(upbeat music) - [Narrator] Major support for Carolina business review provided by Grant Thornton operating in more than 100 countries.

Our tax audit and advisory professionals specialize in helping companies unlock their growth potential Colonial life, providing benefits to employees to help them protect their family their finances and their futures.

High Point University the premier life skills university focused on preparing students for the world as it is going to be.

And Sonoco a global manufacturer of consumer and industrial packaging products and provider of packaging services with more than 300 operations in 35 countries.

- If there were a company more suited for this current health care crisis you'd be hard pressed to find one.

I'm Chris William and welcome again to the most widely watched and longest running program on Carolina business policy and public affairs on this program the chief executive officer of premier healthcare, Susan Divor they are aggregator and convener of purchasing and supply chain issues around healthcare providers.

And of course, related industries we will unpack what it means during COVID in just a moment.

- [Announcer] Gratefully acknowledging support by Martin Marietta a leading provider of natural resource based building materials providing the foundation upon which our communities improve and grow blue cross BlueShield of South Carolina and independent licensee of the BlueCross and blue shield association visit us at www.southcarolinablues.com.

The Duke Endowment, a private foundation enriching communities in the Carolinas through higher education, healthcare rural churches and children's services.

Barings a leading global asset management firm dedicated to meeting the evolving investment and capital needs of its clients.

Learn more at www.barings.com.

(upbeat music) On this edition of Carolina business review an executive profile featuring Susan DeVore CEO of Premier Inc. (upbeat music) - Welcome again to our dialogue.

And we'd like to welcome the chief executive officer of premier healthcare.

Once again, to the dialogue, Susan DeVore.

Susan welcome and I trust you're staying safe.

- Thank you, Chris you too.

- Yeah thank you.

You know, Susan, this is not meant to be a leading question but it is, you know, it's not a big leap to look at Premier Health Care core competency, the idea of aggregating health care purchases and supply chain and bringing a lot of people around a table and applying that to this current public health care crisis.

This seems like, and again, it's a little leading but it seems like it would be your time meaning your and premiere time to shine.

Do you get a sense of that?

- You know, it's been such an important time in US history and I think that times like this really test your mission.

And so it has been a time for us to pull all of our resources together.

You know, we sit at this nexus of healthcare systems providers, physicians, government payers, suppliers and the public-private collaboration that was required to actually respond to COVID-19 was immense.

And so I couldn't be more proud of our team and our health systems and all the great work that's been done as challenging as it has been.

And there are a lot of things we could all do better next time but there's been a ton of learning and a ton of work.

- You know, this, I wanna ask you a little bit about the coalition the formal coalition that you proposed and are bringing together in just a second and you as being an insider and as you hear the discussions around the table with members that you have, that as you've talked about, the providers and the manufacturers, et cetera, et cetera what do you think gets lost in translation between what insiders are doing and how they're working together or not working together and what the larger public perception is here?

- I think this is the most massive supply chain challenge we've experienced in a hundred years probably.

And so I think what's lost in it is truly the complexity of all of this.

A lot of it has been politicized.

And so I think that there was an environment where we were way too dependent on foreign manufacturing.

There was an environment where we had not invested enough as a country in building stockpiles of critical supplies.

There is an environment where the technology in healthcare at the federal level, CDC, HHS, CMS wasn't able to technologically aggregate data and information easily.

And so all of those things kinda came together with a virus that was highly infectious and moving really fast.

And I think when you layer on that we took sort of a de-centralized approach to it as opposed to a more centralized approach to it that created a lot of comp complications.

- Our public HHS health and human services leaders, both in counties and on the state level for the Carolinas at least, do you get the sense that they are deploying the vaccines as quickly as they can.

And did you also get the sense that they are being as clear as possible given all of the nuance you just talked about with politics and what they know and don't know?

- So what I would tell you is there's more than 64 different plans of attack at the state and territory level, which means there's not a national standard for how this is being done.

So it varies by state, you know, you can read and hear the news of 25 million doses have been distributed and normally, you know, 9 million or so have actually been administered.

So we were doing 250,000 a day.

We need to be doing 2 million a day.

And so we've got a long way to go.

Having said that, I think that different States are doing everything they can to take health systems to mobilize mass vaccination sites.

We've heard about a new plan of that here in North Carolina but you know, Chris, do you know who the number one vaccinator in the country is today, even before COVID ?

The department of defense, you know who number two is the retail pharmacy shops.

And so the question is, you know, is there a way for us to mobilize more federal resources more state resources, more retail, pharmacy chains in addition to health systems to really get this done faster, because the fact that we have the vaccines is distributed, but they're not getting into people's arms fast enough is the challenge.

- So what's the barrier between that Intel, as you just described it and getting it to the people they can't do something to that?

- Well, it's complicated because we're in the middle of transitioning and administration.

So we've got sort of the current administration's plan of attack.

And then we've got a new administration coming in Premiere just sent up to the Biden administration, 30 recommendations for accelerating the vaccine administration process.

We have staffing challenges.

We even if we had, you know the retail pharmacy is doing it we don't have enough nurses, pharmacists texts to actually administer it as fast as we wanna administer.

So we set up 30 recommendations.

One is we need a national campaign.

We need an education campaign because we have way too much hesitancy people who are unwilling to take the vaccine.

We need to share the science.

We need to have some solutions for staffing.

More than 50% of our health systems say staffing is the number one problem for getting backseat administered because they have got nurses in their health systems and doctors taking care of COVID patients taking care of regular patients.

And they're supposed to layer on all of this vaccination.

So we need to think about students.

We need to think about retired nurses, doctors we to think about EMT.

We need to think about national guard, but we've sent up a number of recommendations to sort of speed this up.

- Any feedback from the incoming leadership - You know, I was on a call yesterday.

There has been another coalition formed in addition to the supply chain one that we formed several months ago but there's a coalition of government agencies, FDA CDC, health and human services along with companies like premier and manufacturers and distributors to really coalesce around our recommendations to the new administration.

So yes, the ears are open the collaboration is happening and a lot of the recommendations are consistent.

So as we were on this call yesterday talking about it, we are all having the same problems.

- Early days in.

And I say this on behalf of the viewers, early days in the blossoming of this COVID-19 year in the US in April in fact, you announced a coalition a supply chain aggregation.

If you will, to get a lot of folks around the table to start moving the needle.

So where are you with that?

How effective it has been?

Is it better than you thought?

Is there a lot more work to do, et cetera?

- It's interesting.

So my leader in Washington came to me and he said too many disconnected pieces here.

Somebody's got to kind of step up and say let's bring these groups together and see if we can move this forward faster.

That was back in the March April timeframe when we didn't have enough face masks and we didn't have enough supplies and we didn't have enough ventilators and it was early.

And we were completely dependent on Asia.

And what I would say is initially it was a little bit tough 'cause you were bringing together fierce competitors GPOs, distributors, manufacturers, and government agencies.

We had to figure out how to protect the conversations because these were all competitors on the phone together talking about how to solve this problem.

But I think it really did allow the federal government primarily to truly have the inputs to understand even the clinical requirements.

I mean a federal government doesn't understand deeply the clinical supply chain in healthcare.

They understand it in government and in military don't understand it as well in healthcare, in the US.

And so we spent a lot of time describing ventilators talking about pricing for ventilators surveying all of our health systems saying where are the biggest problems building technology to help do the surveillance, so we could predict where it was going next and what kind of supplies were needed in what markets.

And so I think the coalition really did make a difference because it gave the government one place to go.

And we were having calls every day every couple of days on weekends, but it gave all the government agencies one place to go to say here's the next set of information needs that we have, can you help us?

And so I do think it was really effective.

Once we got into November, December of this year the supply chain challenges, the shortages and those kinds of things were not as intense.

And we had learned a lot and we had sourced a lot.

And so we're on a more regular, you know communication basis now, but it's not as urgent as it was back in March, April of last year.

- One of the big dynamics that came out of a lot of this as you well know, has been contact tracing has become a priority and really front and center for not just a lot of providers, but companies in fact, how has that changed this HIPAA barrier that we put up?

How has it changed protecting personal data?

How has it just making us look at this whole thing differently?

- It's interesting contact tracing is a fairly manual effort to try to get in front of a virus.

This virus moves so fast mutated.

We actually think in our world today of technology and artificial intelligence we should have been using technology to surveil and to identify patients symptomatic patients before they ever had the test.

So to me, you know, when you have a crisis like this kind of virus, you have to have the protections of the data that HIPAA requires but you have to get to the people you need to get to.

It was interesting.

I had a situation, whereas as an employee of career I was called and said you were in contact with somebody who's tested positive.

Can't tell you who it is, but you need to quarantine and you need to do what you need to do but that's a highly manual process and probably not very effective.

- Do you think it'll ever be standardized and automated?

- I think what the CDC needs to do is seriously modernize their technology.

And I think HHS needs to make more investment in that technology.

And yes, I think this should be both the progression of the disease in individuals across the country and the technological prediction of supply chain and drug needs tied to that.

Those two things should have existed and need to exist.

And it's not that the technology doesn't exist.

It's that it's just not in place.

It's not in place at a national level.

And that made this a whole lot harder.

And I think if you had that you could automate a lot of that.

- Let's go to the softer science of leadership and personal origin.

Dr. Mooney Cohen, as you all know department of social health and human services in North Carolina really took to this idea of mental health and how mental health has become, not just not just wasn't a, "I'm going to call it a pariah before."

But it didn't have any champions.

And now mental health seems to be coming front and center.

And not just for those who have a mental health history but for members of maybe a leadership team or a lot of members within the premier healthcare employee base that are struggling with things that they never thought that they would feel.

How do you unpack that, how do you talk about it?

And maybe even on a personal level.

- It is really interesting.

And I think early on it there are a couple of dynamics here.

One is the whole remote working environment and the isolation from people.

The other is the fear and anxiety associated with the virus.

The other is the challenges of taking care of family members and all of the things that go with this.

And so as an employer, we had to make sure one we were communicating a lot, two we were making sure people knew we cared more about the safety of our workforce, and we didn't push coming back to the office too early, or those those kinds of things, three we had to make sure they had the resources.

The mental health resources in place.

What's interesting for us is that our employee engagement and satisfaction over the COVID time period went up by nine percentage points.

Meaning actually the virtual environment, the level of effort that we took in communicating and teaming it actually enhanced employee engagement.

I think that that was early on and into the mid and end of last year I think people are really tired now though.

And I think that mental health not just for employer employees, but the country at large will be an artifact of this virus.

One of the hopes I have, and what's interesting is some 50% of the mental health issues that patients had employees or otherwise were handled by tele-health.

So I actually think that the movement in tele-health for virtual visits, along with the increasing mental health challenges gives us a way to continue to deal with it going forward.

But I think it's very real.

- Does that explain some of the dynamic, and these are my words, Susan.

This increasing statistically, the increasing amount of cases, the increase in testing, the increasing amount of positivity rates, yet people are getting more indifferent and even ambivalent about that.

And when you see the gatherings and when you get a sense that folks don't maybe not take it seriously, how do you explain that?

- It's all over the map, you know the super spreader event that occurred in DC last week the super spreader event that occurred after the national championship.

I think there are people who kind of firmly believe it's no big deal, and there are other people who firmly believe it's a very big deal.

And I think the closer they've actually been touched by it the more they see the reality of it.

And the challenge is the unpredictability of how it affects different people.

And so I think senior citizens 75 and over are very frustrated that they can't get their vaccines scheduled.

I think people are frustrated about the rollout.

I mean, if you think about North Carolina, we have what 10 and a half million people in North Carolina let's say 20% of those folks are under the age of 18 means you got 8 million people we need to get vaccinated.

As of this middle of January, we're 266,000 in, and if we wanna get to 75% and had immunity, I think that's what's gonna make people get more comfortable.

And I think the faster we do that the more we're gonna be able to actually put this behind us.

- You had said recently, and I think it was last year.

So apologies if I get this wrong.

But you said in 2020 that COVID is gonna be with us next year.

What about the year after that?

- It's gonna be with us in full force between now and the summer, for sure, probably into the fall.

I am encouraged with the Pfizer vaccine the Moderna vaccine, Johnson and Johnson initial results look really promising.

AstraZeneca has one potentially.

And so I think we are gonna be able to get the production of the vaccine, get it into the arms.

I am worrying a lot about the 30 to 50% of people who still might be unwilling to take it.

That's why I think we need a national public service education program.

We need celebrities getting this.

We need social media.

We need the science to be shared because if we don't get over that 30 to 50% hurdle this is gonna take longer.

I do think COVID and various mutations of it will be with us maybe not so ever.

The question is, can we vaccinate for it?

Will people take the vaccination?

And can we keep it in check?

- One of those issues much like mental health that was very, very much with us but a long time prior to COVID being in our issue now was maternal health.

And you have come out on maternal health and saying I'm gonna quote this.

Isn't just to get it right.

And you said it it's riddled with bias and looked at through a highly political lens.

What does that mean?

And how do you remediate that?

- Yeah, it's interesting.

So we've been working on maternal child health at Premiere for a long time, and we have a lot of data and we've done a lot of improvement work.

I think it's easy to say and it's embarrassing to say that, you know as one of the developed countries in the world we have the worst health outcomes as it relates to maternal and child health.

And then it's easy to say, it's tied kind of purely to socioeconomic and disparities in care.

And actually our data would indicate it's a bigger problem than that.

Yes, that's true but the broader population, we have care variation and we have clinical protocols that are not being followed in a consistent way across the country.

And so our view of it is we need to drive significant improvement in maternal child health across the board.

We did just win an award from a tape test to actually start first with vulnerable populations and make sure that we are really helping drive the improvement into those populations, but there's a ton of work to be done.

And it's shameful actually that the starting point is what it is.

- We've got about three minutes left Susan, when you allow yourself to not, and not saying to do this but we're all so front and center about COVID-19 that it's hard to think more strategically but when you back off and let yourself daydream to some degree how do you look at not just Premiere, but how do you look at how healthcare will operate post COVID?

What will the impacts be?

What will the unintended consequences be?

What are the big pieces going to be that look like?

Because we went through this.

- Yeah, you know, with anything like this there are good things that come out of it.

There are several good things.

One is we're not gonna feed dependent on foreign countries for all of the production of our critical products.

Premier already has initiatives bringing domestic manufacturing back.

We need to diversify that supply chain.

So that was a big learning.

And I think that will be forever different.

Two I think there's been a tele-health learning that you actually can very efficiently provides healthcare in a different way using tele-health.

Third I think one of the learnings is insurance companies did really well during COVID because those premiums kept coming in but they actually didn't have people using, you know clinical care during the crisis.

I think that we're gonna have a problem with the Medicare trust fund and it's not gonna this has been very costly.

And so I think the movement towards paying for health care in more global payment models will come out of this.

We need to have a model where we can predict the cost of healthcare and not have, you know, sort of the unfair advantages and disadvantages that occurred in this kind of a model.

So I think from an employer perspective the way we conduct business will be forever changed.

We've all gotten really good at virtual meetings and the efficiency and the ability to get productivity increases in some ways I think.

So I think we'll have some kind of a new hybrid norm in the way that we actually work.

So those are just the couple of things that come to mind - In about 30 seconds.

As you described the institutional response to that do you get the sense that public will change its behavior around being maybe more healthy so that there aren't more visits?

- Hope so, hope so.

I do think wearing face masks, hand sanitizer just the consciousness of the transmission of the disease.

I mean, I think the reason we're seeing less regular flu is because of all the things we're doing for COVID.

So yes, I do think there'll be some change.

- Yeah okay, Susan, thank you.

I know you're pressed for time and you can't get a paper between some of the things that you're doing.

So best of luck.

Thank you for your leadership.

We appreciate you coming on and spending this half hour with us and stay safe.

Continue the leadership until next time if you have any questions or comments, by the way go to www.carolinabusinessreview.org.

Be safe thank you, (mumbles) - [Narrator] Major funding for Carolina Business Review provided by High Point university, Martin Marietta, Colonial Life, The Duke Endowment, Bearings, Grant Thornton, Sonoco, BlueCross BlueShield of South Carolina.

And by viewers like you, thank you.

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