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- Spring break, summer vacations, possibly the end of the most acute phase of COVID.

And here is where we find ourselves.

Hello again, I am Chris William and welcome again to the most widely watched and longest running source of Carolina business, policy and public affairs seen each and every week across North and South Carolina for the last 30 years.

Thank you for supporting us.

We will start our discussion as the summer and spring months start to unfold here.

And later on, after almost two years in the job, mostly during COVID, the president and CEO of North Carolina Blue Cross Blue Shield joins us again, Dr. Tunde Sotunde and we start right now.

- 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 Blue Shield of South Carolina, an independent licensee of the Blue Cross and Blue Shield Association.

Visit us at SouthCarolinablues.com.

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

On this edition of Carolina Business Review, Leslie Boney of the Institute for Emerging Issues.

Carl Blackstone from the Columbia Chamber of Commerce and special guest, Dr. Tunde Sotunde, president and CEO of Blue Cross and Blue Shield of North Carolina.

(dramatic music) - Well happy spring and in some cases happy spring break.

We're glad to have you back on the program.

Leslie, welcome.

Carl, welcome.

Leslie, you get the first pitch, sir.

So Leslie, because of hostilities, of course, between Ukraine and Russia, and the tragedy that is unfolding there, we have seen more than a spike in energy prices.

We have seen what seems exponential, but will feel, will be felt at the pump, on personal balance sheets and corporate balance sheets.

Are we, have we gone past a tipping point now when it comes to cost of living somewhere in here?

How does this affect us?

- I think it's gonna have subtle effects everywhere and, and more obvious effects in a lot of places.

So you'll start to see it, you know, in a couple of weeks.

And in some cases you're already seeing it on your grocery store shelves.

When it comes time to order the next laptop for your office, you're gonna notice those prices are going up.

When you get your next heating and cooling bill, you'll see that there's a change in price there.

And I do think, I do think there's a ripple effect that, that comes throughout the economy as first gas and oil prices go up and then there are other energy prices that, that people use to substitute.

And so there's a, a greater demand for energy all across the board.

And that causes increases in prices that everybody can see.

- Carl, I know you're not a, a tourism expert per se, but you know a little bit about it.

Certainly the Carolinas are both single largest industry is tourism.

South Carolina absolutely, beaches, et cetera, for summer and spring.

Is this going to be a real headwind for that, for that kind of travel and that kind of activity?

- Well, I, I, I agree with, with Leslie, I mean, it's just kind ripple effect.

And so when you see this on high gas prices and higher costs inflation, the highest rate in 40 years, I mean on the backs of COVID, on the back of supply chain issues and, and a workforce issue.

So it is really a perfect storm if you will, of not great things from the economy.

But I, I think in, if you, I think there's still a pent up demand for getting out and doing things.

So I think it will have a huge impact, but I think for those, it's not gonna deter people from having significant vacation plans.

What it will do is gonna cost a lot more.

And so everybody's gonna have to raise their prices and they're not doing it once or twice a year.

They're gonna do it once or twice a month now.

And it's just for the unseeable future.

That's what we're gonna to deal with.

- Let's, let's pivot gentlemen, and let's talk about education here.

We are two years now, past the first emergence of COVID in, in the US and in the economy.

Leslie, there have been several reports of late around educational attainment for 2021, educational achievement for 2021.

When, when we look back, has it been, two questions?

Has it been an educational crisis from that point of view?

And have we seen a real loss in, in educational attainment?

- Right to the second question, I think there's undeniable loss.

And you know, depending on which study you look at, from which time you'll see, you're seeing four to eight months of learning loss.

And if you look at some of the past things that have happened in the world where we can look back and, and figure out what happened, longitudinally, you'll see that those little bits of learning loss tend to compound themselves over time.

So, you know, what starts off as maybe four months of learning loss, the next year it may, may end up being six months and some people may get lost in the shuffle.

And so I think it's the kind of thing we need to really pay attention to on a K through 12 level.

On a university level, the challenge is that there were people who delayed and didn't go.

So you saw community college enrollment in particular, go down, in some universities, things to climb, not at NC State where I work and not at some of the others, but you did see people delaying going on to higher education as well.

- Carl, same question, has this been not a mortal wound, but certainly a critical wound to education in the Palmetto state?

- I mean, absolutely not.

I mean, as a parent, I've got kids both in college and in, in K12 and, and we've seen a disruption, right?

And so the long term impact is going to be significant.

We've gotta get a handle on it.

Costs are still gonna be an issue for higher ed and the technical college or community college system.

So we've gotta figure out a new path forward, and also I think we're gonna have to change what our goals are, and what I mean by that is what do businesses need to function?

What do they need to have in, in their employee?

You know, some people have arbitrary guidelines for hiring and, and I think we, with the supply chain and, and supply and demand of workforce today, I think we've gotta do a hard look at ourselves and find out what we truly need to be successful in the business world and go out and find those kids.

And we've gotta backfill that with, with some educational attainment issues as well.

- These, this issue of course is, is, is indivisible with the idea of producing men and women that are ready for a workforce.

Leslie, educational attainment goes on to become labor participation, hopefully, and that's been under fire.

So how critical do you think that is?

And is, is, are we past a tipping point on labor participation?

- Well, significant declines in North Carolina in particular, but also in South Carolina and the percentage of people who say that they want to work.

So there's a labor force participation rate that has, is sort of the accepted proxy for how many people are out there that want to work, either are working or say they want to work.

And the decline in North Carolina is such that if we were at the same rate as we were pre-pandemic, we would have an additional 360,000 people available to work.

In South Carolina, they were at the same level as pre-pandemic.

There would be 100,000 more people available to work.

In the absence of that, then we've got a situation where we're actually upside down in terms of job seekers and jobs available.

So in North Carolina, 1.2 jobs for every one person looking for work.

And as we're trying to explode out of this pandemic and, and move, move on to endemic or wherever we we're heading.

That stage, we've gotta figure out a way to get more people interested in working.

And Carl talked about some of it.

We've gotta maybe think about unusual people that we haven't historically been recruiting.

Some people who might fail an initial drug test, or some people who might have a criminal record or some people who might have childcare issues.

We better figure out a way to solve those problems in a, in a real way if we're gonna turn this economy around as quickly as we want to.

- Carl, how do you address that?

- Well, two things, I, I, I think one, the, the cooling off of the economy, the rising rates, but also the conflict that's happening in, in Ukraine right now is probably not good for the market, which has a positive impact on the workforce but frankly, you're see less people getting out.

Yeah.

Labor market.

You're not gonna see as many people retire because the market volatility is just crazy.

So I think that's going help stem some of that.

The other piece is we've gotta look at immigration and this is going be a significant call to arms for our members of the congressional delegations to figure out some path forward.

We, birth rates are declining.

They declined in the great recession.

Those folks are graduating in '25, '26.

So we're gonna see a deeper decline in, in labor pool starting a couple years from now.

What's the answer?

360,000, 100,000 in, in South Carolina.

We can't make that up.

So we've gotta figure out, either invest a whole lot in technology, or we need to fix an immigration issue.

And so there is going to be a painful few years until we can figure this out.

- Let let's bring this idea of technology in.

We've got about a minute and a half left before we bring our guest in.

Leslie, the idea of technology was going to be the savior of the COVID connectivity problem.

And I say that with, with the idea that broadband access was the thing that we were going to deploy, are deploying.

We found out and I'm, and I'm sorry, I'm gonna get to a question here.

But we found out that the bottleneck ended up being well, who owns the poles that this fiber is hanging on.

Will we get past this bottleneck?

And would you forecast that broadband will be in the Carolinas like electric generation?

It is going to be in every home, in every community sooner rather than later.

- Yeah, I think the federal stimulus funds are gonna ensure that we get to probably 95, 98% penetration eventually for availability of broadband.

The bigger problem from my standpoint is that once we build it, people aren't coming.

So if we build it, will they come?

Well right now in North Carolina, a quarter of people who have access to broadband aren't subscribing.

And if you think about the potential that that has, if we could get more people subscribing, not just for children learning at home, but for adults trying to learn at home or people trying to work from home, that could overcome some of the spatial challenges we're having, where there are people available in one place, their jobs in another place.

And if we can find a way to make that available and adopt it, then I think we have a real chance to address some of these short-term labor shortage problems we have.

- Our guest was thrust into a triage mode when he started his job back in the summer of 2020, right smack dab the panic of the COVID health crisis.

We welcome back to the program, the president, chief executive officer of Blue Cross Blue Shield of North Carolina, Dr. Tunde Sotunde.

Your honor, or Dr. welcome back to the program.

Thanks for joining us again.

- Great, Chris, thanks for having me on the show.

- So let's put it in context, you got the job at a very critical time, and now you've been immersed in this health crisis as a, not just a payer, sir, but leadership in health care.

Has there been any single event that has affected health and, and, and healthcare like we've seen with COVID that you can think of?

- No Chris, you know, this pandemic has been an unprecedented public health crisis to say the least.

You know, the, the last pandemic on record that I recall was the 2009 H1N1 influenza pandemic, but it was nowhere close to what we have experienced over the last two years now and counting with the COVID pandemic.

Prior to that, I believe the 1918 influenza pandemic was probably the other pandemic on record.

So, you know, in terms of the last 75 to 100 years, I think is pretty much the influenza pandemic that anything that we could draw any correlations to.

But again, what we have been dealing with is totally unprecedented.

- Dr. Sotunde, you know, at the beginning of it, and even up until a few months ago, it, it felt as if we were in a, still in a triage mode, that we were reacting, flight or flight.

Do, do you get the sense we're past that now in general?

- I do.

I do.

I, I, I really believe that there appears now to be light finally, at the end of the tunnel.

It's not over, you know, by any stretch, but I, I, I think we're now beginning to start to transition from a pandemic to more of an endemic state with, with respects to the viral replication, the viral surges, spikes and so on.

And that's typically what happens.

You know, when you have these pandemics, you know, when you have epidemics, you know, over a period of time, people develop herd immunity, you know, people get vaccinated, which is what has happened.

At least for us here in the United States, we have one of the highest vaccination rates, at least in the Western world.

And what you tend to see is that the virus tends to burn out over time.

It loses it ability to replicate, and then it just becomes endemic.

And we live with the virus.

It's not different with how we are living with the flu virus.

Even there are other strain of coronavirus that we live with today and have, have done so for many years.

- Leslie.

- Dr. Sotunde, one of the things that Blue Cross Blue Shield of North Carolina did most quickly was to make an amazing pivot early in the pandemic to begin covering telehealth.

- Yes.

- And over the first year, I think I saw this, right, that the increase in telehealth visits that you covered was 7500%.

I'm wondering as we move toward an endemic stage, whether you think telehealth will continue to be supported in the same way by both insurance companies, but also embraced by primary care physicians.

- Absolutely, Leslie.

I don't think there's a question about that anymore.

Telehealth or virtual care has proven to be a, a very effective tool and it plays a key role in helping to provide access to care.

You know, to your earlier comment, we actually at Blue Cross have covered telehealth for almost 20 years, believe it or not, right.

But there was hardly much of any use to any degree.

Fast forward to March, April, May, June, you know, 2020, and we saw our telehealth utilization skyrocket 7500%, you know, just in a couple, in a matter of weeks, in a matter of months.

And we've continued to see telehealth even being leveraged even more so throughout the course of the pandemic.

What, from our experience, what we observed was that telehealth seemed to be utilized more, to help provide for mental health and primary care access.

About 80% of the visits that we have experienced so far through telehealth has been for primary and mental health services, which is critically important, not only in the state of North Carolina, but, you know, in many states where a pretty decent amount of the population live in more rural areas of the state.

And what telehealth has shown is that we can actually deliver care more effectively, more timely, you know, particularly in those areas where there is a very low of access to healthcare services.

- Carl.

- Hey, good morning.

You've got such an illustrious background and, and, and you see things from a global perspective, but here in the United States, as you know, especially in the, in the south, childhood obesity and mental health issues are probably two of the most dynamic issues facing us today.

As a healthcare provider, but also as a business, businessman in, in North Carolina, are these the only two issues that, or are the two biggest healthcare issues for kids today that we need to be focused on?

Or is there something else out there?

- Yeah, I, I, I would say that, you know, the, those two pretty much rise to the top.

I mean, there's no question about it.

And unfortunately I think what we, what we are observing as one of, at least the near to medium term impacts of the pandemic is an escalation in mental health conditions.

As you can imagine, in fact, you know, the published literature would suggest that, you know, the mental, the prevalence of mental health or behavioral health conditions is one in five.

Actually believe that it's probably more than more like one in three, because a lot of in all of instance, it goes undiagnosed right until it results in severe mental illness.

So if you ask me what was, which is the number one, I would actually put mental health illness, you know, at the top of the list.

And, and unfortunately, you know, that is one area where even prior to the pandemic, we've struggled with, with respect to being able to provide access.

There's just not enough mental health practitioners, you know, pretty much anywhere in the country.

This is, this is actually prevalent across, you know, the country.

So I, I would say that, that, that, that is probably our number one, when I think about medium to long term impacts, you know, concerns that we have.

What, how has this last two years right, impacted the mental, the emotional, not just the physical health and wellbeing of all of us, but particularly for the next generation coming behind us.

- Thank you.

Let me just take a second on, on the mental health issue, because it's come up more than once of course, Dr. Sotunde, as well as then DHS's secretary Mandy Cohen was, was pounding the table about mental health early in the public health crisis.

Is there something, or rather, how do we support and meet that need legislatively?

If you, as a payer are willing to support it, if the providers are willing to do something about it, then, then what on a policy level needs to get done?

- You know, I, I, so a couple of things, you know.

First of all, addressing mental health (indistinct) and the de-stigmatization of mental health, you know, so those are a couple of challenges we have right now in terms of being able to deliver effective mental health services.

So, you know, mental health priority, the de-stigmatization of, of mental health conditions, I think is critically important.

We have to provide a more robust pipeline of mental health professionals than we have today.

I mean, if, if you ask me from my own personal opinion, I think, you know, one of the areas that we can come together, you know, as a coalition is really to increase the number of mental health practitioners, you know, training supports and so on, you know, upsetting tuition, and, you know, just ensuring that people that have a desire to attend the level of education, whether they can then in turn, provide mental health services, I think is another area of opportunity.

And I think we should incentivize mental health professionals to practice in a more underserved, a more underprivileged parts of the state, allow them to practice at the highest levels of their licensure.

So those are just, you know, a couple of what I've described as meaningful, practical, you know, policy areas that can be addressed.

- Leslie.

- Interesting hat the Blue Cross Blue Shield Foundation has put a huge emphasis on racial equity funding.

And there is ample data to suggest there are dramatic differences based on race and ethnicity, in terms of healthcare outcomes, blacks on average live for four years, less than whites.

During the pandemic, you've seen both the, the Latinx community and the black community really suffer disproportional in terms of infections and hospitalizations and deaths.

I'm wondering what you see that you find to be the most compelling data for an intentional emphasis on addressing racial equity gaps in healthcare.

- You know, so we've known about issues around health equity.

I often describe it as a lack thereof, you know, with respect to, you know, predominantly more so a minority, you know, underserved ,underprivileged, you know, marginalized communities, you know, what has become even more evident as a result of the pandemic.

The pandemic has actually shown a light on the severity and the depth of these health inequities, even moreso than many people, including people like myself, realize.

And I think, you know, as we look forward coming on the back end of, of this pandemic, we have to take those lessons learned and really think differently about how we address those social drivers of health that impacts one's health and wellbeing.

You know, whether it's with respect to housing, whether it's respect with respect, to providing jobs, whether it's with respect to addressing food insecurity and ensuring that people have access to fresh food, vegetables, and so on within a reasonable distance of wherever they might live or work.

And whether it's with respect to addressing social, social isolation and now we also have to address bandwidth because now we are all acutely aware of how important or critically important it is, you know, to be able to leverage technology and tools so that we can provide, you know, better access to them.

- And we literally, we've got 30 seconds left, so it's not fair to bring this up, but you've also, and not to put words in your mouth, but sir, you've also said that that, that education is a determinant of health and overall, overall health and quality of life.

- Yeah.

Education clearly has a direct correlation.

There are many studies that have demonstrated this with improving one's health and wellbeing.

You know, education needs to better health literacy.

In most cases, it leads to better jobs.

It leads to access to better healthcare coverage, it leads to access to better care.

It leads to leads to increased life expectancy, right?

And so on.

So there is no question at all that education and healthcare are interwoven.

- Okay.

I, sorry to interrupt you, sir.

I wish we had more time, but I'm, we'll have you, please come back when you are well past any immediate pandemic issues, but best of luck going forward, sir.

- Thank you very much.

Thanks for having me.

- Absolutely.

Leslie, good to see you.

Carl.

Thank you.

Until next week, I'm Chris William.

- Goodnight.

Major funding for Carolina Business Review provided by High Point University, Martin Marietta, Colonial Life, The Duke Endowment, Sonoco, Blue Cross Blue Shield of South Carolina.

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