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$500,000 conservation request for Children's Home property divides city panel

A plan to preserve almost 100 acres of Children’s Home farmland only a mile from downtown got support on the Winston-Salem City Council’s Finance Committee for a $100,000 city contribution on Tuesday.

That’s $400,000 less than what the Piedmont Land Conservancy is hoping to get from the city, though Northwest Ward Council Member Jeff MacIntosh said he hopes to drum up support for the full amount between now and Monday’s meeting of the full council.

The Piedmont Land Conservancy has worked out a deal with the Crossnore School and Children’s Home to purchase a conservation easement from Crossnore that would permanently preserve 92 acres of the Children’s Home farm property from development.

Crossnore would still own the 92 acres on the northwest side of the institution’s holdings on Reynolda Road, but the easement would set the stage to create walking trails in what the land conservancy calls an “urban sanctuary.” The conservation easement would not affect another 100 or so acres where Crossnore has its buildings and operates its programs.

To seal the deal with Crossnore, the Piedmont Land Conservancy needs to raise $6.5 million by the end of the year, said Kevin Redding, the executive director of the group. That’s the amount of money the group would pay Crossnore for the easement. The money works out to about $71,000 per acre.

The land conservancy has raised about $4.5 million, and still has a couple of major requests out that it is hoping to collect, Redding said, adding that his group was hoping the city could give $500,000.

“It has the opportunity to define the city going forward,” Redding told the Finance Committee. “Every ward comes within one and a half miles of the property. It is surrounded by multiple communities that have supported this project.”

The goal of buying the easement is part of a larger $7.9 million fund-raising effort by the Piedmont Land Conservancy that would include $500,000 for a public trail and parking.

MacIntosh said that if Crossnore were to put the land on the market at anything like the cost of the easement, the land would be immediately snapped up.

“The need for the city to step up and fill this gap is really important,” he said. “It is an opportunity that we will not get again. If it goes to development, we will wish we had done this.”

MacIntosh made a motion to give the land conservancy the $500,000 it was requesting, but could get no second for his motion.

Two council members, North Ward Council Member D.D. Adams, and West Ward Council Member Robert Clark, said they could support giving $100,000, which was the amount that city staffers recommended. Both said $500,000 was too much to ask.

Adams pointed to the results of a recent resident-satisfaction survey in which people said they wanted “affordable housing, roads and park maintenance.”

“I’m not against this project, just like some other projects,” Adams said. “But I have to recognize the fact of the things we have promised to do for some folks in the city. There are projects that need to be completed.”

Adams said the city has parks in her ward that still need improvements, such as water attractions for children to play in. Adams made a motion to give the land conservancy $100,000.

The city would make its contribution to the land conservancy from a $1 million pot of money designated for park acquisition in the 2018 bonds approved by voters.

“You are asking for half our bond money,” Clark said. “That is a lot. There is only so much money in the pot. I will be happy to support the 100, but to come in here wanting half our bond money is a bridge too far.”

Adams and Clark voted in favor of giving $100,000 toward the land project, Northeast Ward Council Member Vivian Burke abstained, and MacIntosh voted against.

In other action, the Finance Committee was unanimous in supporting a proposal to lease 8,000 square feet on the second level of Union Station to Winston-Salem State University at a cost of $80,000 per year for 10 years. The rate works out to $10 a square foot.

Under the deal, the city would pay no more than $300,000 to ready the space in the restored building for the university, which would contribute the cost of fixtures and furniture estimated at $175,000 to $200,000.

WSSU would operate a print shop in the space along with limited postal services. The space would be also used as a one-stop operation area for enrollment and admissions, and would house the university’s passport office.

The second level of the Union Station building is the level below the main level of the building.

East Ward Council Member Annette Scippio said the rental would be good for the community as well as WSSU.

“If you live on the east side of Winston-Salem, you have to travel far to get to simple amenities like a print shop,” she said. The city is looking for a restaurant tenant for the top floor, and Scippio said both students and their parents visiting the WSSU offices would be able to have a meal at the station.

MacIntosh, noting that the lease rate is below the average asking rent of $12.48 per square foot, said his only worry was that the terms might be “too generous” given the length of the lease. But MacIntosh joined the unanimous vote in favor of the lease, which now goes to the full council.

Better health care may come from new insurance network as Atrium and Novant join Blue Premier

Novant Health Inc. and Atrium Health said Tuesday that they have joined a value-based health-care initiative expected to improve cost controls while maintaining or even improving care.

The two not-for-profit systems signed multiyear contracts for Blue Cross and Blue Shield of North Carolina’s Blue Premier network.

They followed Wake Forest Baptist Medical Center, Cone Health, Duke University Health, UNC Hospitals and WakeMed, all of whom helped formed the network in January.

Blue Cross said the Atrium and Novant agreements puts Blue Premier “on track to meet its goal of having 50% of its members served by providers in value-based, shared-risk agreements in 2020.”

In the existing “fee for service” system, patients or insurers pay providers for each office visit or treatment, creating additional revenue for repeat visits or hospital readmissions.

The newer approach typically offers providers incentives for better patient outcomes through emphasizing preventive and maintenance care, which tends to be less costly than treating patients after they get sick.

Blue Premier features a “shared risk” format that’s also a focal point of state Medicaid overhaul. Providers share in cost savings if they meet patient-care goals — as well as in the losses if there are cost overruns.

“In the Blue Premier model, inefficiencies turn into an expense, rather than revenue for a health system,” according to the groups.

Dr. Pam Oliver, the president of Novant’s physician network, said Blue Premier represents the culmination of Novant “thoughtfully approaching the navigation from fee-for-service to value-based care for years.”

“We believe this joint accountability model enhances quality, cost and patient experience as a foundation for care,” Oliver said.

Mark Hall, a professor of law and public health at Wake Forest University and a national health-care expert, said it remains to be seen how much of a game-changer Blue Premier might be.

“But, it is a significant development toward much-discussed but yet-to-be-implemented value-based contracting in health care,” Hall said.

Advocates concerns

Blue Premier represents the latest phase of the “patient-care medical home” and accountable-care organization initiatives that have centered on early intervention and closer monitoring of patients with chronic diseases and the quality of care provided.

In those initiatives, providers are incentivized to offer additional office hours, whether weeknights or weekends, and spend more time with patients per visit.

It could involve being proactive in checking on patients after they are released from a hospital to see that they are taking their medicine as prescribed, as well as encouraging regular checkups — including transportation options — for people with chronic illnesses.

In October 2018, federal health regulators gave the N.C. Department of Health and Human Services the go-ahead to integrate physical- and mental-health care with pharmacy benefits — a strategy that had been sought for several years. The waiver covers Jan. 1, 2019, through Oct. 31, 2024.

The decision included signing off on North Carolina’s plans to shift to a “capitated” Medicaid program, where a flat fee is paid to cover all care services for most Medicaid recipients. The current system operates on a fee-per-service format.

Some advocates have expressed concerns that value-based payments for private-insurance customers could be a step toward rationing care if insurers are allowed to set a flat reimbursement rate per patient similar to state Medicaid overhaul.

For example, in recent years North Carolina legislators have questioned executives with Cardinal Innovations, the state’s largest behavioral-health managed-care organization, about how much of their fund balance came from denying services to recipients in order to stockpile what the lawmakers considered to be excess savings.

The Republican state budget compromise for 2019-20 and 2020-2021 contains a combined $43.9 million in funding cuts to the state’s seven behavioral-health managed-care organizations.

The DHHS defines single-stream funding as a method for paying for services for individuals who have a diagnosis of mental illness, a developmental disability, a substance-abuse issue or a combination of those. Services are delivered by providers contracted with the managed-care companies.

Blue Cross said Tuesday in response to concerns that health care may be rationed that “Blue Premier includes strong quality measures as a basis for payment to alleviate the concern about limiting services.”

“Payments to providers will be reduced if quality of care and outcomes is negatively impacted. This serves as a backstop to ensure high-quality care is delivered,” the insurer said.

Cultural changes

Health-care system officials acknowledge the initiative represents a cultural change for all parties in how services are delivered.

In January, Terry Akin, the president of Cone Health, said, “It’s not just going to happen overnight even with best practices.”

Dr. Kevin High, the president of Wake Forest Baptist Health, has said he is hopeful that Blue Premier will eventually play two key cost roles for consumers: helping to provide more price transparency and improve bottom line estimates; and lowering insurance-premium costs.

“If Blue Cross experiences cost savings on the expense side from the participating systems as more patients go from sick care to well care, it may enable it to lower how much it charges companies and customers in premiums,” High said.

“For those with high-deductible plans, any relief on their premium costs would not only be appreciated but perhaps make it more affordable to seek care when they first get sick, or to be consistent in the management of their chronic disease care,” he said.

State Rep. Donny Lambeth, R-Forsyth, is the author of the N.C. House bill that focuses on Medicaid expansion in the state.

“I think the general idea is a good one and a positive step,” Lambeth said of Blue Premier. “Any proactive plans by providers, even in a group of more than one, that helps better manage patient care and reduce cost while improving outcomes is good for the marketplace.

“I believe this helps them better manage Medicaid as well.

Budget Inn soon to go

The former Budget Inn is being prepped for demolition, and folks who know the property say it’s not a minute too soon.

What’s more, some in the city are excited about the transformation planned for the property, a change that will put affordable housing apartments on the spot where the motel now stands.

That change, plus new investment at West Salem Shopping Center across the street on Peters Creek Parkway, has some people looking forward to a more general improvement in that section of town.

“That property has depressed the recovery of the whole area,” said Dan Besse, a member of the Winston-Salem City Council who represents the part of town, Southwest Ward, where the Budget Inn property is located. “It will be a big advantage simply to have it gone. It is a prime spot for the development of workforce housing, which we so desperately need.”

The Peters Creek Community Initiative bought the Budget Inn site from its previous owners in May for $1.2 million, using funds supplied in equal shares from the city and Forsyth County. The motel was shut down, and workers are removing asbestos ceilings inside in preparation for demolition that will go forward in stages and wind up in the early part of next year.

In a previous life, the motel was a Knights Inn. Under the Budget Inn name the site gained a reputation for trouble: A prostitution ring was busted there in 2000, though police said the management was unaware of what had been going on.

In 2007, a local rap artist named Latravis Green was shot in the thigh by robbers and wandered around the motel looking for help before he collapsed in front of the office. Green died at Wake Forest Baptist Medical Center.

Then, in 2016, the Shalom Project got $15,000 from the city to study redevelopment options for the property. Specifically, the group was interested in creating housing that would be affordable to average working people, in what was called the Peters Creek Community Initiative.

Eileen Ayuso, the executive director of the Shalom Project, said that money is either in hand or anticipated to complete the demolition of the Budget Inn buildings.

Work is proceeding in phases, starting on the part of the former motel on the rear of the property, where asbestos is being removed.

“They will remediate one building at a time and demolish it,” Ayuso said. “The vision is to build 72 affordable housing units. They would be rented based on average median income, with no one paying more than 35% of their income for the space.”

The new apartment building would rise in the center of the property. There will be a slight amount of grading needed on the property, Ayuso said. Most of the new apartments would be one- and two-bedroom units, for which the greatest need is seen.

Ayuso said the project envisions a sliding scale for rent payments, so that for someone making, say, $70,000 a year the rent would be more than for someone making $30,000 a year.

“We believe a mixed-income community is the most healthy community,” Ayuso said, noting that while downtown has a lot of jobs, it doesn’t have a lot of reasonably-priced housing.

“We want people who work downtown to be able to live close to where they work,” she said.

It will take some $10 million to build the kind of apartment building the Shalom Project has in mind. Ayuso said the money will likely come from a variety of sources, including government and private sources.

Ayuso said that while the project has not yet gotten a grant from the N.C. Housing Finance Agency, it will continue pursuing that and other funding sources. That includes asking the city for more support as well, from among the city’s annual support to community organizations.

When the motel property was bought, the Shalom Project worked with a local nonprofit called City with Dwellings to help people who were living in the motel find new homes.

“We probably had about 30 people who came to our meetings,” she said. “For a month or longer we worked with City with Dwellings to rehouse the people who were long-term occupants of the Budget Inn. We helped with down payments and electric bills and things like that. Some of them needed a helping hand to get out of their situation. Some people had other family.”

The Peters Creek initiative is only one of the Shalom Project’s efforts, which also include a food pantry, clothing closet and medical clinic.

Meanwhile, Winston-Salem recently approved some $700,000 for improvements at West Salem Shopping Center directly across the road from the motel site. Efforts are underway to bring a co-op grocery to the property.

Council Member John Larson, whose South Ward includes the West Salem Shopping Center property, noted that the shopping center and housing projects together can be a catalyst for redevelopment that extends throughout the northern end of Peters Creek Parkway.

“I’m optimistic that we are on an upward swing,” Larson said. “It is a corridor leading into the city that is in need of attention.”