The date is set! Please reserve October 5, 2017 from 6:00-9:00pm for the 12th Annual Jim Bernstein Health Leadership Fund Dinner supporting the Jim Bernstein Health Leadership Fellows Program. This premier event convenes health professionals and stakeholders from across North Carolina to network and learn from one another and to celebrate and honor past, present, and future contributions in our state’s health sector. To learn more about the event, click here.
Susan Martin has always been passionate about children’s health. A strong believer that no child should be left without access to care, she has opened both her heart and home to the issue. She spends the majority of her time volunteering for organizations, sitting on various committees and boards, and has previously served with her late husband as a foster parent for newborns with special needs.
“I’m just a normal person who has a strong faith, believes in family and that good health is just our human right,” Susan tells us. “I believe we have a responsibility to a fellow man, woman or child, to give them the opportunity to live a healthy productive life.”
This past October, at the 11th Annual Jim Bernstein Health Leadership Dinner, the Foundation received a generous donation from Susan to support the Bernstein Fellows program. We are extremely grateful for her contribution that will help to support the work being done to advance community health in North Carolina.
What first brought the Fellows program to Susan’s attention was Dr. Steve North, a previous Bernstein Fellow and current Foundation board member. Also passionate about children’s health, Dr. North used his fellowship to develop the Health-e-Schools school-based telemedicine program. He has continued work with this program as the founder of the Center for Rural Health Innovation, an organization focused on applying innovative technologies to improve access to health care in rural communities.
[box] “I have a great deal of admiration for Steve North,” Susan said. “Knowing his story, I wanted to get a better understanding of the other people involved.” [/box]
Impressed by what she learned about other Fellows and their projects, Susan decided to give the program more support. “I really like all the things I’ve read about,” she reflects. “The work they’re doing just makes sense, especially for our rural areas.”
To learn more about the Bernstein Fellows program, click here.
The Bernstein Fellows program is still looking for applicants for the Bernstein Fellows class of 2017-2019. The application deadline has been extended, and those interested can apply to the program now through May 12th!
Additionally, there will now be a pre-application webinar on Wednesday, April 19th from 12:00-12:45. Fellowship staff will explain the program and answer your questions about the application process. All potential applicants are encouraged to attend the webinar, but attendance is not required.
The Bernstein Fellows program is now looking for applicants for the Bernstein Fellows class of 2017-2019. To apply, click here.
What is the Bernstein Fellows program?
The Bernstein Fellows program commemorates the life and career of James D. Bernstein, North Carolina’s rural health pioneer who led the efforts for community-driven care of low- and moderate- income, isolated, and underserved populations for more than 30 years.
Who should apply?
Fellowships are awarded to up-and-coming health professionals from a variety of disciplines (primary care, pharmacy, behavioral health, oral health, social work, etc.).
Work in an administrative or clinical capacity in a rural and/or underserved community in North Carolina or work with an organization that focuses on rural and/or underserved communities
Demonstrate a strong commitment to remaining in North Carolina
Demonstrate a strong commitment to underserved populations and community-driven health care
Demonstrate leadership potential (such as, being a self-starter, resourceful, industrious, motivated, mature, resilient, a good communicator, problem-solver, and team player)
Be sensitive to cultural diversity among client populations in health care settings and programs, and
Hold realistic expectations about working in rural or underserved communities and with vulnerable populations
What does the fellowship involve?
Fellowships are awarded for two-year period (October 2017-October 2019) and are comprised of an educational component and and individual project centered on the core elements of leadership, rural life, NC health sector, and partnerships. Fellows will be expected to spend 10-12 percent of their work time on fellowship activities and will receive up to $3,000 in support of the developing his/her project.
[box] For more information about the fellowship and the application process, click here. [/box]
On October 19thand 20th more than 40 people from across North Carolina gathered at the NC State University McKimmon Center for the NC Rural Health Leadership Alliance’s (NCRHLA) inaugural events. The gathering kicked off on the 19th with an open reception that welcomed guests to learn more about the NCRHLA and connect new partners to its current members. The NCRHLA is a coordinated network of leaders and practitioners aimed at improving the health of rural North Carolinians through education and strategic partnerships. Their work is currently focused on achieving the recommendations of the NC Rural Health Action Plan.
On October 20th, a select group of participants from local, regional and state organizations supporting public health and economic development attended the Discovery & Practice Summit: Connections for Community Health and Economic Vitality. The goal of the Summit was to move North Carolina forward in improving economic and community health and wellbeing through collaboration. The Summit was organized on the premise that collaboration across sectors is essential for healthy, vibrant communities. The day was devoted to exploring opportunities for partnership between public health and economic development practitioners – just two of the many partners needed for successful community change. Through the day, sessions narrowed to focus on community strategies for healthy eating and active living (HEAL) that could have health and economic benefits.
Jamie Cousins, a current Jim Bernstein Health Leadership Fellow, led the coordination of the event. “Being a part of the Bernstein Fellowship, I’ve been inspired and challenged (in the best way) by Jim Bernstein’s commitment and leadership to rural North Carolina communities. The Summit and continued dialogue and action are humble efforts to carry forward his spirit and belief in our rural communities. I am truly grateful to the Kate B. Reynolds Charitable Trust for the support which made the Summit a reality. The NC Rural Health Leadership Alliance provided financial support through the National Rural Health Leadership grant and was a terrific partner in this event.”
In review of the event, participants shared that the Summit was a valuable investment of their time and that the three primary objectives of the Summit were well-met:
they were more aware of practical strategies that address the goals of public health and economic development while supporting healthy eating and active living;
they could identify collaborative opportunities for professionals, advocates, and residents to advance economic vitality and health for all;
they plan to take action to work jointly to advance public health and economic vitality.
Participants wrote Commitment Cards declaring at least one action to complete before the end of 2016. Most of the commitments involved reaching out to local partners such as economic development professionals or chambers of commerce to talk about opportunities for collaboration. Other commitments included sharing information from the Summit and connecting with agencies to move work forward together. As Jamie Cousins continues her Bernstein Fellowship and supports the ideas and new collaborations from the Summit, participants will be contacted in early January to learn how they’ve progressed. Additionally, Summit proceedings will be shared, and several small group discussions are planned to continue to advance dialogue and action.
Sarah Brill Thach, MPH: The Center for Healthy Aging at the Mountain Area Health Education Center
Joanne Rinker, MS: Director of Training and Technical Assistance at the Center for Healthy North Carolina
Marian Sadler Aldridge, MPH: Community Development Specialist at the Buncombe County Department of Health
Jill Boesel, MPH: Project Coordinator for Physician Practice Services with Community Care of North Carolina
Amelia Mahan, MSW, Behavioral Health Program Manager at Community Care of North Carolina
The Foundation is pleased to welcome its newest class of Bernstein Fellows. Five dynamic professionals will participate in the fellowship program through October 2017, they are:
Pete McQuiston: Director of Food and Nutrition at Swain Community Hospital in Bryson City, NC
Rod Jenkins MHA: Deputy Health Director for Cumberland County, North Carolina
Erin Hultgren, MPH: Program Manager at Gaston Family Health Services, Inc.
Catherine Parker, MA: Director of Hertford County Student Wellness Center, a division of Roanoke Chowan Community Health Center.
Jamie Cousins, MPA: Program Manager for the Catalyst for Health Eating and Active Living
We’d like to thank retiring program Director, John H. Frank, for his leadership in the program since 2010. During his time as Director, he strengthened the curriculum, increased the number of programmatic partnerships, and guided thirteen Fellows through completion of the fellowship. The Foundation is extremely fortunate and grateful for John’s leadership and dedication to the Fellows Program.
We also welcome Tom Bacon, DrPH, as the new Director of the Fellows Program. Tom is the retired Executive Associate Dean and NC AHEC Program Director, and he continues to work as a part-time Research Fellow at the Cecil G. Sheps Center for Health Services Research at UNC-Chapel Hill. The Foundation is excited and grateful for Tom’s commitment and leadership in continuing and developing the Fellows program.
Over the past year, our newsletters have focused on the efforts of the Foundation and state and national leaders to transform health care. Success in these efforts will, in part, be measured by the transformation of our current and future workforce. Recently, NCFAHP hosted a national webinar with 3RNET, the National Recruitment and Retention Network discussing workforce needs in the current environment, New Models of Care and their Impact on Rural Workforce.
Dr. Erin Fraher, Ph.D* framed the conversation with her presentation: “The Workforce Needed to Staff Value-Based Models of Care”. According to Dr. Fraher, new roles are emerging to provide enhanced care functions.
Dr. Fraher suggests that two of the common new roles are:
Roles that focus on coordinating care within a health care system
“Boundary spanning” roles that coordinate patient care between health care system and community-based settings
Improving patient care and population health is dependent on “boundary spanning.” It’s one thing to create a descriptive title for the process and quite another to engage the workforce in the process. Change is never easy. Yet, to Dr. Fraher’s point we need to “Plan to provide a workforce of health not a healthcare workforce.” Additionally, she makes the following points regarding boundary spanning roles.
Workforce planning efforts that include workers who typically practice in community and home-based settings
Embracing role of social workers, patient navigators, community health workers, home health workers, mental health workers, dieticians and other community-based worker
Integrating health workforce and public health workforce and planning
Hmmmm, this sounds vaguely familiar… Our May newsletter focused on Accountable Care Communities, which are defined as: “a collaborative, integrated, and measurable multi-institutional approach that emphasizes shared responsibility for the health of the community, including health promotion and disease prevention, access to quality services and healthcare delivery. The ultimate goal of the ACC is a healthier community.” (Healthier by Design: Creating Accountable Care Communities)
At the Foundation, we are impatiently awaiting the release of the Accountable Care Community model by the CMS Innovation Center. Fingers crossed, it will provide the opportunity for uniquely partnering these “boundary spanners” together with a payment model to support the work.
Again, in a previous newsletter, Dr. Jerome Grossman and Dr. Jason Hwang’s “The Innovator’s Prescription: A Disruptive Solution for Healthcare” presents a compelling argument regarding the common sense of a “boundary spanning” workforce of health, “Consider this equation, 2 + 8,758. These numbers reflect the hours spent annually by each of us on healthcare during the year. Two hours is the amount of time people spend annually in a traditional healthcare provider’s office, versus 8,758 hours spent on self-care.”
In the article “New Project? Don’t Analyze‑Act!” from the March 2012 edition of the Harvard Business review, authors Leonard A. Schlesinger, Charles F. Kiefer, and Paul B. Brown make this point regarding new endeavors:
“We acknowledge that action before analysis, learning instead of predicting, can be, well, unpredictable—and messy. And we concede that it’s antithetical to the way most organizations work. However, in the long term, taking lots of small steps actually reduces risk, which makes such an approach ideal for tackling challenges and getting fledgling initiatives off the ground, particularly in today’s skittish corporate environment.”
Perhaps with “small steps” we can create a boundary spanning workforce of health. This newsletter describes some of the “small steps” at the Foundation. The team at NCFAHP strives to be entrepreneurial leaders. I would also call the Fellows boundary spanners in their own communities. Finally, from the same article:
“Entrepreneurial leaders are individuals who, through an understanding of themselves and the contexts in which they work, act on and shape opportunities that create value for their organizations, their stakeholders, and the wider society. Entrepreneurial leaders are driven by their desire to consider how to simultaneously create social, environmental, and economic opportunities. They are also undiscouraged by a lack of resources or by high levels of uncertainty. Rather they tackle these situations by taking action and experimenting with new solutions to old problems. Entrepreneurial leaders refuse to cynically or lethargically resign themselves to the problems of the world. Rather through a combination of self-reflection, analysis, resourcefulness, and creative thinking and action, they find ways to inspire and lead others to tackle seemingly intractable problems…The only way to lead in an unknowable environment is through action.”
The Bernstein Fellows are entrepreneurial leaders. In fact, Sarah Thach is the Fellow who directed me to the Harvard Business Review article. In closing, I think it’s only fitting to end with one of her quotes:
“Just try it…. early frequent failures keep you limber!”
Thanks Sarah, and our thanks to the Fellows current and past!
CEO & President
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.
“Accountable Care Community (ACC): a collaborative, integrated, and measurable multi-institutional approach that emphasizes shared responsibility for the health of the community, including health promotion and disease prevention, access to quality services and healthcare delivery. The ultimate goal of the ACC is a healthier community.” (Source: Healthier by Design: Creating Accountable Care Communities)
In health care, these are exciting times – or, some may say, frightful! For the purposes of this newsletter, let’s stay on the positive side of the transformation and change underway. For the first time, the work of health-care providers and communities can be formally linked and measured in tangible ways.
At NCFAHP’s Board of Directors retreat in November 2012, we began to consider our role in facilitating the development of a new Accountable Care Organization (ACO) model: a model that would include the expertise and services from community partners from the start of the ACO. Too often, ACOs create new services and hire providers to provide health and wellness services, health coaching, etc., rather than relying on community partners. Adding new service lines and providers seems unnecessary when the community is the better choice.
To date, meaningful participation of community health partners in these models has been lean, or often nonexistent. But Akron, OH, has been a pioneer in a new model that takes fuller advantage of community-based partners – an Accountable Care Community (ACC). A 2012 report by Austen BioInnovation Institute cites Community Care of NC as an early model of this approach. Akron’s model takes it one step further by including local growers to provide fresh fruits and vegetables and the National Park system to provide opportunities for better health through walking, kayaking or other physical activity.
The Institute reports that, while the Accountable Care Community may share characteristics with the ACO, there are also factors distinguishing the two:
“ACC encompasses not only medical delivery systems, but the public health system, community stakeholders at the grassroots level and community organizations whose work often encompasses the entire spectrum of health.
ACC focuses on the health outcomes of the entire population of a defined geographic region, rather than a defined and targeted population of health consumers selected by an ACO for their efforts at payment and care delivery reform.”
Natural systems of community care do not follow prescribed patterns of grouping community members together by patient type, but they do organize themselves and health behaviors according to the culture, leadership and priorities within the population. The ACC simply makes sense. Furthermore, as Dr. Janine Janosky, Vice President, Center for Clinical and Community Health Improvement at the Institute states: “As we think about the Accountable Care Community, we have the opportunity to impact the quality of life, and also the economic vitality of our community…”
At NCFAHP, the programs are designed to fit together and complement one another for the purpose of filling gaps to create relationships, services, training, and data compilation that do not “fit” in other places. Workforce data to power the decisions in local communities to actively participate in the recruitment and, most importantly, retention of health-care providers is essential to the ACC. Jackie Fannell’s work with Practice Sights provides some insight to this work.
Since October 2014, the Foundation’s Bernstein Fellows program has emphasized the Fellows’ leadership role in creating accountable care communities. Communities are overwhelmed by the intricacies of the Accountable Care Organization model and see the opportunity and need for their participation in this complex structure. The Fellows are engaged and interested in creating a “place at the table” in their own communities and across North Carolina.
Part of the NCFAHP vision is to engage in innovation to:
Create strategies that significantly affect existing systems
Build on emerging elements within existing systems
Create new systems or strategies by creating partnerships resulting in unique opportunities to combine/refine services and resources
Improve on existing strategies or systems
The Fellows Program faculty includes individuals and organizations interested in promoting the ACC model across North Carolina. True to the model, NCFAHP is not interested in duplicating the work of our colleagues, but instead leveraging the work to heighten awareness and create momentum. We would like to thank the following individuals for providing inspiration and information to the Fellows:
Patrick Woodie, President, NC Rural Center, Misty Herget, Director of Leadership and Chilton Rogers, Director of Community Engagement
Ruth Petersen, MD, MPH, NC Division of Public Health, Section Chief for the Chronic Disease and Injury Section.
Greg Randolph, MD, MPH, Director of the Center for Public Health Quality and Professor of Pediatrics and Adjunct Professor of Public Health at the University of North Carolina at Chapel Hill.
Grace Terrell, MD, CEO Cornerstone Health Care, P.A. a multiple specialty medical group in the Piedmont Triad region of North Carolina with more than 370 providers and 1800 employees who practice at fifteen separate hospitals.
Chris Collins, Director, NC Office of Rural Health and Community Care