Tara Robinson, RN, MSN, MBA, CCM Jamie Philyaw

Tara Robinson, RN, MSN, MBA, CCM
Jamie Philyaw, MSW, CCM
Elizabeth Tilson, MD, MPH
Executive Director
Network Director
Medical Director
Community Care of Wake and Johnston Counties
Electronic Medical Policy Meeting – August 2016
Click the boxes below to view the intended information.
Each section contains a Return to Menu link to bring you back to this page.
We have moved – New Address
4207 Lake Boone Trail, Ste. 100
Raleigh NC 27607
Measles Case – This news release
give details on the confirmed
measles case in Wake County
Here is a summary of some recent NC Tracks Changes
Medicaid Transformation Waiver Process and Status
– The first draft of the Waiver Application was
submitted to the Federal Government on June 1st. A
public comment period was open until July 20th and
more than 1,800 comments were submitted. Some
themes of the comments included: 1) Consideration
for Medicaid expansion; 2) Concern about the
administrative complexity of multiple Pre-Paid Health
Plans (Managed Care Organizations and Provider Led
Entities); and 3) Support of the success of the CCNC
infrastructure. Three recent editorials capture the
flavor of the comment – Editorial #1, Editorial #2, and
Editorial #3. The expected time frame of a transition
is still about 3-4 years, giving us all a good runway to
make a transition to a new way of working together.
Motivation Interviewing Primer – In assessing a
patient’s motivation to change, it can be helpful to
tease out the importance a patient places on making a
change from their confidence in making a definitive
action. A Readiness Ruler can help assess these
elements.
Please join us for our PCMH
Learning Collaborative sessions
Transitions Life Care Pediatric Hospice and Palliative
care services extended to Johnston County
Behavioral Health/Integrated Care
A new billing guide for behavioral health and social
emotional screens, including post-partum depression,
should be coming out soon. We will be sure to send that
guidance as soon as it is finalized.
Tedra Anderson-Brown, MD, Medical Director for Alliance
Behavioral Health Care prepared this overview and
update of Alliance and what directions and investments they
are making to expand needed services. Because of the
changing provider network and range of services, it is
probably most efficient to utilize the Website http://www.alliancebhc.org/ or the ACCESS and Information
24/7 Line 1-800-510-9132. They will be working on
providing feedback to providers when referrals are made
through the Access Center. They are also supporting colocation models of care.
Opioid Overuse Epidemic – Opioid Use, Misuse, and
Unintentional Overdose are major public health and
health care issues. This is an issue for not just patients
who are using opioids, but also for children, teen agers,
and other family members who may have access to
opioids being used by someone else in their household.
More ready access to Naloxone, that can reverse an
overdose, is one of the tools we have to address this
issue. A new Statewide Standing Order for Naloxone
is in effect. This presentation briefly describes the
epidemic, the pharmacology of Naloxone, persons at an
increased risk for an unintentional overdose, and the
details of the standing order. In short, a patient, family
member, or social support member can go to a
pharmacy and request Naloxone without a specific
order from their individual physician.
Community Care Physician Network (CCPN) –
Excitement about CCPN has been very strong. Within the
first 6 months, CCPN has surpassed the first year goal of
bringing on 1000 clinicians and as of July 31st, there are
1,032 CCPN provider members serving patients in 294
practices statewide. This August CCPN newsletter gives
some of the latest information and numbers. The Quality
Committee and Payor Contracting Committees have been
formed. If you are interested in joining one of these
committees, please let me know. Also a free, two-part
webinar Getting Paid with MACRA — a Look into the
Future … is being offered to help practices prepare for
changes coming in Medicare. Information on the
webinars can be found on the left side of the newsletter.
For our Wake Johnston network, we have 130 provider
members serving patients in 44 practices. This make us
the second largest network in terms of practices and 3rd
largest in terms of providers. This also makes us eligible to
nominate a representative to the CCPN Board of
Managers. This is a draft of a proposed process for
submitting this nomination and a draft letter that describes
the role. The thought is to have a window for soliciting
nominations from September 1 through September 23rd.
Please let me know if you have thoughts on this process or
if you would like to be considered as a potential nominee
for the Board of Managers.
Quality Improvement
Practice Transformation Network update – This is the
4 year federal grant CCNC received to help practices
make the change from fee-for-volume to fee-for-value.
Our PTN coach has been our QI specialist and is a
Certified Content Expert in Patient Centered Medical
Home. She is working with 13 practices, including 2
Behavioral Health Practices, on PTN activities and the 5
stages of transformation. Part of the activities also
includes the promotion of integrated care. 2 primary
care practices are working to incorporate a behavioral
health provider and one of the Behavioral Health
practice is working on incorporating a physical health
provider.
Real time ED visit reports – One tool that can be helpful
to address Emergency Department Utilization, is the
population, practice and patient level reports that show
patients who have recently been in the ED. This
presentation shows how you can access this report in
Provider Portal. We are happy to work with your practice
to get these reports for you and to help think about
workflows to utilize these population level reports.
Please contact Betsey Tilson ([email protected]) or 919-792-3661 or one of the Provider Services Team
members with any questions or interest in further information.
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NEWS RELEASE
Contact: Wake County Division of Public Health
Elizabeth Brandt, Communications Specialist, 919-623-4763
Communications Office After Hours
wakegov.com/news
Date: Aug. 2, 2016
Measles Case Confirmed in Wake County
Immunization is the best protection from the disease
The Wake County Human Services Division of Public Health has confirmed one case of
measles in the county. The patient showed symptoms of the disease after returning from travel
overseas.
People who received two doses of the vaccine for measles as recommended are considered
protected from the virus for life. For people who have not been immunized, the disease is highly
contagious.
People may have been exposed to measles at the following locations, dates and times:
RDU International Airport
Hunter Street Park, 1250 Ambergate Station, Apex
Cary YMCA, 101 YMCA Drive, Cary
NCSU Lee Residence Hall, 2500 Sullivan Drive,
Raleigh
UPS Store, 2054 Kildaire Farm Road, Cary
Coastal Credit Union, 2024 Kildaire Farm Road, Cary
SportHQ, 107 Edinburgh South Drive, Suite 100A,
Cary
NextCare Urgent Care, 1110 Kildaire Farm Road,
Cary
WakeMed Cary Emergency Dept., 1900 Kildaire Farm
Road, Cary
7/24/16
7/24/16
7/25/16
7/26/16
7/25/16
7/26/16
7/25/16
2:00 p.m. – 4:30 p.m.
6:00 p.m. – 8:00 p.m.
9:00 a.m. – 10:30 a.m.
9:00 a.m. – 10:30 a.m.
12:15 p.m. – 4:00 p.m.
7:15 p.m. – 10:15 p.m.
8:00 p.m. – 12:00 a.m.
7/26/16
7/26/16
7/26/16
7/28/16
2:00 p.m. – 4:30 p.m.
4:45 p.m. – 7:00 p.m.
2:00 p.m. – 4:30 p.m.
10:00 p.m. – 1:00 a.m.
7/31/16
1:50 p.m. – 4:50 p.m.
7/31/16
3:00 p.m. – 9:30 p.m.
Measles is spread through the air when an infected person coughs or sneezes. Symptoms
begin with a fever, cough, runny nose and red, watery eyes. These symptoms are followed by a
rash that typically appears first on the face, along the hairline or behind the ears, that then
spreads to the rest of the body. Complications can include pneumonia, diarrhea and ear
infections. Severe complications can be fatal. Infants, pregnant women and people with
weakened immune systems are more at risk of complications from measles.
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If you are experiencing symptoms of measles and have not been vaccinated, call your doctor
right away. Your doctor can help determine if you are immune or can make special
arrangements to evaluate you without putting other patients and medical staff at risk.
Immunization is the best protection from measles. Two doses of the MMR (measles, mumps
and rubella) vaccine are about 97 percent effective at preventing a person from contracting the
disease if exposed to it. Two doses are recommended for school-aged children. They should
get their first dose at 12 to 15 months of age; the second dose is usually given at four to six
years of age, but may be given sooner.
People who are traveling internationally should make sure to receive adequate MMR
vaccination.
If you have questions about measles in Wake County, you can reach a public health specialist
at 919-728-5233. For more information about measles, visit
http://www.cdc.gov/measles/index.html.
###
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2016 DATES
MAY 17
JUNE 21
JULY 19
AUGUST 16
PCMH 2014
LEARNING
COLLABORATIVE
Community Care of Wake and Johnston Counties
Main Conference Room : 12 – 2 PM
Join NCQA trained Certified Content Experts for an informal
meeting with other practices to ask questions and clarify PCMH
standards and guidelines. Please send any questions that you
would like answered to [email protected] by the second
Monday of the month. Feel free to bring your lunch.
SEPTEMBER 20
OCTOBER 18
NOVEMBER 15
DECEMBER 20
NEW
Address
!!
CCWJC
4207 Lake Boone Trail
Suite 100
Raleigh, NC 27607
919-480-9586
www.ccwjc.com
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Summary of NCTracks Changes – June & July 2016 Medicaid Bulletin
Direct Enrollment of Mid-Level Providers (June 2016 Bulletin, pg. 10)
Effective August 1 all mid-level providers must enroll with N.C. Medicaid and N.C. Health Choice. This includes Physician
Assistants, Nurse Practitioners, Certified Registered Nurse Anesthetists and Certified Nurse Midwives. Services can no
longer be billed as “incident to.” The mid-level provider’s NPI must be used for all orders, prescriptions and referrals.
NC Tracks now has a new Enrolled Practitioner Search feature to validate information billing, attending, referring,
rendering, ordering, and prescribing providers who are enrolled with NC Medicaid or NCHC.
Suggested Action: Use the Enrolled Practitioner Search screen to check for enrollment of mid-level practitioners
(https://www.nctracks.nc.gov/publicPortal/provider/PractitionerSearch.action). If no record is found by NPI or name
search, mid-level practitioner needs to begin enrollment process in NCTracks. If the record is found, be sure to verify the
service addresses and affiliations within NCTracks to make sure they are correct and up-to-date.
Claim Edit for Rendering Provider Service Location (July 2016 Bulletin, pg. 6)
NCTracks uses the rendering (attending/individual) provider’s NPI, taxonomy code and service location (address) on
claims to determine the appropriate rendering provider location code. Currently, if NCTracks is unable to locate the
rendering provider address in the system, Informational Edit 04528 (pay and report) is posted with the Explanation of
Benefits (EOB) 04528 on the Remittance Advice (RA), stating that NCTracks is unable to determine the rendering provider
location code based on the submitted address
 This was a temporary process to allow providers time to update records with correct rendering provider locations.
Effective November 1, the claim edit will change from “pay and report” to “suspend.”
 Rendering providers MUST have the addresses of ALL facilities where they provide services under their individual
NPI in NCTracks. Claims from facilities whose address is not listed as a location for the rendering provider on the
claim will suspend with EOB 04526 – “Rendering Locator Code Cannot be Derived.”
 When updating a provider record, NCTracks assigns a default effective date to most changes and edits against that
date for subsequent transactions. When adding/reinstating a service location, health plan, or taxonomy code the
default date can be changed prior to submitting the MCR.
Suggested Action: Review all locations listed on your individual provider records in NCTracks. Complete a Managed
Change Request (MCR) for incorrect or missing service location addresses where each provider renders services.
Affiliation Claim Edit (July 2016 Bulletin, pg. 5)
NCTracks requires rendering (individual/attending) providers to be affiliated with billing providers (groups) submitting
claims on their behalf. EOB 07025 currently posts for claims where the attending/rendering provider is not affiliated.
 The EOB advises that the rendering provider is not affiliated with the provider group and to complete a MCR to
add the provider group NPI on the affiliated provider page to prevent claim denial.
 The disposition of this edit was set to “pay and report” meaning claims were not denied. The intent was to alert
providers about situations with no affiliation so the affiliation could be completed.
 Effective November 1, the claim edit disposition changes from “pay and report” to “suspend.”
 Claims failing the edit will be suspended for four weeks and then denied if affiliation is not established.
 The MCR to establish/change affiliation must be initiated by the Office Administrator of the individual
attending/rendering provider, not by a group or hospital that acts as a billing provider.
Suggested Action: Review all group affiliations listed under your individual provider record in NCTracks. Complete an
MCR for incorrect or missing affiliations to group practices where each provider renders services.
Providers may contact CSRA (formerly CSC) Call Center at 1-800-688-6696 (phone), 1-855-710-1965 (fax) or at
[email protected] (email) for assistance.
7/6/16 CCNC V1
It takes a
community
to provide a full
circle of care.
Service Area
Orange
County
Chapel Hill
Carrboro
•
Durham
County
•
Wake
County
Johnston
County
Service in Orange County is available in the shaded area only.
Transitions LifeCare (founded as Hospice of Wake
County) provides a variety of expert care and support
services in the Triangle area.
Make a donation. Transitions LifeCare is
a 501(c)(3) non-profit committed to serving all
patients regardless of their ability to pay. We rely
on the generous support of our community. Please
consider making a tax-deductible donation to help
us include all those in need within our circle of
care. To learn more about ways you can give, visit
transitionslifecare.org/donate.
Serving
Children With
Serious Illness
250 Hospice Circle • Raleigh, NC 27607
919.828.0890 • transitionslifecare.org
7/16 5C
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Care Team
The care team may include a physician, nurse
practitioner, nurse, aide, family support counselor,
spiritual care counselor, grief counselor, and volunteer.
The child’s current physician also serves as a member of
the Transitions Kids team. The purpose of the team is to
embrace the child and family in a circle of care, which
includes regular home visits during the week, with afterhours backup by nurses.
Transitions Kids, a division of
Transitions LifeCare, provides holistic,
supportive care in a competent,
compassionate, and consistent
manner to children (birth-18 years
old) with life-limiting and/or lifethreatening conditions and their
families. The goal is to provide homebased care for the child and family
that is focused on enhancing quality
of life by reducing physical and
emotional pain and distress.
We accept Medicaid, private/
commercial insurance, and other
third party payment.
True to our non-profit heritage,
Transitions Kids provides care
regardless of the family’s ability
to pay.
Physician
Child’s
existing
doctor
Nurse
Nurse
Practitioner
Hospice
Aide
Child and
Family
Family
Support
Counselor
Volunteer
Grief
Support
Counselor
Spiritual
Care
Counselor
For more information,
contact your child’s current physician or visit us
online at transitionslifecare.org/kids.
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MOTIVATIONAL INTERVIEWING (MI)
MOTIVATION = Importance + Confidence
In assessing readiness to change, we should increase our ability to ‘tease out’ if our patients who are
struggling are facing low importance or low confidence. One tool often used in MI is the
‘readiness ruler’. We ask how important patients view the problem then ask how confident they
feel that can take definitive action.
IMPORTANCE
“On a scale of 0 to 10, with 10 being very important, how important is it for you to change?
0
1
2
3
4
5
6
7
8
9
10
Not at all
Somewhat
Very
INTERVENTION: If the problem doesn’t seem important enough, we take time to educate,
inform, and evoke possible consequences.
Don’t forget to discuss the scaling…ex. “Why did you chose a 5 instead of a 3 ?
“What would have to happen for you to move to an 8 ?”
CONFIDENCE
“On a scale of 0 to 10 with 10 being very confident, how confident are you that you can change?
0
1
2
3
4
5
6
7
8
9
10
Not at all
Somewhat
Very
INTERVENTION: If our patient lacks confidence, we point to previous successes, break the goal
into smaller steps, address barriers, and point out social support for the health change.
Strategies to increase Importance and Confidence:\
Elicit and reflect change talk (remember DARN desire, ability, reason, need.)
Explore goals and values
Highlight personal strengths and supports
Brainstorm for solutions
Hypothetical Change “I wonder if…..”
Wake County Medical Policy Meeting 8.4.2016 ***Attention Medicaid Providers and Pharmacies***
Important Information Regarding the Statewide Standing Order for Naloxone
On June 20th, 2016, the state law establishing a statewide standing order for naloxone dispensing was signed into
law. This statewide standing order, which serves as a broad prescription, allows any pharmacist licensed in NC to
dispense naloxone to any patient who meets the standing order criteria without first receiving a traditional (handwritten, phoned, faxed) prescription. The standing order does NOT make naloxone available over-the-counter (OTC)
and it does NOT give the pharmacist prescribing authority because the pharmacist is still dispensing naloxone
pursuant to an issued prescription from a prescriber.
The North Carolina Department of Health and Human Services (“NC DHHS”) has set up a website to educate
pharmacists and the public about the statewide standing order. It may be found at www.naloxonesaves.org.
Does my pharmacy need to notify the Division of Public Health (“DPH”) that we intend to dispense naloxone
under the statewide standing order?
 Although not a requirement, DPH does ask that your pharmacy notify them through the form on
www.naloxonesaves.org if your pharmacy decides to dispense naloxone under the statewide standing order.
Who is eligible to receive naloxone under the standing order?
 Persons who voluntarily request naloxone and are:
1. At risk of experiencing an opioid-related overdose
2. The family member or friend of a person at risk of experiencing an opioid-related overdose
3. In the position to assist a person at risk of experiencing an opioid-related overdose
 Ultimately, it’s up to the clinical judgment of the pharmacist to decide who’s at risk for overdose; however, the
standing order provides a non-exhaustive list of examples for those who may be at risk for overdose.
Can a pharmacist initiate a conversation with a patient about naloxone even though the standing order says that
the patient must “voluntarily request” naloxone?
 Yes. If a pharmacist identifies a patient whom the pharmacist believes may be at risk for overdose, that
pharmacist may initiate a conversation with the patient to determine whether he or she would like to receive
naloxone. At that point, if the patient indicates a desire to obtain naloxone, he or she would be considered to
have “voluntarily requested” the drug under the standing order.
What naloxone products are covered under the standing order?
 Narcan® Nasal Spray and generic naloxone ampules/syringes/vials can be dispensed under the standing order.
These products are preferred on the NC Medicaid and Health Choice Preferred Drug List. Private insurance and
Medicare Part D coverage will vary according to plan. If a patient does not have insurance or their insurance
will not cover naloxone, they can pay the cash price for naloxone which will vary by location.
Where can I find more information about the statewide standing order for naloxone?
 More information can be found on www.naloxonesaves.org, including more FAQs, patient education handouts,
a map of all pharmacies dispensing under the standing order, and local treatment resources.
Thank you for your support in serving our Medicaid and Health Choice communities!
Created 7/14/16
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North Carolina State Health Director’s Standing Order for Naloxone
This standing order signed by the North Carolina State Health Director authorizes any pharmacist practicing in the state of
North Carolina and licensed by the North Carolina Board of Pharmacy to dispense the following Naloxone products to
persons as directed below.
Naloxone HCI Dispensing Protocol
Eligible Candidates
Route(s) of
Administration
Medication and
Required Device for
Administration
Directions for Use
Refills
Contraindications
Patient Education
Notification of
Participation
 Persons who voluntarily request Naloxone and are at risk of experiencing an opiate-related
overdose, including, but not limited to:
–
Current illicit or non-medical opioid users or persons with a history of such use
–
Persons with a history of opioid intoxication or overdose and/or recipients of emergency
medical care for acute opioid poisoning
–
Persons with a high dose opioid prescription (>50 morphine mg equivalents per day)
–
Persons with an opioid prescription and known or suspected concurrent alcohol use
–
Persons from opioid detoxification and mandatory abstinence programs
–
Persons entering methadone maintenance treatment programs (for addiction or pain)
–
Persons with opioid prescription and smoking/COPD or other respiratory illness or
obstruction
–
Persons with an opioid prescription who also suffer from renal dysfunction, hepatic disease,
cardiac disease, HIV/AIDS
–
Persons who may have difficulty accessing emergency medical services
–
Persons enrolled in prescription lock in programs
 Persons who voluntarily request Naloxone and are the family member or friend of a person at
risk of experiencing an opiate-related overdose.
 Persons who voluntarily request Naloxone and are in the position to assist a person at risk of
experiencing an opiate-related overdose.
Intranasal (IN)
Intramuscular (IM)
Preferred method
Inject into shoulder or thigh
Naloxone HCl 1 mg/mL Inj.
Narcan ® 4 mg/0.1 mL
Naloxone HCI 0.4mg/mL Inj.
Nasal Spray
2 x 1mL single dose vials
2 x 2 mL as pre-filled Luer-Lock
 Dispense 1 x two(SDV)
syringes
pack
 Dispense 2 (two) SDV
 Dispense 2 (two) doses
2
(two) x intramuscular (IM)
2 (two) x Intranasal Mucosal
syringe,
3mL, 25 G, 1 inch
Atomizing Devices (MAD 300)
Available from: Teleflex (866-2466990) or Safety Works, Inc. (800-7233892)
Spray 1 mL in each nostril. Repeat
after 3 minutes if no or minimal
response.
Administer a single
spray of NARCAN® in
one nostril. Repeat
after 3 minutes if no or
minimal response.
Inject 1 mL IM in shoulder or
thigh. Repeat after 3 minutes if
no or minimal response.
PRN
A history of known hypersensitivity to Naloxone or any of its components
Every person dispensed Naloxone under this standing order shall receive education regarding the
risk factors of overdose, signs of an overdose, overdose response steps, and the use of Naloxone.
Examples of educational materials that incorporate the above information may be found at
http://www.naloxonesaves.org.
Pharmacies choosing to participate in Naloxone distribution under the authority of this standing
order shall notify the Division of Public Health when initiating their participation; see directions for
notification at http://www.naloxonesaves.org.
_____________________________________
June 20, 2016
________________________________
Dr. Randall Williams, MD
Date
National Provider ID: 1427013002
This order is effective immediately upon signing
and may be revised or revoked by the State Health
Director according to his/her discretion.
Created 7/14/16
Naloxone Statewide Standing Order
Cheryl A. Viracola, PharmD
Pharmacy Programs Manager,
Community Care of Wake and Johnston Counties
Objectives
 Review the US & NC trends on opioid overdose
 Understand key elements of NC’s statewide
standing order for naloxone
 Identify patients at high risk of overdose and
candidates for naloxone
Overdose Deaths in the US
 From 2000-2014, 500,000 drug overdose (OD) deaths
 Surpassed motor vehicle accidents - in 2014, ~ 1.5X more drug OD
deaths vs deaths from MV crashes
 In 2014, opioids (Rx & heroin) were involved in 28,647 deaths, or
61% of all OD
 Rate of opioid OD has tripled since 2000.

The 2014 data –US opioid OD epidemic 2 trends
 a 15-year increase in overdose deaths involving prescription opioid pain
relievers
 recent surge in illicit opioid overdose deaths, driven largely by heroin.
 44 people in the US die EVERY DAY from an Rx opioid overdose
(CDC)
 78 people in the US die EVERY DAY from an OPIOID overdose
 PREVENTABLE side effect from opioids to which there is an
antidote
MMWR - Increases in Drug and Opioid Overdose Deaths — United States, 2000–2014
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6450a3.htm?s_cid=mm6450a3_w
Death Rates* for Three Selected Causes of Injury,
North Carolina, 1968-2014
40.0
Motor Vehicle Traffic (Unintentional)
Drug Poisoning (All Intents)
Firearm (All Intents)
Deaths per 100,000 population
35.0
30.0
25.0
20.0
15.0
10.0
5.0
0.0
1968 1970 1972 1974 1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014
Year
*Per 100,00, age-adjusted to the 2000 U.S. Standard Population
National Vital Statistics System, http://wonder.cdc.gov, multiple cause dataset
Source: Death files, 1968-2014, CDC WONDER
Analysis by Injury Epidemiology and Surveillance Unit
4
Medication or Drug Overdose Deaths by Intent
North Carolina Residents, 1999-2014
1,400
1,200
All intents
Unintentional
Self-inflicted
Number of deaths
1,000
1,306
1,064
Undetermined
Assault
800
600
400
200
203
38
0
Source: N.C. State Center for Health Statistics, Vital Statistics-Deaths, 1999-2014
Analysis by Injury Epidemiology and Surveillance Unit
Medication or drug overdose: X40-X44, X60-X64, Y10-Y14, X85
5
Substances Contributing to Medication or Drug Overdose Deaths
North Carolina Residents, 1999-2014
900
800
Number of deaths
700
Prescrip on Opioid
Cocaine
Heroin
684
600
500
400
300
246
200
202
100
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
20
10
20
11
20
12
20
13
20
14
0
Source: N.C. State Center for Health Statistics, Vital Statistics-Deaths, 1999-2014
Analysis by Injury Epidemiology and Surveillance Unit
6
NC Heroin Deaths: 2008-2015*
300
250
554% increase
from 2010 to 2014
200
100
63
174
76
75
37
50
2008
2009
2010
Source: N.C. State Center for Health Statistics, Vital Statistics-Deaths, 2008- 2015*
*2015 data are provisional and likely increase as cases are finalized
Analysis by Injury Epidemiology and Surveillance Unit
7
179
147
150
0
246
2011
2012
2013
2014
2015*
Heroin Hosp. and ED Overdoses: 2008-2014
1200
1,127
From 2010 to 2014
a 429% increase
for ED visits
1000
800
600
474
400
200
0
643
311
252
213
213
76
75
58
2008
2009
2010
101
2011
ED
Source: N.C. State Center for Health Statistics, Vital Statistics-Hospital Discharge 20082013
NC DETECT- Statewide ED Visit data, 2008-2014
Analysis by Injury Epidemiology and Surveillance Unit
Hosp
122
2012
195
2013
2014
NC Statewide Standing
Order
“This standing order signed by the North
Carolina (N.C.) State Health Director
authorizes any pharmacist practicing in the
state of N.C. and licensed by the N.C. Board of
Pharmacy to dispense the following Naloxone
products to persons as directed below”
Elements of the NC
Statewide Standing Order
 Eligible candidates
 Naloxone products that can be dispensed under standing
order
 Directions for use
 Refills:
 PRN
 Contraindications:
 A history of known hypersensitivity to Naloxone or any of
its components
 Patient Education
 Notification of Participation
Executed/signed standing order
can be found at
http://www.naloxonesaves.org
Naloxone: Pharmacology
Opioid
Naloxone
Opioid receptor
on brain
Naloxone: Basics
 Approved by the FDA in 1971 (available for lay use
since 1996)
 No psychoactive effects
 No street value (because it causes withdrawal NOT EUPHORIA)
 No abuse potential : not known to produce tolerance or physical/psychological
dependence
 Naloxone rarely has any effect on someone not taking
opioids
 Not a controlled substance
 Administration routes
 IM & Intranasal routes : onset 3-5 minutes (give 2nd dose if no
response)
 PO (NOT absorbed - use as abuse deterrent) ; IV – hospital,
SC
 12-18 month shelf life
Naloxone: Safety
 Well-established body of evidence of its safety
and efficacy
 Adverse reactions are rare, however, when they
occur they are often secondary to narcotic
withdrawal (pain, sweating, agitation, etc)
 Typically occurs within minutes
 Subsides within two hours
 Other rare side effects include:
 Increased blood pressure and heart rate
 Arrhythmia
 Nasal Spray premarketing trials showed transient
hypertension, musculoskeletal pain, HA, nasal
dryness/congestion/edema/inflammation
Naloxone: Duration of
Action
 Anywhere from 30 to 120
minutes (shorter than many
opioids)
 May not outlast effects of longacting or ER opioids
 NOT meant to substitute going
to the ED; it just buys more time
AND helps prevents
complications
Which Patients Are Eligible
as Defined By Standing
Order?
Persons who voluntarily request Naloxone and are at
risk of experiencing an opiate-related overdose,
including, but not limited to:
1. Current/history of heroin or nonmedical opioid use
2. History of emergency medical care involving opioid
poisoning/intoxication/overdose
3. Persons with a high dose opioid prescription
 >50 morphine mg equivalents (MME) per day
4. Persons with an opioid prescription and known or
suspected concurrent alcohol use
5. Recent discharge from opioid detox or abstinencebased program
Which Patients Are Eligible
as Defined By Standing
Order (continued)?
6. Patients entering methadone maintenance
treatment (addiction or pain)
7. Persons with opioid prescription and
smoking/COPD or other respiratory illness or
obstruction
8. Persons with an opioid prescription who also
suffer from renal dysfunction, hepatic disease,
cardiac disease, HIV/AIDS
9. Persons who may have difficulty accessing
emergency medical services
10.Persons enrolled in prescription lock in
programs
Which Patients Are Eligible
as Defined By Standing
Order?
 Persons who voluntarily request Naloxone and
are the family member or friend of a person at risk
of experiencing an opiate-related overdose.
 Persons who voluntarily request Naloxone and
are in the position to assist a person at risk of
experiencing an opiate-related overdose.
Which Other Patients Could
Be Considered for
Naloxone?
 Concurrent benzodiazepine prescription with opioid
prescription
 Also sleep aids, muscle relaxants
 Multiple physicians and pharmacies
 Methadone
 Has been associated with disproportionate numbers of overdose
deaths relative to the frequency with which it is prescribed for
pain
 Involved in twice as many single-drug deaths as any other
prescription opioid
CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016
http://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm?s_cid=rr6501e1_w
Naloxone “Just in Case”
Fairfield, Connecticut:
 5 year old stepped (barefoot) on a fentanyl patch left on the
kitchen floor. By the time he got emergency medical attention, it
was too late, and he died of respiratory depression
Burlington, NC:
 High School football player was sore after a Friday night game.
Took his Grandma’s methadone and died
Pain medications are the single most frequent cause of
pediatric fatalities reported to Poison Control.
National Capitol Poison Center: http://www.poison.org/poison-statistics-national
http://sports.yahoo.com/highschool/blog/prep_rally/post/north-carolina-high-school-qb-died-from-takingmethadone?urn=highschool,wp5836
Intramuscular Naloxone
 IM kits contents:
 Advantages:
 2 naloxone 0.4 mg/ml (1
mL) vials
 Least expensive option;
NCHRC distributes
 2 IM syringes with alcohol
swabs
 Covered by most
insurances
 step-by-step instructions for Disadvantages:
responding to an opioid
 Some people not
overdose
comfortable with giving
 directions for naloxone
injections
administration
 Gloves, mask optional
Intramuscular Naloxone –
Evzio®
 Approved 4/3/14
 Pre-filled auto-injector
(IM/SC)
 Each Evzio contains a single
dose of naloxone; do not reuse
 Each carton contains 2 autoinjectors
 Electronic voice instructions
 Advantages:
 Easy to use, instructions given
 Disadvantages:
 MOST expensive product
 NC Medicaid non-preferred
 Cannot be used with statewide
standing order
Intranasal Naloxone (Generic)
2 mg/2mL prefilled syringes

Requires nasal atomizer device for IN
use
Project Lazarus Kits/Generic IN Kits

2 naloxone 2 mg/2 ml prefilled syringes
(filled by pharmacy and placed into kit)

2 atomizers

Step-by-step instructions for responding
to an opioid overdose

Directions for naloxone administration
Advantages:

Needleless

Slight cost advantage over branded IN
product
Disadvantages:

Complex assembly procedure – see
next slide!
Narcan® Nasal Spray
 FDA approved 11/18/15, Released
2/26/16
 Ready to go – no assembly required
 4mg dose
 2x higher dose than generic IN
formulation
 Advantages:
 Easy to use and no assembly required
 NC Medicaid Preferred as of 4/1/16 and
many private/Medicare Part D plans
covering
 AWP $150 for 2 sprays
 Non-profit pricing $75 per 2 devices
 Disadvantages:
 Still somewhat expensive for uninsured
Patient Education
Requirements For Standing
Order
 Risk Factors
 Signs of an overdose
 Overdose Response Steps
 Naloxone administration education
CPESN Naloxone Service Set
Dispense naloxone in accordance with the statewide
North Carolina standing order, and provide the additional
enhanced services:
 The pharmacist will talk with the patient about the aspects of
their prescription medication and other substance use that
increase their risk for overdose
 Utilization of the Controlled Substance Reporting System (As
needed based upon the judgment of the pharmacist)
 Provide enhanced education to the patient and others on
administration of naloxone
 Educate patients about safe opioid and benzodiazepine storage
in the home
 Communicate with prescriber(s) and/or primary care provider to
make them aware of naloxone dispensing
 As needed, participate in CPESN naloxone service set
education provided by CCNC
Wake County
Medications Disposal Sites
Wake County
 Holly Park Pharmacy
 3004 Wake Forest Rd
 Raleigh, NC 27609
 (919-865-9993)
Johnston County
 Beddingfield Drugs
 95 Springbrook Ave Ste 101
 Clayton, NC 27520
 (919)-553-6224
Resources
 NC Specific Site for statewide standing order
• www.naloxonesaves.org
 College of Psychiatric and Neurologic Pharmacists
 www.cpnp.org/guideline/naloxone
 NC Board of Pharmacy – FAQs, Standing Orders,
Protocols
 http://www.ncbop.org/faqs/FAQNaloxoneGoodSamaritanNCHRC.pd
f
 Videos, ordering information, prescription forms, etc:
 www.prescribetoprevent.org
 NC Harm Reduction Coalition
 http://www.nchrc.org/
Return to Menu
Questions
?
Transforming Clinical Practice Initiative (TCPI)
Practice Transformation Network (PTN)
• $18.6 million – 4 year time period
• Broader focus of Practice Transformation
• Includes Pediatric and Adult Practices
1
Five Stages of Transformation for Practices
1. Setting aims and developing basic capabilities
o Specifies goals, begins to examine baseline data, begins training
staff in improvement methods
2. Reporting and using data to generate improvements
o Analyzes quality and utilization measures, identifies community
partners, implements specific care management strategies,
incorporates regular PDSA tests of change in the practice setting
3. Achieving aims: lower costs, better health, better care
o Optimizes use of registries and reports, exchanges health
information outside of the practice, involves patients and families
in QI initiatives, links patients to a provider and care team
Return to Menu
Five Stages of Transformation for Practices
4. Getting to benchmark status
o integrates advanced access strategies, process for identification of
high risk patients, provides care coordination for patients following
hospitalization, reduced unnecessary testing and hospitalizations
5. Practice has demonstrated capability to generate better
care, better health at lower cost.
o sustains improvements in key metrics for at least one year, and has
developed business acumen in alternative payment models
Drilling down to RealTime ED Visits
Medical Policy Meeting
August 4th, 2016
Instructions
Place logo
here
Step 1: Log into the CCNC Informatics Center (IC) at https://ic.n3cn.org
or access IC reports directly at https://icreports.n3cn.org – with your
username/email & password
Step 2: Click on “Go to Practice Standard Reports”, select your county,
and select your practice name to access your practice’s folder
Instructions Cont.
Place logo
here
Step 3: Open the “Current Hospital Visits – Real-Time ED and Inpatient” IC
report
Drop-down boxes in the top section can be selected to set
parameters on your report if desired to narrow your search
Instructions Cont.
Place logo
here
Instructions Cont.
Place logo
here
Note: While you can view the information within the IC and can export in
different formats, we recommend exporting the data as an excel document
so you can easily sort and analyze the data. To do this, click the save icon’s
dropdown box and choose the Excel 2003 option.
*Only hospitals who are participating in ADT feeds will have information reflected
in this report
Current Hospitals on ADT
Feeds
Alamance Regional Medical Center
Annie Penn Hospital
Bertie Memorial
Betsy Johnson Regional Hospital
BRUNSWICK NOVANT MEDICAL CENTER PARENT
Cape Fear Valley Medical Center
Carolina East Medical Center
Carolinas Medical Center
Carolinas Medical Center - Lincoln
Carolinas Medical Center - Mercy
Carolinas Medical Center - Northeast
Carolinas Medical Center - Pineville
Carolinas Medical Center - Union
Carolinas Medical Center - University
Catawba Valley Medical Center
Central Carolina Hospital
Chowan Hospital
Cleveland Regional Medical Center
Columbus Regional Healthcare System
Duke Medical Center
Duke Raleigh Hospital
Durham Regional Hospital
FirstHealth Montgomery Memorial Hospital
FirstHealth Moore Regional Hospital
FirstHealth Richmond Memorial Hospital
Forsyth Medical Center Parent
Gaston Memorial Hospital
Grace Hospital
Heritage Hospital
High Point Regional Health System
Hugh Chatham Memorial Hospital
Kings Mountain Hospital
Medical Park Hospital Parent
Mission Hospitals
Mission Hospitals - McDowell Hospital
Moses Cone Behavioral Health Center
Moses Cone MedCenter High Point
Moses H Cone Memorial Hospital
Nash General Hospital
New Hanover Regional Medical Center
Novant Health Clemmons Medical Center
Novant Health Kernersville Medical Center
Novant Health Thomasville Medical Center
Pitt County Memorial
Presbyterian Hospital Huntersville Parent
Presbyterian Hospital Matthews Parent
Presbyterian Hospital Parent
Presbyterian Orthopaedic Hospital Parent
Roanoke Chowan Hospital
Rowan Regional Medical Center
Scotland Memorial Hospital
Southeastern Regional Medical Center
Stanly Regional Medical Center
Place logo
here
The Outer Banks Hospital
University of North Carolina Hospital Chapel Hill
Valdese General Hospital
Wake Forest Baptist Health - Lexington
Medical Center
Wake Forest Baptist Medical Center
WakeMed
WakeMed Apex Healthplex
WakeMed Brier Creek Healthplex
WakeMed Cary Hospital
WakeMed North Healthplex
Wesley Long Community Hospital
Wilkes Regional Medical Center
Wilson Medical Center
Womens Hospital of Greensboro
**This can also be pulled while in the
report by expanding the “Report Details”
section: “Click for list of hospitals”
Place logo
here
Let’s view the report in Excel…
Return to Menu
Use case examples:
Place logo
here
 Develop a process to identify patients who visited the ED
within the past week (or other timeframe) to add the visit
to patient’s record and/or proactively reach out and
schedule a primary care visit
 Identify the most common times and days of week your
patients are visiting the ED to determine whether your
practice may need additional after-hours availability at
certain times
 Identify the most common primary diagnoses to determine
if possible patient education/outreach is needed
 Determine whether relationship(s) are needed with any
hospital which patients are visiting frequently
Alliance Behavioral Healthcare
Updates
Presentation to CCWJC Medical Policy Forum
Dr. Tedra Anderson-Brown
August 4, 2016
About Alliance
• Behavioral health MCO for Durham, Wake,
Cumberland and Johnston counties
• Operating under Medicaid 1915 (b)/(c)
waivers
• Responsible for 200,000 Medicaid consumers
among a total population of over 1.7 million
Our organizational Vision shapes the way
we conduct our business…
“To be a leader in transforming the delivery
of whole person care in the public sector”
MCO Operations
Administration
Access and
Information
Center
Care
Coordination
Community
Relations
Utilization/
Care
Management
Provider
Network
Management
Quality
Management
Business
Operations
Corporate
Compliance
Information
Technology
Healthcare
Integration
Number Served (CY14)
16299
36240
Medicaid
State
Number Served (FY15)
Number Served (FY16)
Managing Care
• Serving more individuals with Medicaid
• Saving and reinvesting Medicaid dollars
• Maintaining a low 2% denial rate
How We Have Done This
• Ensuring the we provide the right service,
in the right amount, at the right time
• Developing effective, innovative services
• Treating the person and their community
• Implementing a recovery-oriented system
of care philosophy across the organization
Alliance FY16 Funding
Source
Amount
% of Total
Medicaid
$381,577,090
81%
State
$51,541,113
11%
Local
$36,658,095
8%
Total
$469,776,298
100.0%
Refining the Service Array
• Focus on evidence-based practices to ensure
most cost-effective way to provide care
o
Support and technical assistance to providers to
implement EBPs
o
Partnered with AHEC on Learning Collaboratives
o
Increased numbers served in MST, ACTT
o
Provided training and rate enhancement to
implement DBT
Network Development
• Implemented new programs for children
and adolescents
Family Center Treatment
o Intercept
o Enhanced Therapeutic Foster Care
o Strengthening Families
o Eco-Systemic Structural Family Therapy
o Brief Strategic Family Therapy
o Family Behavior Therapy
o
Network Development
• Implemented new services to better address
identified needs
NC START for children
o Enhanced Outpatient Treatment
o ACT Step-down
o
o
CST Plus
o
Medication Assisted Treatment
Network Development
• Implemented First Episode Psychosis
program
• Increased outpatient and MD rates
• Integrated Health pilots
• Critical Time Intervention
• Expand capacity for crisis diversion services
• Services for traumatic brain injury
Network Development
• Youth 30day Assessment/short term PRTF
• Rapid Response Child Diversion
• Fostering Solutions IDD/MH TFC model
Reinvestment
Plan
Utilizing savings to expand services based on
Network Development Plan
(see handout)
Alliance Behavioral Healthcare
• Website
http://www.alliancebhc.org/
•
ACCESS and Information Line 24/7
1-800-510-9132
Alliance Behavioral Healthcare Website
19
Return to Menu
Questions/Discussion
CCPNUpdate
ISSUE
August 2016
01
Issue 03
MAY 2017
2017
Resource Corner
CME credit has been
applied for
for free, two-part webinar
Getting Paid with
MACRA — a Look into
the Future …
presented by Dr. Chip
Watkins, CCPN
Physician Consultant
Click to
Join by Web
Dial to
Join by Phone
+1-855-797-9485 US Toll free
+1-415-655-0002 US Toll
Part One
Tuesday, August 16
5:30 - 6:30 pm
Meeting number (access code):
733 246 552
Meeting password: CxTp4674
Part Two
Tuesday, August 30
5:30 - 6:30 pm
Meeting number (access code):
732 153 885
Meeting password: psXTpqyP
Highlights In this issue
1,000+ Physicians In CCPN P.1
Meet Greg Adams, MD P.2
CCPN Participating Practices P.3
Committee Spotlight, P.4
CCPN Marks Major Milestone
From Allen Dobson, MD, Chairman
The one thousandth clinician
joined the Community Care Physician Network in June, and as of
July 31 we have 1,032 CCPN members serving patients in 294 practices.
So, what does it mean to be a part of this organization that serves more than 1,000 practicing
physicians in nearly 300 practices?
Three things: Critical mass. Engaged membership.
Centralized services.
Critical Mass
Having more than 1,000 clinicians from communities across the state appeals to payers from an
efficiency perspective. Critical mass enables independents to more effectively partner with hospitals and other networks. Critical mass creates the
opportunity to contract with insurers in new performance-based contracts. You are not alone,
because you are part of a high-performing network able to demonstrate improved quality and
value.
Engaged Membership
The clinicians who are a part of CCPN are focused
on improving the quality of care and finding solu-
tions to some of the key business challenges
that all solo practitioners and small group
members face. CCPN committees and working
groups made up of real doctors working in
their own practices across the state already
are looking at solutions in areas ranging from
technology informatics to quality key performance indicators. We have started strong,
and we welcome the growing number of participating physicians to the CCPN organization.
Together we will find innovative solutions that
work in health care reform.
Centralized Services
CCPN exists to support independent doctors
and safety-net providers in maintaining their
independence while giving them the tools to
demonstrate they are a high-performing provider and will be a player in health reform
efforts.
With more than 1,000 clinicians, CCPN can
share data in a meaningful way and track progress so practices can demonstrate quality
improvement that translates into improved
care for our patients. We are here as a resource for you.
CCPN is waiving membership fees through
September 30. So, in the next two months we
expect we will see our number grow even
more. With every new clinician that joins, we
gain expertise and positive momentum.
That’s a lot to celebrate.
By the Numbers
64%*
of the CCNC Medicaid population
is enrolled with
independent physicians
* based on July 2016 Medicaid enrollment
Visit us online at www.communitycarephysiciannetwork.com
1
Practice
Transformation
Network (PTN)
Update
In September 2015,
Community Care North
Carolina (CCNC) was
awarded $3.5 million in
the first year of a
four-year demonstration
to participate in a
Practice Transformation
Network (PTN)
cooperative agreement.
Over a four-year period,
CCNC PTN will engage
3,000 clinicians in
transforming their
practices for success in
a value-based
healthcare
environment. As of July
2016, we have enrolled
1,341 clinicians and will
begin targeted
recruitment for Year 2.
Recruitment will target
CCPN enrolled
practices.
For more information
contact Lynne Taylor,
CCNC Director of QI and
Practice Support at
[email protected]
The project described was
supported by Funding Opportunity Number CMS-1L1
-15-003 from the U.S. Department of Health & Human Services, Centers for
Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do
not necessarily represent
the official views of HHS or
any of its agencies.
CCPN Schedules Meet & Greet Sessions
Friday, August 19, 2016 at 5:30 PM
North Room of the Carolina Hotel
at Pinehurst Resort
Click here for additional information
and to register for the
North Carolina Pediatric Society Annual Meeting
August 19-21, 2016
Wednesday, September 14
5:30 – 7:30 pm
Regional Provider Meeting
Winston-Salem
Meet Greg Adams, M.D., CCPN Board of Managers
My son is starting his residency this year.
Things are very different for him than
they were for me when I started practicing in 1982.
One difference is his generation of physicians expects to
have personal family time
and not to work 65 or 70
hours a week. I think this is a
good thing.
These young doctors are just
as committed to their patients as I was and am. However, they are entering the
profession at a time when
more and more small practices are being
absorbed into hospital systems. As a result, shift work is more prevalent – for all
categories of medical professionals.
When the shift is over, patient care is
handed over to someone else.
This raises a big challenge for small practices trying to recruit. How do we
strengthen and support patient-centered
medical homes in a shift-oriented world?
Or a different way to look at it, how do we
make working as an office-based physician as appealing to these young doctors
as working as a hospital-based physician?
If we don’t figure out the answer, we will
not recruit young doctors into our inde-
pendent and small group practices, and our
patients will receive fragmented care.
Of course, maintaining continuity of care is
easier if patients are confident they can get
the medical treatment they need
conveniently. Some practices have
found that starting the day early at
7 or 8 with a walk-in clinic -- or
offering evening or weekend hours
is a good way to encourage patients
to rely on the practice rather than
seeking treatment at urgent care or
the emergency room. This approach
requires appropriate staffing. But if
practices think creatively about adding flexibility for both patients and staff that
creates a win on all fronts. Solutions like these
are more likely to surface when you’ve got a
large group with a variety of experiences at
your disposal.
That’s just what we have at CCPN, now with
more than 1,000 North Carolina physicians.
CCPN is a great effort that puts us in a position
to enhance medical homes, encourage small
practices, help incentivize patients not to use
the Emergency Department except in emergency situations and ultimately to address
mental health. We have the best Medicaid
program in the nation and I’m glad to be a part
of the network that will give us an opportunity
to do what we do best – and that is care for
our patients.
2
Current Member Practices
(enrolled as of July 31, 2016)
A total of 1,032 clinicians now are a part of the Community Care Physician Network. For a list of practices see below
and on the following pages. Note, practices with multiple office locations are listed just once.
A Brighter Future
ABC Pediatrics of Dunn
Advance Family and Sports Medicine
Center, PLLC
Ahoskie Pediatrics
Ajey B. Golwala, MD, PC
Albemarle Pediatrics
Alleghany Family Practice
Alpha Medical Center
Appalachian Family Practice
Archdale-Trinity Pediatrics
Ardmore Family Practice PA
Ashe Pediatrics
Asheboro Children's Health
Ayyaz Qureshi, MD
Belmont Medical Associates PLLC
Bertie County Health Department
Best Clinic, PLLC
Bland Clinic, PA
Bliss Medical Group, P.A.
Blue Ridge Pediatric and Adolescent
Medicine, Inc.
Boiling Springs Pediatric and Family
Medicine
Burke Primary Care
Burlington Pediatrics
C.W. Williams Community Health
Center, Inc.
Cabarrus Health Alliance
Caldwell County Health Department
Calvary Pediatrics
Camden County Health Department
Cape Carteret Pediatrics and Family
Practice
Cape Center Pediatrics
Cape Fear Family Medical Care
Care Pediatrics
Carmel Pediatrics PA
Carolina General and Integrative
Medicine
Carolina Medical Associates
Carolina Pediatric Group
Carolina Pediatrics of the Triad, PA
Carolina Primary Care and Women's
Health - Apollo Urgent Care
Carolina Rheumatology and Internal
Medicine, PA
Carrboro Pediatrics and Internal Medicine, PA
Carteret Clinic for Adolescents and
Children
Carteret County Health Department
Carteret OB/GYN Associates, PA
Carter's Circle of Care
Cary's Children's Clinic
Catawba Pediatric Associates PA
Cedar Creek Family Medicine PLLC
Central Carolina Medical Clinic
Chapel Hill Children and Adolescents
Clinic
Chapel Hill Pediatrics and Adolescents,
PA
Chatham Pediatrics
Choice Pediatrix P.A.
Chowan County Health Department
Christian G. Anderson, MD PA
Cleveland Pediatrics
Coastal Children's Clinic
Coastal Southeastern Family Practice
Concord Children's Clinic
Cotton Grove Family Physicians
Covenant Pediatrics
Cox Family Practice, PC
Craven County Health Department
Cross Creek Medical Clinic
Crown Clinic, PA
Cumberland Children's Clinic
Cumberland Family Practice
Cumberland Internal Medicine
Currituck County Health Department
Dayspring Family Medical
DeSantis Family Practice
Dunn-Erwin Medical Center, Inc.
Duplin County Health Department
Eastern Carolina Geriatrics Associates
and Family Center
Eastern Carolina Medical Center
Eastern Carolina Pediatrics
Eastover Family Care
Eastowne Family Physicians
Edgewater Medical Center
Edward L. Hawkins, MD
Elitecare of Fayetteville
Elkin Pediatric and Adult Medicine
Evans-Blount Community Health
Center
Evergreen Health Promotion
Excel Pediatrics
Family Care Associates of
Montgomery County, PA
Family Care Clinic
Family Medical Associates of Raleigh,
PA
Family Medicine Associates of Lincoln
County
Fayetteville Children's Clinic
Fayetteville Internal Medicine
Ferncreek Primary Care, PC
First Care Medical Clinic, PA
First Stop Medical Center
Five Points Medical Center
Four Jewels Healthways
France Medical Center
Friendly Urgent and Family Care
Gaston Medical Associates
Gates County Health Department
Goldsboro Pediatrics P.A.
Continued….
3
Current Member Practices
Goldsboro Quick Care
Gowri Sathiraju, MD
Granite Falls Family Medical Center
Greensboro Pediatricians, Inc.
Greenway Medical Associates
Growing Child Pediatrics
Guilford County Department of Public
Health
Health Zone PLLC
High Point Pediatrics
High Rock Internal Medicine
Hildebran Medical Clinic
Himanshu P. Parikh, MD PC
Hodges Family Practice, Inc.
Hope Mills Urgent Care
Hope Physicians & Urgent Care
Horizon Internal Medicine
Integrative Wellness Center, PLLC
Jacksonville Allergy, Asthma and Sinus
Clinic
Jacksonville Behavioral and Mental
Health
Jacksonville Children's and Family Care
Jacksonville Children's Clinic
Jacksonville Gastroenterology
Jacksonville Urgent Care
Jaime E. Trujillo, MD PA - The Salem
Center
Jamal Kamala, MD
James McGrath, MD, PLLC
John R. Mann, MD Family Practice
Johnston County Public Health
Department
Jonathan Weston, MD
Kernersville Primary Care
Kid's Care Pediatrics
Kids First Pediatrics
Kidz Pediatrics, P.A.
Kings Clinic and Urgent Care
Kings Mountain Pediatrics
Kinston Pediatric Associates, PA
Lake Jeantette Urgent Care
Laurel Hill Medical Center
Lax Chudasama, MD
Lenoir Family Medicine
Lexington Internal Medical Care
Life Enhancement Medical Services
PLLC
Committee Spotlight
Lifelink Medical Group
Lillington Family Medical Center
Lincoln Internal Medicine
Little Oaks Pediatrics PLLC
Lumber River Family Practice
Lumberton Children's Clinic
Lumberton Family and Urgent Care
Lumberton Internal Medicine Group
Maria Medical Center
Maruthi Pediatrics
Masonboro Urgent Care
Mathews Internal Medicine
McM Pediatric and Adolescent Home
Practice, PA
Medical Arts Family Practice, PA
Med-Mart Primary and Urgent Care
Metrolina Internal Medicine
Mid Carolina Family Medicine
Mount Airy Family Practice
Mountain Laurel Internal Medicine, PA
Mountain View Pediatrics
Naveed Aziz, MD
New Hope Family Medicine
Newton Family Physicians
North Wake Pediatrics
Northlake Pediatric Care
Northside Urgent Care
Northwest Pediatrics
NP Primary Care
Oceanside Pediatrics
OIC Family Medical Center at Happy Hill
Old Town Immediate Care
Pasquotank County Health Department
Pediatric Associates of Cleveland County
Pediatrician's Urgent Care, PLLC
Pembroke Pediatrics
Perquimans County Health Department
Physicians Eldercare
Physicians Home Visits
Piedmont Adult and Pediatric Medicine
Associates
Pineville Pediatrics
Pinnacle Family Care, PLLC
Pirate Pediatrics
Pitt County Health Department
Continued….
The CCPN Quality
Improvement and Quality
Assurance Committee met
July 18 and will meet next
on August 15 to begin
compiling key
performance indicators for
local practices
Current members of the
QI/QA committee
Timothy Bell, Executive
Director, Children's Health
of Carolina, PA
Susan Huffman, Practice
Administrator, Unifour
Pediatrics
Clint Taylor, Practice
Administrator, Thomasville
-Archdale Pediatrics
Diane Houck,
Administrator, Coastal
Children's Clinic
Cristoph Diasio, MD,
Sandhills Pediatrics
Michael Riddick, Practice
Administrator, Goldsboro
Pediatrics
Kathi Balsinger,
Community Care of
Western North Carolina
Vincent Chiodo, MD,
President,
ABC Pediatrics of Dunn
If you are interested in
learning more about
Quality and other committees please contact
Shelley Keir at
[email protected].
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Current Member Practices
Pleasant Garden Family Medicine
Polyclinic Medical Center
Premier Health Center
Premier Pediatrics P.A.
Primecare Medical Center
Primedical Healthcare PA
R & R Pediatrics, PLLC
Raeford Pediatrics
Rainbow Kids Pediatrics
Rainbow Pediatrics of Fayetteville
Raleigh Primary Care Medicine, P.A.
Randy Long MD PA
Rapha Health System
Rayconda Internal Medicine
Renuka S. Harsh, MD
Revelstone Family Practice
Richlands Children's and Family Care
Richmond Pediatrics
Roanoke Clinic
Roanoke Valley Internal Medicine
Robert A. Krause, MD PLLC
Robeson Family Practice
Robeson Family Practice (Peds)
Robeson Pediatrics
Rockingham County Department of
Health and Human Services
Rockingham Internal Medicine
Associates, PA
Rockingham Medical Clinic, P.C.
Rocky Mount OIC Family Medical Practice
Rubin Pediatrics
Rudisill Family Practice
Sandhills Pediatrics, Inc.
Sanford Pediatrics, P.A.
Shah and Associates Family Practice
Shelby Medical Associates, PA
Shifa Pediatric Clinic
Smithfield Crossings Family Healthcare,
PA
Sneads Ferry Pediatrics and Family
Practice
Sol Medical Group
Spindale Family Practice
StatCare Urgent Care and Primary Care
Summit Family Medicine
Sunshine Pediatrics
Surf Pediatrics and Medicine
Swansboro Childrens and Family Care
Swisher Internal Medicine
Tesfaye D. Fanta
The Child Health Center
The Mental Health Fund, Inc.
The Purcell Clinic
Thomasville OB-GYN
Thomasville Pediatrics
Tots-N-Teens Pediatrics
Triangle Premier Women's Health, PA
Triangle Primary Care Associates
Trinity Urgent Care and Family Practice
Unifour Pediatrics,PA
Universal Family Medicine
Uwharrie Medical Center
Village Pediatrics
Wakefield Pediatrics and Adolescent
Medicine, PA
Washington Pediatrics
Western Wake Pediatrics PA
Wilkes County Health Department
Winston-Salem Pediatrics Highroad,
P.A.
Vineland Family Medicine
Women's Healthcare Associates, PA
Leadership Expands
In June, CCPN welcomed
Greg Adams, M.D., of Blue
Ridge Pediatrics and Adolescent Medicine to the
Board of Managers. Read
his perspective on page 2
CCPN
Board of Managers*
L. Allen Dobson, M.D.
Chairman
Mt. Pleasant, NC
Greg Adams, M.D.
Boone, NC
Debbie Ainsworth, M.D.
Washington, NC
Stephen S. Hsieh, M.D.
Lexington, NC
Thomas White, M.D.
Cherryville, NC
*Additional Managers will
be nominated as networks
and/or organizations enroll
100 or more participating
physicians.
Tell us what's changed:
Have clinicians joined or
left your group?
Have you recently
changed addresses,
phone numbers, or tax
identification numbers?

Please let us know!
Contact Us
Denise Levis Hewson
Chief Operating Officer
[email protected]
2300 Rexwoods Drive
Suite 140
Raleigh, NC 27607
Torlen Wade
Executive Vice President, CCNC
[email protected]
919-926-3892
CCPN
Submit changes to
Shelley Keir at:
[email protected].
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Tara Kinard, RN, MSN, MBA, CCM
Jamie Philyaw, MSW, CCM
Elizabeth Tilson, MD, MPH
Executive Director
Network Director
Medical Director
Draft Process for Nominating a CCWJC Representative
to serve on the CCPN Board of Managers
1. Timing of when to call for nominations
a. After more than 100 providers are participating - done
b. Introduce at August Medical Policy Committee meeting
c. Call for nominations starting Sept 1st, 2016
2. Process for eliciting nominations from participating provider members
a. Note with content to include:
i. rationale (i.e. have more than 100 participating providers)
ii. make up of current Board of Managers and specifications (at least 75% physicians)
iii. role of Manager (language from Operating Agreement)
iv. logistics of service
b. Send by email to practice contact on list and all participating providers (to keep updated CCPN list
serve), mail letter to practice, fax to practice, hand deliver by Provider Services Team
c. Outreach to participating providers who stated interest in serving on executive committees
d. Nominations to include Nominee’s name, bio, why they want to serve and what they can offer CCPN and
colleagues.
e. Nominations period open for 3 weeks until September 23rd, 2016
f. Nominations, Bio, statements will be sent to Elizabeth Tilson, MD, MPH
3. Process for selecting Nominees
a. Submitted nominations will be reviewed by a 5 member Nominating committee made up of Wake
County Medical Society Community Health Foundation (CCWJC) Board members and Participating
Providers.
b. Criteria for evaluating potential nominees will be determined by the nominating committee and may
include such factors as size of Medicaid population served in the practice, level of engagement with
CCWJC activities, evidence of leadership or involvement with colleagues and professional activities.
4. Process for voting on selected nominees
a. Selected nominations with bios and statements will be sent out back out for a vote via an anonymous,
secure way e.g. - Survey monkey to provider emails
b. One vote per participating provider
c. If no clear winner – run off of top vote getters
5. Final nominee will be presenting to CCPN Board of Managers for approval
4207 Lake Boone Trail, Raleigh NC 27607
Phone 919.783.0404
919.510.9162
[email protected]
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Tara Kinard, RN, MSN, MBA, CCM
Jamie Philyaw, MSW, CCM
Elizabeth Tilson, MD, MPH
Executive Director
Network Director
Medical Director
DRAFT Note for nominations to CCPN Board of Managers to CCWJC Participating Providers
Dear Colleagues:
We have had tremendous interest and response to Community Care Physician Network (CCPN) in our community. We
are excited to continue to partner with you and prepare for the future together.
Pursuant to the CCPN Operating Agreement, Community Care of Wake and Johnston Counties now has more than 100
providers participating in CCPN (XXX as of XXXX) and is therefore eligible to nominate an individual to serve on the CCPN
Board of Managers. This nomination is subject to approval by the current CCPN Board of Managers
The current Board of Managers consist of:
1.
2.
3.
4.
5.
L. Allen Dobson, Jr., MD, Family Medicine, President of CCNC, Inc. (Member-Appointed)
Deborah Ainsworth, MD, Pediatrician, President of NC Pediatric Society
Stephen Hsieh, MD, Internal Medicine, Community Physician
Thomas White, MD, Family Medicine, Past President of the NC Academy of Family Practice
Greg Adams, MD, Pediatrician, Community Physician
At least seventy-five percent (75%) of the individuals serving on the Board of Managers shall be Participating Physicians.
Each Manager is entitled to one vote. The initial term of additional Managers is expected to be three years, subject to
Member approval.
The Board of Managers shall have general discretion, power, and authority to manage, control, administer, and operate
the business and affairs of CCPN and to make decisions affecting such business and affairs. The Board of Managers also
oversees the CCPN Committees. Standing Committees consist of: 1) Quality Improvement and Performance; 2) Finance;
3) Data and Technology; and 4) Compliance.
Currently meetings are held on the third Friday of every month. These can be calls or in-person, if possible. Email updates
occur in-between meetings. Special meetings may be called, on occasion, if needed to address CCPN business.
If you would like to submit a nomination (yourself or a colleague – physician or non-physician), please submit:
1. The name of the nominee, professional credentials and roles
2. A CV and Biosketch of the nominee
3. A brief statement of why the nominee would like to serve and what the nominee could contribute to the CCPN
Board of Managers and CCPN as a whole.
Nominations will be accepted through September 23, 2016. Please submit the nomination to Elizabeth Tilson, MD, MPH
at [email protected], Fax 919-510-9162, or mail 4207 Lake Boone Trail, Ste 100, Raleigh, NC 27607
4207 Lake Boone Trail, Raleigh NC 27607
Phone 919.783.0404
919.510.9162
[email protected]