september

Emily Bernson joined the Foundation full-time in October as Office Coordinator. Her organizational and tactical skills are an asset in the office. We asked her a few questions to get to know her better:

Q: What experiences or jobs have led you to work at the Foundation for Health Leadership and Innovation?

My past experience is primarily in development/special events, working with the Juvenile Diabetes Research Foundation, Ronald McDonald House Charities, and United Way. I got my degree in Nonprofit Leadership and Management from High Point University, so when I moved back to NC from Connecticut, finding a position in the nonprofit sector was very important.

Q: What role do you play in the Foundation?

I am currently the office coordinator. In addition to the executive assistant role, I also work closely to facilitate our Communications and Development plans. I even have the flexibility to work with our other programs and on other projects as needed! For example, I assist the NC Oral Health Collaborative with event organization and communication.

Q: What is most rewarding about your job? What is most difficult?

The most rewarding aspect of my job is the connections I am able to make. The Foundation has an amazing network of friends and partners. With every person I meet, I learn something new! I always look forward to meeting new people and growing more every day. Something that is difficult for me is the schedule! I am not a morning person, so everyone knows that I shouldn’t tackle major projects before my coffee.

Maggie-Sauer 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!

-Maggie Sauer

CEO & President

A flexible workforce is essential for the future of our health care system. A massive shift in the way services are reimbursed is coming. This prompts a similar shift in how we train the workforce that keeps our communities healthy. Federally funded insurance will pay providers based on the quality of care instead of the quantity. The Centers for Medicare and Medicaid is already funding pilot projects to encourage this change. These “value-based payment” projects are causing a bloom of experiments all over the country. The goal of these experiments is to provide patients with preventative and comprehensive care that is high quality and affordable.

It’s a big challenge. But it will be easier to manage if healthcare providers learn from each other. On August 18, the NCFAHP, Practice Sights, and 3Rnet hosted the first of many webinars to begin a national conversation on the creative models in action across the country. Rural areas, because of their small size and their unique needs, are excellent places for experimentation.

The webinar is titled “New Models of Care and their Impact on Rural Workforce.” The conversation was led by Erin Fraher, PhD, an expert on health workforce research at UNC-Chapel Hill, and representatives from three states presenting on projects in their community.

Erin Fraher set the stage for the discussion by explaining the difference between “old school” and “new school” workforce characteristics. In conventional, fee-for-service models, the healthcare workforce is trained to operate in isolated specialties instead of in coordinated teams. The “new school” workforce reaches patients in their community, rather than in a hospital or an acute care setting. This new workforce will maximize the responsibility of medical assistants, panel managers, dieticians, and health coaches. These teams will have a different work flow to accommodate new roles.

Fraher stresses that we will have to prepare and equip the 18 million members of our healthcare workforce for this change. Medical training will also need to include an emphasis on integrated care and include rotations with teams that are following a coordinated model.

The rural health centers from North Carolina, Oregon and Colorado are piloting a variety of projects in an attempt to launch value-based care. Every state is different, but all three are creatively addressing the unique needs of their community.

Chris Collins from the North Carolina Office of Rural Health & Community Care discussed the variety of loan repayment programs to attract medical workers to underserved areas, including therapists in integrated care settings. Collins also discussed the growth of telehealth services in North Carolina and the efforts to fill the gaps.

Melissa Bosworth of the Colorado Rural Health Center presented their work on creating a data bank to show the economic impact of their programs. Those programs include reducing the number of mentorship hours for nurse practitioners and introducing mediation services to improve office culture in clinics. The Colorado Rural Health Center is also pairing health IT students with rural clinics to help them transition to changing technologies.

Scott Ekblad from the Oregon Office of Rural Health highlighted the 16 coordinated care organizations across the state. Fourteen of these organizations are rural. These organizations have a “global budget,” and are given the creative power to meet needs. They have an incentive to keep Oregon citizens well using community health teams. Medical assistants, dental hygienists and community paramedics have more responsibility and are well connected to patients in a community setting.

Practice Sights and the NCFAHP will continue the conversation on the efforts of states that are moving to value-based care. Stay tuned for the next webinar!

Maggie-Sauer Every year, we have the opportunity to recognize leadership excellence at the Jim Bernstein Health Leadership Fund Dinner & Lecture. It never ceases to amaze me how enthusiastic, joyful and energetic this event is each year. Three hundred people fill the Friday Center’s Atrium with greetings to old and new friends. This will be the 9^th year that people from all over the state come together in one place to celebrate, catch-up, and share news. People always ask us if we can simply hold the reception and forget about the dinner! It’s the one place, year after year, where people get recharged to do good and important work by spending time with so many of their friends and colleagues.

This year, Tom Bacon, DrPH, recently retired NC AHEC Director, will receive the Career Achievement Award and four Fellows who have completed their projects and two-year program will be recognized. It’s an evening of celebration and an opportunity to recognize Sue and Jim Bernstein and their “pay it forward” leadership style. The Fellowship and Scholarship were established to continue this tradition of community service and innovation.

Last year, John Price, retired Director of the NC Office of Rural Health and Community Care, visited each of the rural health centers eligible to receive scholarship funds for an employee or their dependent. As a result, this year the Foundation’s Bernstein Health Leadership Committee made a commitment to make each award in person. I had the opportunity to attend these meetings in seven communities across the state. Directors from the centers nominate an employee or an employee’s dependent, and two of the centers represented this year had never applied before. We were overjoyed to receive their applications. In most of our visits, the entire center staff attended the presentation of the award, celebrating and sharing how these students were part of the larger rural health center family. As the awarded students begin their college careers, their academic interests include engineering, physical therapy, behavioral health, medicine, video arts and film, and sign language.

Reflecting on the Fellowship, Scholarships and upcoming Dinner, I recall one of the center directors describing how important those first visits with Jim Bernstein and Harvey Estes were to planning for the healthcare needs of the community. The centers continue their work with active community participation on their boards, volunteers and fundraising. These communities, employees and children embody the “pay it forward” expectation. The Bernstein Health Leadership Fellowship and Scholarship are meant to act as catalysts for this way of thinking and most importantly, doing! Even though Jim has been gone for nine years, honoring this way of living will continue to make the greatest difference.

-Maggie Sauer

CEO & President

Emily Bernson Joins the Team as Office Coordinator