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2020 Mid-Year Report North Carolina Healthcare Association

2020 Mid-Year Report

What a difference a few months can make. NCHA began 2020 with great expectations and plans to advance strategies to improve access to high-quality care, reimagine rural health care, redesign health care through innovation, and develop resources to help patients navigate the healthcare system more effectively. Then our work took on greater meaning with the arrival of the COVID-19 pandemic and calls for social justice, inclusion, equity, dignity and respect for all.

"With every great challenge comes great opportunity. The emergence of current events requires us to rethink what health care can look like in North Carolina. We cannot just return to normal when the virus is contained, we need to push forward with our goals to achieve a North Carolina where high-quality health care is equitable and accessible for all." — Steve Lawler, NCHA President & CEO

COVID-19 reminded the public how essential hospitals and health systems are to their communities, culminating in an outpour of appreciation for healthcare workers. North Carolina's hospitals and health systems truly are destinations for hope, compassion, care, and healing for all.

As a show of our support during this extraordinary time, the NCHA Board of Trustees approved a partial dues rebate to those members most distressed by COVID-19. The rebates will total approximately $120,000 distributed to 19 hospitals.

I'm pleased to share this mid-year report to highlight our response to the COVID-19 pandemic, show our progress on redesigning/reimagining health care, and preview what’s to come as we push the pedal on our strategic agenda. — Steve Lawler, NCHA President & CEO

Advocating to Protect Healthcare Providers — Atypical is the best word to describe the legislative year due to COVID-19. Last year’s budget stalemate brought the NC General Assembly back to Raleigh in January to discusses state finances. When the short session officially started in April, the state was in the midst of a global pandemic. COVID-19-related legislation dominated most of the session which wrapped earlier this month. Highlights included:

  • Liability reform for COVID-related healthcare services.
  • $25 million appropriated to NC Healthcare Foundation (NCHF) for personal protective equipment (PPE).
  • A Medicaid managed care go-live date of July 2021 with the hospital supplemental payment program secured.
  • Expanded telehealth options.

A summary of the short session will be shared with NCHA members later this summer. The General Assembly will reconvene on Sept. 2 to appropriate the remainder of the Coronavirus Aid, Relief, and Economic Security (CARES) Act.

In Washington, DC, NCHA staff advocated to influence the outcome of Federal legislation, funding legislation, waiver approvals, and Executive actions through key contacts and personal relationships. NCHA hosted a quarterly Congressional Delegation Staff roundtable to discuss items related to COVID-19 relief. Congressional staff agreed that temporary changes made to telehealth regulations should be carried forward on a permanent basis, resulting in virtually no barriers to telehealth delivery from the Medicare program. In addition, NCHA urged our Congressional delegation to explore more ways to provide relief to hospitals, including temporarily granting rural hospital designations to more health systems to guarantee higher reimbursements to offset revenue losses due to decreased elective procedures. Another round of federal funding is expected soon.

With a big election on the horizon, NCHA will focus on strengthening HOSPAC, educating new lawmakers, engaging with members on position development and preparing for the 2021 long session.

Building Influence — Top Left: Representatives from NCHA, Vidant Health, UNC Chatham, NC Rural Center, Office of Rural Health and the Foundation for Health Leadership & Innovation visited with staff from the offices of U.S. Senators Richard Burr and Thom Tillis in Washington, D.C. to discuss rural health issues in North Carolina. Top Right: NCHA hosted a legislative panel at Winter Meeting in February. It was moderated by Roxie Wells, MD, President, Cape Fear Valley Hoke (on right) with panelists (left to right): Former Rep. Nelson Dollar, Sen. Jim Perry (R-7th), Sen. Mike Woodard (D-22nd) and Rep. Carla Cunningham (D-106th). Bottom Left: NCHA was proud to be the presenting sponsor of a Triangle Business Journal event called "On The Record: A Conversation with Hospital CEOs." (Left to right) Donald Gintzig, Dr. David Zaas, Janet Hadar and Katie Galbraith were panelists. Leah Burns, NCHA Senior Director, Government Relations, led a pre-conference session at Winter Meeting for trustees to learn how to advocate for their hospitals and health systems, as well as engage politically.

Preserving the Healthcare Safety Net

NCHA continues to engage with State leaders on Medicaid reform and the Medicaid Reimbursement Initiative/Gap Assessment Program (MRI/GAP). The MRI/GAP Technical Advisory Committee worked with the NC Department of Health and Human Service (NCDHHS) to secure annual MRI/GAP payments in excess of $1.3 billion received in April, which is the largest net distribution and the earliest funds have been received. Recommendations made to NCDHHS and the Centers for Medicare and Medicaid Services were developed to maximize MRI/GAP funding resulting in an additional $70 million. In the coming months, the NCHA Financial Services Team will develop a work plan to ensure a smooth transition to Medicaid managed care, scheduled to begin July 1, 2021.

During the pandemic, NCHA has taken multiple actions to ensure hospitals and health systems maintain solvency. NCHA will be developing a COVID-19 financial task force aimed at providing members and regulators with recommendations on claiming and reporting State and Federal funds. Here are some financial highlights:

  • Federal legislation passed to support NC hospitals and health systems through the Families First Coronavirus Response Act (FFCRA) and CARES Act.
  • Federal funds received to-date total $1.3 billion. Federal and State efforts resulted in the availability of Medicare and Medicaid advanced payments.
  • Obtained $100 million in COVID-19 relief funds from NC General Assembly.
  • Obtained 5% base rate increase for services provided to Medicaid beneficiaries.
  • Submitted 13 comment letters to various organizations and regulators to assist with COVID-19's financial impact.

The NCHA Data Team has produced several reports intended to track the progression of COVID-19 in North Carolina:

  • Daily updates that trend cases, testing, deaths and hospitalizations.
  • A Pandemic Recovery Acceleration Model (PRAM) — dashboard/stoplight model that detects rapid changes in disease metrics (cases, deaths, percent positive tests), as well as changes in resource utilization (such as ICU beds and ventilators).
  • An analysis of the doubling rate of cases and deaths in NC and by flu region.
  • Member reports related to the impact of the CARES Act are also available through the NCHA website.

WORKING WITH THE STATE TO RESPOND TO THE COVID-19 PANDEMIC

Since the first case of COVID-19 in North Carolina was confirmed in March until May, NCHA has been represented at the State Emergency Operations Center (EOC) by Tatyana Kelly, vice president of Strategy/Planning and Members Services (pictured on right) and Nicholle Karim, policy liaison, (pictured on left). Their presence insured that hospitals and health systems had a voice in the State's strategy and could present urgent member issues to the team at NCDHHS. NCHA staff continues to maintain close contact with the EOC and NCDHHS. Here are a few highlights from our COVID-19 response:

  • Ensured Mutual Aid agreements from all members are signed and available.
  • Worked with the state to establish data-driven triggers that deploy assistance to hospitals in areas of NC experiencing a surge of COVID-19 cases.
  • Worked to alleviate urgent patient placement issues, data submission confusion, supply chain emergencies, and other issues brought to NCHA from members and to resolve issues through stakeholder engagement.
  • Developed NC Protocol Recommendations for Allocating Scarce Resources, in collaboration with the NC Institute of Medicine and NC Medical Society.
  • Developed Strategies to Support Nursing Surge Capacity During Biological Events, in collaboration with the NC Board of Nursing, the NC Organization of Nurse Leaders and NC Directors of Nursing Administration in Long Term Care.
  • Developed “Facility Hardening Considerations” in collaboration with Nebraska.
  • Collaborated with AARP North Carolina on a co-branded Post-COVID-19 Care Workbook for Caregivers.
  • Published email updates about changing guidance, data submission deadlines and requirements, upcoming webinars and other notable content. Also maintained a webpage of resources and quick links.

COVID-19 data reporting has been one of the greatest challenges hospitals face. With recent changes, NCHA is determined to support our members by working at the State and Federal levels to alleviate survey burden.

CONNECTING YOU TO SUPPLIES AND SERVICES TO RESPOND TO COVID-19 AND IMPROVE HEALTHCARE DELIVERY

The shortage of personal protective equipment and other supplies quickly became a major issue during the pandemic. The NCHA Strategic Partners (NCHASP) team sprang into action and have not slowed down in pursuit of connecting members to resources and supplies to safely combat COVID-19. Our group purchasing organization, Vizient, has been instrumental in providing “spot buys” for members and non-members throughout the pandemic. Highlights of NCHASP's response include:

  • Organizing collaborative purchases with healthcare providers across the state. The team developed a “hub and spoke” approach to purchase masks and Level 1 and Level 2 disposable gowns.
  • Distributing a donation of KN95 masks from U.S. Rep. David Rouzer (R-7th).
  • Maintaining a vendor resource list identifying sources for PPE, ventilators, hand sanitizer, and other critical supplies.
  • Working with NCHF to develop a process for using Coronavirus Relief Funds to purchase PPE on behalf of NCHA member hospitals.
  • Sharing a daily supply chain email update to materials managers.

The NCHASP team will continue bringing new partners into the portfolio of services where the COVID crisis has uncovered gaps. Remi, offering an Equipment Maintenance Management Program, joined NCHASP earlier this year. Other recent additions include: Engage Practice Solutions to help with remote patient monitoring; Field2Base, offering a mobile app and mobile structures for COVID-19 testing and screening; and PPE Exchange, a transparent marketplace connecting hospitals and healthcare providers to verified manufacturers of PPE.

NCHASP is also partnering with our Corporate Sponsors on webinars and in other ways to show appreciation for their generous support during a year when in-person events are not possible.

Rural Hospitals & COVID-19 — On April 10, the US Department of Health and Human Services, Assistant Secretary for Preparedness and Response (ASPR) awarded the North Carolina Healthcare Foundation (NCHF) $1.277 million to support urgent COVID-19 preparedness and response needs of hospitals, health systems, and healthcare workers. Funds support preparedness capabilities for NC’s 20 Critical Access Hospitals (CAHs) and small and rural hospitals under 50 beds (using the SHIP grant eligibility criteria). With input from the state’s rural hospital leaders, NCHA drafted a rural plan prioritizing the utilization of rural bed capacity, resources and staff both prior to and during a medical surge.

Redesigning the Delivery of Behavioral Health — NCHF continues to drive better health care and outcomes for behavioral health patients. One example is the ED Peer Support Pilot Project, funded by NCDHHS. Six pilot sites embedded two peer support specialists in their emergency departments, linking patients to harm reduction, treatment, and recovery resources. After two years, the results are promising: of the 4,000 patients to receive the peer intervention, there was a 35% decrease in ED visits and 38% decrease in hospitalizations when compared to one year prior. The pilot will end in August and includes a new implementation guide for hospitals to develop peer programs.

NCHA continues to partner with NCDHHS to implement SB 630, improvements to the involuntary commitment statute. NCHA hosted a successful Behavioral Health Workgroup in February and continues work with partners to drive common-sense policy changes. During the pandemic, NCHA is driving forward meaningful flexibilities for the behavioral health delivery system, including the involuntary commitment process.

NCHA also welcomed two new behavioral health members to the association in 2020: Old Vineyard Behavioral Health Services in Winston-Salem and Brynn Marr Hospital in Jacksonville.

Addressing Health Disparities and Health Equity — NCHF is addressing health disparities and promoting health equity through our support of two key programs funded by The Duke Endowment. AccessHealthNC comprises 18 networks ensuring access to care for the low-income, uninsured across 43 counties. During the pandemic, AccessHealthNC networks have served as a vital partner to meet the growing needs of the uninsured and support the influx of North Carolinians who lost health coverage due to unemployment. In the coming months, AccessHealthNC will support patients through outreach, chronic disease management and accessing telehealth to keep them connected to both the preventative and routine care.

Through technical assistance support, 10 Healthy People, Healthy Carolinas community-based coalitions across 11 counties have responded to urgent community needs related to the pandemic. With schools, churches, and workplaces suspending activities, coalitions are finding creative ways to ensure equitable access to healthy foods and to help individuals manage chronic health conditions, all potentially affecting both near-term and long-term impacts of COVID-19.

The Foundation formed the COVID-19 Fill the Gap Response Fund to partner with private philanthropy, corporate and individual donors to rapidly meet critical needs of organizations across North Carolina as they respond to the pandemic.

To date, the fund has raised more than $4 million. Grants will be distributed in three cycles to organizations working on the frontlines to address emerging, acute, and long-term needs. Lead funders include the David A. Tepper Foundation, Kate B. Reynolds Charitable Trust, State Employees’ Credit Union Foundation, and The Duke Endowment.

The Foundation distributed a request for proposals to healthcare, human service, safety net, and grassroots organizations for projects addressing health disparities created or worsened by the pandemic. Following a review process, $1.6 million in grants was distributed to 19 organizations with an average grant size of $87,635 in the first round of funding. In July, following a second round of review, $1.5 million in grants was distributed to 15 organizations statewide with an average grant size of $102,765. The grants will assist people and places disproportionately impacted byCOVID-19, including people of color, frontline essential workers, and rural communities.

Funds are supporting nonprofit organizations with activities such as efforts to provide hygienic supplies to migrant farmworkers to protect themselves, their families and communities from the spread of COVID-19.

Grant funds to Iredell Memorial Hospital and Iredell Physician Network in Iredell County are supporting video visits and remote monitoring of patients in rural areas who have one or more comorbidity and who are at increased risk of complication if they contract the virus.

The grant will allow Iredell providers to place 50 remote patient monitoring units in high-risk patients’ homes, allowing healthcare providers to closely monitor patient vitals, make adjustments to treatment, and reduce the risk of complications and hospitalizations.

FEEDING THE SOUL CAMPAIGN

In response to the pandemic, NCHF set up a fund to purchase freshly made meals from 18 locally owned restaurants across the state to deliver to healthcare workers. This effort nourished the bodies and souls of physicians, nurses and other healthcare heroes while boosting local economies during a time of acute need.

The NCHA COVID-19 Healthcare Heroes Response Fund “Feed the Souls” campaign ran from March through June and raised $166,701 funds from individuals. NCHA staff and volunteers delivered 17,187 meals to 15 hospitals across North Carolina.

The Foundation also partnered with Trophy Brewing in Raleigh to create the Feeding the Souls IPA. A portion of sales from each purchase will go to support the Foundation’s ongoing COVID-19 response efforts.

Redesigning the Health System through Innovation —NCHF, in partnership with The Duke Endowment, continues to work with the South Carolina Hospital Association to develop the Carolinas Health Innovation Institute (CHI2). In a fragmented health ecosystem, the institute will engage partners to understand needs, evaluate promising practices, and co-design innovative solutions to improve health outcomes and reduce disparities.

Reimagining Rural Health Care — NCHA hosted North Carolina’s Critical Access Hospital leaders for two days in February for the Statewide Critical Access Hospital Quarterly Meeting. The meeting theme was, “Profiles of Innovation: Advancing Performance in North Carolina Critical Access Hospitals.” The participants had active discussions on how to redesign rural health. The event included presentations by the NC Community Action Agency and NCCare360, as well as spotlights from member hospitals. Hospital leaders also received important updates and resources in the areas of quality, finance and operations from our partners with the NC Office of Rural Health.

Improving Access to High-quality Care — The Quality Center Patient Safety Organization (TQC PSO) kicked off 2020 with new goals based on review of 2019 event data, findings from the September 2019 Office of Inspector General PSO report, and feedback from members and the TQC PSO Member Advisory Council. One goal is to support learning and understanding of the protections provided by the Patient Safety and Quality Improvement Act of 2005 (PSQIA). A three-part webinar series began in February with the Alliance for Quality Improvement and Patient Safety (AQIPS) to help members fully utilize PSQIA protections. One TQC PSO member facility presented on a national AQIPS webinar to describe their use of PSQIA protections for a peer support program developed and implemented under the PSO umbrella, as an example of how PSQIA protections go beyond event data to significantly enhance learning.

Growing a New Generation of Diverse Leaders

The NCHF Mentorship Program launched in October 2019 to help cultivate a diverse pipeline of leaders in health care. The one-year program pairs eight high-achieving women and men (like Geard Fossett, a corporate financial analyst with Wake Forest Baptist Medical Center, pictured right), from underrepresented communities who are already employed in health care with five executive leaders from health systems, hospitals and NCHA. Earlier this year, mentees were featured in an NCHF Diversity Fellows Profile video series to share their background and mentorship experience. Healthcare leaders across the state are encouraged to serve as a mentor and identify rising stars within their hospitals and health systems to apply as mentees. Recruitment for the next class will begin later this summer and continue through fall.

Telling the Healthcare Story — The association launched a long-term public relations initiative to strengthen the faith and trust that North Carolinians have in health systems and hospitals, and to position the healthcare field as the leading drivers and voices for a vision of healthcare transformation. To inform strategy for this work, consumer focus groups were held in four regions of the state as well as phone interviews with health system and hospital leaders. An advertising campaign and new content hub website will launch in September along with a series of regional virtual town hall sessions where healthcare leaders will chat with diverse patients and community members to better understand their healthcare needs and wants.

NCHA Communications continues to promote value-based care as a better option for the State Health Plan than the Treasurer’s Clear Pricing Project (CPP). Efforts included a press release with a tie-in to Winter Meeting; media interviews like this Business North Carolina podcast; a communications toolkit to promote value-based care; and more.

Thanking Healthcare heroes and Informing the Public During COVID-19

An NCHA video developed to urge the public to thank North Carolina healthcare workers garnered more than 1 million impressions on Facebook and Instagram and was sent to 120,000 readers of  Our State magazine through an email campaign. Staff members have also coordinated many media interviews about hospitals’ financial losses due to COVID-19 and their transitions to resume elective procedures.

NCHA also developed PSA videos urging North Carolinians to not delay getting needed health care. The videos were shared on social media and were sent to NCHA members and to the North Carolina Association of Broadcasters for distribution to television stations.

NCHA collaborated with other organizations during different phases of the pandemic to create messaging from staying-at-home to reopening the economy — including working with the NC Chamber and North Carolina Medical Society on a joint statement calling on all North Carolinians to help limit the spread of COVID-19 by wearing a face covering when in public or high-risk indoor group settings, practicing social distancing and washing hands often.

NCHA had billboard campaigns thanking healthcare workers and urging the public to wear masks to help prevent the spread of COVID-19.

To celebrate National Hospital Week, NCHA collaborated with the Bandit Flight Team, a North Carolina nonprofit organization, to hold formation flyover tribute events with special television coverage in the Triangle, Triad, Charlotte and Sandhills regions.