Convening Change
North Carolina Healthcare Foundation
2023 has been a year of laying groundwork for several Foundation initiatives that are now ready to test and evaluate solutions to redefine the healthcare delivery system and improve health. This work is possible thanks to many of you answering the call when NCHF convenes diverse voices and perspectives to work on pressing health concerns.
I’m pleased to share an update on how NCHF is enhancing access to care, supporting rural healthcare delivery, creating greater equity of care, improving behavioral health, and strengthening workforce development and retention.
Thank you for collaborating with NCHF and CaroNova, our health innovation incubator, on this important work.
Julia Wacker Senior Vice President, NCHA President, NC Healthcare Foundation Executive Director, CaroNova
Watch this video explaining the North Carolina Healthcare Foundation's role as The Convener of Change.
AccessHealth NC NCHF supports 18 community-based AccessHealth networks across North Carolina that provide access to donated care for uninsured Carolinians — serving more than 55,000 enrollees in 2023. With Medicaid expansion enrollment underway, the Foundation’s technical assistance team has convened AccessHealth networks to leverage their local capacity for Medicaid enrollment outreach and to help care for these new Medicaid-qualified North Carolinians.
Healthy People, Healthy Carolinas (HPHC) The Foundation provides technical assistance to 19 Healthy People, Healthy Carolinas (HPHC) coalitions across North Carolina. This includes the five new coalitions added this year:
North Mecklenburg Economic Mobility Collaborative (sponsored by Atrium Health)
Rockingham County Health Collaborative (sponsored by Cone Health)
Duplin Coalition for Health (sponsored by ECU Health Duplin Hospital)
Healthier Gaston Collaborative (sponsored by CaroMont Health)
Healthy Guilford Coalition (sponsored by Atrium Health Wake Forest Baptist)
In October, these five coalitions advanced beyond the initial one-year readiness grant to prepare for a five-year implementation grant beginning in 2024.
Nearly 100 representatives participated in the Annual HPHC Bi-State Meeting at The Duke Endowment that focused on topics like implementing upstream approaches to tackle complex problems and leveraging the power of coalitions in developing equitable and inclusive community engagement strategies. In addition, coalitions developed equity statements and impact analysis tools to guide framing in decision-making.
Comprehensive Palliative Care for Serious Illness CaroNova’s Comprehensive Palliative Care for Serious Illness Program has created a care model to redesign the system of care for individuals living with serious illness. In 2023, CaroNova began to develop an innovation pilot and long-term demonstration project to build the business case for value-based contracting. BlueCross BlueShield of South Carolina and the Medical University of South Carolina (MUSC Health) have committed to participating in a two-year pilot beginning in 2024 that’s being designed by a payor/provider workgroup supported by CaroNova. During the pilot, sites will leverage grant funds to meet the workforce and operational requirements needed to provide comprehensive palliative care services while continuing to operate under a fee-for-service structure. This funding approach will help confirm the business case for value-based payment arrangements needed to sustain the model long-term. CaroNova has also identified partnership opportunities to pursue in 2024 with commercial payors in North Carolina and with the South Carolina’s Medicaid program.
Home Hospital Early Adopters Accelerator CaroNova’s Home Hospital Early Adopters Accelerator program led to the creation of more than 20 operational workflows and implementation tools for hospitals and health systems to advance or launch new home hospital programs. Additionally, as a direct result of the CaroNova team’s convenings with hospital members and state legislature over the past two years, South Carolina’s budget allowed for the delivery of home hospital services across the state. And in North Carolina, Senate Bill 206 was signed into law allowing hospitals and health systems with Home Hospital programs to continue providing acute care at home until Dec. 31, 2024.
Rural Health Innovation Through funding from the North Carolina Office of Rural Health, NCHF supports equity in care, patient safety, population health, and quality improvement within North Carolina’s critical access and small rural hospitals through the Medicare Flexibility (FLEX) Grant Program and the Small Rural Hospital Improvement Program (SHIP) Grant.
This year, NCHF hosted the bi-annual Critical Access Hospital Statewide Meeting themed Rural Health: Experience It! The sessions engaged rural health executive leaders and quality directors in action planning to support rural health services stabilization. NCHF also launched the fourth year of the Certified Professional Healthcare Quality (CPHQ) Certification Preparation and Professional Development Program. Through this cohort style program, NCHF provides coaching on root cause analysis, return on investment for quality and finance improvement activities, health equity, and population health – and cultivates cross-continuum and organizational collaboration.
Rural Hospital Leadership and Workforce Development Grant The Foundation developed a new grant program in 2023 with $375,000 in funds to support workforce capacity building and retention priorities in rural hospitals. Grants were awarded in April to support rural workforce development projects in nine small and rural North Carolina hospitals. Funded activities include training and certification programs, learning management system implementation, leadership development and efforts to address workplace violence and crisis intervention.
Robeson County Social Impact Project With funding from the Kate B. Reynolds Charitable Trust, NCHF selected Robeson County to pilot a project focused on the social impact needs around transportation. In 2023, NCHF partnered with UNC Health Southeastern to identify key stakeholders to form a Social Impact Community Development team to coalesce around opportunities to address more social needs. In 2024, the team will co-design the parameters for distributing mini-grants to pilot small tests of change around long-standing practices and policies that promote inequities in health outcomes.
Quality Improvement and Safety The Foundation’s focus in quality improvement and safety work this year was to infuse equity into all performance improvement (PI) and safety efforts to ensure true quality-of-care delivery for all. Towards this goal, the NCHF Board created a new board committee, the NCHF Quality Improvement and Safety (QIS) Committee that has prioritized initial PI efforts on maternal morbidity – focusing on post-partum hemorrhage as the metric to improve. The NC hospitals (92% of NCHA membership) that have signed the NCHA Equity Resolution will be invited to join the first round of quality improvement activities in 2024. These activities will be offered in two tracks, a Learning Community open for all members and a regional Action Network focused on reducing disparities in maternal morbidity.
A key focus of the NCHA Equity Committee has been to develop a business case for how health equity investments can help members improve their financial performance. The goal is to clearly show, using relevant hospital financial data, that health equity work should be core to every hospital’s business, and that return-on-investment may be a more useful tool for assessing health equity actions. A white paper demonstrating the business case will be available in early 2024.
NC Emergency Department Opioid Use Disorder Treatment Program The Emergency Department Opioid Use Disorder Treatment Program supports hospital emergency departments with providing buprenorphine, an evidence-based Medication for Opioid Use Disorder (MOUD) that reduces withdrawal symptoms and helps to prevent relapse.
NCHF has worked with eight pilot sites to support their implementation of ED-based buprenorphine with targeted training, education, and coaching support. The pilot has been a hub for testing and refining tools and resources that can be disseminated to other communities. The project is funded by the North Carolina Division of Public Health, Injury and Violence Prevention Branch (IVPB), with implementation coaching and trainings provided by clinical experts at the Mountain Area Health Education Center and Atrium Health. The pilot phase ended in August. The next phase will focus on supporting hospitals with sustaining their programs and on bringing the program to more hospitals.
Opioid Stewardship Accelerator The Opioid Stewardship Accelerator, led by CaroNova, aims to accelerate the adoption of best practice tools and strategies for opioid use disorder prevention, treatment, and recovery among health systems across the Carolinas. The focus has been on implementation coaching and support to hospitals to implement CaroNova’s online opioid library of tools and resources.
Youth Mental Health NCHF is dedicated to addressing the mental health crisis with a current focus on upstream youth mental health interventions and support. CaroNova is now in the third year of partnering with more than 100 stakeholders on activities that include synthesizing the evidence on mental health access barriers for youth and establishing an ideal model of care based on examples of a broad range of programs that promote youth mental wellness. As a result, the team created a Framework for Integrated Youth Mental Health & Wellness Care that simplifies a complex and inaccessible youth mental health system and illustrates how sectors — including health, education, and community — can collaborate to support the mental health and wellness care of all youth. Stakeholder conversations raised a common concern around the impact of violence on youth mental health. CaroNova will explore how to mitigate the effect of violence on youth mental health with a short-term goal of identifying which systems, policies, or processes could have the greatest impact.
Behavioral Health Redesign in South Carolina 2023 marked CaroNova’s second year working with the SC Department of Health and Human Service (SCDHHS) to develop a South Carolina Behavioral Health Master Plan. As each phase of the plan was completed, CaroNova worked with SCDHHS to translate recommendations into actionable investments. In phase 1, CaroNova’s recommendations included the need to add 80 inpatient psychiatric beds to achieve a better statewide bed-to-population ratio. As a result, SCDHHS prioritized investment in creating an innovative regional behavioral health hub in Florence, SC, that includes triage, crisis stabilization, telehealth and outpatient and inpatient services. CaroNova’s phase 2 recommendations directly led to a grant opportunity for crisis stabilization services with SCDHHS providing $45.5 million to 13 hospitals to build specialized emergency psychiatric assessment treatment healing (EmPATH) units dedicated to behavioral health crises.
Additionally, CaroNova began working with SCDHHS this fall to develop a comprehensive school-based behavioral health pilot. The goal of this effort is to launch a pilot for the 2024/2025 school year in Florence, SC, that will serve as a learning lab for integrated school-based behavioral healthcare for the region.
Looking ahead, CaroNova will document and socialize the South Carolina Behavioral Health Master Plan and its success stories with North Carolina state leaders and hospitals to help spur investment and coordination across the state in tandem with the NC Governor’s goal of investing $1B in mental health services.
Diverse Healthcare Leaders Mentorship Program This year marks the fourth year of the Diverse Healthcare Leaders Mentorship Program, which provides career development opportunities to Black, Indigenous, and People of Color mid-career healthcare professionals, including one-on-one executive mentoring, monthly leadership sessions, and peer learning groups. The recent class selection includes 26 mid-career mentees and 21 healthcare executives serving as mentors. The program continues to attract healthcare talent, to date producing 59 graduates representing eight health systems across the state.
Healthcare Workforce Resiliency Accelerator This fall, CaroNova launched the Healthcare Workforce Resiliency Accelerator project that aims to retain and strengthen the current healthcare workforce in the Carolinas by accelerating adoption of best practices for improving resilience and reducing burnout. This program will identify and disseminate effective strategies for health systems to address employee turnover and attrition.
North Carolina COVID-19 Hospital Preparedness Program The Foundation continued to provide technical assistance to more than 50 environmental service (EVS) leaders representing 32 healthcare facilities through the NC Certified Health Care Environmental Services Technician (CHEST) Training and Certification Program in partnership with the Association for the Healthcare Environment. This statewide train-the-trainer program equips EVS leaders to train and certify EVS technicians in their organizations on infection prevention and control practices. The program has led to a 191% increase in CHEST-certified EVS technicians. Facilities with high training and certification rates are reporting increased staff satisfaction, observed improvement in patient safety culture, and improved interactions with clinical staff.
Watch video featuring Kalin Griffin Bostwick, Novant Health's VP of Inclusion and Pipeline Programs, who serves as a mentor within the Diverse Healthcare Leaders Mentorship Program.
Foundation Fundraising Report As of early December, donors to the Foundation have given $21,576 to support healthcare access, equity, and quality. In addition, business owners and organizations across the state have given in-kind donations valued at $8,640. In 2023, 45 new donors have joined the Foundation’s giving community. The Foundation’s end-of-year giving campaign launched in November and ends on Dec. 31.
Funds raised will support the Mentorship Program. In total, $77,613 has been raised for the Diverse Healthcare Leaders Mentorship Program since May 2021. An additional goal is to encourage monthly giving to the Foundation. Our target is to engage 50 donors. The annual giving program plays a critical role in supporting the work of Foundation as all NCHF’s programs are supported exclusively through grants or donations, as opposed to membership dues. Click here to give.
