Tar Heel Footprints in Health Care: Marian Earls, MD, MTS, FAAP

Diana Dayal

doi:10.18043/ncm.77.4.239

Marian Earls, MD, MTS, FAAP, serves as one of the state's leaders in pediatric medicine and value-based care delivery. In addition to her work as a practicing pediatrician, she serves as the medical director of the neonatal follow-up clinic for the Level III NICU at Women's Hospital in Greensboro, and she is a clinical professor of pediatrics at the University of North Carolina School of Medicine. She is also co-chair and improvement advisor for the American Academy of Pediatrics' (AAP's) Bright Futures Preventive Services Improvement Project; a member of the executive committee of the AAP's Council on Early Childhood; and chair of the Mental Health Leadership Work Group of the AAP, which is charged with national dissemination of efforts to integrate mental health into primary care pediatrics.

Earls received a Master's of Theological Studies degree from Harvard Divinity School in 1978, followed by her medical degree from the University of Massachusetts in 1984. Her lifelong career in pediatrics in North Carolina began during her residency at Moses Cone Hospital in Greensboro in 1987, followed by a fellowship and board certifications in developmental and behavioral pediatrics. Early in her career, she had a keen interest in the integration of mental and behavioral health in primary care, as well as an emphasis on comprehensive care involving families in the treatment process. From 1994 to 2012, Earls served as the medical director of Guilford Child Health, a large, nonprofit, private pediatric practice serving families at or below 200% of the federal poverty level, including many Medicaid and/or low-income patients. Throughout her time with Guilford Child Health in Greensboro, she worked closely with Community Care of North Carolina (CCNC), and she joined CCNC as the director of pediatric programs in 2012.

At CCNC, Earls led the implementation of the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) Quality Demonstration Grant from 2010 through 2015. In this role, she championed movement towards improved screening of children and youth for developmental and psychosocial issues, as well as efforts to connect families to the treatment process. Earls' leadership of the Assuring Better Child Health and Development program brought North Carolina's screening rates to rank highest in the nation since 2000. Another key CCNC project Earls has championed is Fostering Health in North Carolina, which brings together agencies and stakeholders across the state to provide primary care and medical home support for children and youth in foster care. Another multistakeholder project convened by Earls is the Sickle Cell Disease Project, involving primary care clinicians, specialists, emergency departments, the Public Health Sickle Cell Program, and CCNC care managers, which coordinates care for children and adults. These programs, among many others in which Earls has been instrumental, have been crucial for empowering practitioners in the health care delivery system to increase value and reduce costs.

For more than 20 years in North Carolina, Earls has served as a leader in medicine, hospital administration, and innovative care delivery. Her work across medicine and advocacy has highlighted the importance of comprehensive care as a way to move from a system that pays for volume to one focused on value. Earls commented, “we know that in terms of value down the road, costs would be so much different if we were doing things comprehensively along the way.”