond. Let’s hit just a few of the things that happened in January and a few other things on the horizon.

In various presentations around the state, Conway has said that Blue Cross NC simply will not agree to increases in fee for service rates, a model he called unsustainable. He has also repeatedly indicated that he hopes to increase the company’s primary care spend from 7.7 percent of their total spend today to over 10 percent in the future. The healthcare systems that are partnering on the “Blue Premier” product include Cone Health, Duke University Health System, UNC Health Care, Wake Forest Baptist Health, and WakeMed Health and Hospitals. The same week that Blue Cross NC made that announcement, State Attorney General Josh Stein announced that he would not oppose HCA Healthcare’s $1.5 billion purchase of Asheville-based Mission Health. This removed one more obstacle for Mission to finalize its sale to the for-profit healthcare company. The sale marks the largest incursion by a for-profit healthcare system in the state’s history.

It looks like it will be an exciting year for healthcare in North Carolina with change moving at a furious pace.

The biggest announcement probably came when Blue Cross and Blue Shield of North Carolina and five of the state’s largest healthcare systems agreed to work together to rein in healthcare cost by sharing risks. Blue Cross NC and the healthcare systems are setting up a payment system that will reward better outcomes rather than traditional fee for service payments.

“Historically, our healthcare system pays for services that may or may not improve a patient’s health, and our customers simply cannot afford this approach,” Patrick Conway, MD, Blue Cross NC President and CEO said in making the announcement. “Moving forward, insurers, doctors and hospitals must work together, and hold each other accountable for improv-

ing care and reducing costs.”

Stein did press HCA for several additional promises, including a pledge to continue to provide services at all of Mission’s local hospitals for at least 10 years. The sale will create a foundation (Dogwood Health Trust) with assets of over $1 billion to work to improve the health and well-being of the people of western North Carolina. Almost simultaneously, Vidant Health and ECU Physicians ended talks to merge their physician practices. Over 18-months ago, the two organizations had reached a preliminary agreement to merge. However, according to Brody School of Medicine Dean Dr. Mark Stacy, “the two entities were unable to reach some of these contractual milestones” and ultimately ended negotiations.

The North Carolina Family Physician

State Treasurer Dale Folwell had questioned whether tax exempt bonds issued for ECU facilities would be put at risk due to the merger. In addition, there were concerns that state employees within the ECU Physicians Network would lose pension and other key benefits once they became Vidant employees. ECU and Vidant already collaborate in many ways and will continue to do so, according to Dr. Stacy. These three stories come on top of a planned February announcement of the new Medicaid Managed care plans in North Carolina by the Department of Health and Human Services (see page 10). The announcements of the selected plans come about six weeks after the state announced a significant increase in Medicaid rates for primary care physicians (see page 8), which will pump another $100 million a year into primary care in our state. This increase was long advocated by the NCAFP and our partners.

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The bottom line: hang on tight. It looks like it will be an exciting year for healthcare in North Carolina with change moving at a furious pace. And this is before the legislature begins to make their own policy changes. The one thing you can count on: your Academy will be here to help you navigate the turbulent waters of change. Donâ&#x20AC;&#x2122;t hesitate to let us know how we can help.

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PROFESSIONAL DEVELOPMENT By Kathryn Atkinson, CMP NCAFP Meetings & Conferences Manager

~ 2019 CONFERENCES LINEUP ~

Meeting your CME Needs and Exceeding Your Expectations The NCAFP is excited to offer five unique learning opportunities to help you meet your CME requirements this year. From the coast to the mountains, and at a couple of fun locations in between, we’ve got several convenient and well-timed Carolina CME possibilities on tap for 2019; fitting for even the busiest of schedules. Mark your calendars for the dates and locations below and plan to join us for these first-rate educational experiences that are guaranteed to exceed your CME expectations this year. Saturday, April 6, 2019 | Charlotte, NC Our first stop will be the Charlotte Marriott SouthPark Hotel for the 2019 Spring Symposium scheduled for Saturday, April 6th, 2019, from 7:30 am to 4:30 pm. Attendees can pocket up to 8.00 AAFP Prescribed Credits by their participation in our convenient oneday program. Slated topics include diabetes, lupus, IBS, migraines, coding, and many more. Current NCAFP committee members, Foundation trustees, and board members should also plan to attend their respective business meetings during this time. To learn more and to register online, please visit our conference registration site at www.ncafp.com/symposium. Thursday, June 13, 2019 | Winston Salem, NC In June, we’ll serve up some terrific CME with a twist at the Kimpton Cardinal Hotel in Winston-Salem, NC. Conveniently scheduled for Thursday, June 13, 2019,

from 6:00 pm to 8:30 pm, the hotel’s Southern legacy and spunky Art Deco styling will make for the most unique CME opportunity around. Make plans now to join us in the Kimpton’s famous Recreation Room for a one-of-a-kind learning experience that just happens to also include optional foosball and bowling. This fun dinner program is the perfect after-office-hours opportunity to earn 1.5 AAFP Prescribed Credits on a timely topic with take-home pearls that you can begin using right away. To learn more, please visit our registration site at www.ncafp.com/winstonsalemcme. Thursday, September 12, 2019 | Wilmington, NC Make plans to meet us where the land meets the sea for another one-of-a-kind and enjoyable CME

Join us in Charlotte for top-quality CME this spring 2019 Spring Symposium A Saturday CME Event Program Chair: Nichole Johnson, MD Mark your calendars now for this opportunity to earn approximately 8.0 AAFP Prescribed Credits. Convenient regional location • One-day format & no lost office time Timely, requested topics • Highly-rated expert speakers Interactive Q&A opportunities

Planned topics include: Diabetes, Lupus, IBS, Migraines, Coding, & many more.

SATURDAY, APRIL 6, 2019 • 7:30 AM TO 4:30 PM Charlotte Marriott SouthPark, Charlotte, NC

www.ncafp.com/symposium

All medical education topics offered by the NCAFP have been reviewed by a family physician, and when possible and appropriate, presented by a family physician. While the NCAFP may receive pharmaceutical funding to help provide education at our events, they are allowed no influence on the content provided. The integrity of the information provided is always the NCAFP’s primary concern.

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opportunity this September. Join us on Thursday, September 12, 2019, at the Hops Supply Company in Wilmington, NC, from 6:00 pm to 8:30 pm for a convenient late-summer chance to earn 1.5 AAFP Prescribed Credits. Known by locals as a top-favorite gastropub with its culinary-inspired American fare and laid-back, relaxed setting, we promise you’ll enjoy this casual and fun after-hours CME opportunity. To learn more, please visit our registration site at www.ncafp.com/wilmingtoncme. Saturday, October 12, 2019 | Raleigh, NC When October rolls around, be sure that our convenient half-day CME opportunity at the Hampton Inn Brier Creek in Raleigh on Saturday, October 12, 2019, is on your fall calendar. Participation in this program’s favorable half-day format from 7:15 am to 12:30 pm will earn you 4.00 AAFP Prescribed Credits and leave your afternoon free to still rake the yard, watch the ball games, and carve your pumpkins. Current NCAFP board members should also plan to attend an afternoon board meeting immediately following this event. To learn more, please visit our registration site at www.ncafp. com/raleighcme. Thursday, December 5 – Sunday, December 8, 2019 | Asheville, NC Affectionately known around the office as “The Big Meeting,” the 2019 Winter Family Physicians Weekend scheduled for December 5 – December 8, 2019, at the Omni Grove Park Inn in Asheville, NC, is beyond a doubt, the one NCAFP CME program that you will not want to miss this year. With optional pre-conference workshops, followed by four days of topnotch general session lectures, innovative seminars, several complimentary satellite programs, and over 25+ AAFP Prescribed Credits up for grabs; this crowd-pleasing event is an annual favorite for over 800 family physicians and other primary care providers every year. Attendee registration and hotel block details will be available this spring. To view highlights from the recent 2018 Winter Weekend and to begin making your plans to attend this year, please visit our conference site at www.ncafp.com/wfpw. On behalf of the NCAFP, we warmly invite you to fulfill your education requirements and enjoy top-quality and exceptional CME with us this year. With our dependable combination of requested lecture topics, highly-rated expert speakers, innovative learning strategies, and over 40+ AAFP Prescribed Credits on the horizon, we are confident that our 2019 CME line-up is sure to exceed your CME expectations. Mark your calendars now for the dates and locations above and contact Kathryn Atkinson, CMP, Manager of NCAFP Meetings & Events, at katkinson@ncafp.com or via direct-dial at 919-214-9058, with questions. Best wishes for a safe and happy new year. We look forward to seeing you soon! All medical education topics offered by the NCAFP are reviewed by a family physician, and when possible and appropriate, are presented by a family physician. While the NCAFP may receive pharmaceutical funding to help provide education at our events, they are allowed no influence on the content provided. The integrity of the information provided is always the NCAFP’s primary concern.

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Winter 2019

RESIDENTS & NEW PHYSICIANS

- INTERNATIONAL -

Global Primary Care is Alive and Thriving By Clay Cooper, MD, MBA Duke University Family Medicine Residency Durham, NC

In late August, I received an email that Duke Family Medicine Program Director Dr. Viviana Martinez-Bianchi sent to our residency inviting us to apply as a World Health Organization (WHO) young leader to attend the WHO/UNICEF Global Conference on Primary Healthcare in Astana, Kazakhstan. After reading the application, I expected being accepted out of a global group of young health professionals to be a longshot, but the advice of my long-time mentor, Dr. Dennis Gingrich, popped into my head. He told me to always shoot for 50% success in what I apply for, because if I am always successful, I will be missing many incredible opportunities. In early October, I was invited to experience one of those incredible opportunities as part of a group of 50 young global primary care health professionals invited to attend the conference, as well as a special pre-conference for this group of young professionals from October 24-26th. With only a three-week window from when I received my invitation until the conference, quick action and generous support were key to making the experience possible, and I would like to share my experience in Astana with you. Early on October 24th, I set off with Drs. Ana Nunes Barata and Pratyush Kumar, young family physicians from Portugal and India, respectively, to attend the preconference for Young Leaders. We

met individuals across the spectrum of health professions to discuss issues facing primary healthcare in our countries and to outline policy priorities to building a future that puts primary care at the center of our healthcare systems. It was stimulating and inspiring to work with people coming from backgrounds and professions so different than mine and to brainstorm solutions to problems as diverse as reliable power sources for rural African clinics to the need for comprehensive payment reform that better compensates primary and preventive care. While we each had unique challenges, we realized that we shared many of the same struggles to bring primary care to the forefront of our health systems. During the last hour, we were broken into three groups, with each group being tasked with determining one policy priority. After a few minutes of controlled chaos as everyone spoke about what they believed to be the most pressing priorities, I approached the whiteboard to facilitate our group discussion. In the next 40-minutes, we distilled a wide range of issues into one

Dr. Cooper is currently an Intern at the Duke Family Medicine Residency Program. He received his Master of Science in Business Administration from the Penn State Smeal College of Business and his medical degree from Penn State College of Medicine prior to moving to North Carolina for his residency training. One of Dr. Cooper’s proudest achievements as a medical student was founding LionCare Tyrone, a student-run free medical clinic in Tyrone, PA. Throughout medical school, Dr. Cooper was very active in the Pennsylvania AFP. He served as the Chair and Student Representative to the Board of Directors and his interest in health policy led him to engagement with their Governmental and Legal Affairs committee and Political Action Committee. At the national level, Dr. Cooper was selected as a Scholar for the inaugural year (2015) of the AAFP Foundation’s Emerging Leader’s Institute. Later, in 2017 he was elected the Student Representative for the AAFP Foundation Board of Trustees. Since arriving in NC, Dr. Cooper has been involved with the Duke FMIG, offering mentorship and ideas to students, and is looking forward to becoming more involved in the NC AFP as he continues his training.

The North Carolina Family Physician

actionable policy priority of advocating for community-accountable education across the spectrum of healthcare specialties. While this will look somewhat different depending on whether an individual is in the United States or Bangladesh, and whether they are training to become a family physician or community health worker, core tenets of community-accountable education include moving health professions education away from “ivory tower” academic institutions that provide the bulk of reactive, tertiary care, and placing the training at the community level in clinics, community hospitals, and even in the homes of the patients we serve. This will help providers of care to better address social determinants of health and to gain more loyalty to the communities in which we train, allowing for more even

distribution of healthcare workers across areas lacking providers, and hopefully reduce brain drain in the number of providers in lower income countries. We were told to prepare a message for leaders we would meet at the conference the next day, but I don’t think any of us expected to have the direct audience of the Director General of the World Health Organization, Dr. Tedros Adhanom Ghebreyesus; the Executive Director of UNICEF Henrietta Fore; and several other dignitaries, including ministers of health and foreign ministers. Our message was well-received, and all who heard it appreciated both the intention and importance of our policy recommendation. Continues on next page

2019

Family Medicine Day Saturday, March 9th, 2019

Hands-On Skills Training Family Medicine Residency Recruitment Fair

The North Carolina Academy of Family Physicians (NCAFP) and the North Carolina Area Health Education Centers (AHEC) program are excited to present North Carolina’s 12th Annual Family Medicine Day. You do not want to miss this educational, rewarding, fun, hands-on event. For complete information and online registration, visit www.ncafp.com/students/fmd

The Global Conference for Primary Healthcare itself was also an inspiring experience. It brought together individuals from over 130 United Nations member states to recommit to the tenets of the Declaration of Alma Atta, signed 40-years prior, which declared healthcare as a fundamental human right and brought primary care to the forefront within health systems around the world. Member states also ratified the Astana Declaration, a modern version of the Declaration of Alma Atta. While this was exciting, it was also disheartening that specific stakeholders -- including, but not limited to, family physicians and youth which were previously named -- were taken out of the declaration with the focus being solely on member states. I was also disheartened that in negotiating its willingness to sign the Astana Declaration, the United States government included a footnote on the bottom of the declaration to draw attention to a point they included which states that, â&#x20AC;&#x153;in no case should abortion be promoted as a method of family planning.â&#x20AC;? Even in Astana, US politics loomed large over what was supposed to be a unifying gathering of world nations. Additionally, much of what was said by the US government delegate to the meeting ran counter to what was actually being done by our executive branch in terms of expanding access to affordable healthcare for all living in the United States. Many people asked me if what he was saying was actually true, and it became clear that many people around the world no longer feel they can trust what our government officials say. However, there was much to be learned at the conference. It was humbling to listen to a minister of health speak about an innovative program their government is implementing in one session, and to find myself

sitting in the seat next to them during the next session, with everyone learning from one another. Two such people I met were the current and previous Ministers of Health of Ecuador, where I spent six months studying abroad in 2011, and then returned for six weeks as a medical student in 2014. I spoke with these women about how impressed I was by the changes in the public health system between these years, and they attributed much of the success to better training of family physicians as a specialty. It was great connecting with them, and I look forward to what doors this connection can open for future work in Ecuador. This is just one example of the incredible collaborative nature of the event. My experiences at both the preconference and conference were fantastic networking opportunities, and I now have young colleagues around the globe in medicine, nursing, community health, pharmacy, and even a health economist. It was inspiring to see the great work everyone is doing in their own countries and communities, and I am encouraged to pursue opportunities for advocacy in my local community and nationally around areas of health equity, community-accountable medical education, and payment reform that reimburses not the cost of services provided, but the value of care provided in terms of healthcare dollars saved and quality of life-years added. I look forward to sharing the work done both at the preconference and conference with my peers to work towards the goals put forward in the Astana Declaration. I hope that through my participation, I can continue to move the needle towards healthcare systems both in the US and globally that put primary care, and specifically Family Medicine, at the center. Thank you again for your support, which made this experience a reality!

The North Carolina Family Physician

Noteworthy AAFP Deadlines for Medical Students and Residents March 1st - AAFP Emerging Leaders Institute This year-long leadership development program focuses on creating future Family Medicine leaders. Medical students and residents are eligible to apply. The Emerging Leaders Institute kicks-off at National Conference in Kansas City in July 2019. Enhance your leadership skills while completing a leadership project, make lifelong connections, and earn scholarships to attend energizing conferences along the way! Complete details can be found on the AAFP Foundation’s website at www.aafpfoundation.org. If you would like to be connected to a student or resident already participating in this program, please contact Tracie Hazelett at thazelett@ncafp.com.

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Winter 2019

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NEWS RELEASE Blue Cross NC Contact: Blue Cross NC Media Line: 919‐765‐3005 Blue Cross NC Online Newsroom: http://mediacenter.bcbsnc.com For Immediate Release: January 7, 2019 Blue Cross NC Funding Program to Create More Primary Care Physicians in North Carolina $750,000 investment will be used by N.C. Academy of Family Physicians to offer training and educational opportunities to medical students interested in primary care DURHAM, N.C. – Blue Cross and Blue Shield of North Carolina (Blue Cross NC) today announced an investment of $750,000 to fund a primary care interest and leadership program designed to address the state’s shortage of primary care doctors, and ultimately increase access, lower costs and improve health outcomes. The program is run by the North Carolina Academy of Family Physicians Foundation (NCAFP). It will offer robust training and educational opportunities to medical students interested in primary care. “We know one of the biggest keys to patient‐centered care is a primary care doctor, but the problem is that there aren’t enough of them. The money we’re investing today is designed to address this,” said Dr. Patrick Conway, President and CEO of Blue Cross NC. “The practice of medicine is first and foremost about people; the better care they receive, the better their overall health outcomes.” Family medicine is a growing focus area for students in the state, with over 15 percent of graduating medical students choosing family medicine as their specialty in 2018 (compared to a national average of 9.4 percent). However, estimates show North Carolina will require another 1,500 family physicians in the next decade to meet the health needs of its growing population. “We are pleased to continue this strong partnership with Blue Cross NC to increase the pipeline of family physicians in our state,” said Alisa Nance, MD, FAAFP, President of the NC Academy of Family Physicians. “Our efforts are working, and we know that early exposure to primary care with ongoing mentorship is a key element of a medical student’s ultimate decision to enter a family medicine or other primary care residency.” Over the next three years, the funds will be used to provide medical students with training and educational opportunities in family medicine. Specifically, NCAFP will use Blue Cross NC’s funding to support opportunities that will include:  Shadowing and mentoring experiences: Medical students will have the opportunity to take part in a hands‐on clinical summer experience between the first and second year of medical school, which also includes partnering students with practicing physicians in rural clinic environments.  Health and policy leadership development: Medical students will be able to participate in key leadership development and educational activities, including the American Academy of Family Physicians National Conference for Family Medicine Residents and Medical Students and the NCAFP Annual Winter Family Physicians Weekend.  Educational sessions and scholarly activities: Medical students will have access to sessions from the Family Medicine Interest Groups regarding the importance of primary care, population health, public health, health policy and other pressing issues for state primary care leaders. Access to primary care lowers costs and improves health outcomes. Studies show that adults who have a designated primary care physician have 33 percent lower health care costs on average.1 Increased primary care access is shown to be correlated with reductions in emergency room visits, hospitalizations, and surgeries. Where rates of access to primary care are higher, death rates from cancer, heart disease, and strokes are lower. The program is based on previous findings and successes from the Family Medicine Interest and Scholars Initiative, a collaboration between the Blue Cross and Blue Shield of North Carolina Foundation and NCAFP Foundation. The initiative saw a majority of graduates enter family medicine residencies, 63 percent of which were in state. The program also saw a positive correlation of students who participated in other NCAFP initiatives and students who elected to enter family medicine residencies in state.

Primary Care: Can It Solve Employers’ Health Care Dilemma? Health Affairs, Health Spending, 2008

STUDENT & RESIDENT UPDATES

Students and Residents Converge to Learn, Lead and Network Asheville Annual Meeting Draws Nearly 200 from Across the State Last December, 117 medical students and 82 family medicine residents joined the NCAFP for the annual Winter Family Physicians Weekend in Asheville. Students and residents participated in educational sessions, business meetings, the research poster contest and took advantage of several social and networking opportunities with other students, residents, and physicians. They also attended the highly-complimented session led by Dr. Betsey Tilson, State Health Director and Chief Medical Officer for the NC Department of Health and Human Services. During her presentation, Dr. Tilson shared the Division’s vision for healthcare in North Carolina and how healthcare professionals can create opportunities for health with those they serve. Her enthusiasm was contagious, and attendees were inspired by her passion and vision for the future.

2018-2019 Student & Resident Leaders During their respective Student and Resident Section meetings, attendees were made aware of the many scholarship and programmatic opportunities available from the NCAFP and the AAFP. The recentlyappointed 2018-2019 Student and Resident leaders were also introduced.

Baker

2018 Poster Presentation Recap During the State of the Academy & Awards luncheon, the 2018 Research Poster Contest winners were announced. Smith

In the medical student category, Mr. Christopher Deery (UNC, MS4) claimed the top prize with his submission: Effects of Physical Activity Calorie Expenditure (PACE) Labels on Physical Activity in a Workplace Environment and Ms. Breanna Johnson (MS3, UNC) claimed the runner-up prize for her entry: Addressing Healthcare Disparities in the Mentally Ill: Increasing Cervical Cancer Screening at Wakebrook Primary Care. This year’s Resident category resulted in a tie between the top two submissions. These included an entry by Dr. Brittney Macdonald (MAHEC-Asheville, PGY-3) entitled: Family Physicians’ Scope of Practice in Western North Carolina, and Dr. Chue Xiong (Cabarrus, PGY3) for his submission: Catching Patients’ Breath: Increasing PFTs in Patients with COPD.

Winter 2019

Ferruzzi

Academy Board of Directors: Resident Director, David Baker, MD (MAHEC-Asheville); and Student Director, Cameron Smith (CUSOM); and Resident Director-Elect, Elizabeth Ferruzzi, MD (Novant Health); Student Director-Elect, Katelyn Turlington (Wake Forest). Foundation Board of Trustees Representatives: Lucy Muhirwa, MD (ECU); Kate Timberlake, MD (Cone); Katherine Mulligan (Brody); and Hannah Smith (Brody). Committee Representatives include Workforce Pipeline: Demetria Rawlinson, MD (CMC) and Geoffrey Houtz (UNC); Payer & Systems Advocacy: Alexa Mieses, MD, MPH (Duke) and Matthew Leary (CUSOM); Member Satisfaction & Practice Environment: Sarita Lavani, MD (ECU) and Scott MacBeth (Wake Forest). Thank you for pledging your service in the coming year.

Turlington

PRACTICE MANAGEMENT By Brent Hazelett, MPA, CAE NCAFP Vice President and Chief Operating Officer

Building Relationships with Health System Executives Why NCAFP is Acting and What It Means to You You’ve asked for greater influence, and we are trying to provide just that. As part of our new strategic plan, “Payer and System Advocacy” is one of NCAFP’s three core focus areas with a goal of strengthening the influence of Family Medicine with both health systems and insurance companies. We took a first step to develop stronger relationships within the executive suites of our state’s large healthcare systems by inviting several presidents and CEOs of integrated health systems to our Annual Meeting last December. The following represents a brief explanation of that process and what we hope to accomplish by opening doors to the corporate suites within our state’s healthcare systems. WHO WAS ASKED TO PARTICIPATE IN THE PANEL DISCUSSION AT THE ANNUAL MEETING AND HOW WERE THEY CHOSEN? In order to have a panel of 3-4 healthcare executives, we asked 6-7 individuals from across the state to participate in the panel. We first looked for regional representation across North Carolina, but also looked at systems whose presidents or CEOs were in leadership roles on the NC Healthcare Association Board (formerly NC Hospital Association). A few individuals who were invited were not able to attend due to scheduling conflicts, leaving us with a panel of three healthcare executives: Dr. Ron Paulus of Mission Health; Mr. Carl Armato of Novant;

and Mr. Terry Akin of Cone Health. We unfortunately couldn’t invite someone from every system because the panel would have simply been too large. However, the NCAFP hopes to engage with all the state’s health systems as we move forward. WHAT DOES NCAFP HOPE TO ACCOMPLISH BY REACHING OUT TO HEALTH SYSTEMS? First and foremost, to build a stronger relationship with our health systems. When thinking of physician organizations, representatives of large healthcare systems probably think of the NC Medical Society first. But the NCAFP is a powerful organization in its own right and wants to build deeper relationships with our hospital systems. Furthermore, as healthcare moves to value over volume, the role of primary care should only grow, making it a perfect time to strengthen these relationships. As a result, there are a few more specific goals we hope to address: • To improve access to ancillary staffing for family physicians including scribes, Medical Assistants, behavioral health professionals, and other team members. Family physicians need appropriate resources to practice the highest quality care possible, and that includes appropriate staff support. • To advocate for a broad scope of practice for family physicians. If our members want to serve in inpatient roles, practice obstetrics or perform procedures in an outpatient setting, we want you to have that opportunity. In fact, research shows that the broader scope family physicians have, the higher quality and lower cost healthcare becomes. Yet again, family physicians need the appropriate time, resources and support to have a broader scope of practice. • To encourage systems, payers and others in North Carolina to incentivize teaching and mentoring. For medical students who want to enter primary care -particularly in underserved settings -- we need them to have positive educational experiences in those same community-based settings. But teaching takes time. We hope to encourage healthcare systems to incentivize teaching in a positive manner and/or reduce

The North Carolina Family Physician

HEALTH SYSTEM CEO PANEL: The NCAFP featured leaders from three of NC’s largest health systems at its December meeeting. From left are Dr. Ron Paulus, Mission Health; Carl Armato, Novant; and Terry Akin, Cone Health.

patient care requirements when community-based family physicians are teaching.

to both wins for our member family physicians and our state’s integrated healthcare systems.

WHAT DID WE LEARN BY HEALTH SYSTEM CEOS ATTENDING NCAFP’S ANNUAL MEETING?

WHAT WERE SOME OF THE KEY MESSAGES FROM EACH OF THE HEALTHCARE EXECUTIVES?

Quite frankly, it became even clearer that we need to provide educational opportunities for corporate executives to learn more about the important role of Family Medicine and primary care, even in their own systems. Our own members started that process in the questions they presented to the panel at the meeting, including reminding the executives to use the term “family physician” as opposed to family practitioner or primary care provider. We also need to provide system executives education about the very broad scope of training family physicians receive and the scope of patients that family physicians can ultimately care for. Finally, we want to make sure health systems understand the tools and resources you need to help the system meet their own goals as we transition from volume to value. We believe the process can ultimately lead

All three panelists emphasized that the current system is not sustainable and that the economic realities will force a move to value.

Winter 2019

“We’ve got to get out of the traditional model where the more I do to you and the sicker you are, the more I make,” Cone CEO Terry Akin noted. “Value has to prevail. And in a value-based world primary care will be front and center. The scales will tip, and we will find better equity and more appropriate compensation.” Ron Paulus, the President and CEO of Mission Health, noted that in 1982 he had a professor say that the system would be totally unsustainable if Continues on next page

the US spent 10 percent of Gross Domestic Product on healthcare, and we are well past that today. He reminded the audience that “the long arc of history leads to justice, but it’s sometimes a long darn arc.” Novant’s President and CEO Carl Armato discussed the complications of a system that has been created in a manner that is simply difficult for everyone to navigate. He noted the need to simplify almost everything, particularly Electronic Health Records. He indicated that over 900 physicians have gone through the Novant Health Resiliency program and that the engagement level of those physicians has increased incredibly, ultimately leading to more and more physicians in seats of leadership. Paulus discussed Mission’s strategy to take a totally irrational world and make it more rational. He noted that Mission is working to identify the hassles of practice and

eliminate them, but also to identify the joys of practice and to standardize them and hardwire them into the system. Akin agreed, noting, that “physician burnout and resiliency are symptomatic of a system that is fundamentally broken and misaligned. We can treat the symptoms and we have to, but we are convinced that the real antidote is system change.” WHEN ASKED WHAT ADVICE THEY WOULD GIVE TO FAMILY PHYSICIANS AND THE NCAFP, THE PANELISTS HAD THIS TO SAY: “Your job is not to accept the world the way it is,” Paulus noted. “Your job is to make the world better, and we’ve got to be in that together. When outside influences split us apart, we ultimately isolate people. We’ve got to be one team based on what’s best for patients.”

Armato noted that “It is clear that you (family physicians) are the secret sauce, and my counterparts are saying the same thing. Make sure your voices are at the table. And if you aren’t finding that table, find another place to have that voice.” “It’s a world where it’s hard not to become jaded and cynical,” Akin said. “I have never seen a time of greater challenge, but I’ve never seen a time of greater opportunity either. If there’s ever a group that’s central to that, it’s Family Medicine.” Leaders from the NCAFP already have follow up meetings set with two of the three system executives who participated in the panel and will be engaging other system executives soon. Look for additional information about our efforts to help make family physicians more valued with fewer administrative burdens in the coming months.

MEDICAID TRANSFORMATION

CCNC / CCPN Can Assist Practices Aiming for AMH Tier 3 Status Community Care of North Carolina (CCNC), together with Community Care Physicians Network (CCPN), a clinically integrated network of independent primary care physicians, can help practices around the state achieve Medicaid’s new Advanced Medical Home (AMH) Tier 3 status. Under North Carolina’s Medicaid Transformation plan, practices

attesting as Tier 3 Advanced Medical Homes can receive care management revenue and value-based payments from health plans for meeting quality targets. To do so, Tier 3 practices take on significant new functions, such as risk stratification and care management. Irrespective of your practice type (system-based or independent), practices need to reach five categories of requirements to

attest as Tier 3. This process may be cost prohibitive and time consuming for independent practices. CCNC/CCPN offers detailed information on how it can help independent practices reach the goals of a Tier 3 AMH. Complete information on CCNC/CCPN services can be located online at communitycarephysiciannetwork. com/services.

The North Carolina Family Physician

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Family Physicians:

• PLACE your job in front of our highly qualified members • SEARCH our resume database of qualified candidates • MANAGE jobs and applicant activity right on our site • LIMIT applicants only to those who are qualified • FILL your jobs more quickly with great talent

• POST multiple resumes and cover letters or choose an anonymous career profile that leads employers to you • SEARCH and apply to hundreds of fresh jobs on the spot with robust filters • SET UP efficient job alerts to deliver the latest jobs right to your inbox • ASK the experts advice, get resume writing tips, utilize career assessment test services, and more

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Deadlines Continued from p. 25

This conference has something for all stages of training -- MS1 to PGY3s -- offering interesting educational workshops, informative and inspiring leadership forums, and the opportunity to meet and network with students, residents and residency programs from North Carolina and across the country.

The AAFP invites you to share your research by entering the National Conference poster competition. Medical students and family medicine residents are invited to share their innovative and effective educational programs and showcase unique community projects. Categories for posters include: Research, Clinical Inquiry, Community Project and Educational Program. The AAFP will select up to 50 entries for display at National Conference. Of those, the top 12 will be invited to give a brief oral presentation onsite for peer review. Submit your research for consideration and network with medical students and residents with similar interests in Kansas City this summer! Submission requirements and full details can be found at: www.aafp.org/nc.

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

April 1st - 2019 National Conference Poster Competition

www.ncafp.com

eligibility requirements, submission deadlines and writing tips please visit: www. aafp.org/nc/scholarships.

Special Note: Many national student and resident positions are elected during this conference. If you are interested in a national leadership position, the deadline to notify the NCAFP of your intention to seek election or appointment is 5/1/19. This deadline is for all elected and some appointed positions. Other appointed positions have a deadline of 8/15/19. Interested students and residents should contact Tracie Hazelett at thazelett@ncafp.com for questions or more information.

May 1st - Family Medicine Leads (FML) Scholarships to attend the 2019 National Conference in Kansas City, MO. There are multiple FML scholarship categories and the AAFP anticipates awarding 250 scholarships in 2019. For

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