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- For more than a year and a half now, hospitals, healthcare providers here in the region have been in triaged mode, reacting to of course the public health crisis COVID.

I'm Chris William, and welcome again to the most widely watched and longest running program on Carolina business policy and public affairs seen over three decades across north and South Carolina.

In a moment, we will talk to one of the large hospital CEOs, Carl Armato, president and chief executive officer of Novant health.

And we start now.

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(upbeat music) - [Announcer] On this edition of Carolina business review and executive profile featuring Carl Armato, president and CEO of Novant health.

(upbeat music) - Well, it's not too early to say happy holidays, So Carl, welcome and happy Thanksgiving.

Thank you for joining us.

I hope you're well, you look well.

- Thank you, Chris and I'm glad to be here with you today.

It's always great to spend some time with you.

- Thank you sir.

Carl, talk about healthcare provider, a hospital.

Boy, what a time it's been the last 20 months, Carl, how do you and your team now go from this is my turn, sir, but go from triage mode, trying to put out some of these healthcare in this public health care crisis fire and being reactive to now strategically operating and working the plan.

How do you do that?

Are you doing it?

- Well, Chris, you know, I think it started with Novant health having a foundation of really a culture that that's been flexible and investing in capability.

So when I say capabilities, I mean like our digital capabilities, our predictive analytics.

And so even though COVID was a surprise to a lot of organizations and all of us, at the same time, we're watching our predictive capabilities, help us get into a zip codes that proactively and really ahead of the COVID curve so that we could get 600,000 masks and education to communities.

We could go and predict where we thought we needed vaccines and underserved areas.

We've put out almost 620,000 vaccines, so, what I'll tell you is this predictive capability not only has been so helpful for us in how we treat patients in the care of patients, but now it's really ingrained into the operations of how and how we're allocating resources and people across our entire system.

And so I'm really pleased about how our movement from where we were in trying to deal with COVID, to now we're dealing with everything that the community needs from a health perspective, including COVID.

- You know, Carl, I was thinking of years ago, the legal action that led Novant to put in place this washing of hands that I know is hard at the beginning, but it seems prophetic now that the hospital that reacted pretty quickly to this idea of washing hands is now also been a first mover in what ended up being a vaccination is as being a condition of employment.

No again, Nova was one of the first movers in that and not trying to be just leading on this Carl, but you have compelled workers to either have the vaccination or not be a member of the team.

How do you manage that so it's thoughtful for the employees, It's thoughtful for the patients, what's behind that?

How do you do that?

- Well, Chris, I would tell you that the beginning for us is this foundation in this culture of inclusiveness.

And what I mean by that is, we have been holding open forums and web-based, you know, conversations with team members across all markets to really help understand and remove the misinformation about what the vaccines zoo and what they're all about.

And really putting myself out there with physicians, with all of our experts, listening to team members answering questions, and I'm proud to tell you that, you know, 35,000 team members stepped up and got vaccinated.

I think we had a maybe a few hundred that decided they were gonna, you know, decide not to get the vaccine, but I'm really just proud of how they did it.

And I'll tell you why that's so important.

Because first of all, we've got patients coming in to Novant health.

And I think about a patient that's dealing with cancer, a patient that's dealing, or a premature child that's in our critical care nursery.

We can't afford to pass any kind of virus and particularly COVID to those patients.

So that's the first protection of patients.

But then Chris, what we also saw was our staffing across our system.

Really, it really became unstable without having our team members vaccinated.

And a great example is we had one of our rural markets where 11 team members on one unit actually went out with COVID in the same day, the same week.

And so you can imagine just being able to care for people became something that we really had to get ahead of.

So I'm proud of the work and the team stepping up and getting vaccinated and be safe for patients and our community.

- You know, and I know that sounds like a politically polarizing question, Carl, but why do you think there's so much hesitation around this vaccine, especially in healthcare workers?

Why do you think that this has been a do or die for so many people?

- You know, Chris, it's really surprising but because, you know, healthcare systems, including Novant health have always used vaccine mandates for the flu, for tuberculosis I mean, there's other, you know, safe vaccines that we have utilized.

I do think, I think unfortunately the vaccine itself for COVID got politicized, it got politicized.

You know, whether you're Republican or Democrat, you had a point of view, whether you were an independent, you had a point of view and it really created a lot of misinformation Chris in the marketplace.

I mean, I'm still addressing misinformation with our physicians that are our scientists who are trying to make sure that this misinformation is not out there, but it's really been unfortunate because all I can tell you is we know the vaccines work.

And I think what helped our team members was to actually see the impact of our own patients in our own facilities.

So it wasn't a federal set of numbers, it wasn't a state set of numbers.

We showed them the impact on patients inside of a Novant health system, that they could see and touch and know the people who put those numbers together.

So I feel like the transparency of sharing information in that way helped us tremendously.

- Do you think you know, living is you and your team members have done, and I mean all 35,000 employees at Novant and the other hospitals as well, living in this day in and day out 24/7, 365 as you've have, do you see that we are closer to a day soon where we're not talking about the vaccine or COVID-19 that it's now something that's back to normal of some sort?

- Well, Chris, I wish I had a crystal ball.

I could tell you the vaccine's gonna disappear, but unfortunately I will tell you that the COVID-19 and particularly the Delta variant has really been difficult for a lot of us in trying to battle it.

I believe that COVID 19 and the different variants are gonna be with us for some time.

Now, what we might see is what we're seeing across the country today and across the world, we've got hotspots here and there, we've got surges, so I'm anticipating and I'm trying to plan with our resources and our workforce, that we're gonna have some form of COVID inside of the system while delivering the remarkable care that we're known for, for a period of time.

- You mentioned a couple of minutes ago, the idea that in one of your units, you had 11 providers out and it was a rural unit.

Let's go back to rural health for a moment, and know that that has been a focus for hospitals, certainly Novant for a while now, even before COVID.

Where's rural health?

And where's the delivery of rural health now, given that a lot of your bandwidth has been taken up with the COVID?

how do you feel about it now?

What are your next steps?

- Well, I I'll tell you what I really am proud of though, is how the health systems, particularly in North Carolina, South Carolina, have really come together to really take on and battle COVID as a team.

And I say that strongly, so competitors, yeah, there there's a lot of competition in both the Carolinas, but the fact that we've all come together, and when I say together, it means inclusive of rural healthcare in bringing rural healthcare into how are we gonna work better together.

And I think COVID, if you find one great thing that happened, was we integrated and tried to understand what was happening in rule, not only North Carolina, but South Carolina, so that we can help with resources in the marketplace and open up capacity in our own facilities to help them deal with the different complex of COVID cases that they were dealing with and other other health care needs that they had.

I think Chris, this gives us a great opportunity, just like diversity inclusion and health equity.

It gives us an opportunity to reassess not only how we're gonna help rural healthcare, but how we're gonna ensure that everyone has the access to the healthcare they need and deserve.

- Do you have the resources to apply it or deploy it to rural healthcare given everything that's going on?

You feel like you can move in that direction?

- Well, here, here's what I'm thinking Chris, is the way we came together as partners to battle COVID, I think you're gonna see some unique partnerships occur.

You know, the relationship that we have, for example, with UNC now, and working with them in Wilmington and in Charlotte, there may be opportunities for Novant health and UNC to even work together across the, you know, the Carolinas to be able to help in rural health care.

So those are examples of new relationships, new partnerships, new approaches to care that I think it's gonna take those that have a lot of resources helping those that may not have the resources they need to deliver care that people need.

- You mentioned UNC, and let's unpack that for just a second Carl.

Certainly your crosstown rival atrium in wake of announced a pretty big tie up when it comes to teaching school, you yourself have UNC.

I wanna read, I've got to read this because I'm not gonna get it right If I don't study suggest, that over one third are thinking about leaving the profession in nursing and in healthcare.

So if you are trying to deploy this idea, if you are deploying this idea of having a teaching hospital tied to a university, and not just you, but others of course, but you've got this forward headwind about these, these folks that are either leaving or just not gonna go to school for nursing or healthcare.

Does that create a problem with these ideas you wanna deploy?

- Well Chris, first of all, obviously there's always a lot of ideas and not enough resources, so we recognize that.

I will tell you, I think the relationship that we are building with UNC health and the UNC school of medicine.

These branch campuses, I think can be really helpful.

And I call them branch campuses 'cause we're not duplicating the UNC school of medicine.

We're actually creating branch opportunities, so we can create more of the resources and the talent that we need in those local markets.

So for example, in Wilmington, we're getting ready to really launch that campus and have a lot more capability, and we're even expanding it to maybe include advanced practice providers and other capabilities there.

So I can see us working with you and see on nursing, on other capabilities that could be very valuable to the health systems that are not only at Novant health, but across north and South Carolina.

Again, we've got our first nine students that are getting ready to start in Charlotte.

Again, a branch campus and there'll be on campus in January and we're just looking forward to working with them and with a curriculum focused on health equity and other capabilities.

- You mentioned Wilmington, new Hanover Regional Medical Center of course, beginning of this year in Q1, you announced and did in fact do an acquisition.

I say an acquisition, but more than a strategic tie up.

Close to $5 billion was not a small amount of money so that I know you want to get that right, and history shows you probably will, but let's, let's talk about that for a second.

So New Hanover Regional Medical centers you all know Carl was passionately a county hospital that wanted to remain or there were many people in that community that wanted it to remain a county hospital.

Bit contentious getting to the point of the acquisition.

How is it now?

How would you characterize what it is now as a Novant patner?

- Yeah, Chris in early 2021 We welcome New Hanover Regional Medical Center as part of the Novant health system.

And really our focus was to expand care along the Carolina coast, both north and South Carolina.

And our goal you know, we set out very clearly in talking to the community, was to increase jobs, new facilities, new access points, increase our financial assistance policies for families, and really start to address some of the real healthcare needs like mental health and substance abuse that we were seeing happening throughout the community.

So I'm telling you that after eight months of the integration, the aligned culture of New Hanover Regional Medical Center with that of Novant health, it just, when I walked the halls at new Hanover, it just feels like they've been part of Novant health for a very, very long time.

The physician partnerships and the things that really matter is to how we listen to nurses and get the voices of clinicians at the table.

All of that is just been a remarkable start for us.

And we're already seeing some remarkable impact of opening up access to health care.

And remember the county had it, you know, as a county facility, they couldn't cross over into other counties to open up access points.

So we're now moving healthcare, primary care closer to where people live and work.

And so I would tell you, Chris, I'm really pleased about how the integration has gone with New Hanover Regional Medical Center and Wilmington.

- Any other surprises that came out of that so far?

- You know, one of the things that we did, a listening tour, which we do in all of our markets, but, you know, diversity inclusion and health equity has been really important.

It's been embedded in the strategy of Novant health.

In everything we do and so, you know, going in and sending Tanya Blackman my chief diversity inclusion and health equity officer into willing to talk to all the community, all the team members.

There were a few surprises of opportunity that we really need to address.

And it goes back in time, there's a history that we have to recognize, but it really is how do we ensure?

how do we ensure that every zip code in every community has the healthcare and the access that they need and deserve.

And to me, those are gonna be those aha moments that we've heard from now from the community and being able to open up those access points are gonna be pretty exciting.

And you may have heard, Michael Jordan has agreed to put two new clinics in Wilmington, in his hometown, and he contributed another $10 million for us to do that.

So, those are the kinds of examples of aha.

We heard you, and now we're going to respond to it.

No, I had not heard that, but thank you.

I mean, to say that that's probably confirmation is an understatement.

We're gonna run out of time as we always do 'cause we've got so much information to pack into this with you.

Carl, let me bring it back something you mentioned a couple of times, this idea about DEI diversity, equity inclusion, and I know you all have been not just sensitive to it, but embracing it for a while.

Back in one of your biggest markets in Charlotte, the mayor mayor by Lyle's announced a what she is called or what her team is called, The Racial Equity Initiative.

And because of that, and Novant was clearly at one of the top partners in that.

The hope is to raise 250 million in that market alone for this idea of racial equity and DEI.

More than a box to check Carl.

How does DEI play into the longterm strategic value?

Am not just what you're doing, but how you're hoping to lead.

- Yeah, Chris, I think first of all, we've already determined years ago, long before there was racial disruption in the environment, in our communities, long before the George Floyd incident and an unfortunate murder.

We actually decided a long time ago at Novant health that we were embedding diversity inclusion and health equity into the strategy, we thought it was the right thing to do.

And Chris, the reason we saw such a beautiful impact on it is, you know it used to be, I had to have conversations with people about why we were winning awards on certain quality metrics, yet when you broke it down by demographic, by patient population, we saw just these disparities in these numbers.

And so to be able now to have an organization with a culture that is going after those disparities without anyone in the corporate office having to ask about them.

So for example, you know, just with pneumonia readmissions, we eliminated, there was a gap in those disparity numbers.

And we actually not only eliminated it between the differences before African Americans and Caucasians by about four to six percent, but then we reduced readmissions for everyone.

So the embracing of that was a great example of why.

I think what the mayor is doing right now is helping us all advance health equity.

And so what I'm really pleased about, is that I think she's getting the voices of not only healthcare, but our entire community.

Our entire community, where people live the local, faith-based individuals, the community leaders and the healthcare organizations to really help her ensure that equity is brought to all in our markets and in our community.

- How do you know, and this is not cynical or even skeptical?

How will you know that once mayor in Charlotte, Vi lyles can say that successfully has raised 250 million toward that equity initiative, racial equity initiative?

How will you know that it is being successful?

What are the bookmarks, or what are the road signs that tell you that it's going in the right direction?

- So, first of all, the first thing that she's already done, that I can tell you is set in the us off to a very successful path is she's being very inclusive about who's at the table.

So she's got a lot of people that have been investing in the social determinants of health.

So for example, you know, whether it's Novant are other health systems, we've been addressing housing, you know, how do you get affordable housing?

We've been addressing a lot of the food insecurities that are out there, but the point is, is now we're gonna have a team of people that can start to really attack and look at different problems across our entire community and ensure we're getting not just a resource here or there allocated, but maybe an entire set of opportunities of resources that can really make a difference and a sustainable difference.

And that's what I'm gonna be looking for Chris.

A sustainable differences, not just something that checks the box for a year.

- Carl, we have about four minutes left or so, and I do want to unpack the idea around mental health.

I know you've been a supporter of it.

Secretary Mandy Cohen, from North Carolina department of health and human services has more than bang the table the last few months about this mental health in general and how it's even more critical now.

How do you re how do you allocate more dollars and more resources to the mental health of your 35,000 team members, but also those patients that are in the mental health units?

- Yeah.

Well, Chris, I'm gonna start with our team members because I think you bring up a great point.

First of all, our team members are physically exhausted.

They're really our focus on their resiliency.

we already had physician and nursing resiliency programs, administrative resiliency programs, but we've had to really launch a whole new approach to thriving together.

And we really are trying to collectively address even some of the mental health issues we're seeing with our own team members.

Think about those critical team members that have watched so much, unfortunately death with COVID in the intensive care units, the critical care units, emergency rooms.

And so I've actually started talking to, we have a general on our board, general James Amos, who was the 35th commandant of the Marines.

And I've actually been working with him on what the Marine Corps dealt with with PTSD, And how do we bring some of that, of mineral capacity in and resource into the healthcare environment?

So what I'm gonna tell you is for team members we're putting resources.

I think we put already this year about $250 million, just in obviously the basics of salary increases benefit, increases incentives, but we're doing a lot more to address the thriving together in their mental health and resilience fee.

And then as far as mental health overall, it's gonna take a partnership.

It's going to take teamwork.

We are investing a lot in it as a system, but that's quite, I think you're starting to see why scale in some of these opportunities to come together with other systems.

We can address it together, but it's gonna take a team of people, both public and private partners coming together to address more of the mental health needs across our communities.

- I know you don't wanna get out in front of your public policy team, but Carl, how do you know when you've got north and South Carolina now that both have substantial budget surpluses from years prior?

There's gotta be some money in there for mental health.

So how do you, how do you access it?

- Well, I think what we're gonna have to do though, is show the impact and the outcomes that we're gonna have first on it.

I mean, that's the thing, we have to articulate it.

In my mind, Chris is not building the same, you know, brick and mortar kind of approach.

We gotta utilize digital capability.

We've gotta get at where people can be and access health care with regard to mental health.

It's a whole different environment.

And if COVID taught us anything, it taught us that we really can thrive in the virtual environment.

I mean, we went from having a very limited number of those virtual mental, health calls or even regular interaction with patients to now.

I mean, it's a million people that have video visits with us now Chris, so my point is, that's another whole way for us to get at mental health and mental capability, both in rural areas and other areas across the Carolinas.

- Carl, Thank you.

We are out of time and of course have left a whole bunch of things on the table, price transparency and all those other things that everybody loves to talk about.

But please come back.

I hope you'll come back soon.

- I will, Chris.

I obviously, I just appreciate being with you and just know that as a type one diabetic, my goal has always been to go into a room and try to find a way to bring remarkable healthcare to everyone across the Carolinas.

- Well said, thank you, Carl.

Happy holidays.

Thank you for watching until next week, goodnight.

- [Announcer] 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 and by viewers like you, thank you.

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