Work Group Meeting, Monday, March 17, 2025, 3:00 to 4:45 pm, Microsoft Teams

Attendees: Jamie Dyvig, Greg Griggs, Elizabeth Hudgins, Arianna Keil, Maebelle Mathew, Lisa McKeithan, Stephanie Nantz, Ishan Sahu, Kristen Spaduzzi, Hugh Tilson, Jr., Stephanie Wilcher, Adam Zolotor; Staff: Ashley Rink

• Welcome and Introductions
  • Lisa McKeithan welcomed participants and reviewed the meeting agenda.
  • New member introductions: Arianna Keil, VP of Clinical and Quality Improvement, NC Community Health Center Association.
  • All attendees briefly introduced themselves and their affiliations.
  • Special congratulations were given to medical students Jamie Cruise and Maebelle Mathew on matching for residency programs.
• Level Setting
  • Hugh Tilson provided an overview of previous discussions and work group priorities.
  • Reaffirmed focus for 2024–2025 on select actionable priorities aligned with Healthy NC 2030 goals.
  • Emphasized the goal of achieving one primary care clinician per 1,500 residents in every North Carolina county.
  • Encouraged feedback and stressed that additional priorities can be revisited in the future.
• Recommendations for Action Plans and Next Steps
  • Priority 1- Medicaid
    • Key Updates:
      • Senate Bill 83 filed; focuses on the Primary Care Payment Reform Task Force and requires insurers to report on primary care spending.
      • Anticipated movement through the state budget process.
      • Advocacy underway to increase Medicaid primary care reimbursement and reduce administrative burdens (e.g., prior authorization reform).
      • Emphasis on working with NC DHHS and Medicaid leadership to elevate primary care workforce priorities.
    • Next Steps:
      • Continue legislative advocacy.
      • Share legislative one-pagers to facilitate DHHS and Secretary-level advocacy.
      • Monitor progress on prior authorization and primary care spending legislation.
  • Priority 2- Loan Repayment
    • Key Updates:
      • Inventory of existing loan repayment programs in development with ORH, CCNC, and AHEC collaboration.
      • New $50 million Primary Care Initiative to launch April 21, 2025, supporting:
      • Recruitment/retention of licensed providers (family medicine, internal medicine, general surgery, pediatrics, OB/GYN, psychiatry) in rural areas.
      • Special incentives for providers in lower-tier counties.
      • Webinars to promote incentive opportunities planned for early April.
    • Next Steps:
      • Finalize loan repayment program improvements and report recommendations by June 30, 2025.
      • Disseminate clear marketing materials distinguishing new incentives from other April scholarship programs.
      • Encourage partners to assist with widespread promotion.
  • Priority 3- Provider Training
    • Key Updates:
      • Preceptor Study completed and published in February 2025; highlights include:
        • Compensation improves willingness to precept.
        • Common barriers: time, space, administrative burden.
        • Broadened involvement beyond MDs/DOs to PAs and NPs.
      • Rural Hubs Initiative:
        • Four hubs actively supporting clinical training.
        • Fifth hub selected; contracting underway.
        • Challenges identified: administrative complexity, sustaining private practice participation.
      • Expansion of Rural Track Residencies:
        • Significant growth in rural residencies across NC (Oxford, Roanoke Rapids, Boone, Robeson, Harnett, and more).
        • New programs emerging in Stanly and Carteret counties.
    • Next Steps:
      • Broaden dissemination of Preceptor Study findings (potentially through NC Medical Journal or partner newsletters).
      • Compile and share a list of rural residency programs.
      • Continue monitoring and supporting rural hub outcomes.
      • Engage with rural tracks on faculty and program director stabilization efforts.
• Closing
  • Summary of Key Points:
    • Momentum continues on Medicaid, loan repayment, and training priorities.
    • Recognized progress made, while acknowledging the need for sustained effort.
    • Celebrated the contributions of future primary care clinicians.
  • Next Meeting:
    • The next work group meeting is scheduled for Monday, May 19, 2025, from 3:00 to 4:45 pm on Microsoft Teams.
  • Action Items Before Next Meeting:
    • Finalize Medicaid advocacy materials.
    • Launch Primary Care Initiative marketing and webinar promotion.
    • Disseminate Preceptor Study findings.
    • Prepare updates on rural residency support initiatives.
    • Refer to linked action plans for specific action items and next steps.

Work Group Meeting, Monday, January 27, 2025, 3:00 to 4:45 pm, Microsoft Teams

Attendees: Lavondia Alexander, Greg Griggs, Becca Hayes, Elizabeth Hudgins, Lisa McKeithan, Alice Pollard, Maggie Sauer, Kristen Spaduzzi, Hugh Tilson, Jr., Adam Zolotor; Staff: Ashley Rink

• Welcome and Introductions
  • Lisa McKeithan welcomed participants and reviewed the agenda.
  • New member introductions were made.
  • Celebrated personal updates shared by members.
  • Reminder of the meeting’s goal: continue focused action planning to support the primary care workforce, tied to Healthy NC 2030 goals.
• Level Setting
  • Reviewed discussions from the previous meeting:
    • NC’s goal is to have one primary care clinician per 1,500 residents in each county.
    • Even in areas meeting numerical thresholds, access to primary care remains a concern.
    • Reinforced the need to focus on concrete, achievable priorities for 2025.
    • Context shared: National forecast of 60,000 primary care clinician shortage by 2040 (American Board of Family Medicine data).
  • Ongoing administrative burden and undervaluation of primary care continue to challenge recruitment and retention.
• Recommendations for Action Plans and Next Steps
  • Priority 1- Medicaid
    • Action Step:
      • Increase primary care reimbursement and reduce the administrative burden to improve recruitment and retention.
    • Next Steps:
      • Advocate for increased Medicaid primary care reimbursement.
      • Advocate for reduced administrative processes (e.g., prior authorization reform, alignment of quality metrics).
      • Leverage evolving technologies (e.g., AI) to free clinician time.
      • Support the reauthorization of the Primary Care Payment Reform Task Force.
      • Measure primary care spending across insurers in NC.
      • Reinstate the Access Monitoring Review Plan for all Medicaid beneficiaries, not just Medicaid Direct.
  • Priority 2- Loan Repayment
    • Action Step:
      • Reduce costs for trainees by enhancing loan repayment and scholarship programs.
    • Next Steps:
      • Create an inventory of primary care financial aid programs (led by ORH, CCNC, and NC AHEC).
      • Continue developing primary care recruitment pathways starting at medical school level, leveraging programs like NC CARE funding and aligning with new requirements.
      • Improve and enhance existing loan repayment and incentive programs.
      • Coordinate efforts with the NC Education Assistance Authority and the Center on Workforce for Health.
      • Utilize the new $50 million Primary Care Initiative to support provider recruitment in rural areas. 
  • Priority 3- Provider Training- 2024-2025 Action Planning.docx
    • Action Step:
      • Expand healthcare provider training in rural communities and support rural workforce development.
    • Next Steps:
      • Finalize and distribute the Preceptor Study and use findings to evaluate options to support community preceptors.
      • Monitor outcomes of new rural residency track programs across multiple institutions.
      • Conduct strategic planning with partners (ORH, NC AHEC, Center on Workforce for Health) to identify and leverage rural health workforce initiatives.
      • Encourage the Department of Commerce to describe workforce-related community development efforts.
      • Continue seeking funding to sustain the Center on Workforce for Health.
      • Consider opportunities to expand access and enhance retention through new practice models and telehealth.
• Closing
  • Summary of Key Points:
    • Finalized priorities and action steps aligned with Healthy NC 2030 goals and prepared to engage state partners, including NCDHHS, NC Medicaid, and other key stakeholders.
  • Next Meeting:
    • The next work group meeting is scheduled for Monday, March 17, 2025, from 3:00 to 4:45 pm on Microsoft Teams.
  • Action Items:
    • Finalize and circulate updated action plans for member review.
    • Refer to linked action plans for specific action items and next steps.

Work Group Meeting, Monday, November 18, 2024, 3:00 to 4:45 pm, Microsoft Teams

Attendees: Evan Galloway, Greg Griggs, Lisa McKeithan, Julie Messina, Maggie Sauer, Kristen Spaduzzi, Hugh Tilson, Jr., Adam Zolotor; Staff: Ashley Rink

• Welcome and Introductions
  • The Primary Care Clinicians Work Group will be co-led by Lisa McKeithan and Hugh Tilson for 2024-2025.
• Data Review
  • Evan Galloway, MPS, Research Associate with the Program on Health Workforce Research and Policy at the Cecil G. Sheps Center for Health Services Research, presented on the Primary Care Clinician (PCC) Index as a method for measuring access to primary care across North Carolina's counties. Refer to Evan’s slides titled, “HNC2030_Primary_Care_Workgroup_2024-11-18.”
  • Below are the key points from his presentation.
    • Purpose: The Primary Care Clinician (PCC) Index measures access to primary care by calculating the population-to-clinician ratio (physicians, PAs, NPs, CNMs).
    • Funding and Data: Funded by AHAC, using licensure data from the NC Medical and Nursing Boards, with support from various partners.
    • Methodology: Adjusts for population demographics and clinician roles; classifies NPs by certifications and practice settings.
    • Index Threshold: 1,500-to-1 clinician-to-population ratio; lower ratios indicate better access.
    • Statewide Findings: In 2023, 76 counties met the threshold, up from 64 in 2017. Access is better in western NC, with challenges in border counties.
    • Trends: Rapid growth in NPs improved access; primary care physicians increased more slowly; CNMs are fewer in number.
    • Regional Needs: Some counties (e.g., Franklin) need more clinicians to meet the threshold; border areas may have distorted data due to cross-state commuting.
    • Limitations: Measures geographic access but not other barriers to care; county-level data may overlook cross-county trends.
    • Conclusion: The PCC Index is useful for assessing access but is not comprehensive and highlights areas for improvement in the primary care workforce.
  • Key Points from the Follow-up Discussion:
    • Urban vs. Rural Health Care Needs: There's debate over whether health care challenges are more severe in rural areas, especially in Western NC. Both rural and urban areas, like Wake County, face significant issues, such as long wait times for new patient appointments.
    • Role of Nurse Practitioners (NPs) in Rural Care: NPs serve a larger share of rural populations and are more likely to practice in primary care settings. However, federal data does not fully capture their role in rural care, potentially underrepresenting the extent of care provided.
    • Primary Care Health Professional Shortage Areas (HPSAs): 92 counties are classified as primary care HPSAs, with most based-on population rather than geographic location. Discrepancies in HPSA designations highlight the need for targeted solutions, especially for populations facing Medicaid access issues.
    • Impact of State Health Initiatives: State health initiatives show progress, but data-driven evaluations are necessary to measure their effectiveness and focus efforts on areas with the greatest needs.
    • Challenges in Managing Health Care Agenda: Efficiently managing the agenda is crucial, ensuring that health disparities in both rural and urban areas are addressed by using data to guide policies and resource allocation.
• Level Setting
  • The priorities and action plans for 2023-2024 were reviewed, with updates on progress and discussion of challenges encountered. For additional information refer to the slides titled, “2024-11-18 Slides- Primary Care Clinicians Work Group Meeting.”
  • Priority 1: Leverage Medicaid, including Medicaid Expansion, to support the viability of all primary care clinicians, especially in rural settings
    • Goals:
      • Conduct a needs assessment.
      • Analyze a study on minimum primary care spending.
      • Improve primary care reimbursement and reduce administrative burdens.
      • Establish a workforce center for health to meet primary care workforce needs.
    • Challenges:
      • Commercial health plans not reporting data on primary care spending due to concerns about proprietary information.
      • Medicaid data available, but it only covers part of the needed information.
  • Priority 2: Increase funding and strategic deployment of loan repayment programs for providers.
    • Goals:
      • Grow conditional acceptance programs for primary care clinicians.
      • Review and inventory financial aid packages (scholarships, grants, loan repayment).
      • Simplify the loan repayment process.
    • Progress:
    • Scholarship programs have been giving out funds, but the difference in incentives between general and primary care scholarships may not be sufficient to attract students to primary care.
    • UNC and ECU are working on defining recruitment pathways for primary care clinicians.
    • Inventory of financial aid programs is limited but being developed.
  • Priority 3: Expand healthcare provider training onsite in rural communities.
    • Goals:
      • Develop plans to financially support rural preceptors for more rotations.
      • Align training and recruitment efforts for providers in underserved rural areas.
    • Progress:
      • Four rural hubs are being developed as per legislation.
      • Preceptor support study is complete, with a report expected in January.
      • Efforts to expand training opportunities face challenges due to Medicaid being overwhelmed and limited resources.
• Priorities and Next Step Discussion
  • The group discussed priorities and next steps for action plans for the year. Refer to action plan tab.
• Closing
  • Lisa and Hugh will draft specific, actionable steps based on current priorities, which will be presented in upcoming meetings. Aim to track progress on these steps, with a focus on tangible outcomes.
  • Community Voice:
    • Request to identify additional members or groups for the workgroup, particularly from communities previously discussed.
    • Aim to have someone from a community, such as a health director, share their experiences and challenges at the next meeting.
    • Suggestion to invite a health director from a rural county to provide on-the-ground perspectives.
    • Explore the possibility of having a provider from an underserved county participate, acknowledging the challenge of finding time for these individuals.
    • Discussed inviting representatives from PAs, NPs, or other healthcare professionals to offer different perspectives, such as through Emily Adams or Tina Gordon.
    • Consider reaching out to past members, such as Randy (who worked with community health centers), or other relevant contacts.
  • Next Meeting and Schedule:
    • Discussed potential dates for the next meeting, either January 13th or 27th, due to the holiday. A final date will be confirmed based on participants' availability.
    • Upcoming meetings will follow the third Monday of every other month, with calendar invites to be sent.