NC Family Physician - Summer 2022

Volume 18 Issue 3 • Summer 2022

The North Carolina

Family Physician Quarterly News in North Carolina Family Medicine

CARE IN FOCUS

The Social Determinants of Health, NC's Healthy Opportunities Pilots and NCCare 360 P10

Fulfill your year‐end CME requirements while recharging your zest for Family Medicine this December.

Program Chair: Deanna Didiano, DO Program Vice‐Chair: Tamieka Howell, MD

www.ncafp.com/wfpw Approximately 30+ Credits Up for Grabs CGM Monitoring Gender‐Affirming Care for Youth Lung Cancer Chronic Cough IBS STEMI and Stroke Long Covid

Monkeypox Social Determinants of Health Chronic Kidney Disease Obesity Pneumococcal Disease Addiction Medicine

Rural Medicine Pediatric Depression & Anxiety Direct Primary Care Physician Burnout Congenital Syphilis And Many More!

Optional Workshops Include

KSA: Hypertension ∙ Lung Cancer ∙ Opioids ∙ Collaborative Care Codes Upper & Lower Extremity with Ultrasound ∙ Practice Management Seminar

Connect | Learn | Engage

Count on a fun‐filled four‐day weekend with meaningful and timely continuing education, impactful networking opportunities, and well‐deserved leisure time with family and friends.

Registration & full conference details available at www.ncafp.com/wfpw Contact Kathryn Atkinson, CMP, Manager of Meetings & Events, at 919.214.9058 or katkinson@ncafp.com with any questions.

It is important to note; there are currently no plans to offer a virtual option for this event.

Inside Summer 2022

MEDICAID

Contracting with Tailored Plans P. 28

PRESIDENT’S MESSAGE

CHAPTER AFFAIRS

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Mentees Teaching Mentors

Sights and Scenes from NCAFP Events & Activities

ADVOCACY

PROFESSIONAL DEVELOPMENT

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18

2022 Legislative Session in Review

CARE FOCUS

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What are the Social Deteriminants of Health? Why are they Important?

From Start to Finish, the 2022 Winter Family Physicians Weekend Features a Spectacular Speaker Line-Up & High-Quality Updates All Weekend Long

PRACTICE MANAGEMENT

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HIPAA Enforcement Discretion During the Declared Public Health Emergency

DEPARTMENTS

PUBLISHED BY

President’s Message 4 Advocacy 6 Chapter Affairs 16 t 919.833.2110 •

fax

Meetings & Conferences 18 Membership 22 Practice Management 26

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. Dimitrios 'Takie' Hondros 2021–2022 NCAFP President

PERSPECTIVES

Mentees Teaching Mentors My most recent medical student told me: “You taught me to keep an open mind, truly listen to patients, and advocate for my profession. Because of you, I am certain I want to be a Family Physician.

You inspire me to keep learning and searching for answers, fight for my patients, and serve my community with loyalty.”

As Family Physicians, it is important to always learn and innovate. Our profession allows us to be the most flexible and adaptable in medicine. We should do as much as possible to keep the care of our patients coordinated under one room. This model helps keep costs low, and at the same time with someone the patient has total confidence in, their personal Family Physician. Being learners also means we pass on what we have learned to others. Mentoring and precepting allows us to always make sure we are at the forefront of our profession, to ensure we educate the future professionals with up-to-date information.

As Family Physicians, we advocate and fight for our patients and our professions. Advocacy is very important to the NCAFP. It helps our patients, our communities, and ourselves. It is an essential part of being an involved physician leader on a regional, state, and national level. We must help address many issues at these levels to ensure that our

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voices are heard. Whether it is related to scope of practice, reproductive health, Medicaid expansion, or administrative burden, Family Physicians should continue to engage and get to know their legislators and policy leaders. This will help ensure when they need trusted medical advice before making important policy decisions, we are the ones they will turn to and ask.

As Family Physicians, community service is also paramount. We have been blessed with a great gift – to be able to ‘totally care’ for individuals. Get involved with your local community free clinic, soup kitchen, homeless shelter, or volunteer for a mission trip to help

The North Carolina Family Physician

2021-2022

NCAFP Board of Directors

Executive Officers President

Dimitrios “Takie” P. Hondros, MD

President-Elect

Shauna Guthrie, MD, MPH

Secretary/Treasurer

Garett R. Franklin, MD

Immediate Past President Executive Vice President

Jessica L. Triche, MD Gregory K. Griggs, MPA, CAE

At-Large Directors Joshua Carpenter, MD Jewell P. Carr, MD Deanna Didiano, DO Nicole Johnson, MD, MPH Mark McNeill, MD Benjamin F. Simmons, MD Ying Vang, MD Courtland Winborne, MD

Academic Position Margaret Helton, MD (UNC)

Resident Director Ryan Paulus, DO (UNC) Resident Director-Elect Matthew Drake, MD (ECU)

Student Director Morgan Carnes (Wake Forest) Student Director-Elect Morgan Beamon (ECU)

give to those less fortunate than us. When you go, take your students with you. Alongside you at these places, not only will they learn more about medicine, but the experience will also help them become more exceptional human beings.

AAFP Delegates & Alternates AAFP Delegate

Richard W. Lord, Jr., MD, MA

AAFP Delegate

Robert L. Rich, Jr., MD

AAFP Alternate

Tamieka Howell, MD

AAFP Alternate

Thomas R. White, MD

Many times, students can teach us as well. Their words can resonate greatly with us and help to further solidify why each of us are truly here. They remind us why we chose Family Medicine as our career choice. Continue learning from those you mentor, the patients you serve, and from those who you interact with and teach. We are truly in the best medical profession, and I am continually humbled to serve as your elected leader this year. Happy Summer to all!

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

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www.ncafp.com

ADVOCACY

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

~ Representing Family Medicine ~

2022 Legislative Session in Review The North Carolina General Assembly adjourned on July 1 with plans to return to conduct limited business once a month throughout the remainder of the year.

During the 2022 Session, the NCAFP priorities included the following: • Coverage expansion, particularly Medicaid expansion.

• Further monitoring the progress around implementing Medicaid Managed Care, including combining Health Choice and Medicaid into one program in the state.

• Preventing scope of practice incursions.

• Expanding support for the primary care pipeline in North Carolina.

• Working to decrease administrative burdens faced by practicing family physicians.

Coverage Expansion The NCAFP remains committed to increasing health insurance coverage in the state. In 2022, for the first time ever, bills leading toward Medicaid expansion passed both chambers of the General Assembly, but with vastly different directions.

The Senate included wholesale changes in health-

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care regulation as part of their expansion bill, including complete independent practice for all Advanced Practice Registered Nurses (APRNs), significant Certificate of Need reforms, Surprise Billing measures, a very insurance-friendly telehealth provision, and more.

The House, on the other hand, passed more of a study bill, which would have directed the NC Department of Health and Human Services to begin expansion negotiations with the federal government. The House bill would have also required a subsequent vote in December after negotiations with the federal government had concluded. In the meantime, Governor Roy Cooper made Medicaid expansion his top policy priority.

Throughout the session, the NCAFP remained engaged with the House, the Senate, and the Governor, hoping for a compromise plan that could be passed this year. Efforts intensified late in the session, and on the last day, numerous proposals bounced back and forth between the two chambers and the Governor, but to no avail. However, there still may be a pathway toward expansion this year during one of the scheduled “mini sessions” the General Assembly plans to hold over the remainder of the year.

After signing the budget on July 11, Gov. Cooper noted that, “both the House and Senate now support it and both chambers have passed it. Negotiations are occurring now, and we are closer than ever to agreement on Medicaid expansion.” Senate Leader Phil Berger and House Speaker Tim Moore released a joint statement shortly after the Govern signed the budget, noting that they “are committed to working to improve healthcare access and expand Medicaid, while providing the necessary safeguards to preserve the state’s fiscal strength.”

Medicaid Transformation and the Merger of Health Choice and Medicaid As you know, Medicaid Managed Care was implemented over the last year, with July 1, 2022, marking the first anniversary of the managed care program in North Carolina. However, certain special needs populations (including the Severely and Persistently Mentally Ill, the Intellectually and Developmentally Disabled, and others) numbering about 170,000 will enter what has been deemed “tailored plans” run by regional non-profit mental health agencies starting December 1, 2022.

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One positive item that emerged in the state budget was the merger of the Health Choice program into Medicaid. Health Choice provides insurance for low-income children that do not qualify for Medicaid but cannot afford private insurance. While it covers many things, it does not include as many benefits as Medicaid. For example, it does not require EPSDT (Early and Periodic Screening, Diagnostic and Treatment) services. Prior to managed care, this difference was less problematic. However, now with five managed care plans, each of those plans also must deal with Health Choice a bit differently, meaning practices are really dealing with up to 10 sets of rules, and for only about 60,000 children receiving Health Choice benefits. The policy change in the state budget will allow all Health Choice recipients to receive Medicaid benefits without changing their eligibility requirements, effective July 1, 2023. This will simplify things greatly for practices, the state, and the managed care plans.

Scope of Practice Scope of practice battles continued to dominate the policy landscape in North Carolina this year, with most of the focus being on Physician Assistants and APRNs. Physician Assistants – Senate Bill 345 sought to provide some flexibility in Physician Assistant supervision and had been thoughtfully negotiated over the last few years through a “Medical Team Task Force” established by the NC Medical Society, which included significant input from the NCAFP, the NC Academy of Physician Assistants and many others. As a result, the NCAFP supported this bill. The bill would have eliminated the requirement of individual physician supervision IF, and only IF, the Physician Assistant met and maintained the following criteria: • 4,000 hours of post-graduate closely supervised training and more than 1,000 continues on next page

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hours of clinical practice experience within the specific medical specialty of practice with a physician in that specialty; AND

FAMPAC

Empowering Family Medicine

• Practicing in a team-based setting.

In the bill, team-based practice was tightly defined to require a level of physician involvement and ongoing quality improvement efforts at the practice level. It also excluded pain management clinics and perioperative settings. In 2021, during the first year of the two-year legislative biennium, the bill passed the State Senate unanimously. Late in this year’s session, the House unanimously passed a revised version of the bill with mainly technical corrections requested by the NC Medical Board. The Senate failed to act further on the bill prior to adjourning, so the bill has not become law. However, there still is an outside chance it could be considered when the legislature comes back for one of their mini sessions throughout 2022.

JOIN THE FIGHT FOR FAMILY MEDICINE See 'Governor's Institute' on back cover Continues on next page

Participating is easy --

• Get to know your elected officials and become their trusted healthcare advisor.

• Contribute so we can support candidates that support Family Medicine.

• Participate in NCAFP’s ongoing advocacy events and efforts.

To learn more about FAMPAC and donate, visit www.ncafp.com/fampac

continues on Back Cover

The NCAFP leadership believes this is a notable example of how scope of practice changes and discussions should take place: in a collaborative manner, with incremental change, where experience and practice setting still matters, and where team-based care is valued.

APRN Scope – Once again this year, the nursing community pushed for legislation that would completely eliminate physician involvement with Advanced Practice Registered Nurses (H277/ S249). The bill would have allowed a newly minted APRN to practice independently with no scope restrictions from their first day out of school.

NCAFP and the entire House of Medicine strongly opposed the bill. Unlike the bill aimed at Physician Assistants, the legislation had no safeguards in terms of

experience or type of practice setting. In addition, the proposed legislation went much further than legislation passed in any other state in the last several years. Legislation passed recently in other states (Virginia and Florida, for example) had experience requirements for APRNs. As stated above, the Senate made this issue much more complicated when that Chamber tacked this bill, along with several other significant regulatory reforms on to their proposal to expand Medicaid. While the NCAFP has always supported Medicaid expansion, our leadership found many of the other provisions (particularly the provisions around APRNs) untenable at best.

The Senate ultimately passed this bill, but it stalled in the House, with the House passing a different version of Medicaid expansion without all the other reforms included. This represented the first time that a bill addressing APRN independent practice had ever passed out of a committee, much less a complete chamber of the General Assembly.

Late in the session, one of the bill’s key sponsors tried a parliamentary move to force the House Speaker to bring the stand-alone APRN bill to the floor, which was at least temporarily thwarted. The NCAFP continues to remain heavily engaged in this important issue.

Primary Care Pipeline The NCAFP has been working on several initiatives to increase the primary care pipeline in recent years. This year, we focused on efforts to increase incentives for choosing family medicine, particularly in rural areas.

House Bill 1090 would have funded 12 annual $25,000 scholarships to medical students who would commit to go into family medicine in rural areas. It is patterned after a program that was available in the 70s and 80s in our state, but at some point was defunded. The scholarships would revert to loans if the medical student did not enter family medicine or did not practice in a rural area. But for those who did end up practicing rural family medicine, the students would avoid paying significant interest by receiving up-front scholarships versus loan repayment after the fact. All four House Health Chairs served as primary sponsors of the bill, which would have initiated a four-year pilot. A group of 11 other bipartisan House

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members also served as sponsors.

The NCAFP and Community Care of North Carolina worked closely together on the legislation. While we were not surprised that the bill did not move as a standalone piece of legislation, it came remarkably close to being included as part of the budget. At one point, the funding had increased from $1.5 million to $7 million for the pilot. However, given that the budget is a second-year adjustment of the biennium, some legislative leaders did not want to fund any “new” programs. On the positive side, both House and Senate Health Chairs believe we have a great chance of funding this effort during the 2023 legislative session because of the strong support it received this year.

The NCAFP also continues to work with others to try to find ways to incentivize precepting, particularly in rural and underserved areas. We know that early and frequent exposure to rural Family Medicine is positively correlated with medical students ultimately practicing in those areas.

Administrative Burden Reduction Due to the speed and intensity of the legislative session, we were unable to move forward legislation aimed at reducing administrative burdens. However, we continue to talk to legislative leaders about the need for reforms.

We have had particularly positive conversations around reducing Prior Authorizations and expect legislation could be filed to address this topic in 2023. We also continue to work with payers to address administrative burden in primary care, including sharing the results of a survey the NCAFP completed on the topic in 2021.

In conclusion, we believe we are on the precipice of passing several pieces of legislation that would have a positive impact on family physicians and your patients, either later this year or next year. We will keep you updated in our e-newsletter and this magazine as our efforts continue.

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CARE IN FOCUS -- SOCIAL DETERMINANTS

What Are Social Determinants of Health? Why are they Important?

By Amelia Tilson, NCAFP Summer Intern

As a family physician, you know a person’s health is about more than just their physical body, much more.

A person’s health is also impacted by a combination of their mental health, the communities in which they live and work, their relationships and support systems, their early childhoods, and so much more.

reported experiencing some kind of violence in their relationships.

This idea of non-medical drivers of health has been labeled Social Determinants of Health (SDOH). These factors play a significant role in health outcomes, as studies have shown that up to 80% of a person's overall health is driven by social and environmental factors. These basic needs (secure housing, stable access to enough healthy food, a job that pays enough, transportation and education, for example) have a tremendous impact on people’s health.

• Nearly one-quarter of children in North Carolina have experienced some kind of adverse childhood event 1.

• On average, 7% of the state’s population does not have access to a vehicle and reports that it inhibits their ability to access healthcare.

These kinds of unmet needs can contribute directly to conditions such as diabetes, asthma, obesity, chronic pain, anxiety, and de-

On both national and state levels, non-medical factors that contribute to poorer health are incredibly prevalent. In North Carolina: • 16% of families with children live in poverty, and it’s even higher among families with at least one child under the age of five (21 percent).

• More than 1.2 million people cannot find affordable housing.

• More than 1.85 million people have low access to a grocery store.

• Almost 44% of women in North Carolina have

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The North Carolina Family Physician

pression. In order to properly work to better the health of the residents of North Carolina, working to address SDOH must be a part of treatment plans.

Social determinants have a major impact on all health outcomes, but more commonly affect minority communities. Low levels of education, low-income levels, and a poor living environment are all social drivers of poor health. And for hundreds of years, policies and social norms created inequities within society that continue to drive these problems today. Redlining, for example, was a discriminatory policy that denied the opportunity to live in “good” parts of cities based on race or ethnicity. It pushed these groups into less desirable areas, including areas that lacked green space, had limited access to healthy food, or were in close proximity to a i r pollutants. The National Air Toxics Assessment of Cancer Risk shows that the most toxic air

Summer 2022

is mainly in areas with a high percentage of black populations and communities of color2. These non-medical drivers leave these communities vulnerable to conditions such as heart and lung conditions, and further exacerbate health inequities in our nation.

Addressing social determinants of health on a wider scale requires your work as family physicians. There is now a growing knowledge and consensus that in order to address and achieve the well-being of a population all of the factors of health have to play a role, including the non-medical ones. AAFP released an article in which they explained that a substantial proportion of health care to America’s underserved populations is provided by family physicians and that family physicians are the first line o f care for many families and young children. Your role as the first line of care means that there is an

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opportunity to integrate the social determinants of health and their impacts into screenings, diagnoses, and treatments.

What barriers are your patients facing that are preventing them from accessing their basic needs?

What services are they lacking in their communities?

Implementing these kinds of questions surrounding SDOH can aid in catching early signs of conditions such as diabetes and asthma, as well as being able to more holistically understand a patient and their needs. So, in order to properly be able to treat families and children, social determinants must be a part of the diagnostic conversation.

Approaches in North Carolina There are multiple systems being set up in our state to address this idea of whole person health and incorporate social determinants and non-medical factors into care. NCCARE 360 and the Healthy Opportunity Pilots are two systems in our state that have been developed to assist in aiding patients and providing them with access to the non-medical services they need to achieve healthy living. These programs are setting up systems that allow people to access resources to meet their basic needs and are making healthcare more holistic. Learn more about these two landmark programs in the additional articles that follow.

References 1. All stats from: North Carolina Department of Health and Human Services. “Using Standardized Social Determinants of Health Screening Questions to Identify and Assist Patients with Unmet Health-related Resource Needs in North Carolina” April 5, 2018.

2. One reason why coronavirus hits Black people the hardest.

(May 22, 2020) . Vox News. from https://www.youtube.com/ watch?v=XAFD-0aMkwE

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North Carolina's Innovative Healthy Opportunities Pilots

By Amelia Tilson, NCAFP Summer Intern

The North Carolina Department of Health and Human Services (NC DHHS) is embracing the idea of whole person health, and the idea of buying health, not healthcare. One key part of their work is the Healthy Opportunities Pilots. The Healthy Opportunities Pilots are the nation’s first comprehensive program to test and evaluate the impact of providing and paying for (with Medicaid dollars) select evidence-based, non-medical interventions related to housing, food, transportation, and interpersonal safety and toxic stress of high-needs Medicaid enrollees.

These pilot programs are part of the flexibility that NC DHHS received through the 1115 Medicaid Demonstration Waiver. The 1115 Waiver is an agreement between North Carolina's Medicaid program and the federal Center for Medicare and Medicaid Services (CMS), that allowed North Carolina to transition the Medicaid program from fee-for-service to managed care. As a part of that waiver, CMS authorized North Carolina to spend up to $650 million dollars of Medicaid funds to develop the Healthy Opportunities Pilots. The largest portion of the authorized spending will pay for a set of evidenced-based, non-medical services that are not typically covered by Medicaid.

Traditionally, Medicaid only covers medical care: doctor’s visits, prescription drugs, in-patient and outpa-

The North Carolina Family Physician

Healthy Opportunities Network Leads and Regions

Awarded Healthy Opportunities Network Leads Access East, Inc.

Beaufort, Bertie, Chowan, Edgecombe, Halifax, Hertford, Martin, Northhampton, Pitt.

Community Care of the Lower Cape Fear Bladen, Brunswick, Columbus, New Hanover, Onslow, Pender.

Impact Health

Avery, Buncombe, Burke, Cherokee, Clay, Graham, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Polk, Rutherford, Swain, Transylvania, Yancey.

tient care, etc. While these are important to a person’s health, about 80% of a person’s health is driven by non-medical factors, such as housing and food access.

Through the pilots, North Carolina has the opportunity to provide services to assist with non-medical drivers of health. The Pilots focus on four specific domains: housing, food, transportation, and interpersonal safety/toxic stress. NC DHHS created a fee schedule that defines and priced a set of 29 non-medical services that are being tested through the Pilot Program.

Martin, Northampton, and Pitt.

Currently, the Pilot Program is authorized to operate in three rural regions of the state for people enrolled in Medicaid Managed Care: two regions in the eastern part of the state and one in the western part of the state. These are shown in the map above.

Individuals enrolled in Medicaid Managed Care must meet both a physical or behavioral health criteria and have at least one social risk factor to qualify to receive pilot services.

The Access East pilot serves these counties: Beaufort, Bertie, Chowan, Edgecombe, Halifax, Hertford,

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The Community Care of the Lower Cape Fear pilot serves these counties: Bladen, Brunswick, Columbus, New Hanover, Onslow, and Pender.

And lastly, the Impact Health pilot serves these counties: Avery, Buncombe, Burke, Cherokee, Clay, Graham, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Polk, Rutherford, Swain, Transylvania, and Yancey.

A second goal of the Pilot Program is to further develop the infrastructure throughout North continued on BACK COVER

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What is NCCARE 360 and How Can It Benefit Your Practice

By Amelia Tilson, NCAFP Summer Intern NCCARE 360 is another product of the North Carolina Department of Health’s aim to buy health, not healthcare. NCCARE 360 is a relatively new statewide system that aims to better connect health and human services providers by electronically linking patient needs with resources to accommodate their needs and create a feedback loop to ensure quality care is being provided. NCCARE 360 has two main components: a statewide resource directory and a software technology platform.

The resource directory contains a multitude of resources that your patients may need access to, but have a hard time finding, such as housing, food, clothing, transportation, and more. This resource directory is available in all 100 counties and includes over 13,000 service listings in over 26,000

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service locations. The resource directory also contains a call center with trained navigators who can help clients find what they need to, as well as online chat capabilities to ensure that the website is as easy to use as possible.

Unite Us created the software technology platform that onboarded the resources from the directory, as well as additional resources such as health care and social services providers. Prior to NCCARE 360, health care and social services in North Carolina were siloed from healthcare. There was no infrastructure connecting these two systems, which led to many patients falling between the cracks. This platform works to streamline referrals for patient needs, and essentially creates a “no-wrong-door” approach making the resource list one that can be more

The North Carolina Family Physician

easily implemented into North Carolinian’s lives, rather than just a list of intangible resources. Additionally, this platform will create a closed loop referral system which will ensure that there is follow-through from the resources in the database. Just like you connect patients with cardiologists and orthopedists, you can connect patients with resources that can work to address the non-medical drivers of health.

proper steps to control his diabetes, hence creating this closed loop referral system.

The resource directory and online technology platform are incredibly transformative for healthcare around the state, but are not useful if all members of a team are not trained to use it. To support all communities in using this tool to its fullest extent and see its full outcomes, NCCARE 360 has a community engagement team powered by Unite Us who work with community-based organizations, health systems, government agencies, and health care and social services providers to get them onboarded onto these online platforms. They can help onboard your practice directly.

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NC COUNTIES

Within this closed loop referral system, physicians or your team can safely and securely send and receive electronic referrals and track patient outcomes and information.

For example, you as family physicians can identify a problem such as Billy with diabetes having trouble getting his condition under control. You find out that Billy is having trouble controlling his diabetes because he has limited access to healthy foods. So, you use the resource directory to connect Billy with his local food pantry, and they set up a box of healthy foods for Billy to pick up a few times a week. But, Billy lacks access to transportation to get to and from the food pantry to collect his basket of healthy food. This technology platform can help connect patients with transportation, making sure that patients not only have access to resources such as healthy foods, but they also have the means to get there to access them. The food pantry confirms when Billy picks up his box to you as his doctor, and you can ensure Billy is taking the

2,500+

ORGANIZATIONS

42,000+ USERS

It has been proven that 80% of a person’s health is shaped by non-medical drivers of health. As North Carolina shifts into value-based payments for healthcare, it is now even more important to ensure patients are having the best outcomes. Within the closed loop referral system, there is an opportunity for members of your team to make sure that all the necessary connections are being made for your patients. As family physicians, utilizing NCCARE360 can help you achieve the best possible outcome for patients, which rewards both you and them, creating a win-win for both parties.

Amelia Tilson is a rising junior at the University of Richmond majoring in Leadership Studies and minoring in Health Studies, on track to graduate in May of 2024. She is a Raleigh native and graduated from Enloe High School in June 2020. During her senior year of high school, she began realizing her interest in public health and public policy. As a result, during her first two years of college, she took classes that provided her a better understanding of what those worlds mean. She is very interested in the social justice aspect of healthcare, and after college anticipates entering the public health policy field.

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Sights & Scenes from Chapter Events

PROFESSIONAL DEVELOPMENT By: Kathryn Atkinson, CMP Manager of NCAFP Meetings & Events

~ The 2022 Annual Meeting in Asheville ~

From Start to Finish, the 2022 Winter Family Physicians Weekend Features a Spectacular Speaker Line-Up & High-Quality Updates All Weekend Long The 2022 Winter Family Physicians Weekend will be here before you know it, and we can hardly wait to see you there! Mark your calendars and make your plans now to join us at the beautiful Omni Grove Park Inn from Thursday, December 1, through Sunday, December 4, 2022. Count on a fun-filled fourday weekend with meaningful and timely continuing education, impactful networking opportunities, and well-deserved leisure time with family and friends.

From start to finish, the NCAFP’s annual premier learning opportunity is packed with over 25 clinical and informative sessions, along with several optional CME workshops and satellite seminars that you will not want to miss. Altogether, everyone’s favorite annual weekend in the Blue Ridge Mountains is set to serve up approximately 30+ CME credits along with a heaping side of beautiful mountain views!

Program Chair Deanna Didiano, DO, and Program Vice-Chair, Tamieka Howell, MD, will lead the way each day with their selection of timely, relevant, and practical learning opportunities. Their robust slate of topics includes essential updates on CGM monitoring, lung cancer, pneumococcal disease, chronic cough, strokes, upper and lower extremity neuropathy, IBS, hair loss, hidradenitis suppurativa, obesity,

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nutrition, chronic kidney disease, congenital syphilis, monkeypox, asthma, pediatric depression and anxiety, gender-affirming care for youth, rural medicine, social determinants of health, direct primary care, physician burnout, and many more.

Even better, this year’s five-star faculty line-up reads like a blockbuster movie cast. After you visit the bustling exhibit hall each morning for breakfast, grab a seat in the lecture hall and join your colleagues and friends for high-quality updates from many of your first-rate speaker favorites. We are thrilled to welcome Dr. Shannon Dowler, Dr. Jay Patel, Dr. Lisa Cassidy-Vu, Dr. Sara Neal, Dr. Nicholas Pennings, Dr. Carolyn Dunn, Dr. Dawn Caviness, Dr. Nicole Swiner, and Dr. Thomas White to the center stage this year. Several more talented Family Medicine experts you’ve come to know and love will also take the stage, including our friend and North Carolina’s State Health Director and NC DHHS Chief Medical Officer, Dr. Betsey Tilson. Don’t miss Dr. Tilson’s important update on Long Covid and where Covid stands in general here in NC and nationally.

The weekend also includes several innovative sessions with guest speakers just as impressive as the

The North Carolina Family Physician

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crowd-pleasing favorites listed above. After a full day of clinical updates, you are sure to enjoy a unique “Mega Trends” presentation on Thursday afternoon by the one and only former NC Spin host, Mr. Tom Campbell. This session will explore transformative trends impacting healthcare, society, and you personally over the next decade. His presentation will address society’s biggest challenges, how they relate to healthcare, and the opportunities we have to positively influence these changes. Don’t miss this enticing look at trends that will shape all our lives for years to come.

If you are an NCFM Today podcast listener, you already know how excited we are to have Dr. Benjamin Gilmer, family physician, and acclaimed author, take center stage on Sunday morning. Listen and learn as Dr. Gilmer outlines the importance of storytelling and advocacy in medicine by crafting personal narratives to affect change for your patients. Dive right in when he explores elements of Family Medicine’s unique role in interprofessional collaboration as it relates to advocacy. Dr. Gilmer’s dynamic and one-of-a-kind presentation will highlight what is special about family medicine that sets family doctors apart in patient-advocacy messaging.

We are also excited to include a new “addiction medicine block” on Friday with two general sessions dedicated to opioids and alcohol abuse. An optional complimentary CME workshop to further discuss opioid addiction will follow that afternoon. Plan to earn two CME credits that will also count towards the state’s controlled substance CME requirement by your participation. Additional workshops slated for the weekend include an engaging collaborative care codes seminar and a hands-on sports medicine workshop with ultrasound. Those interested in fulfilling their ABFM requirement with a KSA self-study are invited to join us for the optional pre-conference Hypertension KSA with Dr. Jonathon Firnhaber on Wednesday, November 30, from 3:00 pm to 7:00 pm. KSA participants can pick up eight additional

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CME credits and 10 ABFM activity points by their participation.

As a quick reminder, Friday morning’s annual Practice Management Seminar, co-hosted with the NC Medical Society Foundation, is always a terrific opportunity for physicians and their office staff to improve their practice management skills and knowledge. Discussions during this year’s optional seminar will include coding, leading while coming out of a pandemic, being well to serve well, and tips and tricks from the insurance perspective. Conference attendees can add this concurrent session to their conference registration for an additional $45. Those interested in attending only the Practice Management Seminar can register and attend the course for $55.

Even with this year’s busy learning schedule, there is still plenty of time for fun and relaxation. When the lecture hall closes on Thursday afternoon, grab dinner with friends and family, then head to the Biltmore House for a self-guided candlelight tour from 8:30 pm to 10:00 pm. Adult discount tickets are $109, youth tickets are $55, and children under 9 are free but still require a ticket. Add tour tickets during your online registration and pick them up when you check in for the conference (Note: Transportation is on your own). Enjoy the afternoons with friends over signature craft cocktails in the Grove Park Inn’s Great Hall, and be sure to swing by the famous life-size Gingerbread House for an Instagram-worthy mug of decadent hot chocolate. And last but not least, don’t forget about the Grove Park Inn’s world-class subterranean spa with water features, eucalyptus steam rooms, therapeutic waterfalls, and the mountain view hot tub. Guests of the GPI should reserve their spa appointments soon.

Speaking of fun, the annual Presidential Gala ranks right at the top of the list (just below those unbeatable CME presentations) when it comes to what folks

The North Carolina Family Physician

ADVISORY

enjoy most about the Winter Weekend. The Saturday evening celebration will begin with a delicious gourmet meal prepared specially by the GPI chef. Then, we’ll all raise our glasses for a toast and celebrate Dr. Shauna Guthrie as your new 2023 NCAFP President. After that, get ready to hit the dance floor! Everyone’s favorite band, Too Much Sylvia, will take the stage with their brand of live music that will have you dancing the night away. Come dressed in your holiday best, and be sure to pack your favorite dancing shoes!

The 2022 Winter Family Physicians Weekend is always an excellent opportunity to fulfill your year-end CME requirements while recharging your zest for Family Medicine. Enjoyed and anticipated by hundreds of family doctors and their health care partners every year, we invite you to join us again this year for a CME program designed with you in mind. We look forward to seeing you and celebrating the specialty of Family Medicine with you this December! Learn more and register soon at www. ncafp.com/wfpw. Please contact Kathryn Atkinson, CMP, Manager of NCAFP Meetings & Events, at Katkinson@ncafp. com with any questions.

Your NCAFP Team is committed to providing you with the best meeting experience possible, and we have implemented enhanced health and safety measures in connection with its meetings and events. As a result, as you register for this program, you will be asked to agree to these measures, and walk-in registrations are not allowed. Lastly, there are currently no plans to offer a virtual option for attending this year’s program. However, we are keeping a watchful eye on official public health guidelines and mandates, and we will keep you well informed of any changes to the plans for this event.

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Summer 2022

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MEMBERSHIP & MEMBER SERVICES

MEMBERS IN THE NEWS

Dr. Thomas White Named Citizen of the Year in Cherryville Recently, the Cherryville Chamber of Commerce named Dr. Thomas R. White, NCAFP Past President (2014-15) its Citizen of the Year. Dr. White was recognized for his leadership in the community, including his work during the COVID-19 Pandemic. During much of the pandemic, Dr. White and the City Manager

hosted a weekly radio show updating the community.

Dr. White has also worked very closely with the local Fire Department on improving health for the community's firefighters, has been involved in numerous health and wellness efforts in the community, as well as the effort to revitalize downtown Cherryville.

In other news related to Dr. White's contributions and leadership, he has also been selected by the American Medical Association (AMA) as an AAFP representative member of the Technical Expert Panel (TEP) for the AMA Prediabetes Measure Development and Testing Project. The AAFP noted his clinical expertise, interest in the prevention of diabetes and cardiovascular disease, and focus on clinical lipidology and weight management in their nomination letter. He will lend a valuable voice to this important panel.

June 2022 - Interview with Author of "The Other Dr. Gilmore"

A Family Medicine Community Podcast

www.ncafp.com/podcasts

July 2022 - Statewide Effort to Reduce Maternal Mortality Learn about the state’s Maternal Health Innovation grant from five Family Medicine champions working on the program, including Dr. Amy Santin, Dr. Carmen Strickland, Dr. Narges Farahi, Dr. Janalynn Beste, and Dr. Mona Xiao. They discuss the specific role of Family Medicine champions in the grant and how all family physicians can help ensure that medical conditions that women develop during pregnancy have ongoing care.

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NCFM talks to Dr. Benjamin Gilmer, a family physician in western NC and now acclaimed author of the riveting medical mystery, “The Other Dr. Gilmer.” Dr. Gilmer discusses his own journey as he works to determine why Dr. Vince Gilmer, who previously practiced in the same clinic, came to murder his own father. Today, Benjamin Gilmer is advocating for mental health and prison reform nationally. Prior to becoming a book, part of this journey was documented on an episode of This American Life.

April 2022 - Workforce Pipeline This episode focuses on the Family Medicine workforce pipeline in North Carolina, specifically two efforts co-sponsored by the NCAFP and the NC AHEC Program: the first-ever Family Medicine Academic Summit for academic Family Medicine faculty around the state, and the 2022 Family Medicine Day, where NCAFP brought more than 70 medical students together to learn about the specialty and our state's Family Medicine Residency The North Carolina Family Physician Program.

NC Family Physician Selected to Serve on AAFP Reproductive Health Advisory Group After being nominated by the NCAFP, Dr. Dalia Brahmi has been selected as one of five family physicians nationally to serve on the AAFP’s Women’s Reproductive Health Advisory Group. AAFP convened the Advisory Group to assist in identifying and developing physician and patient-facing resources that will assist members in providing comprehensive reproductive healthcare to their patients.

Among other things, the scope of the group’s work includes: identifying and developing clinical, practice and education resources for family physicians seeking to provide comprehensive reproductive healthcare; identifying and developing education and resources

The Family Doctor Podcast Reviews the First Year of Episodes One year ago, The Family Doctor: Lessons Learned, Wisdom Shared podcast was launched. In July, Greg Griggs, the CEO and Executive Vice-President of the NCAFP, speaks with Dr.

for individuals seeking comprehensive reproductive health from their family physician or health care team; creating patient education materials on healthy pregnancy (Maternal Mortality work); and advising the AAFP’s Division of Government Relations on public policy, pharmaceutical products and delivery modalities associated with comprehensive reproductive health care. The group will work on these issues over the next year.

Dr. James McNabb Announces Publication of Newest Textbook Dr. James McNabb has announced that his newest textbook, “A Practical Guide to Joint & Soft Tissue Injection Fourth Edition,” (copyright 2022) has been published by Wolters Kluwer Health. It is recognized as the best-selling musculoskeletal text worldwide. The first edition, published in 2005, won first place in the physician's category of the 2005 American Medical Writers Association awards. In this fourth edition, Dr. McNabb called on his good friend and faculty colleague, COL(Ret) Francis G. O'Connor, MD, MPH, to provide additional content expertise. Dr. O'Connor is widely recognized as an outstanding leader in sports medicine education and research. The new edition features effective injection procedures that can be performed with simple equipment in a variety of settings.

Thomas White, one of the creators and Moderator of the podcast. Hear Dr. White share how the podcast originated (on the floor of his mother's kitchen!), what lessons he took away from each of the physicians interviewed to date, and what he and Dr. Beatty plan for the next year. This review will no doubt motivate you to re-listen to the past year's episodes and continue to listen in the coming months. You can find the podcasts on the front page of the NCAFP website; on the Apple Store; Google Store and Spotify.

NCAFP President-Elect Named CMO of Maria Parham Health Dr. Shauna Guthrie, president-elect of the NCAFP has been named Chief Medical Officer of Maria Parham Health, a Duke-Lifepoint Hospital in Henderson, NC. Guthrie took over the role on June 27.

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Dr. Guthrie remains Medical Director of the Granville-Vance Health District and practices at Sunflower Direct Primary Care. The CMO role is expected to be approximately half-time and had been a shared role with another hospital in Wilson.

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Dr. Amir Barzin Receives 2022 Massey Award

NCAFP member Amir Barzin, DO, received one of six 2022 C. Knox Massey Distinguished Service Awards from UNC-Chapel Hill on April 23rd. The award was established in 1980 and honors “unusual, meritorious or superior contributions” by UNC employees. Dr. Barzin was recognized for his efforts in leading UNC Health's Respiratory Diagnostic Center’s rapid testing efforts during the pandemic. He then served as director of the Carolina Together Testing Program, which focused on campus testing and contact tracing. Barzin currently serves as Assistant professor, UNC School of Medicine’s Family Medicine department, medical director for UNC Health Virtual Care Services and the UNC Health Clinical Contact Center.

QUIT NOW 2022 CME Re-Election Deadline

Ask us how

is December 31st

QUIT NOW Be tobacco-free Ask us how Members with a CME Re-election cycle ending 12/31/22 have

until end of this year to earn the 150 required credits for Bethe tobacco-free the three-year re-election cycle. The cancelation date for any . Da result ados. CME credits will be early March, so make plans unreported now to report your hours before the holiday rush. Reporting by gratis. Da the 12/31/22 deadline will also remove you from any reminder resultado s notifications.. You may report your credits any of the following ways:

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• Visit www.aafp.org/cme (your username is your email address on file with AAFP) 0-784-8669 ) • Call 1-800-274-2237 M-F 9:00 a.m. – 6:30 p.m. .gov (1-800-784 • Fax to 913-906-6075 -8669) • Scan letters of participation on AAFP’s free mobile app okefree .gov • Mail submissions to: AAFP Member Service Center, 11400 Tomahawk Creek Parkway, Leawood, KS 9/9/10 66211-2672 9:18 AM

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9/9/10

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AM If you have retired, interrupted practice, or moved out of NC, please contact the AAFP immediately for a status transfer or chapter relocation. If you are a 2023 re-election candidate, remember that you may count teaching/precepting, Board certification exam, and medical staff/society meetings. And a bonus, the AAFP will inform the American Board of Family Medicine (ABFM) once you have met its CME requirement!

If you have any questions, please email aafp@aafp.org, call 1-800-274-2237, or visit CME FAQs at aafp.org/cme. The AAFP would also be happy to “walk through” your transcript with you to ensure all the credits you’ve earned are included.

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The North Carolina Family Physician

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2022 - Resident Pharmacolog & Student Research Poster Guide Presentation - Online Trainin - Group Visits G - Coding for Pa The NCAFP Foundation’s twenty-seventh annual Research Poster Presentation will be held at the Academy’s 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.

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PRACTICE MANAGEMENT

By Shawn P. Parker, JD, MPA NCAFP General Counsel & Chief of Staff

TELEHEALTH IN FOCUS

HIPAA Enforcement Discretion During the Declared Public Health Emergency The Health Insurance Portability and Accountability Act of

1996 (“HIPAA”) is a federal law that, among other measures, led to the establishment of national standards for safeguarding patients’ protected health information (“PHI”) and ensuring the confidentiality, integrity, and availability of PHI created, maintained, processed, transmitted, or received electronically.

Interestingly, the initial purpose of the law was to create a simpler way to transfer health insurance information as individuals moved between employers. The original long title of the Act does not even mention patient privacy or data security: “An Act to amend the Internal Revenue Code of 1986 to improve portability and continuity of health insurance coverage in the group and individual markets, to combat waste, fraud, and abuse in health insurance and health care delivery, to promote the use of medical savings accounts, to improve access to long-term care services and coverage, to simplify the administration of health insurance, and for other purposes.” 1 The law later evolved to support healthcare providers who needed access to patient medical records in order to provide adequate treatment by eliminating the need to have the patient serve as the primary point of contact for this information. The adoption and implementation of the Privacy Rule and Security Rule created minimum privacy, technical, and administrative requirements. The Privacy Rule went into effect in 2003 and regulates the use and disclosures of PHI (more specifically, PHI that is disclosed without the

26

patient’s consent or knowledge) in healthcare treatment, payment, and operation activities.

The Security Rule, unlike the Privacy Rule which regulates PHI regardless of how it's maintained (i.e. on a digital server or in a filing cabinet), deals specifically with electronic medical records and specifies administrative, physical, and technical safeguards required for compliance. The Security Rule also went into effect in 2003. HHS’ Office for Civil Rights (“OCR”) is responsible for enforcing these rules., In 2006, the HIPAA Enforcement Rule was adopted with provisions relating to compliance and investigations, as well as the imposition of civil monetary penalties for violations of the HIPAA Rules.

ENFORCEMENT GUIDANCE IN RESPONSE TO COVID-19 PUBLIC HEALTH EMERGENCY. The U.S. Department of Health and Human Services published guidance regarding the enforcement of HIPAA and its privacy and security requirements in response to the COVID-19 public health emergency (“PHE”). To date, OCR, which enforces HIPAA, has announced that it would not impose penalties during the PHE for violation of certain HIPAA rules in connection with (i) good faith provision of Telehealth services, (ii) a Business associates use and disclosure of PHI for public health and health oversight activities (without the direction of the covered entity), and (iii) specific privacy rule requirements applicable to hospitals during the first 72 hours that the hospital has instituted disaster protocols. For the purpose of this article, our summary and guidance will focus on telehealth specifically.

Telehealth During the COVID-19 national emergency, which also constitutes a nationwide public health emergency, covered health care providers subject to the HIPAA Rules may seek to communicate with patients and provide telehealth services through remote communications technologies. Some of these technologies, and the manner in which they are used by HIPAA covered health care providers, may not fully comply with the requirements of the HIPAA Rules.2

The North Carolina Family Physician

public facing remote communication products like TikTok and Facebook live. The guidance advises providers to seek additional privacy protections for telehealth while using video communication products. It advised providers to deliver such services through technology vendors that are HIPAA compliant and endorsed entering into HIPAA business associate agreements (BAAs) in connection with their provision and use. Additionally, it encouraged them to provide notice to the patient that these third-party applications potentially introduce privacy risks, and providers should enable all available encryption and privacy modes when using such applications.

Tips to Reduce Telehealth Non-Compliance Risk While providers are able to take advantage of the enforcement discretion to care for patients and cooperate with public health agencies, caution is warranted. Compliance with HIPAA is still required by law; the enforcement discretion is not a broad waiver of HIPAA or its implementing rules. Further, the guidance does not affect the application of other federal or state laws, so you should continue to observe privacy and security procedures as feasible and otherwise work to reduce or contain their compliance risk.

Here are a few considerations for minimizing your risk: • Obtain and document consent of your patients to proceed with the services via telehealth.

OCR stated that it would not enforce penalties for noncompliance with HIPAA regulatory requirements against covered health care providers “in connection with the good faith provision of telehealth during the PHE,” referring specifically to the technology used to provide services via telehealth. OCR’s enforcement discretion applies to services that are related to the diagnosis and treatment of COVID-19, as well as services to assess or treat any other medical condition even if not related to COVID-19. The guidance provided a non-inclusive list of popular applications that allow for video chats, including Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, Zoom, or Skype, but would not commit to endorsement, certification or recommendation of these applications’ compliance outside the issued guidance and indicated there may be other technology vendors that do offer HIPAA compliant video communication products.

OCR did not elaborate on what constitutes “good faith” but did provide examples of bad faith, including using

Summer 2022

• Be sure to note the potential for interception and security issues and that (during enforcement discretion) the application being used may not be compliant with HIPAA regulations and standards.

• Use HIPAA-compliant devices and software and private Wi-Fi networks when available.

• Telehealth services should be provided in a private location, with reasonable precautions to reduce the possibility that the information may be overheard.

• Maintain compliance with medical record requirements and continue to comply with federal and state laws that are not affected by HHS’s guidance.

References: 1. PLAW-104publ191.pdf (govinfo.gov) 2. Notification of Enforcement Discretion for Telehealth; HHS.gov

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MEDICAID Tailored Plan Information for Primary Care Practices

Contracting with Tailored Plans Beginning Dec. 1, 2022, NC Medicaid will transition approximately 170,000 beneficiaries who may need services for a mental health disorder, substance use disorder, intellectual/developmental disability (I/DD) or traumatic brain injury (TBI) to Behavioral Health and I/DD Tailored Plans (Tailored Plans). Tailored Plans offer a comprehensive benefit package, including physical health, pharmacy, and behavioral health services. Beneficiaries enrolled in Tailored Plans may choose a primary care provider (PCP) and a Tailored Care Management (TCM) provider. TCM providers, including AMH+ or Care Management Agencies, will coordinate all physical and behavioral health, substance use services, home and community-based services and supports.

participate in the Tailored Plan provider networks.

Tailored Plans have the option to contract directly with primary care providers or to partner with a Standard Plan to contract with primary care providers. If primary care providers have not been contacted by Tailored Plans, providers should contact the Tailored Plan directly to discuss the process and requirements.

You can find information about tailored plans on the NC DHHS website at: https://medicaid.ncdhhs.gov/ health-plans#behavioral-health-idd-tailored-plans. It is important to contract with multiple, if not all, networks who serve beneficiaries in your community so that existing patients and their families can remain in network.

Primary care physicians provide a critical medical home for this complex group, and it is important that they

Terms & Definitions Advanced Medical Home Plus (AMH+): Deliver both primary care services and tailored care management services.

KEY TAILORED PLAN DATES AUG. 15, 2022 – Beneficiary Choice Period begins. Enrollment Broker begins mailing Enrollment Packets to beneficiaries, and beneficiaries can choose a PCP and Tailored Care Management provider by contacting their Tailored Plan.

SEPT. 15, 2022 – Last day for PCPs to have fully executed contracts with Prepaid Health Plans (PHP) for inclusion in PCP Auto-Assignment.

OCT. 14, 2022 – Last day for beneficiaries to choose a PCP and Tailored Care Management provider before auto-assignment.

POST OCT. 14, 2022 – PCP and Tailored Care Management Provider Auto-Assignment for beneficiaries who have not chosen a PCP or Tailored Care Management provider.

DEC. 1, 2022 – Behavioral Health I/DD Tailored Plans launch.

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Behavioral Health and Intellectual/Developmental Disabilities (I/DD) Tailored Plan (Tailored Plan): An integrated health plan for individuals with significant behavioral health needs and I/DDs. Care Management Agencies (CMAs): Deliver behavioral health, substance use, and/ or intellectual and developmental disability services and care management.

Tailored Care Management (TCM): Care management services for individuals in Tailored Plans. Tailored Care Managers must coordinate all physical, behavioral health, substance use services, home and community-based services and supports. TCM can be provided by an AMH+ or a CMA.

The North Carolina Family Physician

Special to the NCAFP from the ARC of North Carolina

Why Should Tailored Care Management Matter to Primary Care Physicians?

By Lisa Poteat, Deputy Director, The ARC of North Carolina Holly Richard, Director, Program Development, The ARC of North Carolina

As a family physician, you may have seen it before. Your patient, “Joe,” comes in for an office visit after being referred by the local Emergency Department. He presents with a painful UTI and signs of diabetes, complicated by weight gain. How do you untangle this? You’re not sure he reads well or really understands a treatment plan. He has an obvious intellectual disability and you’re not sure if he has any of the supports he needs. How can you help him improve his health?

Bridging the gap between medical services and community-based services and supports for Medicaid recipients with intellectual and developmental disabilities has not been a hallmark of our current or past systems. Our current system is bifurcated and fraught with disconnects, creating gaps that often lead to poor health outcomes, disparity in services, and disenfranchisement for people who need to seek care and support. Emergency Department misuse and overuse, along with poor health outcomes are products of these gaps.

The Tailored Care Management model in the future Tailored Plans is an opportunity for our state to finally integrate physical health services with support services for people with intense needs to help improve health and support people in living their best life. Building bridges between the two systems will create partnerships that improve health, improve lives, and ultimately contain the rising costs of care. Tailored Care Managers will help build these bridges, facilitating plan-

Summer 2022

ning and service coordination to promote all services working in concert for each Medicaid member. We encourage family physicians to collaborate with Tailored Care Managers across the state and in different organizations. Tailored Care Managers will have in-depth, firsthand knowledge of each person and their needs, and will be able to help integrate health-improving strategies into the lives of the people they support.

What are Tailored Plans and how do they work?

The current Local Management Entities/Managed Care Organizations (LME/MCOs) will become NC Medicaid Managed Care Behavioral Health and Intellectual/Developmental Disabilities Tailored Plans (TPs) on December 1st. TPs will be the health plans that manage the integrated physical health and specialty services for people with moderate to high support needs who have intellectual and developmental disabilities (IDD), traumatic brain injury (TBI), mental illness, or substance use disorders.

As Tailored Plans launch on December 1st, every person receiving services managed by a TP will become eligible for Tailored Care Management.

Tailored Care Management will help guide the integration of each person’s physical health services, specialty and community-based services, pharmacy, long-term services and supports, and non-medical drivers of health, such as housing, food inadequacy, transportation, and personal safety. Tailored Care Management will be focused on the whole person, will be community-based and provider-driven, and will be focused on improving overall health and well-being for each person.

Three types of entities will be certified to provide Tailored Care Management, including the TPs, Care Management Agencies (CMAs), and some Advanced Medical Homes (AMH+s).

What is a Care Management Agency (CMA)?

Care Management Agencies (CMAs) are existing community-based service providers who are going through a rigorous development and certification process and will

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begin providing Tailored Care Management on December 1st. CMAs, and their Tailored Care Managers, will be available to collaborate with family physicians to help address the needs of patients like Joe. Family physicians will benefit from this extra set of hands who can expertly assist patients and their families in navigating the larger system, connecting to needed resources in the community, and accessing services, supports, education and information needed to improve health and improve lives. In Joe’s case, the CMA might help with ensuring he takes his medications accurately, gets involved in an exercise program, secures nutritional food he can afford, gets involved in cooking lessons and a diabetic support group, and has sufficient staff support to help where he needs assistance. In these and other ways, the Tailored Care Manager within a CMA can bring to life a physician’s treatment plan and “go live” with options that work for the patient.

NC DHHS has established a four-year glide path for TPs to assign 80% of the Tailored Care Management responsibilities out to CMAs and AMH+s by the end of that period. This evolution will help ensure that Tailored Care Management happens for people like Joe at the local level, connecting them to local services, supports and resources.

What is Tailored Care Management at The Arc of NC? Tailored Care Management will be the “glue” for whole-person, integrated care. People will have a single designated Tailored Care Manager supported by a multidisciplinary care team to provide whole-person care management that addresses all of a person’s needs, including physical health, behavioral health, IDD, traumatic brain injuries (TBI), pharmacy, long-term services and supports (LTSS), and unmet health-related resource needs.

The Arc of NC is a statewide nonprofit and has been certified as a CMA. Our goal in providing care management will be to help people with IDD and TBI improve their health and overall quality of life as much as possible. At The Arc of NC, care management staff will assess the needs of each person, coordinate a full team of people and service providers around each person and lead a collective effort among that team to develop and implement plans to improve health and quality of life for each unique person. With almost seventy years of experience, we understand that connectedness works, and we will focus on building relationships and productive partnerships that benefit each person in unique and person-centered ways. The Arc of NC’s Tailored Care Managers will

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work to collaborate with health care professionals across the state and throughout this process.

Who is eligible for Tailored Care Management in the Tailored Plans?

People receiving services managed by the Tailored Plans and funded by Medicaid or state funds will be eligible for Tailored Care Management on December 1st. This includes people with IDD, TBI, mental illness, and substance use disorder who have moderate to high levels of need for supports and services. There are over 70,000 people in NC with IDD and TBI who will be eligible for Tailored Care Management. Around 15,000 of those people are currently receiving services under the Innovations Waiver, a Medicaid-funded group of services focused on supporting people with significant IDD to live in the community, rather than an institution. In addition, there are over 17,000 people in NC with IDD and TBI waiting on these waiver services, and the average wait time has increased to over 10 years. Only the NC General Assembly can allocate more funds to increase these waiver services. As individuals and families wait, Tailored Care Management can help support them in locating resources for other needs and help coordinate any physical health and community-based services that may be available.

Who can a physician turn to if they have questions or concerns for individuals with IDD or TBI? The Arc of NC is available to help. We have several offices across the state and will provide Tailored Care Management statewide. Lisa Poteat, Deputy Director and Holly Richard, Director of Program Development, can assist in supporting PCPs and ensuring health care professionals are connected with the right people and resources during this transformative time.

Are there other ways for a primary care practice to become involved in Tailored Care Management?

If a primary care practice is already an Advanced Medical Home Tier 3, they can decide to become an AMH+. An AMH+ is a Tier 3 practice whose providers have experience delivering primary care services to the Tailored Plan eligible population or can otherwise demonstrate strong competency to serve that population and is willing to provide in practice care management to that population.

The North Carolina Family Physician

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Summer 2022

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'Healthy Opportunities Pilots,' continued from p13

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Pontiac, Illinois Permit No. 592

The Pilot Program is in its early phases.

Food services began being offered in

These Pilots are important for Family Physicians for several reasons. Family Physicians who care for patients in the three Pilot Regions can help identify eligible patients and refer them for pilot services through their care manager or the health plan’s care manager. Perhaps more importantly, medical homes are a safe place for members to share their unmet needs and your engagement in asking the right questions, and providing for unmet needs, will be rewarding for your practice and for the patient.

The success of the Pilots could catalyze sustainable funding sources for services critical to the health of your patients. For Family Physicians involved in Advance Payment Models or Accountable Care, these pilot services help address the 80% of their patients’ health and health care costs that are not within the control of the four walls of a medical practice, but for which the physician is accountable and can potentially result in significant shared savings.

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The Pilot Program is authorized for 5 years and will undergo consistent robust evaluation for results. The goal of the Pilots is to learn what service or combination of services work to improve health and meaningfully lower health care costs for high needs Medicaid enrollees. These learnings will inform CMS coverage policy with the goal of including effective services as part of allowable Medicaid spending nationally. The Pilot program, if continued, would stay under Medicaid, but could also be used as a blueprint for other payers to address the non-medical drivers of health in a way that prioritizes whole person health.

This program can provide resources for payers, both state and federal, to expand beyond Medicaid, and implement similar programs in Medicare and commercial insurance. Other payers can leverage the infrastructure being built for the Pilot, the fee schedule developed for Pilots, and the evaluation.

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Carolina to connect health systems, health care payers and community-based organizations (CBOs) for the Pilots and to ultimately continue beyond the Pilots. As part of the 1115 Waiver authorization of Medicaid funding, North Carolina was given the flexibility to use up to $100 million on capacity building, which goes directly to community-based organizations such as food pantries and homeless shelters, but also to Healthy Opportunity Network Leads (HONLs). HONLs are new types of entities that form and manage a network of CBOs who then deliver the Pilot services. The HONLs provide technical assistance and training to these organizations, ensure network adequacy of Pilot services, and link the CBOs to health insurers, including Medicaid Managed Care Pre-Paid Health Plans.

March 2022 in the pilot regions, which includes services such as diabetes prevention programs, healthy food box pickups or deliveries, and fruit and vegetable prescriptions. Housing and transportation services were launched in May 2022. Some housing services covered under the Pilot program are a one-time payment for a security deposit or one month’s rent, essential utility set up, and home remediation services. Under the transportation services, health-related transportation, both public and private, are reimbursed. Toxic stress services were launched in June 2022, and include evidence-based parenting curriculum, violence intervention services, home visiting services, and dyadic therapy. More services for toxic stress will be added in the coming months. Interpersonal violence services do not yet have a set release date.