As health systems continue to advance integrated models of care, communication remains a central facet of how interprofessional team members can concurrently address physical health, behavioral health, and social needs.
{"title":"Fostering Psychological Safety: Building Team-Based Care Communication Skills","authors":"Lisa de Saxe Zerden, M. Zomorodi","doi":"10.18043/001c.117225","DOIUrl":"https://doi.org/10.18043/001c.117225","url":null,"abstract":"As health systems continue to advance integrated models of care, communication remains a central facet of how interprofessional team members can concurrently address physical health, behavioral health, and social needs.","PeriodicalId":39574,"journal":{"name":"North Carolina Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141003069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Team-based care, the optimal result of interprofessional education and often referred to as interprofessional practice, is a critical ingredient in the success of efforts to address health and workforce needs. Articles in this issue provide an update on what has occurred across North Carolina related to team-based care since this journal last covered it in 2018, highlighting innovations and infrastructure that address health equity, population-based care, reducing costs, and increasing quality.
{"title":"An Update on Interprofessional Education and Practice in North Carolina: The State of the State","authors":"Jill Forcina, M. Zomorodi","doi":"10.18043/001c.117087","DOIUrl":"https://doi.org/10.18043/001c.117087","url":null,"abstract":"Team-based care, the optimal result of interprofessional education and often referred to as interprofessional practice, is a critical ingredient in the success of efforts to address health and workforce needs. Articles in this issue provide an update on what has occurred across North Carolina related to team-based care since this journal last covered it in 2018, highlighting innovations and infrastructure that address health equity, population-based care, reducing costs, and increasing quality.","PeriodicalId":39574,"journal":{"name":"North Carolina Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141005584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Erratum to “Syndemic Approaches Are Needed to Address Maternal Substance Use and Syphilis in North Carolina”","authors":"NC Medical Journal","doi":"10.18043/001c.108606","DOIUrl":"https://doi.org/10.18043/001c.108606","url":null,"abstract":"","PeriodicalId":39574,"journal":{"name":"North Carolina Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140698659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rashida Callender, Carolina Avendano, Mercedes A. Bravo, Joshua L. Tootoo, Ed Norman, Marie Lynn Miranda
Research has consistently shown that there is no safe blood lead level (BLL) for children. Despite progress in lead poisoning prevention, lead exposure remains a persistent threat to the health and neurological development of children. To identify high-risk ZIP codes for use by families and health care providers for the entire state of North Carolina, we developed a risk model using ZIP Code Tabulation Area (ZCTA)-level census data. We obtained all available BLL testing data from the North Carolina Department of Health and Human Services for the years 2010–2015 via data use agreement. We fit a multivariable regression model with the ZCTA-level mean of log normalized BLLs as the dependent variable and ZCTA-level census data for known risk factors of childhood lead exposure as predictors. We used this model to create a priority risk categorization. We organized ZCTAs into 20 quantiles, or priority risk categories, that can be used in local and statewide screening programs. The first six (of 20) quantiles were identified as particularly high-risk areas for childhood lead exposure. Because BLL testing is not universal, the BLL testing data used in this study are likely biased toward those most at risk for lead exposure. This study demonstrates the utility of ZCTA-level census data in identifying high-risk ZIP codes for childhood lead exposure, which can be used to ensure that the highest-risk children are tested in a timely manner. This approach can be replicated to address lead exposure nationally.
{"title":"Identifying High-Risk ZIP Codes for Childhood Lead Exposure: A Statewide ZCTA-Level Priority List for North Carolina","authors":"Rashida Callender, Carolina Avendano, Mercedes A. Bravo, Joshua L. Tootoo, Ed Norman, Marie Lynn Miranda","doi":"10.18043/001c.94878","DOIUrl":"https://doi.org/10.18043/001c.94878","url":null,"abstract":"Research has consistently shown that there is no safe blood lead level (BLL) for children. Despite progress in lead poisoning prevention, lead exposure remains a persistent threat to the health and neurological development of children. To identify high-risk ZIP codes for use by families and health care providers for the entire state of North Carolina, we developed a risk model using ZIP Code Tabulation Area (ZCTA)-level census data. We obtained all available BLL testing data from the North Carolina Department of Health and Human Services for the years 2010–2015 via data use agreement. We fit a multivariable regression model with the ZCTA-level mean of log normalized BLLs as the dependent variable and ZCTA-level census data for known risk factors of childhood lead exposure as predictors. We used this model to create a priority risk categorization. We organized ZCTAs into 20 quantiles, or priority risk categories, that can be used in local and statewide screening programs. The first six (of 20) quantiles were identified as particularly high-risk areas for childhood lead exposure. Because BLL testing is not universal, the BLL testing data used in this study are likely biased toward those most at risk for lead exposure. This study demonstrates the utility of ZCTA-level census data in identifying high-risk ZIP codes for childhood lead exposure, which can be used to ensure that the highest-risk children are tested in a timely manner. This approach can be replicated to address lead exposure nationally.","PeriodicalId":39574,"journal":{"name":"North Carolina Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140233529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Connor Drake, Eugenia R McPeek Hinz, B. Granger, Isa Granados, Abigail Rader, Ariana Pitcher, Shemecka Mcneil, William K. Bleser, Carolyn Avery, Janet Prvu Bettger, Elena Tenenbaum, Megan Shepherd-Banigan, Eleanor Wertman, Lisa McNerney, Marissa Mortiboy, John Purakal, Dev Sangvai, Susan E Spratt
Efforts to improve population health by being responsive to patients’ social and economic conditions will benefit from care models and technologies that assess and address unmet social needs. In 2019, NCCARE360 launched in North Carolina as the first statewide digital care coordination network to “close the loop” on referrals between community-based organizations (CBOs), health service providers, and social service agencies. The platform creates a shared network for sending and receiving electronic referrals and track client outcomes. As a case study, we compare NCCARE360 resolution rates for community resource referrals originating from a large integrated health system primarily in Durham County from September 1, 2020, through February 28, 2021. In the first year, COVID-19 Support Services Program (COVID-SSP) funding was available to reimburse associated CBOs for providing food assistance and case management services. We compared this with the same period the following year after funds had been exhausted. We present frontline implementation experiences and highlight opportunities, challenges, and recommendations for NCCARE360 implementation. Multi-level considerations for individual end users, organizations adopting the platform, and policymakers are presented. Additionally, we find that when COVID-SSP funding was available, more referrals were placed (3,220 cases) and referrals were more likely to be resolved (88% resolution rate) when compared to the same time frame when funds were no longer available (860 cases; 30% resolution rate). These results underscore the importance of reimbursement mechanisms and funding. The examination of referral rates is observational and may not generalize to other contexts. The shift to value-based care is an opportunity to embrace structural solutions to health and social care fragmentation. There is also an opportunity to realize the potential of NCCARE360 and efforts like it to contain costs and improve health outcomes and equity.
{"title":"Implementation of NCCARE360, a Digital Statewide Closed-Loop Referral Platform to Improve Health and Social Care Coordination: Evidence from the North Carolina COVID-19 Support Services Program","authors":"Connor Drake, Eugenia R McPeek Hinz, B. Granger, Isa Granados, Abigail Rader, Ariana Pitcher, Shemecka Mcneil, William K. Bleser, Carolyn Avery, Janet Prvu Bettger, Elena Tenenbaum, Megan Shepherd-Banigan, Eleanor Wertman, Lisa McNerney, Marissa Mortiboy, John Purakal, Dev Sangvai, Susan E Spratt","doi":"10.18043/001c.94877","DOIUrl":"https://doi.org/10.18043/001c.94877","url":null,"abstract":"Efforts to improve population health by being responsive to patients’ social and economic conditions will benefit from care models and technologies that assess and address unmet social needs. In 2019, NCCARE360 launched in North Carolina as the first statewide digital care coordination network to “close the loop” on referrals between community-based organizations (CBOs), health service providers, and social service agencies. The platform creates a shared network for sending and receiving electronic referrals and track client outcomes. As a case study, we compare NCCARE360 resolution rates for community resource referrals originating from a large integrated health system primarily in Durham County from September 1, 2020, through February 28, 2021. In the first year, COVID-19 Support Services Program (COVID-SSP) funding was available to reimburse associated CBOs for providing food assistance and case management services. We compared this with the same period the following year after funds had been exhausted. We present frontline implementation experiences and highlight opportunities, challenges, and recommendations for NCCARE360 implementation. Multi-level considerations for individual end users, organizations adopting the platform, and policymakers are presented. Additionally, we find that when COVID-SSP funding was available, more referrals were placed (3,220 cases) and referrals were more likely to be resolved (88% resolution rate) when compared to the same time frame when funds were no longer available (860 cases; 30% resolution rate). These results underscore the importance of reimbursement mechanisms and funding. The examination of referral rates is observational and may not generalize to other contexts. The shift to value-based care is an opportunity to embrace structural solutions to health and social care fragmentation. There is also an opportunity to realize the potential of NCCARE360 and efforts like it to contain costs and improve health outcomes and equity.","PeriodicalId":39574,"journal":{"name":"North Carolina Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140233145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
After three years of continuous Medicaid coverage as permitted by COVID-19-related waivers, in 2023 counties had to begin redeterminations of eligibility, “unwinding” this continuous coverage. As unwinding and eligibility determination continues, Medicaid expansion has begun, and county public health leaders are navigating uncertain but exciting waters. Lisa Macon Harrison, MPH, of Granville Vance Public Health, and Joshua Swift, MPH, of Forsyth County Department of Public Health, share their experiences, concerns, and hopes for the future.
{"title":"Q&A: Continuous Coverage Unwinding and Medicaid Expansion on the Ground in Two North Carolina Counties","authors":"Shannon Dowler","doi":"10.18043/001c.94873","DOIUrl":"https://doi.org/10.18043/001c.94873","url":null,"abstract":"After three years of continuous Medicaid coverage as permitted by COVID-19-related waivers, in 2023 counties had to begin redeterminations of eligibility, “unwinding” this continuous coverage. As unwinding and eligibility determination continues, Medicaid expansion has begun, and county public health leaders are navigating uncertain but exciting waters. Lisa Macon Harrison, MPH, of Granville Vance Public Health, and Joshua Swift, MPH, of Forsyth County Department of Public Health, share their experiences, concerns, and hopes for the future.","PeriodicalId":39574,"journal":{"name":"North Carolina Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140235008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
NC Medicaid experienced a dramatic increase in enrollment during the COVID-19 pandemic. To support county Departments of Social Services, NC Medicaid worked quickly to improve automation, provide flexibility, and streamline processes to better manage the workload increased by pandemic enrollment and Medicaid expansion implementation.
{"title":"Keeping North Carolina Insured: Strategies to Support County Departments of Social Services and Continuous Enrollment","authors":"Melanie Bush","doi":"10.18043/001c.94849","DOIUrl":"https://doi.org/10.18043/001c.94849","url":null,"abstract":"NC Medicaid experienced a dramatic increase in enrollment during the COVID-19 pandemic. To support county Departments of Social Services, NC Medicaid worked quickly to improve automation, provide flexibility, and streamline processes to better manage the workload increased by pandemic enrollment and Medicaid expansion implementation.","PeriodicalId":39574,"journal":{"name":"North Carolina Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140235321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Intro: Expanding Medicaid, Expanding Life in North Carolina","authors":"Peter J. Morris","doi":"10.18043/001c.94839","DOIUrl":"https://doi.org/10.18043/001c.94839","url":null,"abstract":"","PeriodicalId":39574,"journal":{"name":"North Carolina Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140235377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Salama S. Freed, Nicole Frascino, Kelley A Jones, Abhigya Giri, Lucas Stewart, Keren Hendel, Amy G. Clark, Courtney Van Houtven, Aparna Higgins, B. Kaufman
NC Medicaid is amid a transformation to value-based care models. The transformation requires the consideration of models that may best serve the 1 in 5 NC Medicaid beneficiaries who are dually enrolled in Medicare. The lack of integration of Medicare and Medicaid administration, financing, and care may contribute to suboptimal health outcomes and care experiences. Integrating Medicare and Medicaid to improve care for dually enrolled individuals requires knowledge of the demographic, eligibility, and enrollment trends, as well as the medical needs of these individuals throughout North Carolina. We performed a cross-sectional analysis of 2019 NC Medicaid administrative enrollment data and 2015–2020 Medicare and Medicaid public use files. Nearly half of North Carolina’s full-benefit dual-eligible (FBDE) population was eligible for Medicare due to disability. About one-third of the FBDE population lost full Medicaid benefits at some point during 2019; of these, 65% were under age 65. Most FBDE beneficiaries were enrolled in Medicaid fee-for-service, with 3.5% enrolled in Community Alternatives Program (CAP) waivers, 2% in Medicaid waivers for beneficiaries with behavioral health or intellectual and developmental disabilities (BH/IDD) or traumatic brain injury (TBI), and 1% in the Program of All-Inclusive Care for the Elderly (PACE). Enrollment in Medicare Duals Special Needs Plans (D-SNPs) increased from 7.3% of the FBDE population in 2015 to 32.5% in 2021. This descriptive, cross-sectional evaluation of North Carolina duals may not be generalizable to other time periods and contexts. Medicare-Medicaid integration presents an opportunity to improve the value of care for dual-eligible beneficiaries and aligns with the goals of NC Medicaid transformation. Integration strategies that leverage the current infrastructure may minimize disruption of services for beneficiaries and mitigate the impacts of unstable enrollment, particularly among working-age adults and disabled beneficiaries. The diversity within the dual-eligible populations requires a strategy designed to improve health equity across race, disability, eligibility, geography, and health care needs.
{"title":"Opportunities for Integration in the Dual Medicare-Medicaid Population: North Carolina Landscape Analysis","authors":"Salama S. Freed, Nicole Frascino, Kelley A Jones, Abhigya Giri, Lucas Stewart, Keren Hendel, Amy G. Clark, Courtney Van Houtven, Aparna Higgins, B. Kaufman","doi":"10.18043/001c.94879","DOIUrl":"https://doi.org/10.18043/001c.94879","url":null,"abstract":"NC Medicaid is amid a transformation to value-based care models. The transformation requires the consideration of models that may best serve the 1 in 5 NC Medicaid beneficiaries who are dually enrolled in Medicare. The lack of integration of Medicare and Medicaid administration, financing, and care may contribute to suboptimal health outcomes and care experiences. Integrating Medicare and Medicaid to improve care for dually enrolled individuals requires knowledge of the demographic, eligibility, and enrollment trends, as well as the medical needs of these individuals throughout North Carolina. We performed a cross-sectional analysis of 2019 NC Medicaid administrative enrollment data and 2015–2020 Medicare and Medicaid public use files. Nearly half of North Carolina’s full-benefit dual-eligible (FBDE) population was eligible for Medicare due to disability. About one-third of the FBDE population lost full Medicaid benefits at some point during 2019; of these, 65% were under age 65. Most FBDE beneficiaries were enrolled in Medicaid fee-for-service, with 3.5% enrolled in Community Alternatives Program (CAP) waivers, 2% in Medicaid waivers for beneficiaries with behavioral health or intellectual and developmental disabilities (BH/IDD) or traumatic brain injury (TBI), and 1% in the Program of All-Inclusive Care for the Elderly (PACE). Enrollment in Medicare Duals Special Needs Plans (D-SNPs) increased from 7.3% of the FBDE population in 2015 to 32.5% in 2021. This descriptive, cross-sectional evaluation of North Carolina duals may not be generalizable to other time periods and contexts. Medicare-Medicaid integration presents an opportunity to improve the value of care for dual-eligible beneficiaries and aligns with the goals of NC Medicaid transformation. Integration strategies that leverage the current infrastructure may minimize disruption of services for beneficiaries and mitigate the impacts of unstable enrollment, particularly among working-age adults and disabled beneficiaries. The diversity within the dual-eligible populations requires a strategy designed to improve health equity across race, disability, eligibility, geography, and health care needs.","PeriodicalId":39574,"journal":{"name":"North Carolina Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140235594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
North Carolina is expanding Medicaid insurance coverage while simultaneously removing coverage from individuals as a result of the end of the COVID-19 emergency. These large-scale eligibility changes have created an opportunity for improved processes. North Carolina chose to build upon the existing Medicaid Family Planning program to maintain access to health care while launching Medicaid expansion.
{"title":"Keeping People Enrolled During Medicaid Expansion and COVID-19 Continuous Coverage Unwinding","authors":"Emma Sandoe","doi":"10.18043/001c.94842","DOIUrl":"https://doi.org/10.18043/001c.94842","url":null,"abstract":"North Carolina is expanding Medicaid insurance coverage while simultaneously removing coverage from individuals as a result of the end of the COVID-19 emergency. These large-scale eligibility changes have created an opportunity for improved processes. North Carolina chose to build upon the existing Medicaid Family Planning program to maintain access to health care while launching Medicaid expansion.","PeriodicalId":39574,"journal":{"name":"North Carolina Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140234998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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