Welcome to Your 2025 Wrapped

If 2025 were a playlist, it would be an epic mix of resilience, innovation, and hard work. As we close out the year, we wanted to take a moment to look back at the "music" we made together.

This year, practice managers and staff across our region didn't just keep the rhythm—you set the tempo for better healthcare in Northwest North Carolina. From navigating complex payer changes to launching new care models, you turned challenges into chart-topping successes.

Here is what your year sounded like, according to the numbers.

📊 The "Minutes Listened" (Our Impact by the Numbers)

You were incredibly busy this year. While much of the healthcare world was just tuning in, you were logging serious hours to improve access and quality.

• Total Practice Coaching Encounters: 2,297
  • That represents nearly 2,300 specific touchpoints where we worked side-by-side with you to solve problems and improve care.
• Top Region on the Charts: Ashe County ⛰️
  • Ashe County was our "Top Artist" this year with 164 encounters, proving that rural health remains the heartbeat of our region.
• The Rising Hits:
  • Alleghany and Alexander counties also topped the setlist, keeping the momentum strong across our footprint.

🎹 Your Top Genre: Medicaid Managed Care

If 2025 had a main genre, it was definitely Medicaid Managed Care.

Just like in previous years, this was the beat driving most of our work. Whether it was deciphering the Standardized Performance Incentive Program or navigating Advanced Medical Home (AMH) tier support, you stayed in sync with the state's biggest changes.

Your Top Sub-Genres (Trending Topics):

• Billing & Coding: The technical solos that kept your revenue cycle moving.
• Practice Management Operations: The daily rhythm of running an efficient office.
• Quality Payment Program (QPP): The critical performance reviews that ensured you got credit for your quality care.

💿 The "Viral Hits" (Top Stories of 2025)

Every year has those standout tracks that everyone talks about. These were the success stories and resources that defined 2025 for our network.

• The Story: Facing a surge in mental health needs, the team at Twin City Pediatrics implemented the Collaborative Care Model (CoCM).
• The Result: By June 2025, they didn't just launch—they became revenue-positive six months ahead of schedule. It was the feel-good hit of the summer and a blueprint for others to follow.

 The Indie Favorite: Fall Risk Assessment 

• The Story: Released in June, the self-paced course Falls: Screening, Risk Assessment and Care Planning became an instant essential for clinicians working with older adults.
• The Vibe: Since its debut on 6/16/25, it has racked up 223 registrations. By focusing on the STEADI framework, you proved that keeping patients safe and steady is a timeless classic that never goes out of style.

• The Story: With the announcement that the Clear Pricing Project ends on Dec 31, 2025, we shifted focus to transition planning.
• The Shift: You worked hard to prepare for the move away from CPP and into new fee schedules for 2026, ensuring your practices remain financially stable during the switch.

🔮 Your "Musical Aura" for 2026

Based on your listening habits late in the year, 2026 is shaping up to be a year of Innovation & Resilience.

We are already queuing up tracks on AI in Clinical Decisions, Cybersecurity, and leveraging the newly relaunched NC AHEC Digital Library. The setlist for next year is going to be exciting, and we can't wait to explore it with you.

Thank you for a chart-topping 2025!

Here’s to keeping the beat going in the New Year.

— The NW AHEC Practice Support Team

Need help planning your 2026 playlist? Reach out to us at practicesupport@wakehealth.edu.

North Carolina needs primary care clinicians to support the state’s rapidly growing population, and the Primary Care Clinician Index from the Sheps Center tracks changes in the healthcare workforce. This recent article in the NC Medical Journal discusses the changes that this index shows in the NC healthcare workforce, highlighting the statewide patterns in clinician location and type.

To learn more, check out the ADL’s December 1 Highlighted Resource: Unpacking the Primary Care Clinician Index: Understanding How Changes in Population and Workforce Supply Affect Access to Primary Care in North Carolina

For more on health factors in NC, check out the latest issue of the NC Medical Journal: Turning the Curve: Halfway to Healthy North Carolina 2030

We’re excited to invite you to the last Community Health Worker (CHW) Integration Workgroup meeting of the year on:

📅 Date: Tuesday, December 9, 2025
🕑 Time: 2:00 – 3:00 p.m.
📍 Location: Virtual (Zoom)

This session will feature El Futuro, sharing their experience implementing the Collaborative Care Model (CoCM) program with CHWs. It’s a great opportunity to learn from their journey and explore strategies for integrating CHWs into care teams.

Join Zoom Meeting:
https://us02web.zoom.us/j/89721245320?pwd=vZahdMsTNgYvfumrx08NsjzpnFPyKn.1
Meeting ID: 897 2124 5320
Passcode: 758973

Questions Contact Jessica Rodriguez at jessica.rodriguez@mahec.net.

Looking Ahead to 2026

This workgroup series will continue next year, highlighting CHW integration efforts across the state. Stay tuned for more opportunities to connect, share, and learn!

Are you a new or aspiring practice manager, or a provider interested in learning more about practice management? The NC AHEC Practice Management Academy is your gateway to professional growth, networking, and leadership development.

Practice Manager Boot Camp: Leadership Module

Spaces are still available for the Leadership module, starting January 2026!

• Dates: Thursday, January 8, 2026 – Monday, March 9, 2026
• Time: 3:00 PM – 4:00 PM
• Format: Virtual Classes (9 Contact Hours)
• Registration: https://www.southernregionalahec.org/courses-and-events/75763
• Registration closes: January 7, 2026
• Fee: Register by 12/8: $180 | After 12/8: $225

Who Should Attend?

• New and aspiring practice managers
• Providers interested in practice management
• Anyone seeking to enhance leadership and management skills

What You’ll Learn

Week-by-week topics include:

• Braveheart Leadership: Characteristics of inspirational leaders, personal strengths and growth opportunities
• Becoming an Authentic Leader: Impact of gender and implicit bias, authentic leadership styles
• Understanding & Building Your Team: Emotional intelligence (EQ) vs. intelligence quotient (IQ), team dynamics
• Vampires in the Workplace: Identifying and managing toxic staff
• Effective Communication: Professionalism, conflict cycles, and resolution
• Managing Conflict: Power dynamics, critical conversations, crisis communication
• Retaining Effective Employees: Creating a constructive work environment
• Mentoring Physician Leadership: Strategies for orienting provider-leaders, collaboration
• How to Run a Meeting: Structured agendas, facilitation, best practices, and formal meeting structures

Speakers

• GeGe Beall (MS, FACHE, SPHR, SHRM-SCP): Expert in industrial/organizational psychology and HR/organizational development
• Matt Johnson (BA, MA, MBA): Experienced practice administrator, NC Medical Group Management Association board member
• Jane Moran (BA, MLS): Project Specialist, NCAHEC Practice Management Academy, customer service and education expert
• Melissa Overton (BSN, RN, CEO): Award-winning educator, mentor, and CEO of MedicalTraining.me

Why Join the Practice Management Academy Community?

• Free Membership: Access free courses, news, and networking opportunities
• Professional Development: Learn and register for upcoming courses
• Networking: Connect with other practice managers and providers

Many patients with high blood pressure also struggle with limited access to food. A group of North Carolina researchers recently investigated which method of food insecurity interventions worked best to help patients improve their high blood pressure, evaluating food subsidies, delivered food boxes, and lifestyle counseling.

To learn more, check out the ADL’s November 1 Highlighted Resource: Food Insecurity Interventions to Improve Blood Pressure: The Healthy Food First Factorial Randomized Clinical Trial

Guidance for Practice Managers on Navigating the 2026 Network Transition

Practice managers should be fully prepared for the substantial changes coming to the North Carolina State Health Plan (NCSHP) network in 2026. The Plan is facing a $507 million deficit, prompting a thorough evaluation of existing programs and reimbursement models. Sincere gratitude is extended to all organizations that have supported both the Plan and its members during these times. This post outlines what’s changing, why, and what practical steps your practice may need to take.

Clear Pricing Project (CPP) Ending December 2025

The Clear Pricing Project (CPP), launched in 2020, promoted transparent healthcare pricing and aimed to incentivize quality primary and behavioral health care by offering zero copays to members who visited participating providers. While this model brought increased reimbursement rates for many providers, it has not been financially sustainable. As a result, CPP will conclude on December 31, 2025. After that point, providers will no longer receive current elevated reimbursement rates, and members will not have a $0 copay structure for behavioral health services.

Preferred Providers: New Structure in 2026

Effective in 2026, the State Health Plan will roll out the Preferred Provider initiative. The only way for practices to become Preferred Providers will be through affiliation with CCPN (Community Care Physician Network), Aledade, or The Alliance. Practices outside these partnerships will still be considered in-network, but cost shares for members will be different—typically higher than those for Preferred Providers.

Key Action: Review your current affiliations and consider whether joining CCPN, Aledade, or The Alliance is right for your practice. Preferred Providers will grant patients access to lower copays starting in 2026.

Behavioral Health Access Program (BHAP)

To continue supporting behavioral health, the Plan is launching the Behavioral Health Access Program (BHAP) in 2026. This program creates a custom fee schedule for behavioral health providers, specialties, and a specific set of CPT codes:

• 140% of current NC Medicare rates (updated annually, effective May 1) for key codes: psychotherapy, evaluation & management, psychological testing
• ABA services reimbursed at NC Medicaid rates
• TMS codes reimbursed at Aetna Market Fee Schedule (AMFS) rates (same as current CPP)

Action for Behavioral Health Practices: If interested in joining BHAP, visit the Aetna website for enrollment details and next steps.

Working with Aetna: Network Participation & Resources

Aetna will serve as the third-party administrator for the Plan starting January 2026. Practices must be part of Aetna’s Choice POS II network to remain in-network for State Health Plan patients. If not already participating, please visit the Aetna website to begin the enrollment process.

Additional Resources for Practice Managers:

• 2025 NCSHP Network Participation Agreement (Aetna)
• 2025 NCSHP Network Rate Schedule (Aetna)
• 2025 NCSHP Network Professional Fee Schedule (Aetna)
• Aetna Provider Website
• Signup for Aetna emails
• OfficeLinks Updates Newsletters
• Aetna Provider State Health Plan site
• Aetna Resources

For contract, reimbursement, or benefits questions, contact Aetna Provider Line at 888-632-3862. For clinical or precertification information, refer to Aetna’s clinical information and prior review resources. Email NorthCarolinaNetwork@aetna.com for network queries, or SHPProviderNetwork@nctreasurer.com for State Health Plan questions.

What Practice Managers Should Do Now

• Evaluate providers’ current affiliations and consider joining CCPN, Aledade, or The Alliance for Preferred Provider status.
• For behavioral health, review the BHAP program and assess if it matches the needs of your practice.
• Ensure participation in Aetna’s Choice POS II network before January 2026 to maintain in-network status.
• Stay updated on policy changes, copay and reimbursement structures, and communicate these changes to your team and patients.

UnitedHealthcare’s New Remote Monitoring Policy

UnitedHealthcare (UHC), one of the nation’s largest health insurers, has announced an updated policy change regarding coverage for remote patient monitoring services. As of the latest update, UHC will end coverage for most remote patient monitoring (RPM) when it is determined to be “unproven and not medically necessary,” specifically targeting standard cases of Type 2 diabetes and hypertension. This decision has broad implications for healthcare professionals, patients, and those tracking healthcare policy developments.

Details of the Policy Change

UHC’s new policy discontinues coverage for remote patient monitoring in cases where the service is considered unproven or not medically necessary, focusing chiefly on routine management of Type 2 diabetes and most hypertension cases. However, there are notable exceptions:

• Heart Failure: Remote monitoring will continue to be covered for patients diagnosed with heart failure, reflecting evidence supporting improved outcomes in this population.
• Hypertensive Disorders of Pregnancy: Coverage remains in place for pregnant individuals with hypertensive disorders, a group for whom remote management has shown benefit and can mitigate risks to both mother and child.

These exceptions underscore UHC’s commitment to supporting RPM where research demonstrates clear clinical value. The policy applies to new and existing patients as of the effective date, which is detailed in UHC’s provider communications.

Impact on Members: Who Is Affected?

The policy affects UHC members across several plan types, including those enrolled in Medicare Advantage, commercial employer-sponsored insurance, individual exchange (Marketplace) plans, and Medicaid. For most individuals with Type 2 diabetes or standard hypertension, remote monitoring devices and associated services will no longer be reimbursed unless a specific exception applies. Providers and patients should carefully review plan details to understand ongoing eligibility and coverage for RPM.

CMS Rule Changes: Upcoming Service Rate Adjustments

The Centers for Medicare & Medicaid Services (CMS) is expected to implement new rules that adjust payment rates for remote patient monitoring services in 2025. These changes may influence how payers and providers structure RPM programs and could impact future coverage decisions. Stakeholders are watching closely to understand how these federal updates will interact with insurer policies like UHC’s.

Implications for Patients and Providers

UnitedHealthcare’s revised remote patient monitoring policy marks a notable shift in coverage for chronic disease management. While the decision narrows access for many with Type 2 diabetes and hypertension, it maintains support for populations where RPM has proven benefits. As CMS finalizes new rules and advocacy groups push for policy reconsideration, patients and providers should stay informed about coverage updates and seek guidance to ensure continuity of care where remote monitoring remains essential.