| Affiliation: | 1. Department of Family Medicine, Brody School of Medicine at East Carolina University, Greenville, North Carolina, and School of Pharmacy, University of North Carolina – Chapel Hill, Chapel Hill, North Carolina;2. School of Nursing, University of North Carolina – Chapel Hill, Chapel Hill, North Carolina;3. Department of General Internal Medicine, School of Medicine, University of North Carolina – Chapel Hill, Chapel Hill, North Carolina;4. Department of Family Medicine, School of Medicine, University of North Carolina – Chapel Hill, Chapel Hill, North Carolina;5. Division of Cardiology, School of Medicine, University of North Carolina – Chapel Hill, Chapel Hill, North Carolina;6. Center for Health Promotion/Disease Prevention, Gillings School of Global Public Health, University of North Carolina – Chapel Hill, Chapel Hill, North Carolina;7. Department of Social Medicine, School of Medicine, University of North Carolina – Chapel Hill, Chapel Hill, North Carolina;8. Community Care Plan of Eastern Carolina, Greenville, North Carolina;9. CMS Innovation Center, Centers for Medicare and Medicaid Services, Baltimore, Maryland |
