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Transition in Chaos — Chip Baggett ‘16

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Memorials

Transition in Chaos

BY CHIP BAGGETT ‘16 EVP/CEO North Carolina Medical Society

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North Carolina will reach a landmark in its history this March with more than 875,000 COVID-19 cases confirmed, 11,000 deaths attributed, and 1 million doses of vaccine administered. For me, it will also mark the passage of my first six months as only the fourth EVP/CEO of the North Carolina Medical Society (NCMS), the oldest professional society in NC, founded in 1849, serving physicians and physician assistants. Our previous leader held the reigns for over two and a half decades. While the transition was not unexpected, the timing was not what anyone could have anticipated.

You will remember that September 2020 was a peak of instability. COVID cases were flattening at a very high daily rate after a summer peak. Students were returning to virtual school after a few months of hope that in-person learning would be possible in the fall. We were amid a massive awakening to systemic injustice. The nation was at odds with itself over the impending Presidential election just 60 days away.

These were trying times to say the least, but for NCMS members it also meant the eighth straight month of record low patient appointments. Revenues were 30-50% below budget. Expenses were up due to new COVID requirements. There were massive shortages of essential personal protective equipment (PPE). Some small, private practices had even closed their doors by this point never to reopen. The ones that remained open plunged headlong into utilizing new technology for virtual visits in an attempt to maintain relationships with their patients and prevent further impacts of chronic disease than were already anticipated. These were trying times indeed.

I am thankful to have been with the NCMS for more than thirteen years before having this new opportunity as its leader. The familiarity gave me an ability to hit the ground running at a time when new leadership could have needed to take a step back. I moved to Raleigh in 2007 to take over the NCMS’ state legislative duties after running the Buncombe County Medical Society, working in pharmaceuticals, and even teaching art in a previous life. Five years later, the NCMS supported me as I took on the challenge of working a fulltime job while attending the NCCU School of Law Evening Program. Another four years passed, and I would emerge from the feat a little battered but not beaten. The challenge had been overwhelming at times but there was always a light at the end of the tunnel. I knew when that ride was going to conclude, one way or another.

That is not the case for this pandemic. We each play a role in how fast it ends or how long it stays, but the virus has a life of its own. Wearing a mask has become the norm. We all wash our hands nearly as often as our mother once told us to. And physical distancing has taken on dynamic new meanings, keeping families and friends separated for so long that we now expect a wave of mental health concerns to follow in the virus’ wake.

And yet, the virus marches on. It mutates and adapts to our every move. New strains emerge more virulent and possibly more deadly. Who would have known just a year ago that we would be talking about a variant of the common cold with such concern? But there is new hope. Now three vaccines provide relief from serious illness and death from this pathological malady. These vaccines will likely become a part of our routine yearly medical visits in years to come. But for now, they are revolutionary and, I for one, am relieved that we are about to reach a level of supply that matches demand.

COVID has not hidden or eliminated the existing difficulties for our health care system. We continue to face persistent access-to-care issues, and skyrocketing health insurance coverage costs. The insidious health disparities that have plagued our care model since the dawn of our nation have been newly illuminated. These are challenges that NCMS has attempted to address for decades. But this virus has given us a renewed focus and forced us to throw off old thinking and resolve to be solutions-oriented.

My team at NCMS has worked virtually for the last year, but they have risen to the challenge to advocate and represent our members at every level of government and within the health care system to address the pandemic and maintain our member’s ability to care for our friends, family and neighbors. I knew this team well as we had been in the trenches together for more than a decade. My board was and remains committed to keeping this talented group of people together, even as many professional associations are cutting back on staff. And during this unprecedented time, my team did not hesitate to capitalize on this crisis to rethink how we are internally structured, challenge our systems to find efficiencies and reimagine a vision for what NCMS can deliver for North Carolina in the next decade. This has been one of the most humbling aspects of my new

job. It has been amazing to lead a group of professionals who are inspired by their work because they can see what that work is building toward. Our mission at NCMS is to unite, serve and represent physicians and their teams to enhance health. Our new vision focuses that health enhancement to include the wellbeing of everyone in North Carolina. This has given us new breath to speak to urgent needs within our community practices, our public health infrastructure and in the very lives of the patients that our members serve.

We are aligning ourselves with groups we might have previously opposed to challenge our own thinking and to amplify the positive effect we can have when our forces are working toward a common good rather than focusing on small disagreements. As an advocacy organization, we can choose a defensive posture, or we can dream of a better tomorrow. NCMS has thankfully always been focused on creating a better tomorrow for our members and their patients. While we can all be bogged down at times by a reluctance for change, NCMS members and staff are realizing, now more than ever, the time has come to challenge existing norms.

We must figure out a way to purchase health rather than health care. Our organization has been working with like-minded groups for more than a decade to move our reimbursement system away from fee-for-service to value. Value pays your health provider for partnering to keep you well rather than churning on the hamster wheel of sick care. While this seems practical in concept, the complexity of changing a system that is focused on codes and payments is daunting. But health care has adapted before to better serve patients and we can do it again.

During this pandemic, NCMS has worked to acquire funding from the North Carolina General Assembly (NCGA) for essential PPE, liability protections and financial relief. We received all of those supports. During the fall of 2020, NCMS delivered $5 million in masks, gowns, and face shields to private practices across North Carolina. Hospitalemployed physicians were receiving like services through the Emergency Management System. In the last 58 days of the year, NMCS stood up a brand new technology system to collect financial receipts related to COVID expenses from hundreds of private practices. The system was utilized to distribute $25 million in hometown medical clinic financial assistance provided by the NCGA. That is unprecedented.

While these successes were timely and amazing, we will need equal urgency and focus to make a difference in the ongoing struggles of our existing system of health. The cultural change that has started within NCMS must extend well beyond to include extraordinary partnerships. We must reimagine how and where we deliver care as we normalize remote visits to achieve real improvements in behavioral health. We must fully embrace accountable care as we transform payment models to better reflect the outcomes we seek to achieve with our patients rather than the services we perpetually deliver without measured improvement.

All of this will require the gifts of analysis, examination, and creativity that I acquired during the extraordinary opportunity to hone while attending NCCU School of Law. This one-time art teacher (and later lobbyist) went back to school late in life to emerge with training that extends well beyond legal interpretation. They say it’s never too late to teach an old dog new tricks, and I guess I’m living proof of that. This health care system might be an old dog, but together we can continue this transition in crisis and arise with a model that is truly focused on delivering the best for every patient.

I lead my team now because of the support of countless individuals. They include my family and many of my current colleagues, but also the amazing professors in the evening program and my steadfast study group. I will always remember a meeting with my dean during school when I was facing a particularly challenging time with a family illness, overwhelming work, and the weight of law school. She said, “It’s really pretty simple. You can quit, or you can keep going.” No matter the obstacle, I choose to never give up.

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