The policy forum of this issue reviews new models of health care payment and delivery. North Carolina is a national leader in some of the new models envisioned under the Affordable Care Act, and this forum features authoritative commentaries about 6 types of models in the state: entrepreneur-driven activities, management of innovations, applications of technology, changes in financing, market approaches, and structures involving changes in how health care professionals work. Also in this issue, original articles describe overweight and obese employees’ perceptions about lifestyle-associated changes in health benefits, career transitions among physicians dually trained in internal medicine and pediatrics, and hospitals’ use of data to identify disparities in the care of minority patients.
Denise Levis Hewson, BSN, RN, MSPH
Because of her experience growing up in England, Denise Levis Hewson was accustomed to a universal health care system in which everyone has equal access to services. After coming to the United States and receiving her nursing degree from the University of North Carolina (UNC)–Chapel Hill, Hewson began working in Duke University Hospital’s emergency department, where she saw many patients who had no insurance or were covered by public health plans visiting the emergency department for primary health care. She says she “could not understand why these poorer people could not get proper health care.” It was then that she decided to work toward redesigning the health care access and delivery system for underserved individuals.
Hewson began working toward her goal by returning to UNC–Chapel Hill for a master of science in public health degree. While Hewson earned her degree, she researched how to increase primary care access to the Medicaid population. During this time, she also began working for the North Carolina Office of Research, Demonstrations, and Rural Health Development (currently titled the Office of Rural Health and Community Care) as a health and managed care specialist. Torlen Wade, who began working with Hewson during her graduate internship, says that she is “extraordinarily passionate and effective in getting people to work together and tireless. It is a combination of those that makes her a wonderful person to work with.”
In 1990, Hewson began working on an innovative new program called Carolina Access. Carolina Access used a medical home model to provide primary health care and care management to the Medicaid population in North Carolina. The program eventually led to the development of Community Care of North Carolina (CCNC), a nationally recognized medical home program for Medicaid beneficiaries in the state.
As the current director of clinical and quality improvement programs at CCNC, Hewson fulfills her goal of providing health care to the underserved. She works with coordinators at all 14 CCNC networks to identify opportunities to improve quality, access, and use of health services. Susan Yaggy, who worked with Hewson during the launch of CCNC in 1998, says that Hewson is successful because she is “incredibly smart, conceptualizes beautifully, and is very balanced and clear about what needs to be a priority.” Yaggy also applauds Hewson’s wonderful sense of humor, which, as Yaggy notes, “you need in this business.”
Hewson’s work has been recognized through the honor of serving on many different committees and boards. During 2005-2009, Hewson served with the Agency for Health Care Quality Research to improve quality in Medicaid management and provide expert support and leadership to other states. Other organizations Hewson has worked with include the Centers for Disease Control and Prevention, the Institute of Medicine of the National Academies, the National Association for Community Health Centers, the North Carolina Medical Society, and the North Carolina Institute of Medicine.
Contributed by Rachel E. Williams, research assistant, North Carolina Institute of Medicine, Morrisville, North Carolina (firstname.lastname@example.org).