| | The Cecil G. Sheps Center for Health Services Research | | |
As we move into spring, I am struck by how much momentum we have across the Sheps Center. Today is GiveUNC—a moment each year when our community comes together to invest in the people and projects shaping the future of health care in North Carolina and beyond. Your support fuels the mentorship, interdisciplinary collaboration, and early‑career development that allow our researchers to ask bold questions and deliver meaningful, real‑world impact.
This newsletter highlights exactly what that impact looks like. From national testimony on strengthening the health care workforce, to pioneering work in palliative care, to statewide conversations about the future of graduate medical education, our teams are helping policymakers and practitioners navigate some of the most pressing challenges in health services today. We also share major new research efforts—from a comprehensive behavioral health workforce report, to innovations in responsible machine learning, to new federal funding that will deepen our understanding of Medicaid reform.
At the heart of all this work is a shared commitment to improving the health and well‑being of North Carolinians. Whether we’re expanding access to behavioral health care, evaluating transformations in Medicaid, or developing tools that help systems serve patients more equitably, Sheps researchers continue to provide the evidence and insight needed to guide lasting change.
Thank you for the many ways you contribute to this mission. Your engagement, collaboration, and generosity enable the Sheps Center to remain a trusted resource for our state and the nation. I hope you enjoy this issue, and I look forward to the work we will continue to advance together.
— Mark Holmes, PhD
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Today is the day! GiveUNC is Carolina’s university-wide day of giving—a day when alumni, friends, faculty/staff and other Carolina supporters come together to support the causes they care about most, like the Sheps Center.
As an important member of the Sheps Center community, you have an opportunity over the next 24 hours to make a difference. Your gift today will support early career health services researchers by providing them with mentorship, travel funding to present their research, interdisciplinary faculty connections, a workspace with a built-in peer network, and so much more, including fostering successful research and policy work that will affect the health of our communities, our state, and our nation.
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On February 24th, Emily Hawes, PharmD, BCPS, CPP, director of the Sheps Graduate Medical Education Technical Assistance Center, testified to the US House Committee on Ways and Means Hearing on Advancing the Next Generation of America’s Health Care Workforce.
Dr. Hawes focused her testimony on how strengthening rural graduate medical education (GME) can expand and stabilize the U.S. health care workforce. She emphasized that rural training programs are cost‑effective, evidence‑based, and essential to reversing physician shortages. They not only attract clinicians to underserved areas but also revitalize local health systems and improve community health outcomes.
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Laura Hanson, MD, MPH, faculty researcher from the Program on Aging, Chronic Illness, and Long-Term Care at Sheps, delivered the keynote presentation at the Annual Assembly of Hospice and Palliative Care on March 6th in San Diego, CA. Her session highlighted emerging models of dementia‑specific palliative care at a time when more than 7 million Americans are living with dementia and facing complex symptoms, caregiver strain, and fragmented care.
The symposium featured innovative approaches across home, hospital, and hospice settings, including findings from the IN‑PEACE and ADRD‑PC trials. Dr. Hanson shared insights from inpatient palliative care consultations and synthesized common themes—such as structured communication, caregiver engagement, and interdisciplinary teamwork—and connected them to evolving payment models like GUIDE. Sheps Research Fellow David Lynch, BMBS also contributed to the panel presentation.
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On March 18th, the ShepsGME Technical Assistance Centers convened the 2026 State Graduate Medical Education (GME) Summit, a virtual event that brought together state offices, policymakers, rural residency programs, teaching health centers, and other national partners to explore strategies for strengthening state-level initiatives in rural and underserved areas.
Across presentations and interactive breakout sessions, participants examined the evolving national healthcare workforce landscape and discussed emerging opportunities related to state GME financing. Sessions highlighted examples from multiple states and explored strategies for governance, stakeholder engagement, and policymaker collaboration that can support sustainable GME infrastructure.
Weren't able to attend? Watch select sessions as they become available: https://www.youtube.com/@ruralgme.
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On March 10th, Erin Fraher, PhD, MPP presented to the North Carolina General Assembly’s Joint Legislative Oversight Committee on Health and Human Services on maternal health care access in the state. With the 11th highest infant mortality rate in the US, maternal healthcare access is a pressing issue in North Carolina. Erin’s presentation on the distribution and characteristics of obstetric clinicians in the state provided much needed data to inform potential policy solutions to address maternal healthcare access.
Key findings:
- 81% of births in NC are attended by physicians
- While the number of physicians providing obstetric care deliveries has increased over time, the number of births per physician has decreased from 135 in 2005 to 101 in 2024
- There are no clinicians or facilities providing deliveries in 28 NC counties
- Physicians and certified nurse midwives (CNMs) are concentrated in urban areas; 17 counties with longest travel times have few or no clinicians providing deliveries
- ~12 and 18 rural hospitals in North Carolina have either closed completely or closed their OB unit in past 12 years. In 2024, nearly 12,000 births originated from these counties
- 29 states are currently, or in process of, implementing Medicaid reimbursement for doulas; NC is not one of them.1 More data are needed on the size, distribution, and characteristics of the NC doula workforce.
1 - Georgetown University McCourt School of Public Policy – Center for Children and Families “Doula Medicaid Reimbursement by State.”
| | Senator Gale Adcock, Dr. Fraher, and Senator Jim Burgin. | | BHWRC Report Identifies Critical Gaps in NC Behavioral Health Services Workforce | | |
The Sheps Center has released a seminal new report offering the most comprehensive view to date of North Carolina’s mental health and substance use services workforce. Commissioned by the N.C. Department of Health and Human Services, and executed by the Behavioral Health Workforce Research Center (BHWRC) within the Sheps Center, the assessment examines more than 20 behavioral health professions—including psychiatrists, psychologists, addiction counselors, peer support specialists, and community health workers—to identify where workforce capacity is growing and where significant gaps remain across the state.
The report finds that while most behavioral health professions grew between 2014 and 2024, workforce expansion has not kept pace with the rising demand for mental health and substance use services. Graduate‑level clinicians, led by clinical social workers and mental health counselors, make up the largest share of the workforce, yet access to these providers remains uneven. Metropolitan counties consistently have more clinicians relative to population need, leaving many rural counties with limited or no access to key specialties such as child and adolescent psychiatry or licensed psychology.
The report provides an essential foundation for policymakers, offering detailed maps, provider counts, and credentialing information to inform strategic planning and help build a more equitable and accessible behavioral health system for all North Carolinians.
Congratulations to Brianna Lombardi, PhD, MSW, and the BHWRC team on their hard work producing this much-needed report!
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Above (L-R): BHWRC team members Monica Jimenez, Brianna Lombardi, Erin Fraher, Regan Gregory, Lisa de Saxe Zerden, Adote Junior Beni Akue-Ka, and Jennifer Headley.
Left: Dr. Lombardi proudly shows an infographic from the report.
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Confronting Bias Through Responsible Machine Learning (ML)
By: Ashley Avis, MSA, Lead Data Scientist, Sheps Data Analytics Research Team
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It’s one thing to read about models that perpetuate bias, it’s another to build one and see how easily real harm can occur. In 2022, I developed a model using advanced statistical methods, and when we reviewed the fairness metrics, the racial disparities were impossible to ignore. That moment shifted my work. I began a deep, years‑long study of Responsible AI and ultimately created the Responsible Machine Learning Plan (RMLP).
The RMLP is a framework designed to help teams examine whether a model reinforces bias, whether a technology should exist, which data are ethical to use, and how outputs may reflect existing inequities or dominant values. We’re past the point where a small group of people should decide what technologies are built and what values they encode. The RMLP encourages a more deliberate process, helping teams decide how and whether to build a model, what information to rely on, and how to broaden the perspectives involved. My hope is that it supports thoughtful, value‑centered conversations where there may be no single right answer, but there can be “both‑and” solutions.
About the Plan
Modeled after a Statistical Analysis Plan (SAP), the RMLP helps teams define the population, identify who may benefit or be harmed, plan how to address those risks, and document decisions throughout development. It also serves as a learning resource, with citations woven throughout.
How to Use the Plan
This is intended to be completed as a team so multiple perspectives can be heard. As you work through the plan, it may expand into more conversations, more investigation, and more listening.
| | K12 Grant Examines Medicaid Reform Effects | | |
Sheps researcher Brittany Raffa, MD, MPH, received an NC TraCS K12 Award for her proposal “The Effect of Medicaid Managed Care Organizations on Mothers and Young Children.” Medicaid services are increasingly delivered through managed care organizations (MCOs) rather than fee-for-service models, but there is scarce research on the effect of Medicaid MCOs on mothers and their children.
This study addresses this gap by examining the effect of the NC Medicaid Transformation among cohorts of mothers and young children in the pre- and post-policy periods in NC. By using Medicaid claims data from NC and two control states, one which utilized a Fee-For-Service (FFS) model and another which utilized an MCO model during the study period, Dr. Raffa and her team will determine the effect of the NC Medicaid Transformation on health outcomes and healthcare utilization among the family dyad, isolating the effect of the policy change using a controlled interrupted time series. They will also conduct interviews with NC mothers of young children in the post-policy period to elucidate their experiences seeking care.
| | The NCIOM Welcomes New Board Members in 2026 | | | |
On Monday, March 16, 2026, the North Carolina Institute of Medicine announced the appointment of five new members to its board of directors.
The newly named members, chosen by North Carolina Speaker of the House Destin Hall and Senate President Pro Tempore Phil Berger are:
- Dr. Christopher Grubb of Pitt County
- Riteshkumar Patel of Wake County
- Dr. Abhijit Roychowdhury of Wake County
- Michael Tart of Cumberland County
- Dr. L. Allen Dobson, Jr. of Cabarrus County
“These appointments reflect a breadth of important experience, both across fields of health care and across geographic regions of North Carolina,” said Michelle Ries, President and CEO of the NCIOM. “We are grateful for Speaker Hall and President Pro Tem Berger’s thoughtful selections, and we are looking forward to working with these new board members.”
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Emily Hutchens, PhD
Behavioral Health Services Research Program
Emily is a Research Associate with the NC Behavioral Health Evaluation and Learning Lab (NC-BELL). Her work focuses on evaluating the impacts of children's behavioral health services in communities and schools. She has been working at UNC for nearly a decade and has a PhD and MSPH from the Gillings School of Global Public Health.
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Abby Rigatti, MSBA
Data Analytics and Research Team (DART)
Abby is a Data Analyst and Visualization Specialist at Sheps. With a background in business intelligence and experience across multiple data visualization tools, she works with principal investigators to translate metrics into consumable, public-facing dashboards. Her recent projects include developing an implementation tracker for the NC DHHS Multisector Plan for Aging and a comprehensive dashboard featuring 20+ metrics on North Carolina oral health. Abby earned her Master of Science in Business Administration (MSBA) with a concentration in Business Analytics from Virginia Tech.
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Nathan Tarr, MS
Program on Health Workforce Research and Policy
Nathan is the Data Systems Manager for the NC Health Professions Data System. He is modernizing the infrastructure and tools used to process annual licensure data from 27 professions into a one-of-a-kind longitudinal data system. Nathan holds a Bachelor of Arts from Guilford College and a Master of Science from North Carolina State University.
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Sasha Zabelski, PhD
Behavioral Health Services Research Program
Sasha is a Research Associate with the NC Behavioral Health Evaluation and Learning Lab (NC-BELL) where she is managing an evaluation of the state's crisis behavioral health system. In this role, she leads the mixed methods portion of the evaluation which includes surveys and focus groups with crisis providers and crisis service users. Sasha holds a PhD in Public Health Sciences and a master's degree in clinical psychology. She is a former crisis behavioral health provider and uses her experience to inform her work with NC-BELL.
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📆 April 16
2026 State of the Child Summit
8:00am - 4:30pm EST
Hilton Raleigh North Hills, Raleigh, NC
Hosted by NC Child and the North Carolina Institute of Medicine (NCIOM), the State of the Child Summit will focus on the current state of children’s health and well-being in North Carolina, and engage parents, lawmakers, and leaders across communities, sectors, and organizations in discussions around policy solutions to ensure North Carolina’s children have the opportunity to reach their full potential.
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📆 Aug 31-Sep 2
SAVE-THE-DATE: 2026 Rural and Underserved National Graduate Medical Education Conference
Bethesda North Marriott Hotel & Conference Center, Rockville, MD
Hosted by the ShepsGME Technical Assistance Centers.
Follow us on LinkedIn @RuralGME and @THCGME, or email us at info@shepsgme.org to be added to our listserv, to be the first to know when registration, accommodations, and the agenda are available.
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Tania Jenkins talks to Medscape about physician burnout and the 'social contract' between medicine and society.
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Mark Holmes talks with KFF News about the Rural Health Transformation Program and how states’ technical scores will drive future reallocation of RHTP funds.
- Sheps Behavioral Health Research Program projects—NC-BELL and MODRN—are highlighted in this EdNC article about NC's investment in behavioral heatlh services.
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Hospital closure data from the Rural Health Research Program helps provide context on Medicaid-driven hospital vulnerability and reliance on Medicaid funding reported on by NC Health News.
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Want to read a previous issues of this newsletter? Click here.
Have feedback on this newsletter or suggested content for future newsletters? Contact Lindsay McCall.
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