In this episode we hear from Chris Weathington, Director of Practice Support for North Carolina Area Health Education Centers, about how his organization provides training and resources to enable practices to focus on value rather than spending time on administrative burdens, thereby freeing up providers to better focus on patient care.

Chris Weathington, welcome to the Move to Value podcast.

Well, thank you for having me.

Great. So Chris, for our listeners that may not be familiar with you, can you give us a little bit, tell us a little bit about yourself and your background?

Sure. Well, I, I'm the director of practice support at North Carolina Area Health Education Centers, otherwise known as NCAHEC. I'm originally from Eastern North Carolina in small town called Winterville in Pitt County. My background is I've been working in Health Administration for a very long time, mostly working in a large health system but working largely with primary care and in the field of practice management and business development over the years. I've worked extensively in rural health helping providers figure out how best to survive and thrive with value-based care. So my educational background is about a master's in Health Administration and Bachelor of Science in public health from UNC Gillings School of Public Health. So, I'm a true Tar Heel, but I've been in North Carolina my entire life.

Great. That's great background, Chris. Thank you. And go Heels. So, you mentioned currently you're the director of NCAHEC practice support. Tell us about NCAHEC. Give us a little bit more and specifically what your role is and what your team that you ever see does.

Sure. Well, North Carolina, AHEC was established in the early 1970s. It's been around for about 50 years. It's a state agency. Our program office is based out of the UNC School of Medicine and we have 9 regional AHEC centers located throughout the state, many of them part of large health systems and some that are independent 501c3 not-for-profits. So they're geographically dispersed in Asheville, Charlotte, Winston Salem, Greensboro, Raleigh, Wilmington, Greenville, Rocky Mountain, Fayetteville, and Greensboro. And the mission of AHEC is to recruit, train and retain the state's health workforce. As you know, we have significant health workforce challenges if we didn't have them already prior to COVID. So practice support is one of several offerings or service lines, if you will, to fulfill that mission. So in practice support, we are committed to helping train and retain the state's health workforce. So working largely with practices in rural and underserved areas, primary care safety net providers such as FQHCs and rural health clinics and health departments, specialist and behavioral health providers, helping them to stand on their own two feet and working in doing that in partnership with accountable care organizations and CINs such as yourself over at CHESS. So that's really what we're all about. And in the value-based world, while practices are working in the Fee-for-service model, which still is around maybe a little bit less, but it's still largely there, helping practices not only function in that environment, but also survive and thrive with value based care. And that's hard and it's hard work, but that's what we're committed to do.

That's a great mission and, and you guys do great work. I love meeting with you and hearing about how things are going throughout the, the state and healthcare. You guys have a great pulse on that always. And as you mentioned, one of the things that you guys or one of the areas you really focus on really is in the rural communities. And as you know, much of the care in North Carolina is delivered in those rural communities. And, and what role can you talk a little bit more about the role that your team plays in helping rural and underserved areas adapt to the rapidly changing healthcare landscape?

Sure. We have 42 practice support coaches dispersed all across the 9 regional AHEC centers. And each of those coaches works with a portfolio of the practices that I just described. Many of our coaches have backgrounds and practice management, quality improvement, health information technology, behavioral health, health education, and, and some of them are actually clinicians. We have nurses and, and clinicians that are part of our group. We have a medical director, Doctor Adam Zolotar, who's a family physician at the UNC Department of Family Medicine, myself and several dedicated team members at our program office to support these practices. But we work with these practices on a wide range of practice support needs. We meet them where they are, and we I mentioned earlier we helped them stand on their own two feet. So when we sit down with the practice, we take a very much a needs-based approach to see what it is that keeps them up at night and that may be working with them on quality improvement, it may be working with them on revenue cycle management. It might be or been working with them on community health worker integration or behavioral health integration. So it depends on what they're most interested in. And so we work with close to 1,100 sites spread out all across the state of North Carolina. And as I mentioned earlier, we partner with ACOs and CINs to do that if the practice is a member of one of those organizations. And we work very closely with North Carolina Medicaid and Department of Health and Human Services. They're a very significant partner of ours. And we also work in collaboration with the professional organizations both in primary care and specialty care to fulfill that work. So that's kind of what we offer in a nutshell. And it's all no cost, by the way, we do not charge for our services.

Yeah, that's I'm sure that is a huge satisfier for the 1,100 practices that you guys help to support. That's not a small thing. So amazing work and I love the concept of the needs-based approach that you guys take. We at CHESS take a very similar approach and how we help folks in that transition to value-based care. So curious your thoughts as you guys across these practices that you work with and looking at their needs, is there a common thread or something that that stands out as the most significant resource or technology or support that that AHEC provides to these practices in rural communities?

Well, as you know, the administrative burden for practices as well as the clinical burden is very, very high. If, if anything, it's more intense than it ever used to be. Whether it's commercial health plans or Medicaid or Medicare, there's a lot of hurdles that practices have to overcome through either prior authorizations, getting paid in a timely manner or in an accurate manner, more regulations and requirements, and there's a lot of good things in there. But it also presents a hurdle for independent practice and safety net providers to overcome versus those that are part of large health systems. Not that problems don't exist there too, but when you are resourced more lean and mean, if you will, your mom and pop type organization it, it's harder. So where we where we typically help practices in terms of most stuff that's most in demand, I would say selecting or optimizing their electronic health record to get data out, integrating their electric electronic health record in a way that meets their needs with their clinical and administrative work flows. Billing and coding is a very common request. Figuring out how to do things more in a more standardized way across all patients and all payers in doing so with fewer resources. So they're not blessed with a lot of staff, if you will. So, they got to figure out how to do things in a smart way and still get the work done at the end of the day. So there are a number of things that practices are working on that seem to be pretty, pretty constant. I would say some of the newer things that we're seeing folks in terms of innovation is the interest in behavioral health integration with something such as called the collaborative care model. It's not the only model out there, but it's one that we are heavily involved in community health worker integration. And then, and then also trying to figure out how to align all of the quality-of-care requirements from all the various payers and see how, how can we get the information out and do the work, close the care gaps, if you will, in a way that is streamlined and easy to manage. So there's no, there's several hot potatoes, but there's a lot of them in in the oven.

Yeah, that's great. We'll, we'll hit on the behavioral health here in, in just a minute. And I know you guys, you've mentioned heavily working on optimizing the EHR, building those workflows, the HR and I know you guys have done a lot of work in that over the years as meaningful use came on online and, and helping them support practices and did a lot of great work there. Another giant sort of elephant in the room, if you will, has been the Medicaid managed Medicaid transformation. And how do you practice support teams assist practices with that transition?

Sure. Well, since Medicaid managed care go live, we've helped practices address issues that have come to the table, whether it's a contracting need or they're trying to address a, a payment issue that's occurring where they're not getting paid in a timely manner or in an accurate way. You know, the, the folks that work at the health plans are all good people. And I, I think there are a lot of success stories out of Medicaid managed care, but there are also some challenges. And I think we all can appreciate the admin burden is very high dealing with so many different plans and they're, they're not all the same, if you will. But so practices used to just have to file their claims to one entity now. And it's, well, it was 5 standard plans. So now you've got several tailored plans. And then you've got the foster care children that will eventually roll out into Medicaid managed care at some point. So helping practices just understand the environment that they're in and operating in a way that's most effective for them, while still at the same time trying to address the access needs for quality health care for it for every member on who is covered by Medicaid. And you know, it's, it's not too different to me than what you may see in the Medicare Advantage market. So, you know, they're just a lot more payers out there versus what typically was just your Medicare, your Medicaid and your Blue Cross Blue Shield North Carolina and a few small ancillary ones, maybe Tricare, but that was it. Now there's a lot more and it requires when you're when you're not able to do this in a way where you can add more staff or hire more staff or pay more staff more money based on their subject matter expertise. It's really, really hard. We're you've seen so much turnover in practice managers and even in in clinicians as well. You know, a lot of folks have moved on and retired with the great resignation after COVID. So that's aggravated the situation with Medicaid managed care, but that's true across all payers. So we're just trying to help them with issue resolution and also help them figure out how to provide quality care that aligns with the quality measures that are outlined by Medicaid and other payers.

Yeah, that's great. Chris, you talked about the administrative burden is extremely high on these practices and having been in practice management pre managed Medicaid myself before value-based care, it was already high and and I know these things are continue to be challenges for practice management and physicians and these private practices. What would you say are the key challenges and or the opportunities for private practices in North Carolina as we shift the value-based care? Do you have any specific things that that you think are standing out as challenges to them or ways that they maybe be more excited about how that opportunity is coming about North Carolina through MSSP, through ACO REACH now Making Care Primary and those sort of initiatives. Can you talk about that a little bit?

Well, you know, I think it's also a mindset of do you look at the glasses half full or half empty. So, I think if when folks try to focus on strategic priorities for the practice and established performance metrics that for those priorities. And I think if you keep your eye on the ball for those that matter the most to you. And that is how you measure your own success versus trying to do so many things and make everyone happy. That's really hard to do when you're a small practice. So what we, I, I've always enjoyed seeing is when a, when a practice manager has got on a spreadsheet, a list of all of, of the contracts that they participate with, what their rates of reimbursement are and what are the quality measures that they're held accountable for? And what is their performance related to those quality measures? They can sort of take a look and see what do that need to do better on this year? What are going to be my goals for the coming year and, and try to do better and what do I need to maintain? And maybe there's some things here that I just need to reassess whether to be involved in at all. And so I think every practice is or practice manager is a little different in what their priorities are. One of the things we're particularly proud of with is something called the practice manager Academy. As we've seen a lot of new people in going into the profession. But we also see people who've been recently promoted, maybe they were the nurse for 20 years and now they've been put into the practice manager role, or maybe they work the front desk and now they're being put into that role. Is the need to learn basic leadership in the management skills. And so we, we offer a curriculum focused on human resources, financial management, quality improvement, health information technology, and it's all on demand and at very low cost for practice managers not only to learn from us, but to learn from each other and to network with each other. So that's something we've been very proud of. I think to date, right now we've got it close to 350 practice managers taking our curriculum and that's done in partnership with the North Carolina Medical Group Management Association. We're getting ready to expand that to dental practice managers sometime this fall. So that's something we're particularly proud of. And, and the other thing I'm particularly proud of is some of the practice managers that have rolled up their sleeves to figure out how to integrate behavioral health or a community health worker into their work, which is something they have historically not had any experience doing. So those are some of the neat things we talked early about challenges. I, I do think they're practice managers and you sit down with them asking what are they most proud of? They probably will say something where we expanded appointment access or, or we did better on our revenue cycle management or we were able to, to, to implement to close some quality-of-care gaps that we historically haven't done with adult diabetes or trans transitions of care or hypertension or pediatric immunization. So it probably varies from practice to practice, but I think those are some of the highlights of what I would think probably are things that are practice managers could be proud of.

Chris, this has been a great conversation. Would you mind sticking around for a few more minutes to continue the conversation?

Josh, I'd be happy to,