Updated 3/21/2024

2023-2024 Priorities:

• Leverage Medicaid, including Medicaid Expansion, to support the viability of all primary care clinicians, especially in rural settings.

• Increase funding and strategic deployment of loan repayment programs for providers.

• Expand healthcare provider training onsite in rural communities.

Policy 1: Leverage Medicaid, including Medicaid Expansion, to support the viability of all primary care clinicians, especially in rural settings

• Short Term Action Plans (1-2 years):
  • Creating a conducive environment where current and prospective primary care providers and their family will thrive to be successful in primary care, including economic viability.
    • Conduct a Needs Assessment (e.g. What are the rate limiting factors?) Who is doing the work and what is known. Engage the department of Commerce to determine the current state.
  • Examine the results from the study on minimum primary care spending commissioned by the General Assembly in fiscal year 2024.
    • The study is ongoing; need to evaluate the results/recommendations to determine appropriate next steps.
  • Improving primary care reimbursement and simplifying related administrative burdens will result in healthcare students making rational choices to enter all forms of primary care practice while in school and residency programs.
    • Reimbursement optimization
      • Payment without administrative burdens (e.g., medical necessity, prior authorizations, etc.).
      • Identify missed opportunities for payment.
      • Ensure alignment of payments that are most impactful and not just a ‘band-aid’.
  • Establish a Center on Workforce for Health to develop, coordinate and implement strategies to meet primary care workforce needs in targeted geographies of greatest need.
    • Continue to develop momentum and support for the need for the Center on Workforce for Health.
• Long Term Action Plans (5+ Years):
  • Creating a conducive environment where current and prospective primary care providers and their family will thrive to be successful in primary care, including economic viability.
    • Department of Commerce recommendation for overall economic viability.
    • Define what communities need and can sustain for a health infrastructure. (How can communities afford and sustain community hospitals in the state? How can you sustain a primary care infrastructure without referral sources? What are the care gaps between the two?)
  • Examine the results from the study on minimum primary care spending commissioned by the General Assembly in fiscal year 2024.
    • Establish an ongoing council/committee to create a process to assess the spending levels (Are the spending levels producing the desired outcomes. If not, what actions need to be taken?).
  • Improving primary care reimbursement and simplifying related administrative burdens will result in healthcare students making rational choices to enter all forms of primary care practice while in school and residency programs.
    • Leverage the primary care spending legislation to increase reimbursement and funding for primary care.
    • Build Value Based Payment arrangements designed to recognize, support, and respond to the unique needs and contributions of primary care.
  • Establish a Center on Workforce for Health to develop, coordinate and implement strategies to meet primary care workforce needs in targeted geographies of greatest need.
    • Develop and deploy a strategic plan for primary care.

Policy 2: Increase funding and strategic deployment of loan repayment programs for providers.

• Inventory the medical schools (including NPs and PAs), to see what kind of programs are available. Partner with AHEC and complete by May 2024.
  • Actions:
    • Fostering relationships with programs leads to ensure up to date information is available and shared with AHEC and across other programs.
    • Deep dive into legislative increase, provide bill number specific to reimbursement. Socialize to all provider groups to get feedback.
  • Measurement Criteria:
    • Tangible list of programs, relationship building will be ongoing
    • When these funds are allocated, measuring impact (are they being dispersed, to whom, and impact)
    • Measure retention by following providers and how long they stay
• Short-term work with UNC system and ECU schools to do Intentional marketing program to UNC institutions—minute you enroll, get county of origin and email or campaign interested in NP, PA, medical school, and want to go back home we have a pathway for you. Partnership with UNC System and the Primary Care Workgroup.
  • Actions:
    • This workgroup will engage with stakeholders in the UNC system to see if this is feasible.  Complete with the UNC System and Primary Care WG by April of 2024.
    • In the meantime, create broad marketing emails that highlight the importance of rural healthcare and thriving rural communities to practice in. Completed by the Primary Care WG by August of 2024.
  • Measurement Criteria
    • UNC representative attended
    • UNC has provided feedback and approval to share with students

Policy 3: Expand healthcare provider training onsite in rural communities.

• Short Term Action Plans (1-2 years):
  • Standing up 3 to 5 rural professional teaching hubs. (1)
    • There was legislation that passed to stand up 3 to 5 teaching hubs. AHEC has identified those 5 and are optimistic they will be operational by July 1st.
  • Identifying a contractor for the preceptor study.
    • Due to challenges with finding contractors for the study, AHEC will be doing it themselves and is identifying their capacity to do this.
  • Continuing formative work for developing pathway to rural primary care track.
  • Continuing and expanding existing supports in state budget (including bullets 1&2) NC-PAL
  • Looking at investment structures for rural and primary care example: Medicaid primary care task force (2)
  • Assuring support such as transformation collaborative or making care primary have appropriate rural components
  • Looking at what works well and should be replicated
• Long Term Action Plans (5+years):
  • Evaluating the legislative pilots.
  • Identifying solutions from the preceptor study and garnering support for strategies.
  • Identifying resources to support preceptors.
  • Creating a system where schools can understand available preceptors across the state and request placements for students; coordination across the system.
  • Identifying current and future preceptor needs. (Applying analytics to population trends.)
  • Consider appropriate primary and rural care investment
  • Looking at what works well and should be replicated.
  • RFP for rural health training hubs & contractor for preceptor study – In process
  • Expand GME opportunities in NC, require systemic approach and buy-in from DHHS; what can we do as a state and a Center?  medical school more affordable for NC residents (loan repayment/GME/tuition/etc)

2023-2024 Primary Care Clinicians Work Group Meeting Schedule:

• Monday, October 16, 2023, from 3:00 to 4:45 pm, Microsoft Teams
• Monday, December 18, 2023, from 3:00 to 4:45 pm, Microsoft Teams
• Monday, February 19, 2024, from 3:00 to 4:45 pm, Microsoft Teams
• Monday, April 15, 2024, from 3:00 to 4:45 pm, Microsoft Teams
• Monday, June 17, 2024, from 3:00 to 4:45 pm, Microsoft Teams

Monday, April 15, 2024, from 3:00 to 4:45 pm, Microsoft Teams- Work Group Meeting

Attendees: Lavondia Alexander, Kathleen Batton, Greg Griggs, Elizabeth Hudgins, Lisa McKeithan, Stephanie Nantz, Allison Owen, Emily Roach, Alice Salthouse, Chris Shank, Kristen Spaduzzi, Gretchen Taylor, Hugh Tilson, Jr., Patrick Woodie; Staff: Ashley Rink

• Welcome and Agenda Overview
  • Lavondia Alexander welcomed everyone and reviewed the agenda.
  • The following guests were in attendance as panelists to provide feedback on policy action plans.
    • Emily Roach, Director of Policy and Strategic Planning at NC Department of Commerce
    • Kathy Batton, Communications and Engagement Manager at NC Medicaid
    • Katherine Restrepo Martin, Senior Advisor for Health Affairs to the President of the University of North Carolina System Office
    • Patrick Woodie, President and CEO of the North Carolina Rural Centers
• Grounding and Level Setting
  • Lavondia Alexander reviewed the ground rules, Year of Action asks, roles and expectations, and timeline. 
  • At the previous work group meeting, the group continued developing action plans.
  • The Co-Leaders for the Primary Care Clinicians Work Group are Lavondia Alexander, Leslie Mason, and Gretchen Taylor.
• Policy Review
  • Gretchen Taylor reviewed the 2023-2024 policy priorities and related action plans the work group has been working on.
    • Leverage Medicaid, including Medicaid Expansion, to support the viability of all primary care clinicians, especially in rural settings.
    • Increase funding and strategic deployment of loan repayment programs for providers.
    • Expand healthcare provider training onsite in rural communities.
• Panelist Discussion of Action Plans
  • The panelists provided feedback on recommendations for lead agencies and action plans for each of the policy priorities.
  • The group acknowledged they were moving in the right direction and a need to consider feasibility before identifying deadlines for action steps.
• Next Steps
  • The co-leaders, Lavondia, Leslie, and Gretchen will follow-up with the panelists that expressed being involved about next steps and how they could be involved in May.
  • The next work group meeting will be on Monday, June 17, 2024, from 3:00 to 4:45 pm on Microsoft Teams.

Monday, February 19, 2024, from 3:00 to 4:45 pm, Microsoft Teams- Work Group Meeting

Attendees: Lavondia Alexander, Elizabeth Hudgins, Leslie Mason, Lisa McKeithan, Maggie Sauer, Kristen Spaduzzi, Gretchen Taylor, Hugh Tilson, Jr.; Staff: Ashley Rink

• Welcome and Agenda Overview
  • Lavondia Alexander welcomed everyone and reviewed the agenda.
• Grounding and Level Setting
  • Lavondia Alexander reviewed the ground rules, Year of Action asks, roles and expectations, and timeline. (Refer to the slides for additional information on these topics.)
  • At the previous work group meeting, the group began asset mapping and developing action plans.
  • The Co-Leaders for the Primary Care Clinicians Work Group are Lavondia Alexander, Leslie Mason, and Gretchen Taylor. The co-leaders are meeting in the odd months.
• Action Planning
  • Gretchen Taylor reviewed the identified priorities:
    • Leverage Medicaid, including Medicaid Expansion, to support the viability of all primary care clinicians, especially in rural settings.
    • Increase funding and strategic deployment of loan repayment programs for providers.
    • Expand healthcare provider training onsite in rural communities.
  • Review Action Plan StepsThe work group broke into the following policy subgroups for action planning discussions.
    • Policy 1: Lavondia Alexander, Kristen Spaduzzi, and Hugh Tilson, Jr.
    • Policy 2: Lisa McKeithan and Gretchen Taylor
    • Policy 3: Leslie Mason and Elizabeth Hudgins
  • Subgroup Discussions
    • The subgroups were asked to consider what could be implemented between now and July 2024. 
• Group Report
  • Group report outs were as follows. (For additional information refer to the notes for each policy subgroup.)
    • Policy 1:
      • Identified potential lead agencies to be involved and engaged partners.
      • The results on minimum primary care spending are ongoing, there is a need to evaluate those results to determine appropriate next steps for short-term actions.
      • Engagement with the Department of Commerce and recommendations for them for the five-year plan.
    • Policy 2:
      • Action steps identified included inventorying the medical schools (including NPs and PAs), to see what kind of programs are available and work with UNC system and ECU schools to do intentional program marketing.
      • There is a need to do a deep dive into the legislative increase in the last budget.
      • Maggie Sauer shared work being done related to the legislative increase from the last budget (House Bill 259). There were a number of providers in that bill that are receiving loan repayment that had not done so previously.
      • Socializing (providing an opportunity for comments and feedback) a draft of what the loan application could look like were various groups, including this work group, the provider groups, Medical Society, CCP program, community practitioners, Sheps Center, AHEC, and other groups.
    • Policy 3
      • Reviewed the notes from the previous group meeting and prioritized some of the strategies.
      • The two key priorities identified were standing up 3 to 5 rural professional teaching hubs and looking at investment structures for rural and primary care.
      • These actions will be done through partnerships.
• Partner Discussion
  • The following recommendations were discussed for speakers to invite to the next group meetings to provide feedback on action planning.
    • Kenny Flowers, Assistant Secretary for Rural Economic Development at the North Carolina Department of Commerce, or someone from the Department of Commerce that could share about their community investment and strategies to make communities viable.- Maggie Sauer to contact.
    • Katherine Restrepo Martin, Senior Advisor for Health Affairs to the President of the University of North Carolina System Office- Hugh Tilson can coordinate with Katherine on her thoughts about primary care, including medical schools and PA and NP schools.
    • Maggie Sauer, Stephanie Nantz, and Lisa McKeithan, from the Office of Rural Health with the Department of Health and Human Services can do a presentation about some of their thoughts around loan repayment at the April meeting for about 20 minutes with 10 minutes for questions.
    • Patrick Woodie, President and CEO, NC Rural Center- Maggie Sauer to contact.
    • Reginald Speight, State Director for North Carolina, Rural Development, USDA- Maggie Sauer to contact.
    • The co-leaders will share the meeting details with those contacting speakers.
  • The next work group meeting will be on Monday, April 15th from 3:00 to 4:45 pm via Microsoft Teams.

Monday, December 18, 2023, from 3:00 to 4:45 pm, Microsoft Teams- Work Group Meeting

Attendees: Lavondia Alexander, Elizabeth Hudgins, Maggie Sauer, Chris Shank, Kristen Spaduzzi, Gretchen Taylor, Hugh Tilson, Jr., Christopher Vann, Adam Zolotor; Staff: Ashley Rink

• Welcome and Agenda Overview​ 
  • Lavondia Alexander welcomed everyone and reviewed the agenda.  
• Grounding and Level Setting​ 
  • Lavondia Alexander reviewed the ground rules, Year of Action asks, roles and expectations, and timeline. (Refer to the slides for additional information on these topics.) 
  • At the previous work group meeting, the group reviewed the 2022-2023 priorities and updated the priorities for 2023-2024. The work group decided on three priorities. The work group will begin to develop and implement action plans and update progress throughout the next meetings.  
  • The Co-Leaders for the Primary Care Clinicians Work Group are Lavondia Alexander, Leslie Mason, and Gretchen Taylor. The co-leaders are meeting in the odd months.  
• Priority Review​ 
  • Gretchen Taylor reviewed the identified priorities and suggested revisions. The changes are highlighted in yellow.   
  • Work group members shared relevant updates related to each of the priorities. 
• Action Planning​ 
  • The work group broke into the following policy subgroups for asset mapping discussions. (For additional information refer to the notes for each policy subgroup.) 
    • Policy 1 Subgroup: Medicaid- Kristen Spaduzzi and Lavondia Alexander 
    • Policy 2 Subgroup: Loan and Scholarships- Maggie Sauer, Hugh Tilson, and Gretchen Taylor 
    • Policy 3 Subgroup: Provider training- Elizabeth Hudgins and Adam Zolotor; Notetaker- Ashley Rink  
  • The following asset mapping questions were shared to guide discussions.   
    • What lead agencies should be engaged and/or involved? 
    • What are recommended lead agencies? 
    • What are short-term action steps or strategies (1 to 2 years)? 
    • What are long-term action steps or strategies (5 years or more)?  
    • Decide as a work group what is considered short versus long-term. 
    • What partners should be engaged? 
    • What resources (materials, money, staff, and/or other assets) are needed? 
    • What are action steps to advance this priority based on the previous questions? 
• Review of Action Steps​ 
  • In February, the policy subgroups will continue to develop action plans, including mapping agencies to engage, strategies to accomplish these policies, and identify metrics of success.  
  • After action planning in February, the work group will try to implement pieces of the action plan between then and the Community Council’s Annual Meeting in July 2024.  
  • Subgroups are welcome to meet before the next meeting in February.   
  • Policy 1 Subgroup shared there was a need to align what several lead agencies are working on related to Medicaid and Medicaid Expansion and opportunities for them to share what they are doing and then go from there.  
  • Policy 2 Subgroup shared the most important step to start with was to do an inventory of what was going on with loans and scholarships and how those might align with existing programs, if at all.  
• Adjourn 
  • The next Primary Care Clinicians Work Group meeting is scheduled for Monday, February 19, 2024, from 3:00 to 4:45 pm via Microsoft Teams.  

Monday, October 16, 2023, from 3:00 to 4:45 pm, Microsoft Teams- Work Group Meeting

Attendees: Lavondia Alexander, Patrick Brown, Elizabeth Hudgins, Leslie Mason, Lisa McKeithan, Stephanie Nantz, Alice Salthouse, Maggie Sauer, Kristen Spaduzzi, Gretchen Taylor, Hugh Tilson, Jr., Christopher Vann, Adam Zolotor

• Welcome and Agenda Overview
  • Lavondia Alexander welcomed everyone and asked for introductions. The icebreaker question was what they were concerned and excited about for the work group for the year of action. (Refer to page 5.)
  • The Co-Leaders for the Primary Care Clinicians Work Group are Lavondia Alexander, Leslie Mason, and Gretchen Taylor.
• Grounding and Level Setting
  • Lavondia Alexander reviewed Health Indicator 17: Primary Care Clinicians from Healthy North Carolina 2030. Refer to the 2023 NC SHIP report for the updated indicator data and information at https://schs.dph.ncdhhs.gov/units/ldas/docs/NCSHIP-2023-101723.pdf or https://schs.dph.ncdhhs.gov/units/ldas/docs/17-PrimaryCareCliniciansIndicator2023NCSHIP.pdf.
  • The Year of Action asks, roles and expectations and timeline, were also reviewed. Refer to the slides for additional information on these topics.
• Priority Review
  • Leslie Mason shared the purpose of the priority review was to determine if each priority is clearly stated, actionable, resourced, and will continue to be a priority.
  • The 2022-2023 priorities were:
    • Leverage Medicaid, including Medicaid Expansion, to support the viability of all primary care clinicians in rural settings
    • Increase funding for provider loan repayment programs
    • Expand healthcare provider training onsite in rural communities
  • The revisions from the discussion will be shared back with the work group for review. 
• Action Planning
  • Lavondia Alexander shared action planning would include ensuring the work group has the support needed from the state, other outside groups, and interested parties.
  • The work group began action planning for, “Expand healthcare provider training onsite in rural communities.” 
• Review of Action Steps
  • For next steps, work group members were asked to:
    • Review the updated priority list.
    • Come prepared to the next meeting with ideas for action planning, including what agencies, programs, and/or current initiatives could support the priorities and actions.
• Adjourn
  • The next Primary Care Clinicians Work Group meeting is scheduled for Monday, December 18, 2023, from 3:00 to 4:45 pm via Microsoft Teams.

• American Academy of Family Physicians: Primary Care Spend (October 2021): https://www.aafp.org/dam/AAFP/documents/advocacy/payment/apms/BKG-PrimaryCareSpend.pdf
• Human Services Department: Graduate Medical Education Expansion in New Mexico Five Year Strategic Plan (January 2022): https://www.hsd.state.nm.us/gme-expansion/
• NCDHHS Office of Rural Health- Health Professional Shortage Area 2022 Profile (June 2023): https://www.ncdhhs.gov/nc-dhhs-orh-hpsa-one-pager/open