February 2022 OutreachNC by OutreachNC

FEBRUARY 2022 - 1

F E B R U A R Y 2 0 2 2

Feature Intro: Concierge Medicine: A New Frontier for Primary Care A year ago, a friend remembered the days when doctors made house calls and healthcare seemed more personal. While we can all agree good healthcare is important, high-quality healthcare can feel hard to find. Office wait times are on the rise. According to research in the journal Health Services Research (2021), wait times in emergency rooms have increased by 10% as of 2021, with average wait time over two hours. Wait times in primary care offices are roughly 18 minutes, but friends and colleagues report waiting longer than that for some appointments. Many doctors are limited in the time spent with patients and have heavy patient loads. If a patient has multiple concerns, they’re often told to make multiple appointments. If this sounds frustrating for patients, it’s upsetting for doctors as well. Research in the Journal of Internal Medicine (1999) reports, “In the current practice environment, physicians face mounting demands on their time. Increasing administrative requirements for health care delivery (e.g., service and authorization requests, utilization review processes) encroach on time spent with patients.” The situation has only gotten worse with COVID, administrative work and the ever-shifting landscape of insurance. Enter concierge medicine, a growing style of primary care medicine offering personalized care and direct access to physicians for better overall health and wellness outcomes. What used to be available mostly to the wealthy and elite, concierge medicine is growing nationwide among all social classes.

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CONTENTS ASK THE EXPERT: NATIONAL DONOR DAY FEATURE: CONCIERGE MEDICINE: A NEW FRONTIER FOR PRIMARY CARE

LETTER FROM THE EDITOR

Amy Phariss, Editor-in-Chief, OutreachNC | editor@outreachnc.com

FEBRUARY 2022 - 2 We hope this issue of ONC finds everyone warm, with power and drinking something soothing by a fire. After snowstorms, ice and falling branches throughout the Sandhills, we could use a blast of blue skies and the promise of a spring thaw. This month we explore the burgeoning world of concierge medicine, growing both nationally and locally. In Southern Pines, FirstHealth’s Concierge Signature Medicine is open and accepting new patients. ONC sat down with Drs. Belyea, Johnstone and Baugher to discuss what concierge medicine means, which services patients can expect and why this growing medical model is beneficial for patients and doctors alike. In Ask the Expert, AOS Care Management Associate Ashley Seace answers questions about organ donation and offers advice regarding how to have this important, but often delicate, conversation with a loved one. I think Walt Whitman’s words are most fitting as we power through February and onward toward spring:

Keep your face always toward the sunshine - and shadows will fall behind you .

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ASK THE EXPERT: NATIONAL DONOR DAY

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FEBRUARY 2022 - 4 Q: I am a health care professional and I work with a variety of patients who have different health issues. I find myself asking individuals if they are organ donors or if they have talked to their family members about organ donation. This can sometimes be an awkward conversation to have. They often have a lot of questions about the process. Can you offer some suggestions for having this conversation with my patients?

Only when you are declared legally dead is when organ donation becomes an option. Another concern about organ donation is fear if someone’s religion may not support donation or that it may affect the funeral plans they already have in place. In fact, most major religions accept organ donation as a final gift or a final act of compassion. Donate Life compiled a list of several religions that support organ and tissue donation including:

• Amish • Assembly of God • Baptist • Buddhism • Catholicism • Christian Science A: Great question! It’s important to have these conversations and to help patients understand the impact they might have on someone else after they pass away. Donate Life offers a lot of useful information about organ and tissue donation on their website (www.donatelife.net). There is even a national system that matches organs from the donor to someone on the waiting list, removing the guesswork for medical providers and families. You may share with your patients that one individual donor can help save up to eight lives via organ donation! Organ donation can also restore sight to two people through cornea donation and heal more than 75 people with tissue donation. Individuals may not understand the wide impact they will have when they donate their organs or tissue. Donors give several families an opportunity to continue living. Easing fears is also important. Some patients may think that because they are an organ donor, they are not going to receive proper medical attention because a doctor might want to donate their organs. This is not the case! All doctors are trained to save your life.

• Disciples of Christ • Episcopal • Evangelical Christian Church • Greek Orthodox • Hinduism • Islam • Judaism • Lutheran Church • Mennonite • Church of Jesus Christ of Latter-day Saints (Mormon) • Presbyterian • Sikhism • Southern Baptist Convention • United Methodist

FEBRUARY 2022 - 5 Any funeral arrangements you have laid out will not be affected by organ donation either. It is still possible for your family to carry out your wishes, even if you request a viewing. Organ donation treats your body with care and respect so that your plans can still be carried out. It doesn’t matter who you are or what your background is when it comes to organ donation. Organs and tissue are donated based on blood type, body size, how sick someone is, donor distance, tissue type, and the amount of time on the donation list. Donation does not take into account your sexual orientation, gender, gender identity, race, income, or social status. Saving someone’s life does not require you to be the most famous person in your town or someone of a certain race. It is simply a desire to utilize your organs for the benefit of someone else. You might advise your patients that the best way to start the conversation with family about their wishes for organ and tissue donation is

to explain how organ donation offers hope to those who need a life saving or life enhancing donation. People can explain that it is a way to share love with another family who could have more time with their loved one through organ donation. Another way to start the conversation about organ donation is by showing your family members your own ID with a heart on it. This is how medical professionals and family members can identify you as an organ donor. Making the decision to be an organ donor in advance can help reduce stress families may feel after a loved one has passed away. Remind patients, when deciding to become an organ donor, it is important to know what you are signing up for and the impact it can have on your community, as well as including family in this decision. Visit organdonor.gov for more information.

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FEBRUARY 2022 - 6

CONCIERGE MEDICINE: A New Frontier for Primary Care by Amy Phariss

continued from page 1 ONC sat down with three concierge physicians at FirstHealth Concierge Signature Medicine in Southern Pines. We explore all of these issues and more as Drs. Loni Rogers Belyea, W. Miller Johnstone III and Julie Baugher offer insight and perspective into what concierge medicine is and how it can benefit patients and doctors alike. ONC: What exactly is concierge care? How does it differ from what we think of as “normal” primary care? Dr. Johnstone: With concierge medicine, individuals pay a subscription fee, usually annually, which buys them membership into the practice, so to speak. With that, we’re able to limit the number of patients a physician sees at any given time. In our practice, our limit is 400. In a normal medical practice, this can be 20% of what I would see. So, it becomes an equation. When you have 3,000 patients, you can only feasibly spend so much time. With the concierge model, I am able to see a patient who has a need that comes up. I am not fully booked, so I can have touches in continuity. I can see them and fit them in. We can have extended visits. Also, with extended visits, we can address a number of problems that may have taken three visits. Also, you have 24/7 access to a physician. One of us is on call in the evenings and on weekends, and our patients are able to access us. You don’t have to use a phone tree or leave a message. One of us is acting in real time. It’s patient-centered and provides high levels of access and continuity. Dr. Belyea: We also have time to discuss prevention. That’s huge. It has really come out as a buzz word in health care: preventative maintenance. We’re not just addressing chronic medical issues. We have time and get to know patients well enough to prevent a heart attack, to prevent a stroke or further bone loss, etc. Dr. Baugher: Yes, we focus a lot on wellness. What can we do to make your life better? We’re not just checking a box for a mammogram. Can we get you an athletic trainer or do something else to improve your overall quality of life? We’re looking at the whole picture of

FEBRUARY 2022 - 7 the patient. We can set goals with patients. Maybe a patient doesn’t want to take medication. We can set goals to make that happen. Dr. Belyea: It all comes back to relationships. How do you decrease medications, for example? We have time to come up with treatment plans that actually fit into the patient’s lifestyle. We can really talk about their personal lives and circumstances. You can develop plans that the patient can actually do and succeed with. ONC: What is the biggest myth about concierge care? Dr. Johnstone: That it’s just for the affluent; that it’s just for someone with all the resources and money. It works for patients of a lot of demographics, a lot of socio-economic statuses. If you break it down monthly, it’s roughly $150 a month. It’s not just for people making half-a million dollars a year. Dr. Baugher: Many of our patients would not be considered wealthy. They come from all socioeconomic backgrounds. Dr. Johnstone: Families feel like it’s a good investment. Dr. Baugher: Another myth is that it’s solely for elderly patients. Many young people are just blown away by the focus on wellness and how wellness helps them long term.

One population we serve is the veteran community. We have many veterans who are in their 40s and 50s who’ve served overseas. They often have complex medical issues, especially for their age. We’ve really been able to help those veterans achieve a better quality of life. ONC: What made you, as physicians, move toward this type of care? Dr. Baugher: I just felt like I couldn’t spend time with my patients. Now, I can sit down and actually spend time with my patients. It’s an hour and a half for the first appointment. You really develop this personal connection with patients. Even the patients I saw before I joined concierge practice, now I get to spend more time and get to know them better.

FEBRUARY 2022 - 8 Also, just navigation through healthcare is hard. We have a nurse navigator who takes care of your travel through the health care system. That’s a huge benefit for both the patient and for us doctors. Dr. Belyea: So, as a medical student, one of my mentors was a geriatrician. What we realized is that in order to practice geriatrics effectively, you need to be able to spend time with your patients. When you’re treating a patient, it’s not just treating them; a lot of times you have to do a lot of education with the family, the caregivers, and provide guidance on what this is going to look like in the future. You can’t fit that into 15 and 20 minutes. And so, what my mentor did with half his practice, was make it concierge medicine. The fees his patients pay with concierge medicine allow him to keep his panel small enough to allow him to provide this level of care.

There is a therapeutic benefit to the relationship you establish with your patient. Time is very helpful in building this relationship I also have an MBA in non-profit healthcare administration, so I always thought I would also have a hybrid or full-on concierge panel, and now I get to do that. Also, in our office here, we have a weekly geriatric subspeciality consult clinic. We have that one half day each week. Concierge care allows us to provide these programs. ONC: Does health insurance have a role in concierge medicine? Dr. Baugher: We bill and accept all insurances. We bill the patient’s insurance. Whatever standard co-pay they’re used to is what we bill. Dr. Belyea: The only additional out of pocket cost is the annual membership fee. Dr. Baugher: We do accept cash pay, too. You don’t have to have insurance to be part of our practice, but if you do have insurance, we will work with that. ONC: What if a patient uses Medicare? Can they see a concierge doctor? Dr. Baugher: Yes. We take all insurance including Medicare and Medicaid.

ONC: We know wait times in many offices are increasing. Can you speak to what wait times look like in your office? Dr. Baugher: In terms of wait times, we strive for on-time appointments. We have a small waiting room, and that is rarely ever full. Within a few minutes of your appointment time, you will be back in the exam room. It’s rare there is more than five minutes of wait. Dr. Belyea: We’re ready for the patient when they get here. We sit down with the nurse before the patient comes in, and we know what we need to cover before the patient walks in the door. This preparation allows for efficient appointments. ONC: What level of communication can a patient expect with a concierge doctor? What would that look like compared with a normal primary care physician? Dr. Johnstone: Patients have access 24/7. When they call here, they will speak to a person. They will speak to that physician’s clinical staff, and then if they need to speak to us, we have the availability in that day to get back to them to address that. We can get back to them that day.

We will call our patients personally to talk to them about labs and test results, especially if they are abnormal. We call and say: this is what it is. This is what we’re going to do about it. Just not having a phone tree alleviates so much stress patients feel with the healthcare system. Even in the off hours, you get a person, a physician. Unless we’re on the phone with another patient, we answer. Dr. Baugher: We have a patient portal for secure messages as well. We discourage patients to message after hours so we can address issues by phone. But they can send us a message any time through MyChart, which gets checked all day long. ONC: Do you offer any unique services that might be difficult to find in a typical primary care setting? Hormone replacement? Health coaching, etc.? Dr. Johnstone: We’re able to leverage a lot of services under the FirstHealth umbrella that’s been recognized

FEBRUARY 2022 - 9 by their quality of care. That helps our referral base and accessing other services. We’re engaged in increasing the services we’re able to offer. Dr. Belyea and I are both board-certified geriatricians. We have all obtained Titleist Performance Institution (TPI) Level 1 certification and plan to achieve Level 3 this year. Dr. Belyea: With TPI certification, it’s been amazing to offer a different perspective when looking at patients with mobility issues. And this goes back to lifestyle. When we can keep patients in their golf game; it’s not just physical. It’s social. And also, where they’re having the pain may not be where the problem is. It may be something with the back that is causing the knee pain. And it’s about their community. Keeping our patients playing golf keeps them connected to their golf community. I am board-certified in obesity medicine, and we all plan on achieving the certification soon. Dr. Baugher: Yes. As patients age, it’s so important to have community and socialization. ONC: What are the fees associated with concierge medicine, and how does a patient address this when looking for concierge care? Dr. Johnstone: We offer two levels. There is the basic level, which is an annual payment of $1800, and we

offer the Concierge Signature Medicine Package, which is $2500 annually. With this package, patients receive a membership to the FirstHealth fitness center, eight personal training sessions, six massages per year and quarterly dietician appointments. ONC: We know seeing a doctor isn’t just about the doctor. We spend time with his or her staff, which can be its own experience. In fact, sometimes we spend more time with staff than with the physician. What are the benefits for your staff in providing this type of care? Dr. Belyea: Each one of us has our own personal staff member. We work one-on-one with that person, and that person develops relationships with our patients. You develop a relationship with our whole staff. Dr. Baugher: It’s more of a family environment. The patients get to know their doctor and the other doctors, too. So, if someone is out and a patient needs to be seen, they know that doctor. Dr. Belyea: I’ll tell you, I have several patients who come in, and they might love me, but they love Candace more than me! I think our staff members feel connected to the patients. They find value in their work, and they’re recognized as a valuable member of the team. No matter what our career path is, we all want to find value in what we do. Staff who join our practice, they want to find that, too.

FEBRUARY 2022 - 10 Dr. Johnstone: Our clinical staff know our patients about as well as we do. I share information with my staff, so they know what is going on. They know where the patient is right now. They can move forward. There is a big comfort factor when the clinical staff know them as well as the physician. They know that staff member is their point person. Dr. Belyea: Our clinical staff take ownership and are really invested. Their job satisfaction is obvious. They help identify recourses and it shows. The patients feel that.

Dr. Johnstone: We walk out of here fulfilled because we get to practice the type of medicine we imagined when we went to medical school. The staff walk out fulfilled, too. Dr. Belyea: Another thing that comes along with that, it’s just education. We have time to educate our staff about medical issues and non-medical issues. So, they feel really comfortable talking to patients. They know about treatments and medications. We talk, together,

about all of this. A few weeks later, if a patient calls with a question, the staff knows how to address that. Everyone is working at the top of their license. It’s good for us who have staff who want to do more and learn, and that’s good for our patients as well. ONC: Will patients see the same provider for each visit if there are multiple providers in a practice? Dr. Johnstone: Our patients see the same physician every time unless we’re on vacation or the patient needs to see a doctor who is on call. But yes, you’re assigned to the same doctor every time. Dr. Belyea: And we build in time every day to be able to see someone urgently. It’s rare that we’d send a patient to urgent care. ONC: What do you think patients need to consider most when thinking about switching to concierge care? Dr. Belyea: I think their healthcare goals. Do they want a more patient-centered, comprehensive level of care…what are the goals?

FEBRUARY 2022 - 11 Dr. Johnstone: I think another thing to consider is that your primary care physician changes when you switch to concierge care. It’s not an add on. You are deciding to change your primary care physician. Dr. Belyea: If you’re satisfied with your current primary care doctor, stay with them. If you want additional services and a higher level of care, you can look at concierge. Dr. Johnstone: We’re not saying we’re the only good physicians in the community. A lot of great physicians practice in a system that doesn’t allow them to have this kind of time. ONC: What does having more time with patients mean to you as physicians? Dr. Belyea: We keep our panel low, so we can really provide personal and comprehensive care. We get to know our patients, and they get to know us. We know that if Mrs. Smith calls in, it must be really serious because we know Mrs. Smith. So that call doesn’t get pushed back. A lot of times, reassurance and education are often what patients need, but if you don’t have time, that gets lost. Dr. Baugher: The other thing about having so much more time, you’re not just taking care of the top three issues like hypertension and diabetes. You can address other pain, like knee pain, right then and there rather than saying “We don’t have time for that. We’ll just send you to a specialist.” Now I have the time to manage those complex medical conditions just as their primary care doctor rather than sending them somewhere else. Dr. Belyea: Another thing is care coordination. We have time in our day that is flexible, so we can address something acute that comes up. But it also gives us time to respond to emails or call a specialist if we need to. We can call a pharmacy. We can talk to other physicians and come up with a plan. Sometimes, with medical notes, there is a lot that gets lost in translation, so having those conversations can really help clear up the plan. Dr. Baugher: Especially when we’re trying to coordinate multi-level care and bringing it back to together to create a unified treatment plan. Also, we can utilize the hospital resources. Most concierge care isn’t practiced in a hospital system.

But being part of a hospital system, we have access to EPIC, which is our electronic health records. So, we have access to images and results from other specialists. So, we don’t have to call and get those notes, that lab work, those images. With EPIC, because we’re part of the FirstHealth system, if a patient is sent to the ER or is admitted, I can coordinate with the ER physician by just chatting with that physician. It’s a succinct system to take care of the patient both in-patient, outpatient and with care coordination. Also, we have patients who utilize services at UNC and Duke, and they utilize EPIC. So, we can view so much information by being part of the FirstHealth Health System. Dr. Johnstone: We all feel very fortunate to be given the opportunity to practice in this model. If you asked physicians – what if you had a chance to get to know 400 patients and get to know them and really take care of them, would you do it? So many of them would do it! I tell my wife every day, I’m just so fortunate to be able to go to work like this, happy. Dr. Belyea: We’re all good doctors, and we want to provide high quality of care but you’re on a hamster wheel and afraid you’re missing something because you’re on that wheel. Dr. Baugher: Yes. When you see 30 patients in a day, you lie awake at night and worry. You lay awake afraid you’re going to miss something that could be devastating. Dr. Belyea: What patients don’t see is that doctors are taking home hours of paperwork at night. Dr. Baugher: I would put my kids to bed and do two hours of paperwork. I would sit at night and my husband would watch TV, and I’d do work. Even on vacation my kids knew I had two hours of tasks to complete each day. It was never-ending. Now, I can go on vacation. My staff can handle it. I remember going on vacation and not taking my laptop. My kids asked where it was. Dr. Belyea: It’s also nice having a small practice; you get to know your colleagues. You can trust them. You trust them to care for your patients. For more information about FirstHealth Concierge Signature Medicine, you may call (910) 684-5499.

FEBRUARY 2022 - 12

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FEBRUARY 2022 - 13

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Across 1. Dog-eared 5. Open, as a bottle 10. Adult male swans 14. On the safe side, at sea 15. Anklebones 16. Catcall 17. Abstruse 18. At full speed 19. "The Snowy Day" author ___ Jack Keats 20. Threatening with divine punishment 23. Fireplace 24. High-hatter 25. Used to indicate the maiden or family name of a married woman 26. Kind of approval 27. "The Matrix" hero 30. Utah lilies 32. ___ lily 34. Electrical gizmo 38. Automatic mechanical device causing new records

to be played without manual intervention 42. Kind of lineup 43. Aces, sometimes 45. Zoroastrian 48. "___ bad!" 50. Be in session 51. Bauxite, e.g. 52. Butcher's offering 56. Full of veins 58. Easily influenced 62. Arias, usually 63. Bit of color 64. Commanded 66. "-zoic" things 67. Barely beats 68. Auspices 69. Harmony 70. Change, as a clock 71. Mar, in a way Down 1. Large amount of money 2. Ornamental shrub 3. Carry out again 4. High land 5. Its motto is

"Industry" 6. Finger, in a way 7. Studies intensively 8. ___ flu 9. It's spotted in westerns 10. At the home of 11. Leaking out 12. 3rd largest island in the world 13. Levels 21. Big ___ Conference 22. "A Doll's House" playwright 23. Conditions 28. Benjamin Disraeli, e.g. 29. "What are the ___?" 31. "Cogito ___ sum" 33. Wood sorrels 35. Appear 36. Excellent, in modern slang 37. Hawaiian tuber 39. Antipasto morsel 40. Fodder harvested while green and kept

succulent 41. Controlled 44. Chester White's home 45. Carries in equilibrium 46. Collection of resources 47. Redesign 49. Egg cells 53. Banana oil, e.g. 54. "All kidding ___..." 55. American hakes 57. Fell off 59. Kind of computer architecture 60. Arch type 61. Home, informally 65. "C'___ la vie!"

FEBRUARY 2022 - 14

RESOURCES. EXPERIENCE. SOLUTIONS.

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It has always been universally understood that listening to favorites is enjoyable and can lift one’s mood. However, during the past few years we’ve come to better understand the therapeutic value music can have on those with dementia. For qualified individuals, AOS & Friends Care offers a program which provides a music player loaded with personalized songs.

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FEDERAL LAW PROHIBITS ANYONE BUT REGISTERED USERS WITH HEARING LOSS FROM USING INTERNET PROTOCOL (IP) CAPTIONED TELEPHONES WITH THE CAPTIONS TURNED ON. IP Captioned Telephone Service may use a live operator. The operator generates captions of what the other party to the call says. These captions are then sent to your phone. There is a cost for each minute of captions generated, paid from a federally administered fund. No cost is passed on to the CapTel user for using the service. CapTel is a registered trademark of Ultratec, Inc. NC Department of Health and Human Services • Division of Services for the Deaf and Hard of Hearing • ncdhhs.gov/divisions/dsdhh • NCDHHS is an equal opportunity employer and provider. • 04/2021

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