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- So does it feel like hot days of summer?

Well, it certainly does in more ways than one.

Welcome again, to the most widely watched and the longest running program on Carolina business, policy and public affairs.

I'm Chris William.

Welcome, again to our dialogue.

South Carolina's General Assembly wrapped session recently and North Carolina's still banging it out in budget for their state house.

North Carolina also does a trifecta, in other words, the third time now, The old North State was named Top Place for Business by CNBC.

Later on, UNC Health CEO, Dr. Wesley Burks joins us again.

And we hope you will stay with us.

We start unpacking the issues right now.

- [Announcer] Major funding also by: BlueCross BlueShield of South Carolina, an independent licensee of the BlueCross and BlueShield Association; and Martin Marietta, a leading provider of natural resource-based building materials, providing the foundation on which our communities improve and grow.

(dramatic music) On this edition of "Carolina Business Review," Terik Tidwell from NC IDEA's Black Entrepreneurship Council, Allen Smith of OneSpartanburg, Inc., and special guest Dr. Wesley Burks, CEO of UNC Health and Dean of the UNC School of Medicine.

(dramatic music) - Hello, welcome again to our program.

Happy summer, gentlemen, right in the middle of July and August and the dog days of summer.

Terik, let me start with something that's not very vacation oriented, but certainly an issue.

Supreme Court of the United States reversed the affirmative action consideration when it comes to higher ed, not surprising, maybe a surprising decision.

But now we are a few weeks beyond that and we have businesses that are considering DEI changes.

- Mm-hm.

- Or are we?

What are you hearing?

- Well, I mean, Chris, there's just been so much talk, and also there's been so much already happening.

I think for many of the companies, for particularly higher education as a whole, it's been rethinking about how do we have a diverse campus?

What kind of policies do we put in place?

What kind of infrastructure?

How do we build out that network and support?

And because there's a lot of industry who do look at those institutions to see, how do we get that talent?

Now you start looking at the kind of companies, you start saying, well, listen, we still need to make sure that we're gonna have a diverse workforce, but we need to make sure we put in processes and policies in place, but have the staff and competencies there to make sure that folks are able to come, stay, and grow in those corporations.

So you're seeing a little bit of a mix and reshuffling of the decks.

But I think some really good corporations are gonna find a way to make it happen.

- Yeah, Allen, what are you hearing from your membership of some of the business people in South Carolina?

- So, Terik said, "Diverse workforce."

I would say a workforce in general.

I don't think the Supreme Court decision has really caused any businesses, as of yet, to change their philosophy because in South Carolina, we still have a major workforce issue.

So - - [Chris] You mean it's just tight?

Talent?

All of that?

- Well, it's number ten.

And we have more jobs than people.

In fact, for the first time in my career, we are prioritizing high investment and low job announcements.

That's who we're pursuing, because we can ill afford to have another announcement of 750, a thousand jobs.

We led the state of South Carolina in investment last year.

But again, we just can't afford to do that.

And a company cannot afford to have any real or perceived barriers to entry, either.

So it's an imperative that they create a workforce and environment where all people feel like they could come and work there.

Businesses are at that point where they have to, they have no choice.

- Terik, so diversity, equity, and what's now kind of being called belonging, DEB or DEI, can it absorb this change?

Can it pivot?

Can it adapt to it, and are you expecting that it will?

- Yeah, I think, you know, particularly for corporate companies and corporations, they're being held to a different standard, a higher standard around environmental, social and governance.

You're seeing shareholders and stakeholders look at these companies and saying, we need to see long-term growth.

And then seeing the bottom line is really having that kind of diversity, equity, and belonging.

Because it's not just something about having people at the table.

Do they feel that they can contribute at the table?

Do they feel that they're part of the table and connecting those dots?

So you're seeing a very important strategy for corporations that are thinking about long-term investments in that ESG framework that many corporations already have as a part of their strategy.

- Allen, I suspect you know something about this.

North Carolina, for the third time, was Top Place for Business according to CNBC.

That's the first time a state has done it three times.

As a South Carolina business person, how do you feel about that?

- Well, you know, it's a mixed bag.

Being from Greenville, North Carolina, I'm obviously proud of The Old North State.

But again, I think that there are a lot of lessons to be learned from North Carolina.

I have been very impressed with the Department of Commerce's First in Talent strategy.

I think that's something that our Department of Commerce needs to look at.

It's been very comprehensive.

It's included community college, higher ed.

Talent gap analyses across the board, that's something that we've done locally.

But, you know, I think that's a key.

And it goes back to what I said earlier.

I mean, the currency of economic development now is people and talent.

And North Carolina is doing a very good job in that space.

- About two minutes left, Terik, and gotta get to this one fairly quickly, and I know it's a complete change.

But innovation and a creative early stage type of development.

If we do have a recession, if we have a slowdown, are you seeing these kind of indications of it in innovation and startup?

- No, I mean, we're looking at this and saying North Carolina, North Carolina has seen significant growth with innovations and startups between 2014-2022.

You went from $1 billion of private investment capital going into startups, to now looking at $4 billion in North Carolina for startups.

So we're looking at this and saying, there is an opportunity if there is a recession.

And that's kind of the thing about innovation and entrepreneurship.

Out of crises, they're able to find opportunities and turn it into value.

So this is kind of a good thing in supporting the early stage innovation.

Now the question is, who's gonna be able to benefit?

And how are they gonna be able to benefit?

So we need more investments into those communities that have been missing or may not been contributing or participating in those kinds of opportunities.

- Will the cash seek that out?

Will the investment go to it?

- Well, that's gonna require a lot of infrastructure.

And I think we're seeing from some of the things related to broadband investments, because that's really important.

North Carolina is one of the most rural states in the country.

So we need to make sure there's infrastructure in place to ensure that if innovations are starting to come up, particularly in biomedical or biodevices, we need to be able to reach those audiences.

And that's part of the infrastructure.

- Okay, we're gonna leave it there and bring our guest on and unpack some other issues.

Coming up on this show in the near future, he is considered as one of the most powerful men in North Carolina.

He's a POLITICO, not surprising, he is the North Carolina Senate Speaker pro tem, I'm sorry, North Carolina Senate pro tem.

His name is Phil Berger.

He will be our guest on this program again.

Also coming up, the Chairman and CEO of Duke Energy, Lynn Good, also will be returning.

Joining us now is someone who knows a little bit of something about healthcare.

He's been at the top of a major provider around healthcare.

In any conversation in North Carolina, you usually end up talking about policy like education, and not surprisingly, healthcare.

We're glad to have back on this program, the CEO of UNC Health, Dr. Wesley Burks.

Dr. Burkes, welcome back.

- Chris, thank you.

It's nice to be with you this morning.

- You look smiling and healthy after three years post pandemic in pandemic.

Pretty amazing.

- It's been a long three years.

Our world around all of us has changed significantly, particularly in healthcare.

- We were talking about before the show, Dr. Burks, the idea that you probably felt like you were on the edge, strapped on the nose cone of a rocket for about three years and always in triage mode.

But now, finding your way through hospital consolidation, nursing and staff shortages, redefining of behavioral mental health, policy issues, what's the single biggest challenge at hospitals and providers now?

- For us, in all the issues that you've talked about, it's really how to design a healthcare system around a patient and around the people that provide the care for that patient.

And both of them have way different expectations.

It had been going in that direction prior to the pandemic, and it just accelerated the changes that people as providers want in how they provide healthcare and also that us, as patients, what we expect out of our healthcare.

Both of them changed dramatically during the COVID years.

- This is gonna sound like a little bit of an ignorant question because I'm not a healthcare administrator.

Is the course, and not just UNC Health is on, but you're on and some of your other colleagues as hospitals, is it sustainable the way it is?

Can you continue to provide high quality healthcare the way reimbursements are, the way that people pay, the way that you have to deploy in rural, et cetera, et cetera?

- We absolutely can provide high quality healthcare.

I'm convinced of that, or I wouldn't be sitting here with you.

But we have to do it in new and different ways, ways that we take all the resources that we have, virtual care, AI, new reimbursement models, new models of care, how we do care in the urban areas versus the rural areas.

Those all have to be different than they were pre pandemic.

But we can absolutely provide high quality healthcare.

- Terik, question?

- Yeah, I'm really curious and seeing so much of great stuff coming out of UNC Health.

In maternity, health is becoming an issue, right?

It's really important.

Black maternal health is even more of a crisis.

So love to hear, how is UNC Health looking to address Black maternal health, or just maternal health in general?

- Maternal health for all of us, the society, the culture that we're in, is really a big deal, as you talked about.

North Carolina has unique challenges because as you all have talked about, the number of people that live in rural areas, it's three and a half million people.

That's second only to Texas in the country.

So how we provide the maternal and child health is really important for us as we think about how we provide healthcare all across the state.

And utilizing, as we just talked about, all the different ways that we can provide healthcare now that we couldn't five and 10 years ago.

It's really important in that discussion to ensure that every person has access to that high quality healthcare.

- [Chris] Allen.

- So it seems like the expense side of the ledger in healthcare just outpaces the income side of the ledger.

And I've been so proud of our local systems, Spartanburg Regional Healthcare System.

They've seemed to strike a good balance.

But I would say, and maybe you can agree or disagree, that the quickest growing expense, particularly over the past three years, has been labor.

How are you managing that?

- So the cost of healthcare, the supply of drugs, other supplies, has gone up significantly.

The cost of labor has gone up significantly.

And the reimbursement, both federal as well as third party payers, is all pre pandemic.

And it hasn't kept pace with that, as you talked about.

So as we look at designing a healthcare system around a patient and the people that provide that care, new models of doing it.

Old healthcare used to be based around the person and the institution, a place, and it no longer can be that way.

It can be virtual, it can be in your home, it can be in places outside the hospital.

And all those are better ways for me, as a patient, to get care, but also better ways to meet the financial demands that you're talking about.

- You, know, I wanna go back to the way you answered with Terik about the rural healthcare equation.

When you and your colleagues, give us a peek behind the curtain, either internally in your operating committee, or when you're looking at the rural facilities that you influence or work with or run.

How do you look at that as an administrator, as a provider of health, Dr. Burks, but how do you look at it as an employer?

And quite often, as you know, you're the biggest employer in the community and that's an important role.

I mean, how do you wear that hat?

And what does it mean to you when you deploy assets to make sure those hospitals not just stay vibrant, but provide the care?

- As you think about each of the communities that we work with, whether it's in the mountains or over on the coast, you have to go back to your mission and you have to go back to, what's healthcare, what's best for that person, and then the people that provide that healthcare?

And then design the system that way.

And it is different in the urban areas.

It's different in the rural west, in the rural east, and using the resources that we have to help provide them better care.

As an example might be for acute psychiatric care.

With our rural hospitals now, they're able to have access for a patient coming in that needs acute psychiatric care, virtually to a psychiatrist.

Before, they might wait days to weeks, literally, months in some cases, to be able to see a psychiatrist because they couldn't, they were not available locally.

Now, within four hours in our local hospitals, they can see a psychiatrist virtually and be able to take care of that, whether it's medication or whatever it might be, that they would've waited a long time.

And we can use those resources that we have to take care of people differently.

It's not gonna be like the 1950s that all the providers are staying locally, but there is enough access through our phones, through our computers, through other ways in the hospital, in the emergency rooms, for virtual care, that we really can provide high quality care, but just do it differently.

- Just as a quick follow up, has there been expansion in agreements like public-private partnerships in some of these communities that maybe you wouldn't have done five or 10 years ago?

- For healthcare, big picture, we're having to partner with lots of different people.

That wouldn't have happened 10 years ago.

Healthcare then, people tried to do it on their own, whether it's AI or virtual.

But now we know that we have to partner with corporations and companies, startups that do this well.

And we partner with them, again, with the two goals of providing really high quality healthcare for that person and taking care of the people that are providing that care.

- [Chris] Terik.

- Yeah, so I saw recently that FDA granted a $50 million funding to UNC Health and UNC schools to support regulatory innovation.

So one of the things that has really come to my mind is what kind of policies, what kind of things need to be adjusted as you talk about providing care, to support folks who may be in different communities, but accessing them as well?

- So there are a number of regulatory issues that in healthcare we deal with literally, every day.

And one might be the antitrust issues.

So with a large population in rural North Carolina, the antitrust issues that are really important in rural areas are different for the urban areas.

So for us, if we're taking care of patients in two different counties in the rural east, then we can't go to the third county that's between them because of antitrust issues.

So that's one example of the many regulatory issues that we face, really, every day, and we know that need to be addressed to provide that high quality healthcare.

- Allen.

- You know, this is maybe a bit of a softball, maybe you've quantified it before, but people view hospitals as a place where I go and I get service when I need it.

They don't necessarily view the hospital as an economic driver.

Have y'all measured the impact of UNC Health from an economic perspective?

- So as we think about UNC Health, both in Chapel Hill and Raleigh, and really throughout the state, the impact on those local communities for the people that work there, the resources that we bring in, the innovation that we bring in through our research, the education that we bring so people can train there, the impact economically of all those is significant.

And we measure it and look at it all the time.

- Do you talk internally?

Or is there a consortium of CEO colleagues that you have in hospitals that have some conversation going on about how you model up AI, and where the hotspots are gonna be, what the easy low hanging fruit is, and what kind of short term and long term effect that's gonna have on not just the delivery, but the quality of the care?

- Yeah, in the last several years, particularly in the last year, the discussion around AI and healthcare is huge.

The benefits that you can see are really, really transformative for what we can do.

The scary parts of AI are there.

We're aware of it.

We have 15 people at UNC Healthcare alone, that that's what they're doing right now, is thinking, how can we utilize AI to do those two things earlier, to provide better high quality healthcare and to provide a better experience for the person providing that healthcare?

As an example, right now, if you're on MyChart, which is our electronic health record, you're a patient and you email the person who's providing your care, that person gets 30 to 50 of those a day.

You want immediate response, but also, the person doing it, like that's an overwhelming amount of work.

And so a pilot project that we're doing with the maker of our electronic health record and Microsoft and others, is how can we use AI for you email me, I can have a draft done of my response back to you.

I'm not gonna send it to you till I approve it.

But that's a huge amount of work that I have to spontaneously do, provides you a better letter, a note back.

It provides me access to more time.

So there are lots of things that can be done in AI that really will provide a better experience for the person and the provider.

There's scary parts to it, but it's exciting in healthcare what can be really done with it.

- Is personal data security one of those big things that needs to be worked out?

Or have you all felt like you've figured out a way to make sure that the HIPAA requirements, et cetera, et cetera, are being met?

- The HIPAA requirements are important, like for all of us.

It's important that we design our system so that there's not a breach in that.

But that's really everything that we do, even right now.

There are millions of hits every day to try to get access to data.

AI increases that some, but it's not hugely different.

- I love this AI conversation 'cause I get asked it a lot, so I'm over here just itching.

Because we start thinking about AI and drug discovery and particularly supporting better kind of opportunities for getting AI and drug discovery to come together.

So we'd love to hear how UNC Health is thinking about that kind of integration.

- So UNC Health, the biggest part of our operation is the UNC School of Medicine.

And in the UNC School of Medicine last year, we did well over a half a billion dollars in research.

And the people that are working in that space, there are a segment of them that are thinking like you are, like, how do we combine healthcare and AI to provide a better patient experience, to help us diagnose patients better?

How do we design care around a cancer patient?

But also, how do we provide a better experience for the person providing that care?

Both those are going on all the time right now.

- Fascinating business.

But I'm delighted that I have my job and you have yours.

I want to ask you, just a change of subject, what did you learn, what did the system learn from COVID?

What were the takeaways?

Maybe some positive things that came outta that experience?

- So there's so many lessons that we learned during COVID.

The biggest one for me and for us is that there's a monumental occasion that happens once in a more than one lifetime event.

And that we rose to the occasion.

The people that I work with, I sit here representing 45,000 people.

And to a person, they stepped up, focused on a really specific disease and how we take care of them.

A lot of people in the intensive care units, a lot of people in the hospital and the outpatient units, they met the demands in something that we'd never done before, nobody in healthcare had done.

So that's the the biggest lesson, that we can do that.

We can meet the demands of things that are radically different than we've been before.

The other things about how to work with people better, how to work with patients better, the healthcare changes that were coming, we learned lessons there.

But the biggest one is that we can step up to the occasion and really meet the demands that are coming, regardless of what it is.

- In North Carolina specifically, Dr. Burks, the State Treasurer, Dale Folwell, struck a chord with a lot of people when he talked about the weaponization of medical debt.

And you see a lot of people nodding their heads and not saying he was wrong, and even some people off the record agreed with him.

But as a hospital provider, as someone that has to bill and collect, how does that wash over you when you hear that term?

- So the discussion that the treasurer's having and other people across the state, one, I understand.

I understand, likely better than most.

Some of the information that's being used to support those claims, I probably would have some concern about.

It's not the full picture.

As a healthcare system for us, though, I'm proud of our transparency that we have with our patients and our consumers.

And we work literally every day to try to make it a better patient experience just for your healthcare and how to have a better patient experience related to the billing practices that we do, so that they have more information, so that they are well-informed.

- This is not enough time, but in a couple minutes left, we're using these terms interchangeably.

We're using behavioral health, mental health.

What is the difference?

They're clearly related, but what is the difference?

- So it really depends on the person.

Some people use them interchangeably.

Behavioral health is our mental health plus some, it depends on the psychiatrist that you talk to.

But what I do know is that for the state of North Carolina, that's the biggest healthcare issue right now, particularly for our children and adolescents.

There's not adequate care, there are not adequate places to provide that care.

It really, really is a big deal.

An adolescent with a mental health crisis is more likely to be in jail or an emergency department than receive an appropriate care right now.

- And do you feel like there are, is mental health, specifically, mental health getting enough?

Does it have enough champions in funding or policy that may agree with you?

But are they backstopping their concerns with money and policy?

- Working with the legislators in Raleigh pretty intently in the last six months, there's a way better recognition from both sides of the aisle that mental health is a big issue for the people of our state, both from a healthcare standpoint and from an economic standpoint, it really is a big deal.

We've worked with the Department of Health and Human Services to open a new facility just north of Chapel Hill that will house up to 50 children and adolescents on a short term basis.

Facilities like that need to be throughout the state.

We need to have five or six of them regionally, and we need to have a central facility for those that need longer term care.

That's not there right now.

- We have about a minute left.

Sorry guys, I'm gonna keep the mic here for a second.

Just about a minute left, Dr. Burks.

South Carolina modified their Certificate of Need.

That was ratified, it was signed by the governor.

Does North Carolina need to do a CON that's different?

- So our CON laws have changed, they're changing here.

Two thirds of the states nationally don't have CON laws like we do.

The concern for healthcare, healthcare systems has been how rapidly that changes so that we're prepared to work in a new model.

That's really it.

It's not necessarily that it's bad to have it or good to not have it, it's how do we take a time period and have enough time to adjust a new business model of how we do things?

- Okay.

Thank you.

Did you ever get COVID, by the way?

- We did, yes.

- [Chris] Yeah, okay.

Glad you're okay.

Glad you still have a job.

(all laughing) Nice to see you, Doctor.

- Thank you, it's nice to be here with you today.

- [Terik] Thank you.

- [Allen] Thank you.

- Allen, good to see you.

Glad you brought your daughter, Eloise.

So, hey, Eloise.

We can hear you.

- [Allen] That's right.

- We can hear you out here.

(all laughing) Terik, good to see you.

Thanks for making the trip.

- Always.

Thank you.

- Okay.

Thank you for watching our program.

If you have any questions or comments, CarolinaBusinessReview.org.

That's the place to watch and to make suggestions.

Until next week, I'm Chris William.

Happy summer.

Good night.

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