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By most accounts, it's been 16 years since a real recession and a real bear stock market.

Welcome to Carolina Business Review.

I am Chris William.

Just because it's been 16 years does not mean a recession or a bear market is imminent.

However, odds do increase when we get that far out on the statistical distribution scale that economists call it right around the corner from spring.

Now, in business, policy and politics are in full bloom and in full form in the Carolinas.

And we're going to discern as much as we can in the next 30 minutes or so.

And later on, he is about 60 days into the new job.

We are joined by North Carolina's new Department of Health and Human Services secretary, Doctor Dev Sangvai.

Stay with us.

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And, Martin Marietta, a leading provider of natural resource-based building materials, providing the foundation on which our communities improve and grow.

On this edition of Carolina Business Review, Jessica Helms from the Charlotte Area Chamber of Commerce Carl Blackstone of the Columbia Chamber of Commerce, and special guest doctor Dev Sangvai, secretary of the North Carolina Department of Health and Human Services.

Hello, welcome again to our program.

Thank you for joining us again.

Why am I having this kind of trouble?

This is, about our fifth restart.

We're not going to restart.

Carl.

Jessica, it seems like I need a little help on cue cards, but welcome again.

Great to see you.

To see you.

Good to see you.

And and, Jessica, welcome to the dialog for the first time.

We're glad to have you here.

Carl, I'm going to start with you before I mess this up and one more time.

The idea that, we're 16 years past any real slowdown we've had just head of steam going for years, certainly nationally, but in the Carolinas.

Are you getting any sense if you can tease out any anxiety around tariffs in South Carolina or any of your members, are you getting any sense that there's a real slowdown in the offing?

I think there was a huge, not significant slowdown, but a slowdown last year during the election time.

And now now, as things start unraveling a little bit in DC as things play out, there is a bit of a slowdown.

But it's hard to really see what is a slowdown when you're growing so fast in the South.

And the Carolinas are just seeing significant economic boom throughout both states.

I think if it does slow down, it will be a small thing.

But I don't really anticipate anything significant.

You know, the don't want to go back and down the road too far.

But even in the last slowdown.

08-09-10 it was ugly.

It was hard for everyone, but it seemed the Carolinas were less coupled with the national hurt that that went down.

Is that fair to say?

I think so, and I think there is some regionality to this.

I think other places around the country may feel a little worse than we are.

The growth that they're seeing here in Charlotte, the growth that they're seeing in Charleston and Greenville, even Columbia, I don't really I'm not too worried about it.

Is there a dark side to growth?

A dark side.

I dont know about that.

Were seeing close to 100 people a day moving to Charlotte.

So maybe traffic, but.

Growing pains are significant wherever any type of environment.

I think what we're all seeing are we just have to deal with different set of challenges than we've had.

So maybe not a dark side.

It's just you got to refocus a little bit and think more strategically on how to deal with the growth.

Are you - the same thing for you Jessica, when you talk to your members, when you convene groups and talk about the - in Charlotte or the Charlotte region for you, how do you tease out anxiety around maybe policy and politics versus what's really going on in the economy?

Yeah, we hear from our members.

There's still a lot of growth happening there.

New businesses starting every day.

We did as a Chamber, 57 ribbon cuttings last year alone.

So there are a lot of new businesses coming to Charlotte and still opening and still growing.

And so, I'm not seeing a slowdown.

People might be tightening their budgets a little bit.

Careful with expenditures, but, not significant.

Is there a when you, some of your members obviously small business mid-sized businesses, what's the biggest barrier to growth?

Is it still financing?

It is.

Yeah.

Yes.

Access to capital financing.

Even finding affordable office space.

We've seen that, there's a big launch of co-working spaces to try to accommodate that.

What about jobs?

Jobs?

Hiring?

We're still struggling to keep up with job growth.

It's now rethinking about how do we take as we transform our market, how do we retrain employees?

How do we get kids, they're graduating school interested in an advanced automation, manufacturing jobs and in the pool is getting a little smaller.

This is the first class.

You mentioned the recession this year.

Graduating seniors were born in 2007, and that was a 2007 - 08 - 09 were significantly smaller birth rates, lower since World War two.

So we are finally seeing the pipeline has started to get a little smaller.

So we have to be a little bit more creative in how we get people straight into the workforce.

I want to I want to hit the transportation issue quickly because you mentioned it Jessica.

And also places like Charlotte in the Charlotte region, the low country, upstate South Carolina, certainly the triangle, traffic is becoming horrendous.

And that's not a very technical term, but is the Charlotte transportation debate around the transportation plan?

Is it moving ahead?

Do you feel like that city, your region is going to have an answer to that?

You know, it's funny, one of our members recently joked about it and, considered the plan to be moving from this is absolutely never going to happen to, there's a possibility that this is going to take place.

So, we are seeing some movement around that.

We, the Charlotte area chamber just had a public policy meeting, and we were talking about I-77 and some of our major interstates and a way to to have managed lanes is the plan within that transportation package and what that looks like, because funding seems to be the major issue with some of this plan and getting things off the ground.

But it's a long process.

Oh, there's no doubt.

South Carolina Lowcountry a major development in, no pun intended, but literally real estate development is the South Carolina ports sold a major parcel in a historic part of the District of Charleston waterfront, for 250 million or so.

We get the sense to Ben Navarro that's been in the offing for at least a year that we know about.

This is it.

This is a it's a big monetary deal, but it is a big developmental deal for a town that's historically not in my backyard or front yard.

I don't want any change.

How does this unfold?

I think it's a great opportunity for both the state as well as, for Charleston.

You've got the state selling the asset, but frees up capital for them to put back into infrastructure for the Port Authority.

So that's a win.

Secondly, you get a Charleston fella who's grown his business there, who's been a great developer, investing in Charleston, plays the tennis center, build a world class charter school in the inner city port of Charleston.

Ben's been a great corporate citizen.

So I think this is a win for for the development as well, because you get a local guy who's really wants to do it, right?

Yeah.

Not to go down that road too far, but how much that Ben is a local, quote unquote, had to do with him accepting and approving whatever that look like, and not just the ports and Barbara Melvin, but the community has a larger say in that.

Of course.

I think it speaks to the previous deal that was being considered from somebody out of town, out of state, and I think they feel a little bit better that this will be managed in a way that's respectful of what Charleston historically has been.

So.

So I think this is going to be a win win.

Okay.

Thank you both.

Stay with us.

We're going to bring our guests on a moment.

Boom Supersonic.

That may ring a bell.

Announced up in the triad of North Carolina as being the next phase, the next development of high speed, supersonic personal air travel.

We're going to have the chief executive officer on from Boom Supersonic.

His name is Blake Scholl.

He will be on this program also coming up, he is the attorney general in South Carolina and has also been on this program before.

Alan Wilson joins us again as well.

Right here on this set.

There is nothing like a well-made deep state political national intrigue thriller to stream on Netflix or Prime or any streaming services, but is close to that is our current state may seem we're talking reality now, and our our special guest operates at a very high level of political leadership, certainly in the state.

But it also can be politically charged but yet is directly responsible for citizens everyday mental and physical health, among many other important things.

He oversees a complex agency with 18,000 employees, plus or minus annual budget of about 38 billion.

Joining us now is was family medicine doc, university professor, hospital administrator, but now North Carolina's Department of Health and Human Services secretary, doctor Dev Sangvai, Sangvai...I keep getting that wrong, and you've been so gracious about this offset.

But thank you, Doctor Sangvai.

It's good to have you here on the program.

It's great to be here.

Thank you for having me.

Thanks for letting me go through that, because that was tough.

You are now on the inside of HHS.

You were a hospital administrator.

You were a doc.

What's it like to be on the inside when you pull back that veil?

How is it.

Different?

Yeah, Chris, thank you for that question.

You know, I've been a part of the health care landscape in North Carolina for over 20 years, and I've had different sorts of interaction with HHS.

As a doctor.

I got to see what it meant for my patients to get Medicaid that previously didn't have Medicaid.

And then certainly many of the human services, what I've been most impressed by, and maybe shouldn't be so surprised by, has been the people who work for the agency.

We've got a remarkable group of individuals who are committed to the work that they're doing.

Earlier you were talking about labor shortages, with the other guest.

We're facing some of that as well.

So I'm really impressed with the number of people in the agency who come to work day in and day out in service to the 11 million people of this state.

You you've got and you had mentioned in a recent interview, Your Honor, that there was 20 to 23% openings of jobs postings within the agency.

Is is that a liability?

Is that is that is that punitive to you?

It's not punitive, but it does create challenges, because when you do have that 23% vacancy rate, you have to make priorities.

And our priorities have really been to make sure we put people first, to make sure we're serving those who are most in need of our of the services we provide.

But it is a challenge.

And we're mostly seeing that in our state run facilities.

It might surprise many people, but we actually run hospitals in North Carolina.

We have about ten treatment facilities as well.

And those those areas where we directly take care of patients is where we face the greatest labor challenges.

Carl.

Hey.

Thank you.

Nice to meet you, Mr. Secretary.

Looking out years, we're seeing so much automation.

AIs just really in a in a stratospheric, growth mode here.

Where do you see health care and how can I help you run a large system?

But what's the impact it has on access to health care?

Absolutely.

That's a great question.

Thank you.

Carl.

As a bureaucracy, as an agency and one that provides health care services, there is so much administrative burden, and there's a real opportunity for responsible AI to help us, de burden individuals who are on the front line so that if you have capacity, you can optimize the use of that capacity.

There's an opportunity to think about automation with respect to some of the work that we do around enrollment and many of the other things that we do.

So, as we have that labor shortage, as we have that vacancy rate, I'm optimistic that we can use technology tools to help close some of that gap.

Is that help?

Sorry.

Oh, please.

Is that help from managing the roles of, who's on Medicaid for in North Carolina and South Carolina?

It could, you know, right now that process is still very manual determining who's eligible, making sure that those who are eligible continue to tap into those benefits.

But as we've seen, AI has so much potential and possibility.

I'm really optimistic that it can help not only on the clinical side and the services side, but those back office administrative functions as well.

Thank you.

Jessica.

Yes.

Doctor Sangvai, nice to meet you too.

What is the DHS-DHHS doing to help with our small business community?

Helping to lower health care costs and making it affordable for employers.

Yeah, that's a great question.

There's no secret that health care costs are going up and up.

One of the most important things, I think, for small employers is the work we've done around Medicaid expansion, because we know many individuals who currently have Medicaid in North Carolina are actually working, but they're working in settings where their employer is unable to, offer employer sponsored health insurance.

So by continuing to have a robust Medicaid program supporting the type of expansion that we've had in the state of North Carolina, what we're able to do is to keep people healthy so they show up to work.

They're able to be present.

It decreases your absenteeism rate.

So there is a direct connection between the small employer and Medicaid, and it's often a connection people don't make.

I want to follow up on that.

One of your stated priorities is improving access to health care and creating a healthier North Carolina for all.

Where are we most unhealthy in the state?

Yeah, that's a great question.

I think it's really around chronic disease.

We have so much opportunity to help individuals manage chronic disease, diabetes, heart disease.

Some of it's tobacco use.

If we can find a way to ensure that individuals are getting early access to care, particularly primary care, we can de burden the downstream utilization.

As a family doctor, it's always going to be about prevention.

From the perspective I'm coming from, prevention cost less to the employer to the state.

You get better outcomes.

You have decrease downstream utilization.

So we really need to focus on prevention.

What's what's been the biggest barrier to hit the chronic disease where they where you can make the most effective.

Yeah there are a couple of barriers I think one is access.

You know, we have a state that's largely 80% rural.

And so being able to access those direct primary care services has been a challenge for many North Carolinians.

We've been fortunate, even with our Medicaid expansion, though, that we haven't seen, a pent up demand or a demand for those services.

So if we can get individuals Medicaid, we are able to get them to their doctors and to other health care providers.

But it's really access in the rural communities.

And then the second piece is these addressing those things that aren't directly related to health care in the classic, setting of services.

And it's really around these health related social needs you may have heard them sometimes describes as social drivers of health.

We also need to make sure that individuals have access to food, food, nutrition, transportation, those things because a heavy investment in that, a solid investment that is really augments primary care.

And again, keep those people healthy.

So you have less utilization of that more expensive downstream care.

We're seeing, at least in South Carolina, a significant, trend towards the hospital systems getting larger, lots of M&A work, lots of consolidation of hospital systems.

It's been true in North Carolina as well.

What is the answer?

How do you continue to get access to telehealth has gone a long way, especially since Covid.

But how do you get to those rural communities and do we need to start looking as an economic development type of model of incentivizing large health care systems to go in to more rural communities?

I think it's all of the above for the rural communities.

If there is a community hospital, we have to do everything we can to support that hospital.

I imagine it's the same in South Carolina, but certainly here in North Carolina, where we have those smaller hospitals, we have to definitely figure out how to support them.

They're surviving on razor thin margins and often those margins are dependent on providing care to individuals who have insurance, oftentimes Medicaid.

So I think one of the most important things we can do is to ensure that individuals who do go to those hospitals have some, some form of insurance so that the hospital can get reimbursed, have a healthy enough margin to continue to do what they're doing.

It's another way to really think about how important Medicaid really is, because it supports that hospital.

And as you know, sometimes it's the most important employer in some of these smaller areas.

So the downstream impact can be felt pretty quickly if that hospital isn't stable, if it isn't solvent, it can't keep the labor force it needs.

It can't continue to hire.

And then you can see what the impact can be from there.

In Charlotte we're seeing an increase in concierge, small private health service, businesses.

And so how can the business community collaborate with DHHS?

Well, there are a number of ways that, you can collaborate.

Those concierge practices are great because they offer a particular type of service to individuals who can access them.

And sometimes it's quite honestly just being able to afford those types of services.

I think what we really need from the, employer community in North Carolina is really support for some of those key things that we're doing, at HHS, I keep going back to Medicaid, but that's so important for what we do.

Because if we can continue to have a stable Medicaid program.

And sorry, I think the best one we have is in North Carolina.

Maybe the second is the second best is in South Carolina.

If we can continue to do what we have, I think what that does, it creates a healthy workforce that allows them to, like I said earlier, to, to come to work, to be present.

But it also allows us to ensure that we get the downstream economic impact.

By some estimates, in North Carolina, the Medicaid program adds around $28 billion, to the economic impact.

So that's in the provider side and other related services.

So it's not too hard to connect the dots.

Has it become more complicated to have the discussion as you're talking about it now?

Medicaid, when Medicare and Medicaid are being debated so hotly on the national level.

It can be.

You know, the good news for us, though, is, is that, up until now, there doesn't seem to be a whole lot around what's going to happen with Medicare, at least at the federal level.

We don't hear as much around cuts.

And so some of the opportunities to reduce cost, we see that more focused in the Medicaid space.

But at a very basic level, we sometimes have to spend some time educating individuals on the difference between Medicare and Medicaid.

Sure.

I want to a quick follow up.

You're at least two predecessors, Doctor Cohen, Doctor Mandy Cohen and Secretary Kody Kinsley.

Both were very big, proponents for mental health in the deployment of mental health and the development of mental health.

You seem to be in that same vein.

How do you become a champion?

How do you deploy the kind of mental health attention that you think need is needed?

Yeah.

Thank you for that question.

For me, it really comes from when I was taking care of patients.

So many of my patients had behavioral health and mental health needs.

It became very easy to be an advocate in that space.

I think what we've done in North Carolina is truly remarkable.

We've we've invested $835 million, in behavioral health.

A good chunk of that is to ensure that mental health providers, behavioral health providers, have rates, compensation, reimbursement, that allows them to be competitive enough to be able to open up their offices and open up their practices to see patients.

But it's also making that investment in the community.

So a balance of that money has really been invested into the community, to how you prop up community based resources, to ensure that it's not always bricks and mortar or even Tesla, but you have the kind of services in the community that you need.

If you've got one of the largest state agencies, you've got such a huge economic impact with what your agency works on, what keeps you up at night as one, as a physician, but also running such a large institution?

That's a great question.

We are, an agency that, as was mentioned, is about 19,000 employees, a budget of around $39 billion and 33 divisions within that.

And we cover everything from Medicaid to food and nutrition to, the licensing of facilities.

So, there are a lot of things that keep me up at night.

I think one of them is, is that, I really want to make sure that the programs and we services we provide really reach all North Carolinians.

And, what gives me pause is when we're not able to do that.

And so it's easy to think at the macro level.

But what really keeps me up is when you think at the micro level, the individual that isn't able to go see the doctor isn't able to fill that prescription, or in some cases isn't able to access their food and nutrition benefits.

Because it's easy to think at a big level.

But fundamentally, at the individual level, we want to make sure we don't fail.

Yeah.

And let me let me do a quick I hate to jump in line ahead of you here, but we're going to run out of time and I want to follow on the heels of that.

So so to that point, when you argue your point to those who make law to policymakers and you because you are the chief advocate for the health in North Carolina.

So you how how do you include everyone in the General Assembly and have them feel the passion of what your argument is that you're making?

Yeah, it's a great question.

You know, first of all, I feel that they have the passion to win my, 60 days of having an opportunity to meet with many of our elected leaders.

They too feel passionate about it.

They too feel the importance that this has for their constituents.

For me, it's really focusing on the facts, keeping them basic and simple, ensuring that we're able to communicate that in a clear and concise fashion, and then reintroducing those facts because sometimes it doesn't just, end with one conversation.

But I truly believe in our state that when we look across both the legislative side, the administrative side, everybody really wants to be a part of the solution.

We have about a minute and a half left.

I want to get to you know, immigration is, again, hotly debated.

In in policy, as far as I can tell, sir, is the idea that in, in North Carolina, Health and Human Services will address undocumented immigrants through emergency medicine and related services.

I'm sure you want to expand that because you seem to be a guy with heart.

How how do you support the undocumented now, given that it's become such an acute debate?

Yeah.

You know, I look at it this way.

There are 11 million people in the state of North Carolina, and we serve individuals who live in rural communities.

We serve individuals who live in urban communities.

We have programs that are specifically designed for disabled.

We have programs that are designed to help individuals who are aging veterans, children's and others.

My focus is really on what do we need to do to ensure that our programs and services are working for all.

Does does the General Assembly support that in in, in in principle.

Do you in my conversations, it's been pretty consistent that individuals really want to see what we can do for the best in North Carolina.

Doctor Sangvai, thank you for taking time.

I mean, you've got it.

You got a job ahead of you.

And and I know you know that.

But clearly your passion is coming out, and, our best to you.

I hope you'll come back, because I know you're you're you hit the ground running across the state, and I appreciate it.

Yeah.

Thank you very much for joining us.

Right.

Thank you.

Yeah.

Jessica, I hope we didn't scare you off.

Please come back.

Thank you for being so open to.

And Carl, always good to have you.

Great.

Thank you.

Thank you for watching our program.

If you have any questions or comments, we would encourage that.

Go to Carolina Business Review dot org, watch past programs, make comments and join us again.

Coming up on several programs.

But thank you for joining us.

Until next week, I'm Chris William and we hope your weekend is good and that you have a happy spring.

Good night.

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