2020-06-04 PAG FinalPARTNERSHIP ADVISORY GROUP
JUNE 4, 2020 MEETING PAGE 1
ASSEMBLY
The Partnership Advisory Group met to hold a virtual meeting on Thursday, June 4, 2020, at 5:30 p.m. in
Wilmington, North Carolina.
Members present via roll call: Co -Chair Barbara Biehner; Co -Chair Spence Broadhurst; Vice Co -Chair Bill
Cameron; Vice Co -Chair Dr. Joseph Pino; Members: Dr. Virginia Adams; Evelyn Bryant; Robert Campbell; Chris
Coudriet; Cedric Dickerson; Brian Eckel; Jack Fuller; Hannah Gage; John Gizdic; Dr. Sandra Hall; Tony McGhee; Dr.
Michael Papagikos; Dr. Mary Rudyk; Dr. Rob Shakar; Jason Thompson; Meade Van Pelt; and David Williams.
Staff present via roll call: County Attorney Wanda Copley; Clerk to the Board Kymberleigh G. Crowell;
Assistant County Manager Tufanna Bradley; Chief Financial Officer Lisa Wurtzbacher; Chief Communications Officer
Jessica Loeper; Budget Officer Sheryl Kelly; Intergovernmental Affairs Coordinator Tim Buckland; New Hanover
Regional Medical Center (NHRMC) Director of Marketing and Public Relations Carolyn Fisher; NHRMC Chief Legal
Officer Lynn Gordon; NHRMC Chief Strategy Officer Kristy Hubard; NHRMC Executive Vice -President and Chief
Financial Officer Ed 011ie; Joseph Kahn, Shareholder with Hall Render and outside counsel for NHRMC; Bobby Hamill,
Attorney with Hall Render and outside counsel for NHRMC; David Burik, Managing Director with Guidehouse; Greg
Van Alstyne, Senior Strategy Consultant with Guidehouse; Eb LeMaster, Managing Director with Ponder & Company;
and Robert Jaeger, Vice President with Ponder & Company.
Co -Chair Broadhurst called the meeting to order and thanked everyone for participating in the virtual
format. This meeting is being held as a permissible virtual meeting with public access to open session components
in accordance with state law. As with all other meetings, the public can hear the open session portion of the
meetings, but is not participating in the meeting discussion, and there will be no questions from the public in this
forum.
Co -Chair Biehner stated that when the PAG moves into closed session, the public access will have a
placeholder slide of "Closed Session Portion" and no audio; this slide will close and audio will be turned back on as
the PAG goes back into the open session portion of the meeting. This will be the public's visual cue to resume
listening. It is anticipated the closed session will last approximately 60 to 90 minutes.
APPROVAL OF MINUTES
Vice Co -Chair Cameron MOVED, SECONDED by Vice Co -Chair Pino to approve the May 21, 2020 regular
minutes as presented. Upon vote, the MOTION CARRIED UNANIMOUSLY.
PRESENTATION ON EXPLORING HEALTH EQUITY: SOMETHING WE DO OR WHO WE ARE? (SLIDES 5 —14)
Co -Chair Biehner stated this portion of the agenda is in follow-up to the last PAG meeting where it was
reiterated that health equity is a critical component of this process and it was identified that there was a need for
more education. The PAG has continued its discussion of health equity in smaller groups and will be conducting
further due diligence on the advancement in health equity that each request for proposal (RFP) respondent could
support in our community. She then introduced Dr. Philip Brown, NHRMC Chief Physician Executive, stating that Dr.
Brown will present information on what is currently being done relative to health equity.
Dr. Philip Brown, NHRMC Chief Physician Executive, thanked the PAG and the support team for their work
and stated he feels health equity is the most complex topic amongst all of the NHRMC strategic initiatives. As a
result, it is one of the most complex topics the PAG will have to deal with in the exploration process. He can provide
assurance that the topic is confusing and some of the components are unsettling. It takes a deep commitment to
achieve health equity and has to be developed over a long period of time. Of the three plus years of the NHRMC
strategic plan in implementation, execution, and preparation this one topic has taken many phone conversations,
hundreds of hours of study, thousands of pages of reading, and tons of hours of classroom time to understand these
concepts by the NHRMC organization. His goal during this presentation is to present a field of concepts that will
provide the PAG some pragmatic ways of what needs to be looked at as part of the exploration process. He also
wants to share why he is convinced that this singular topic holds the key to prosperity for NHRMC, the community,
and the state.
Dr. Brown reviewed slide 5, NHRMC Identified Strategic Need: Full -Scale Health Equity Program, noting that
the current challenge that exists is a small scale program with committed people and somewhat limited resources,
but with a lot of energy and alignment with the community. For example, the Northside community assessment led
to subsequent actions across the community such as the significant funding of Portia Hines Park to change it to a
community park with updated resources, commitment to upgrade the aquatics facilities, and multiple other different
improvements in that part of the community. What is important to understand is that the strategic need is around
what you need to look for in terms of data analytics, not only the equity gaps but also track them in a meaningful
way in terms of learning where we are and how we are closing the gaps. He would encourage the PAG during this
exploration when looking for a full scale equity program to not only look for the results from the respondents, but
expect results.
In review of slide 6, Health Equity: Attainment of The Highest Level of Health for All People, Dr. Brown stated
the definition of health equity is actually simple. It is the attainment of the highest level of health for all people.
Simple to say, but sometimes hard to do. NHRMC's intention around this is to do what is stated on the left side of
slide 6. As he stated earlier, NHRMC has an incredibly diverse and committed workforce who is dedicated to meet
the unique need of every individual. The whole concept around what the goals are as shown on the slide, but what
he wants to put emphasis on is the last bullet point, which is the targeting of disparities that have wide-ranging
impacts and how to develop initiatives that eliminate the gaps to create a healthcare system that is equitable. This
PARTNERSHIP ADVISORY GROUP
JUNE 4, 2020 MEETING PAGE 2
is done essentially to deal with health disparities created around social determinants of health in a way that
ultimately eliminates them and integrates them across the entire community that we serve.
In review of slide 7, Health Equity: Social Determinants of Health, Dr. Brown stated that social determinants
refer to an ecosystem of conditions and are really the conditions of our life. The examples shown on the slide, while
separated into columns are ultimately all connected in many different ways. If you want to understand how social
determinants work, you have to understand the areas of concentration. For example, the concentration of poverty.
When you look at our region, there are several different concentrated areas of poverty, and they are almost
completely confined to the African-American community. That is not to say poverty does not exist in other areas,
but this is about concentrated poverty. This important concept has many ramifications when talking about economic
stability, education, access to food and healthy activities, access to healthcare provider availability, transportation,
safety, built infrastructure likes parks, playgrounds, and walkability. All these things are adversely affected by
concentrations of poverty and also are additional challenges in rural areas.
Dr. Brown stated in regard to the question of "How satisfied are you with the current state and the status
quo?" in review of slide 8, when looking at health equity and the current status in the United States and North
Carolina, this nation is the most expensive for healthcare. We're approaching 20% of our gross domestic product
expenditure. Another thing is that we have consistently poor outcomes as compared to every other developed
nation in the world. North Carolina ranks 36th in the United States for overall health. He then reviewed the health
rankings of the counties served by NHRMC within the state and the parenthetical numbers are how each county has
been affected by COVID-19 and how the challenges will be worse going forward. The rhetorical question is "Are you
satisfied with this level of performance when your life or the life of a family member, friend, or neighbor depends
on it?"
In review of slide 9, Health Equity: Snapshot of North Carolina Disparities We Know, Dr. Brown reviewed
examples of health disparities in the state on infant mortality, diabetes mortality, kidney disease, geography, life
expectancy, and race. The information shows some of the differences in care that are not explained by anything
scientific and there are other factors. The slide is on race, but there is more information based on age. The questions
about why the rates shown on the slide are higher for African-Americans and American Indians than for whites are
tough questions. These are the very questions that need to be grappled with to understand health equity and to
begin to engage in population health management in meaningful ways.
In review of slide 10, Health Equity: Fundamental Concept 1, Dr. Brown stated the first of two concepts that
need to be understood is that health equity is not the same as charity care. Charity care is a small portion of health
equity. Focusing on health equity across the board to create programs provides opportunities for everyone to reach
their high level of equity. Health equity is not about giving a person a fish. Health equity is about teaching people to
fish and teaching everyone to fish so that everyone can eat. He hopes this concept gets everyone to start to think
"What does this mean for the whole value based concept that has been heard." That leads into the second
fundamental concept on slide 11 that financial viability in value based care requires a conscious decision. For an
organization to be successful in value based care they have to decide between the option of cherry -picking the
population served or the second option that is contingent upon successful population health management of all
people. In order to accomplish this, each disparity (gap in service) must first be identified, then minimized and
ultimately eliminated in order to enable each member to reach their highest level of health, hence optimizing margin
on per member per month (PMPM) reimbursement. In a value based concept, everyone needs to be as healthy as
possible for financial viability.
In review of slide 12, Health Equity: Building upon NHRMC Health Equity Track Record, Dr. Brown reviewed
NHRMC's track record to date. He provided an overview of the ten items listed under NHRMC's health equity track
record. He then reviewed the full scale health equity version noting that the Centers for Medicare and Medicaid
Services (CMS) gives awards to those who enable communities to achieve the highest levels of health. It is for what
is done, not what is said. He noted that two of the RFP respondents have earned this award by demonstrating a
commitment to eliminating disparities particularly with respect to and in this order: race, ethnicity, gender, LGBTQ,
and those living in rural areas. In terms of thinking about this region and about the dividing line he spoke of earlier,
then about the particular rural challenges, and the disparities there, you start to understand the magnitude of the
challenge because the analytic capabilities you need to do to make an impact on the disparities that exist on the
north side and south side of Wilmington versus what you need to do to impact all those other counties that are
tremendously rural areas are dramatically different. We need a different capability. He cannot personally, nor could
his whole team that works on health equity, cover that geography with shoe leather like they did on the north side
of Wilmington. More needs to be done. When looking at these programs, it's about delivering results on the items
as shown on the right hand side of the slide across all populations. In talking about health equity, for Dr. Brown this
is the core value and the way things should be done and makes sense, but he knows there needs to be reason. He
also knows the organization can never succeed in population health management until the gaps can be closed. These
gaps are too huge between the different populations. We need different capabilities, plain and simple, but it can be
done.
In review of slide 13, Health Equity: "We Don't All Have the Same Chance to Be Healthy", the illustration is
a classic example of the difference between equality and equity and this is what actually enables each person to
reach their highest level of health. It is more than what we would do in the health system in terms of support, but
it's how we lead the system with the message, how we lead the community to outstanding health by getting out and
using analytics to figure out where the gaps are in the community, as was done with the Northside community,
except on scale with seven or eight counties and maybe beyond. To do that, NHRMC has to have a full scale health
equity program.
PARTNERSHIP ADVISORY GROUP
JUNE 4, 2020 MEETING PAGE 3
Dr. Brown concluded his presentation thanking the PAG for their work. Co -Chair Broadhurst thanked Dr.
Brown for the presentation and opened the meeting to questions.
In response to questions, Dr. Brown stated that Novant received the CMS Health Equity Award in 2018 and
Atrium received the award this year. Beyond those two, there are other systems across the country who have been
effective in health equity. As far as which one stands out that can be looked at, it is hard to beat Novant and then
Atrium behind them. These are the first two to ever receive the CMS award. As to why other very prestigious health
care organizations have not received them, it has to do with what their missions are. He would encourage the
committee to compare what the organizations are trying to do to versus what NHRMC is trying to do and it will solve
itself. The reason why those two have gained such national notoriety is because their missions in those areas around
diversity and around the marriage of rural and urban requires that they do it and take action.
Co -Chair Broadhurst thanked Dr. Brown for his and his team's work and their contributions to the NHRMC
organization.
CLOSED SESSION
Co -Chair Broadhurst announced that the meeting would move into closed session for confidential
discussion and review of confidential information, pursuant to North Carolina General Statute (NCGS) 143-
318.11(x)(1); NCGS 143-318.11(a)(3); and NCGS 131E-97.3. These protect competitive healthcare activities and
attorney-client matters. He asked for a motion to move into Closed Session.
Motion: Member Fuller MOVED, SECONDED by Vice Co -Chair Cameron to enter into a Closed Session pursuant to
NCGS 143-318.11(a)(1), NCGS 143-318.11(a)(3), and NCGS 131E-97.3. These protect competitive healthcare
activities and attorney-client matters. Upon vote the MOTION CARRIED UNANIMOUSLY.
Co -Chair Broadhurst excused the public participants and convened to Closed Session at 6:18 p.m.
CONVENE TO OPEN SESSION AND PREPARATION FOR RESPONDENT PRESENTATIONS DURING THE WEEK OF JUNE
8TH
Co -Chair Broadhurst called the meeting back to order at 7:58 p.m. and thanked the members for their
discussion and work during the closed session and expressed appreciation to public who remained on the line during
that time.
Co -Chair Biehner stated that the three respondents will be presenting to the PAG in open and closed
sessions. The question and answer session will be held in closed session to provide PAG members a forum to ask any
additional clarifying questions to aid their continued assessment of the proposals. Duke Health will present on June
9`", Novant Health on June 10`", and Atrium Health on June 11`". Each presentation will begin at 5:30 p.m. with each
having an hour to present. Community members and general public can stream the presentations live on NHCTV.com
and NHCTV cable stations (Spectrum channel 13 and Charter channel 5). The respondents will be talking about their
commitment to the communities that they currently serve, their culture and values, key differentiators, and looking
at their vision for what a partnership would include. As far as meetings after next week, there will be a PAG meeting
on June 18`" and it will potentially be held at UNC -Wilmington (UNCW) in the Burney Center to accommodate an in-
person meeting. More information will be forthcoming on the location. The County Commissioners public hearing
on all six respondents will be held on June 22"d at 5:00 p.m. and further details will be released next week. The July
2"d PAG meeting has been moved to July 7`" in recognition of the holiday weekend.
CLOSING REMARKS AND ADJOURNMENT
Co -Chair Biehner stated the next step of the PAG, per the charter, is to narrow the recommendation to one
recommended partnership or combination of partnerships, further assess that refined partnership option against
the status quo or internal restructuring, and then vote on which of these three options the PAG supports,
communicating that to the NHRMC Board of Trustees and the County Commissioners, for their respective
deliberations. A lot of great work has been done by the PAG members, support team, consultants, and there has
been a lot of great input. This evening there were 18 lines participating from the public. She expressed appreciation
for the public's interest in this very important matter and comments that have been sent to the PAG. As a reminder,
tonight's meeting will be posted for the public at https://nhrmcfuture.org/. There being no further business, Co -
Chair Biehner adjourned the meeting at 8:01 p.m.
Respectfully submitted,
/Kymberleigh G. Crowell/
Kymberleigh G. Crowell
Clerk to the Board
Please note the above minutes are not a verbatim record of the Partnership Advisory Group meeting. Meeting
materials associated with this meeting are included as attachments to these minutes for reference.
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