august

Neftali The Center of Excellence for Integrated Care adds another level of expertise by welcoming Neftali Serrano as Associate Director. The Center of Excellence aims to integrate patients’ physical and behavioral health across health care settings. Serrano has years of experience doing just that, and we asked him a few questions to get to know him better:

What attracted you to the Center of Excellence?
After 14 years as a clinician and program developer I was looking for an opportunity to train a behavioral health workforce in primary care in a more efficient, scaled fashion. The Center of Excellence provides this opportunity to engage an entire state in developing an integrated care workforce. This is a really exciting opportunity.

Where were you before accepting this position?
Before coming to the Center of Excellence I was the director of behavioral health at Access Community Health Centers in Madison, Wisconsin where I developed a primary care behavioral health program that is one of the most mature and successful programs in the country. The team there is great and one of my proudest accomplishments professionally is that when I left the program was a strong as it ever was and will continue on in perpetuity as a result.

What are your hopes for the position?
I hope that in five years or so we are all able to look back and reflect how we were able to train hundreds of behavioral health professionals to provide integrated care to thousands of patients across the state of North Carolina and set a model for how to do so in a sustainable fashion for other states to follow.

In your experience, what’s been the best strategy for successful behavioral health integration?
The keys to successful integration are actually pretty simple. First, it is essential to have a relatively healthy organization. No project of any kind thrives in a dysfunctional organization. Second, it is essential to have clear that one of the main goals of integration is to support the day-to-day work of primary care clinicians. In other words, whatever you do should make life easier for the main cogs of your workforce. Third, you need behavioral health professionals who are truly able and willing to adopt a new professional identity related to primary care. Mental health professionals who work in primary care become a new breed or type of professional and embracing this is core to working through all the inter professional issues that will arise. And of course it is essential the mental professionals remember the first key, which is the primary care clinician is their first customer.

Zulayka The North Carolina Oral Health Collaborative brings together partners across the state to address oral health gaps. Zulayka Santiago joined our team as director in August. Her vast nonprofit experience includes working in the public, private, philanthropic, nonprofit and cooperative sectors. To learn more, we asked her some questions about her life’s work and her interest in oral health:

What attracted you to the Oral Health Collaborative?
My career thus far has had some interesting twists and turns. Yet themes that are consistent throughout are a commitment to social justice, equity and community building. All you have to do is scratch the surface to understand that there are strong intersections between oral health and health equity. The people most directly impacted by the disparities in oral health are the same folks that are experiencing very similar health disparities in other areas: working class or poor people of color, our elders, folks in rural areas and people with intellectual and developmental disabilities. It is simultaneously heartbreaking and inspiring to know that dental caries remains the number one chronic disease of childhood, even though it is entirely preventable. This is part of the work of the NCOHC is to highlight the ‘entirely preventable’ aspect of this astounding fact and to work together to implement solutions.

Where were you before accepting this position?
I had been an independent consultant for almost 3 years immediately before starting this position. Prior to that I had taken a year to focus on being a full-time mother to my newborn daughter, and prior to that I had a brief, but significant role as a Program Officer in Health Disparities with the NC Health and Wellness Trust Fund.

How does your background in social justice and equity connect to the NCOHC?
There are many reasons why inequities in oral health exist including: lack of health literacy, limited English proficiency, cultural, societal and economic barriers. Part of these inequities are also linked to the workforce issues facing healthcare as a whole. Regardless of geography, socioeconomic background, race, ethnicity, age or mental/physical ability, it is tremendously important to ensure that all North Carolinians have access to good dental care, provided by someone they trust, in a timely and compassionate manner.

I think part of my role will be to find a way to help create space for and elevate the voices of the folks most directly impacted by these issues. I am all too familiar with ‘outsiders’ flocking into marginalized communities and dictating how and why things should be done. It is important that the work we lay out for this collaborative be relevant, respectful and considerate of the folks who have to grapple with these issues at a community level.

What are your hopes for the position?
I am a strong believer in the power of the collective. This type of transformative work requires us to work across difference of silos, sectors, political ideology, etc. towards goals that will benefit all of North Carolina. There is great potential in this work. Potential for dramatic change within our lifetime and that is very exciting to me. My hope is that we can build upon the wonderful work that has already been done and develop a comprehensive plan of action that will bring to life NCOHC’s mission of reducing oral health disparities and promoting improved oral health for all North Carolinians.

In your experience, what’s been the best strategy for successful collaboration in the non-profit world?
Building authentic and trusting relationships. Relationships are the key to so many things, and definitely for successful collaborations. Focusing first on the vision, mission and values that bring us together and then laying out a roadmap with some clear goals and outcomes that benefits our individual organizations and pushes the work of the collaborative forward. There is already an incredibly powerful, dedicated, and well-connected group of folks that make up the collaborative. Now it’s just a matter of keeping them engaged and figuring out the best way to harness their brilliance towards achieving our collective goals.

It takes a cooperative and effective workforce to accomplish value-based, quality-driven care. Ron Gaskins, executive director of Access East, is an alumni of the Jim Bernstein Fellows program. Gaskins is leveraging healthcare communities in the direction of team-based care.

Access East is a nonprofit located in Greenville, NC, whose mission is to improve the health status of the underserved and indigent in eastern North Carolina through enhancing access to quality health care and implementing and coordinating healthcare delivery models. Access East is part of Community Care of North Carolina, a care network that’s evolved over 25 years, with support from the NCFAHP.

“We provide wrap around services for high-risk Medicaid patients with an interdisciplinary team focus,” said Gaskins, “We deploy care managers to the home in a timely fashion in order to keep patients out of the hospital.”

The interdisciplinary team at Access East and their partners collaborate with primary care providers in an ambulatory setting to proactively engage and manage chronically ill patients before their conditions become severe enough to merit care in higher-cost, more acute settings such as the emergency room. Access East uses a vast network of professionals (e.g., registered nurses, social workers, pharmacy technicians, pharmacists, patient advocates, health coaches, etc.) to support its initiatives, which encompass transitional care, medication management, pediatrics, chronic pain, palliative care, and behavioral health integration. The goal is to navigate patients to the right level of care.

“Workforce development is key,” said Gaskins. “As value-based reimbursement becomes more and more prevalent, the right prescription of team-based care will be vital in effectively managing populations.” Access East has built a workforce infrastructure to ensure the transition to proactive and coordinated care. “This infrastructure requires a holistic framework around workforce diversity that taps into the many different backgrounds and experiences that professionals can bring to the job,” Gaskins added.

The constant need for more healthcare professionals looms in the background of every conversation on rural health. “More primary care physicians are needed, of course,” said Gaskins, “but to meet the demands in care that the coming decades will bring with baby boomers retiring and medicine extending lives longer will require using mid-level providers (i.e., nurse practitioners and physician assistants) to fill in the gaps. Moreover, connecting support staff such as nurses, social workers, and community health coaches with direct providers, we will begin creating team-based care models that can further assist in engaging patients and improving health outcomes.”

Gaskins gives the example of boosting the role of pharmacists in the coordination of value-based care. “The data tells us that Medicaid patients on average visit their primary-care provider two to four times a year, while they see their community pharmacy close to 20 times a year,” said Gaskins. “With this frequency of exposure to the patient, it makes perfect sense to engage the pharmacist out in the community more on chronic disease management.”

To accomplish this, Access East is partnering with Community Care of North Carolina on a project called Community Pharmacy Enhanced Services Network (CPESN) that financially rewards community pharmacists for conducting on-site education around medication management when people pick up their prescription, and reporting any important information back to the patients care manager and primary care provider. “We see the potential of expanding the medical home to more of a medical neighborhood mentality that encourages the cross-pollination of professional disciplines throughout the community,” Gaskins said. What’s needed to empower a workforce that drives value-based care? “Strong community connections, solid care coordination, and holistic, interdisciplinary teams,” he said. “We’re piloting projects to see what works.”

The Foundation is excited to announce Ron Gaskins, Bernstein Class of 2011—2013, as the first Distinguished Fellows Award Recipient. Ron will receive this award at the 10th Annual Jim Bernstein Health Leadership Dinner on October 8th, 2015.

The NCFAHP is excited to announce the formation of the North Carolina Rural Health Leadership Alliance (NCRHLA). The Alliance is comprised of nonprofit and government leaders working in health and rural development. These rural health leaders have been meeting informally for 25 years. The original team included the following organizations and people: NC Office of Rural Health (Jim Bernstein), NC Medical Society Foundation (Harvey Estes) and NC Area Health Education Centers (Gene Mayer). They met at least monthly to discuss how they could partner regarding the rural health needs of North Carolina. Since 2014, the NCRHLA has grown and aligned itself to do the work as recommended by the North Carolina Institution of Medicine’s Rural Health Task Force.

The present-day Alliance is now becoming an official organization with technical assistance and grants from the National Rural Health Association. The NCFAHP will serve as the administrative home for the Alliance. The health and flourishing of rural communities is of prime importance, as one-in-five North Carolinians reside in a rural area. Rural communities struggle with the challenges of economic depression, lack of health-care access, and substance-use risks. Despite these challenges, rural communities are resilient and grounded in a sense of place. The Alliance intends to find solutions to rural challenges by harnessing the strengths of these communities and mobilizing existing rural organizations and leaders. The purpose of the Alliance is to act as a base for collaboration and partnership. The structure and size of the Alliance will continue to be flexible, and will be guided by the work of the group. For now, the Alliance has structured itself into six work groups based on the goals outlined by the “North Carolina Rural Health Action Plan”;

Invest in small businesses and entrepreneurship to grow local and regional industries.
Increase support for quality child care and education (birth through age 8) and parenting support to improve school readiness.
Work within the formal and informal education system to support healthy eating and active living.
Use primary care and public health settings to screen for and treat people with mental health and substance-abuse issues in the context of increasingly integrated primary and behavioral health care.
Educate and engage people in rural communities about new and emerging health insurance options available under the Affordable Care Act and existing safety net resources.
Ensure adequate incentives and other support to cultivate, recruit, and retain health professionals to rural and underserved areas of the state.

Each of these work groups is made up of members who work in related fields and can lend their expertise and resources. The work groups meet between quarterly meetings of the collective Alliance to facilitate progress in their designated work areas and to develop communication materials regarding the needs and the efforts in the work area.

Jim Bernstein played a key role in creating many of the rural health centers in North Carolina, with the belief that health care is community-based. He worked to ensure that community members are the owners and drivers of their own health programs, and began the Jim and Sue Bernstein Health Leadership Scholarships.

Scholarship recipients are selected by the Jim Bernstein Health Leadership Committee, a committee made up of members of Foundation’s Board of Directors. This year the committee sought to strengthen the relationships between Foundation and the scholars and wanted to recognize the important contributions that are made to the community by scholars’ families and health centers.

To do this, Maggie Sauer, President and CEO, along with members of the Foundation’s Board of Directors, took the opportunity to visit nearly all of the scholars in their home communities. They were able to meet several parents and staff members at the rural health clinics involved in the scholarship program, and hear the stories of how this student came to be nominated for the scholarship. A member of the Board of Directors joined her on most visits to present the award, with Olson Huff, committee chair, participating in the visits in western North Carolina, and Tom Irons, chair of the Board, participating in the visits in Mt. Olive.

This year, nine individuals were awarded Jim and Sue Bernstein Health Center Scholarships to help offset the cost of their higher education. Eight of this year’s scholars are children of employees of a rural health center, and one scholar is a current employee of a center.

The following Rural Health Centers and scholars were represented this year:

Celo Health Center……………………………………………Caleb Stevenson
Hot Springs Health Program………………………………Travis Rice
Black River Health Services………………………………..Moriah McTavish
Rural Health Group – Roanoke Rapids………………….Elarnta Darden
Rural Health Group – Enfield………………………………Breanna Joyner-Foreman
Rural Health Group – Enfield………………………………Keanna Joyner-Foreman
Mt. Olive Family Medicine Center………………………Ali Marie Eakes
Mt. Olive Family Medicine Center………………………Rose Brock
Benson Area Medical Center……………………………..Katherine Burnette

Rural areas are not the only places for which health care access is a challenge.

In urban areas like Wilmington, North Carolina, access is also an issue, especially for teens and young adults in underserved populations who face barriers like transportation, location, and insurance coverage. Jill Boesel, the Development and Outcomes Director at WHAT, or Wilmington Health Access for Teens, has been a part of closing the gap and bringing health care closer to where teens and young adults are.

WHAT is a community-based nonprofit health care organization that focuses on improving health care access and integrated care for adolescents and young adults between the ages of 11 and 24 in the Wilmington area.

WHAT opened its first school-based health center in 1999 and currently runs centers in three of the four local public high schools in Wilmington. The centers are located on the high school campus, open to students as walk-ins or by appointment. The centers are staffed with multidisciplinary teams that include a primary provider, mental health counselor, and registered dietician at each site.

School-based health centers have several advantages from their location. In addition to overcoming the barriers mentioned above (transportation, geography and insurance coverage), WHAT minimize lost class time for students, as students are able to simply walk down the hall to their appointment. WHAT also minimizes lost work time for parents. Parental participation in appointments is strongly encouraged, but rather than a parent having to pick their child up, take them to the doctor and back to school, parents can simply come to the school for the appointment and then return to work.

In addition to offering health care services to students in the form of one-on-one appointments, WHAT also provides the entire school with ongoing education about the health care needs of students, and WHAT providers work closely with school counselors, social workers, faculty and administration to improve the overall health of students.

Along with the school-based clinics, WHAT also runs a centrally located facility that offers adolescents and young adults, ages 11-24, access to primary care, mental health, nutrition and prevention services. Three-quarters of the population served by WHAT clinics are either publicly insured or uninsured, which provides a fair share of challenges for the clinics, especially in the rapidly shifting health care environment in the country and in this state.

Jill Boesel came to the Wilmington area and to WHAT in 2007, and her primary role focuses on seeking and securing public and private grants and managing current grants. She is also a member of the organization’s leadership team, and believes that the key to her work is communicating very effectively the advantages of having a school-based health center situated conveniently on campus for students and parents.

“The most cherished aspect of my job is having the ongoing opportunity to develop relationships with so many incredibly talented, energetic and committed people—both within and outside of Wilmington—who are working relentlessly to pave the way for a better tomorrow here in North Carolina, despite the often seemingly insurmountable challenges we face in health care today,” Boesel says.

She points out that WHAT is focused on “whole person care”, where the traditionally separated areas of primary care, mental health care, nutrition, and other areas occur within a connected network. This enables the provider in each area to be aware of what is going on in other areas and proactive in connecting the dots when appropriate to give the patient the best overall care possible. By having different types of providers serving patients in a team-based approach in the same location, integrated care works naturally and improves the patient experience and outcome.

Boesel is a current Bernstein Fellow, and her project is very fitting with the true integrity of the Bernstein Fellowship program and the mission of Jim Bernstein: ensuring access to health care for the populations that are most vulnerable in our state. She is exploring how WHAT as an organization can improve the use of data for population health and patient engagement, within the context of an integrated school-based healthcare setting.

Boesel says: “My fellowship has afforded me the unique opportunity to connect with others doing similar work throughout other regions of the state, including my “fellow Fellows” and many others.”

Neftali Serrano Joins the Center of Excellence for Integrated Care as Associate Director