>>Announcer: THIS IS CAROLINA BUSINESS REVIEW.

MAJOR SUPPORT PROVIDED BY-- >> Chris: SOMEONE ONCE SAID MOST NEWS IS NOT WORTH KNOWING.

THAT'S ANOTHER WAY OF SAYING IT'S HARD TO TEASE OUT THE BONA FIDE, CURRENT ISSUES THAT WE REALLY NEED TO KNOW AND WHAT COULD AFFECT US AND WHAT'S MOSTLY NOISE.

WELCOME, AGAIN, TO THE MOST WIDELY WATCHED AND THE LONGEST-RUNNING POLICY BROADCAST ACROSS THE CAROLINAS FOR THREE DECADES.

THROUGH FOR SUPPORTING THAT EFFORT.

WITH REASONABLE HEADS WE WILL UNPACK THESE KEY ISSUES THAT ARE WORTH KNOWING ON THIS PROGRAM WITH OUR PANEL.

LATER ON, SHE LEADS AN IMPORTANT NORTH CAROLINA HEALTHCARE PROVIDER.

DR. MARY JO CAGLE FROM CONE HEALTH.

>>Announcer: MAJOR FUNDING BY BLUE CROSS/BLUE SHIELD OF SOUTH CAROLINA, AN INDEPENDENT LICENSEE OF THE BLUE CROSS/BLUE SHIELD ASSOCIATION.

[ THEME MUSIC ] >>Announcer: ON THIS EDITION OF CAROLINA BUSINESS REVIEW, ANNA BEVIN GRAPHLY FROM N.C. FREE, DR. JOSEPH VON NESSEN FROM THE DARLA MOORE SCHOOL OF BUSINESS, UNIVERSITY OF SOUTH CAROLINA.

AND SPECIAL GUEST DRE HEALTH.

>> Chris: WELCOME BACK.

HAPPY FALL.

HOPE YOU ALL HAD A GOOD FALL.

LET'S START WITH THE POLITICAL QUESTION.

>> PLEASE DO >> Chris: WAS SUPPOSED TO HAVE A BUDGET DONE, 30 BILLION OR SO IT SEEMS TO BE HELD HOSTAGE BY THE IDEA OF GAMING OR CASINOS IN RURAL NORTH CAROLINA.

>> YEAH.

>> Chris: HOW LONG IS THE TAIL ON THAT?

WHEN IS NORTH CAROLINA GOING TO HAVE A BUDGET?

>> I WAS ON A PANEL EARLIER THIS WEEK WITH THE SAME EXACT QUESTION AND AT THAT TIME, THERE WAS HOPE THAT THERE WAS GOING TO BE SOME SORT OF RESOLUTION ON A BUDGET YEAR THIS WEEK OR NEXT WEEK, BUT AS IT PROGRESSED, IT LOOKS LIKE WE WON'T GET ANYTHING FOR QUITE SOME TIME.

WE WILL SEE FULL FALL FOLIAGE AND THANKSGIVING BEFORE THERE'S ANY SORT OF MOVEMENT AND AGREEMENT ON A BUDGET.

YEAH.

PRETTY DIVIDED.

>> Chris: HOW MUCH FRUSTRATION ?

KODY KINSLEY, SECRETARY OF HEALTH, WAS HERE AND THEY SEEM IMPATIENT ESPECIALLY GIVEN THAT MEDICAID EXPANSION WAS GOING TO HAPPEN IN IN NORTH CAROLINA BUT THEY CAN'T DO ANYTHING WITHOUT A BUDGET IT'S A CANARY IN A COAL MINE.

HOW MUCH FRUSTRATION IS THERE AROUND THE STATE AGENCIES?

>> I THINK THERE'S A LOT OF CONFUSION.

TYPICALLY IN THE PAST, OUR BUDGET HAS TAKEN A BIT OF TIME.

IN 2015, THE GENERAL ASSEMBLY PASSED A BILL THAT WOULD ALLOW THE STATE TO CONTINUE IN ITS OPERATE ON ITS LAST AGREED-UPON BUDGET WHICH WAS A GREAT MOVE SO THE GOVERNMENT WILL CONTINUE TO RUN PEOPLE WILL CONTINUE TO BE PAID ESSENTIAL OPERATIONS WILL CONTINUE TO HAPPEN.

IT'S THE NEW BUDGET AND THE ADDITIONAL ALLOCATIONS.

SO IF YOU ARE AN AGENCY OR A GROUP OR EVEN TEACHERS OR STATE EMPLOYEES LOOKING FOR INCREASES OR GUARANTEES ON PROJECTS, YOU'RE DEFINITELY FRUSTRATED BY THIS.

>> Chris: OKAY.

SOUTH CAROLINA DOES NOT HAVE THE BUDGET DEBATE BECAUSE THEY'RE DONE.

BUT THEY HAVE A SURPLUS, LIKE NORTH CAROLINA.

>> YES.

>> Chris: WHAT SHOULD SOUTH CAROLINA BE DOING WITH ALL THAT EXTRA MONEY, IT'S BILLIONS AND IT'S THREE YEARS OF SURPLUSES?

>> WELL, ONE THING THAT SOUTH CAROLINA IS LOOKING AT IS INFRASTRUCTURE SERIOUSLY LOOKING FORWARD.

>> Chris: IS THAT D.O.T., JOEY?

>> LARGELY D.O.T., YES.

THIS IS INFRASTRUCTURE, ROADS AND BRIDGES, INTERNET BROADBAND, PARTICULARLY IN THE RURAL AREAS AND THIS IS GOING TO BE CRITICAL BECAUSE WE HAVE MORE POPULATION GROWTH EXPECTED IN THE CAROLINAS AND IN THE SOUTHEAST GENERALLY THAN ANY OTHER REGION OF THE COUNTRY AND OF COURSE, THAT INCLUDES SOUTH CAROLINA AS WELL SO WITH MORE PEOPLE MOVING IN, MORE BUSINESSES MOVING IN, INFRASTRUCTURE IS GOING TO BE CRITICAL FOR US TO MAINTAIN THE STRONG ECONOMIC GROWTH THAT SOUTH CAROLINA HAS SEEN AND THAT THE CLIERN THATS HAVE SEEN MORE GENERALLY.

THAT'S A PRIORITY GOING FORWARD.

>> Chris: I WANT TO IMPACT THE SCIENCE OF ECONOMICS A LITTLE BIT MORE, JOEY.

BACK TO YOU ANNA, IN NORTH CAROLINA ESPECIALLY.

THIS IS GOING TO BE A TOUGH ONE IT'S NOT A FAIR QUESTION.

YOU CAN HANDLE IT.

IN A SHORT PERIOD OF TIME, SO IN NORTH CAROLINA, NOT JUST TEACHERS AND TEACHER PAY AND RETENTION.

AND AND YOU HAVE PETER HANS AT THE HEAD AND GETTING HIGH MARK AND THE NORTH CAROLINA COMMUNITY COLLEGE HAS DR. COX, WHICH IS A NEW PLAYER AND WIDELY SEEN AS A FORCE FOR GOOD.

WE'VE GOT ALL OF THESE DYNAMICS GOING ON IN THE OLD NORTH STATE AROUND EDUCATION.

SO WHEN YOU TAKE THOSE DYNAMICS AND THE LACK OF A BUDGET, IS THAT CAUSE FOR CONCERN, OR WAS THE EDUCATION PIECE ALWAYS GOING TO BE A HARD, FOUGHT, BANGOUT WAR TO GET WHAT EVERYONE NEEDS?

>> YEAH I THINK EDUCATION SEEMS TO BE IN ITS OWN WORLD AND BUBBLE.

THAT IS SOMETHING THAT IS TALKED ABOUT SEPARATELY BUT TOGETHER WITH THE BUDGET, IF THAT MAKES SENSE.

>> Chris: YEAH.

>> THERE'S THE BUDGET CONVERSATION AND THE BUDGET FIGHT IN THE BREAKDOWN OF THE BUDGET BECAUSE IT INCORPORATES SO MANY OTHER THINGS AND THERE'S THE DISCUSSION OF HIGHER EDUCATION OVERALL, AND THEY LEAD INTO EACH OTHER FOR SURE, BECAUSE WE'RE TALKING ABOUT WORKFORCE DEVELOPMENT AND INVESTMENT IN TRYING TO MAKE OUR COMMUNITY COLLEGES CONTINUE TO GROW AND BE BETTER PROSPER AS WELL AS UNIVERSITY INVESTMENTS IN THE FUTURE.

>> Chris: DO YOU GET THE SENSE-- I DON'T WANT TO PUT WORDS IN YOUR MOUTH.

WE HAVE (INAUDIBLE) ON THE PROGRAM SOME TIME AGO, AND THERE WAS SOME ALLOCATION THAT THE GENERAL ASSEMBLY IN NORTH CAROLINA WANTS TO DO SOME LARGER PLAN AROUND TECHNICAL COLLEGES, COMMUNITY COLLEGES AND HIGHER ED FOR A CLOSER TYPE OF RELATIONSHIP.

DO YOU GET ANY CHIF OF THAT?

>> I HAVE NOT GOTTEN A HUGE WHIFF, BUT I HAVE NOT ASKED A TOWN OF THOSE QUESTIONS TO GET THAT KIND OF ANSWER.

THAT IS NOT OUTSIDE OF THE REALM OF POSSIBILITIES WITH THE INCREASED FOCUS OF TRYING TO CREATE A COMPETENT AND STRONG WORKFORCE TO BACK UP THE STRENGTH OF NORTH CAROLINA.

WITH OUR RECENT SECOND YEAR IF A ROW, CNBC RATING OF NUMBER ONE STATE TO DO BUSINESS, WE'RE LOOKING TO FIND WAYS THAT WE CAN CONTINUE THAT SO WE CAN GET IT FOR A THIRD YEAR IN A ROW AND ADDITIONAL ACCOLADES AND HOW FAR CAN WE PUSH?

>> Chris: ECONOMIC HEADWINDS, JOEY, AND NOT JUST FOR SOUTH CAROLINA.

I KNOW YOU CAN SPEAK BROADLY, INFLATION, CLEARLY INFLATION.

>> YES.

>> Chris: ALSO, YOU KNOW, WE WATCHED INTEREST RATES RISE OVER A PERIOD OF TIME AND THERE WAS SOME SPECTOR AROUND WORRY BUT NOW THE COST OF LENDING IS HIGHER AND THE DEBT LEVEL IS HIGHER AND IS THAT STARTING TO PRESENT ITSELF IN A REAL-TIME FASHION?

>> YES, WE HAVE SEEN IT START TO BITE.

THAT FIRST STARTED WITH THE HOUSING MARKET WHICH HAS SEEN A SIGNIFICANT PULLBACK IN THE LAST 12 MONTHS.

WOO VERY SEEN MORTGAGE INTEREST RATES, OF COURSE, DOUBLE IN THE LAST 12 MONTHS AND SALES ACTIVITY HAS COME DOWN ACCORDINGLY.

IT IS LEVELING OFF IN 2023.

THAT'S THE GOOD NEWS.

BUT WE ALSO LOOK AT HOUSEHOLD DEBT, WHICH HAS BEEN GOING UP.

CREDIT CARD DEBT HAS BEEN GOING UP AND WE CAN SEE CONSUMERS AFFECTED AND LOOKING AT 2024, IT'S ALSO IMPORTANT TO RECOGNIZE THAT MOST OF THESE INTEREST RATE HIKES THERE ARE CLOSE TO A DOZEN OF THEM OVER THE LAST 18 MONTHS AND IT CAN TAKE 18 MONTHS OR LONGER FOR THE EFFECTS TO BE FULLY REALIZED IN THE U.S. ECONOMY.

IN 2024, WE'RE STILL GOING TO CONTINUE TO SEE THESE EFFECTS.

THEY ARE LAGGED SO WE HAVE TO BE PREPARED FOR THAT.

I DON'T THINK WE'RE OUT OF THE WOODS, EVEN THOUGH A RECESSION IS PROBABLY LESS LIKELY TODAY THAN IT WAS SIX MONTHS AGO.

>> Chris: JOEY, DO YOU THINK THE RESUMPTION OF STUDENT LOAN PAYMENTS COULD BE A TIPPING POINT FOR PEOPLE'S PERSONAL BALANCE SHEETS?

>> WELL, IT CERTAINLY MATTERS.

IT HAS A SIGNIFICANT AFFECT FOR SOME CONSUMERS, SOME STUDENTS, AND THAT IS A-- ONE FACTOR AMONG MANY BUT IT MATTERS AND WHEN YOU COUPLE THAT WITH THE FACT THAT THE EXCESS FINANCIAL RESERVES THAT HOUSEHOLDS HAVE HAD BECAUSE OF THESE STIMULUS CHECKS, THOSE JUST NOW HAVE BEEN EXHAUSTED IN THE LAST SEVERAL MONTHS OVER THE SUMMER.

SO YOU PUT THOSE TWO FACTORS TOGETHER AND THAT MATTERS FOR CONSUMER SPENDING GOING FORWARD, AND OF COURSE, CONSUMER SPENDING IS THE BIGGEST COMPONENT OF GDP.

THAT IS SOMETHING THAT WE HAVE TO CONTINUE TO MONITOR CLOSELY.

>> Chris: QUICK LAST QUESTION JUST TO THAT.

DO YOU THINK HOLIDAY SALES ARE GOING TO BE AFFECTED AND TAKE A HIT BECAUSE OF ALL THE THINGS YOU JUST SAID I DON'T WANT TO PUT WORDS IN YOUR MOUTH.

WHAT IS YOUR GENERAL SENSE OF THAT?

>> I THINK SPENDING IS STILL LOOKING GOOD SO FAR.

WE HAVEN'T SEEN A MAJOR PULLBACK IN CONSUMER SPENDING.

I THINK OVERALL IN TERMS OF DOLLAR VALUE , THAT'S GOING TO BE UP JUST BECAUSE OF INFLATION THIS YEAR.

BUT IN TERMS OF REAL SPENDING, IT COULD BE FLAT OR PERHAPS SLIGHTLY DOWN.

PARTICULARLY IN THE GOODS MARKETS.

BECAUSE WE HAVE SEEN THE PENDULUM SWING TOWARD THE PURCHASES OF SERVICES AND AWAY FROM GOODS OVER THE LAST YEAR.

>> Chris: WE'RE GOING TO END THE FIRST PART OF THE PROGRAM THAT WE STARTED AND THAT'S WITH YOU.

ENAS JOEY TALKS ABOUT SOME OF THESE FINANCIAL MARKERS, IF YOU WILL, IS THE NORTH CAROLINA GENERAL ASSEMBLY TALKING AND DEBATING ABOUT ALL OF THAT AT ALL AS THEY TRY TO CLOSE IN ON THIS BUDGET?

ARE YOU HEARING THIS DIALOGUE?

>> THE BIGGEST WAY THEY ARE HAVING THE DISCUSSION IS THROUGH THE DISCUSSION AROUND TAX CUTS.

EARLY ON, THE SENATE WANTED TO ACCELERATE TAX CUTS.

THE HOUSE WANTED TO TAKE A MORE CAUTIOUS MEASURED APPROACH BECAUSE THEY WERE LOOKING TOWARD THE FUTURE AND TRYING TO BE A LITTLE MORE CAUTIOUS AND ABLE TO CATCH ANY SORT OF ECONOMIC DOWN TURN THAT WE V THAT'S WHERE IT IS HE SHOWING UP LARGELY.

>> Chris: OKAY.

THANK YOU.

STAY WITH US, PLEASE.

WE'RE GOING TO BRING OUR GUEST ON.

BEFORE WE DO THAT.

WHO IS COMING UP ON THIS PROGRAM NEXT WEEK ON THIS PROGRAM, WILLIAM FLOYD.

MIGHT NOT BE A HOUSEHOLD NAME TO YOU BUT IN SOUTH CAROLINA AROUND EDUCATION AND WORKFORCE, HE IS BECOMING A HOUSEHOLD NAME.

HE IS THE EXECUTIVE DIRECTOR OF WHAT IS CALLED THE SOUTH CAROLINA DEPARTMENT OF EMPLOYMENT AND WORKFORCE.

HE WILL BE OUR GUEST ON THIS PROGRAM AND THEN ALSO IN THE VERY NEAR FUTURE, SHE IS LYNN GOOD, THE CHAIRMAN AND CHIEF EXECUTIVE OFFICER, I SHOULD SAY, CHAIR AND CHIEF EXECUTIVE OFFICER OF ONE OF THIS NATION'S LARGEST PUBLIC UTILITIES, DUKE ENERGY, AND SHE COMES BACK TO THIS PROGRAM.

THE SUSTAINABILITY OF BEING PROFITABLE, DELIVERING HIGH QUALITY SERVICE, HAVING SATISFIED AND ENGAGING WORKFORCE AND OH, YEAH.

DOING IT ALL UNDER A VERY ACUTE REGULATORY AND PUBLIC SCRUTINY, SCRUTINIZING IT IS AT BEST DIFFICULT AND DESERVED OR NOT, HOSPITALS HAVE BEEN IN THAT SITUATION LONG BEFORE COVID.

JOINING US NOW IS THE CHIEF EXECUTIVE OFFICER OF GREENSBORO-BASED GUILFORD COUNTY, NORTH CAROLINA BASED HEALTHCARE, CONE HEALTH, FROM MOTHER JOE CAGLE.

DR. CAGLE, NICE TO SEE NEW PERSON, BY THE WAY.

YOU REMINDED ME, IT WAS VIRTUAL LAST TIME WE WERE TALKING.

THANK YOU.

WELCOME.

>> THANK YOU.

IT'S A PLEASURE TO BE HERE.

>> Chris: I'M GLAD YOU ARE DOING WELL.

COVID, DR. CAGLE, HERE WE ARE TALKING ABOUT COVID AND ANOTHER VARIANT.

ARE PEOPLE-- I DON'T WANT TO PUT WORDS IN YOUR MOUTH EITHER.

IS THERE A LOT OF FATIGUE ABOUT PARTICIPATING IN YET ANOTHER ROUND OF VACCINATIONS AND EVEN CARING ABOUT COVID?

>> I THINK THERE IS WITH THE GENERAL PUBLIC.

THERE ARE SEGMENTS OF POPULATION THAT ARE STILL PAYING ATTENTION.

I THINK OUR ELDERLY POPULATION IS PAYING ATTENTION AND WHAT WE'RE SEEING IN GREENSBORO IS THAT OUR AFRICAN-AMERICAN POPULATION IS PAYING ATTENTION.

AND CERTAINLY OUR STAFF IS PAYING ATTENTION.

WE ARE HEARING FROM OUR STAFF THAT THEY WANT TO KNOW WHAT THEY NEED TO DO TO PROTECT THEMSELVES AND THEIR FAMILY.

SO I THINK-- I DON'T WANT TO GENERALLY SAY THAT PEOPLE AREN'T PAYING ATTENTION, BECAUSE I THINK WE HAVE TO BE A MORE ATTENTIVE TO WHO WE'RE TALKING ABOUT AND WHO WE'RE TALKING TO.

ONE OF THE LESSONS WE'VE LEARNED THROUGHOUT THE BEGINNING OF THE PANDEMIC IS WE HAVE TO TAILOR OUR MESSAGE TO THE AUDIENCE, ARE AND I THINK THAT'S TRUE NOW.

WHAT WE ARE LEARNING IS THAT COVID'S GOING TO BECOME LIKE THE FLU.

IT'S GOING TO BE SEASONAL.

IT'S GOING TO SHIFT FROM YEAR TO YEAR AND INDEED, THAT'S WHAT WE'RE SEEING.

>> Chris: IS THE MORBIDITY NUMBER ANY DIFFERENT?

>> IT HAS CHANGED.

IN FACT, IT APPEARS THAT THIS VARIANT THAT WE'RE STARTING TO SEE NOW IS-- THERE'S LESS MORTALITY WITH IT UNLESS YOU ARE VERY ELDERLY OR UNLESS YOU HAVE GREATER COMORBIDITIES.

IN OTHER WORDS, OTHER CHRONIC DISEASES ASSOCIATED WITH IT.

AND SO THOSE SEEM TO BE SOMEWHAT MILDER AND FOR PEOPLE WHO HAVE HAD THE VACCINE OR BOOSTERS, IT CERTAINLY APPEARS TO BE MILDER.

>> Chris: OKAY.

ANNA, QUESTION?

>> YEAH.

WE'RE LOOK AT A SHIFTING LANDSCAPE IN HEALTHCARE.

YOU HAVE TOUCHED ON SOME OF THE RESEARCH AROUND COVID.

HOW ARE YOU GUYS ADJUSTING IN OTHER PLACES TO TRY TO SORT OF GET AHEAD OF SOME CONCERNS AROUND TECHNICAL ISSUES OR JUST INNOVATION IN THE HEALTHCARE SPACE OVERALL?

>> SURE.

IT IS GREAT TO HEAR DR.

VON NESSEN TALKING ABOUT THE INFRASTRUCTURE THAT SOUTH CAROLINA IS WORKING ON WITH BROADBAND.

BECAUSE WE ARE REALLY FINDING THAT PEOPLE ARE PREFERRING TO GET CARE AS CLOSE TO HOME AS POSSIBLE.

WHEN THAT'S FEASIBLE AND APPROPRIATE ONE OF THE THINGS WE REALLY WANT TO SEE IS THAT HAPPEN AS WELL IN NORTH CAROLINA.

SO THAT IN OUR RURAL COMMUNITIES UP IN ROCKINGHAM COUNTY, DOWN IN RANDOLPH COUNTY, WE'RE ABLE TO PROVIDE THAT KIND OF CARE.

PRE-COVID, ONLY A VERY SMALL PERCENTAGE OF THE VISITS THAT WE PERFORMED WERE VIRTUAL.

TODAY, THIS PAST YEAR, IN EXCESS OF 370,000 VISITS WERE DONE VIRTUALLY.

>> WOW.

>> IT'S JUST EXPLODED BECAUSE THAT'S WHAT OUR PUBLIC WANTS FROM US.

SO THAT'S ONE OF THE BIG INNOVATIONS.

IT'S HIGH QUALITY CARE.

YOU KNOW, IN THE PAST WHEN WE TALKED ABOUT BUILDING NEW BUILDINGS, PEOPLE IMMEDIATELY WENT TO HOSPITALS.

BUT THAT'S NOT THE CASE TODAY.

WHEN WE WERE DESIGNING NEW BUILDINGS, THEY ARE LOOKING AT THE AMBULATORY OR OUTPATIENT SPACE BECAUSE MOST OF THE PROCEDURES WE THINK ABOUT DOING TODAY ARE PROCEDURES THAT IN THE PAST MIGHT HAVE BEEN DONE IN THE HOSPITAL.

WE'RE ABLE TO DO THEM IN THE OUTPATIENT AREA AND WE'RE ABLE TO DO THEM SO PATIENTS ARE ABLE TO GO HOME THE SAME DAY OR CERTAINLY BY THE NEXT DAY.

THEY'RE WITH US FOR A MATTER OF HOURS.

THEIR RECOVERY TIME IS MUCH SHORTER, AND THEY'RE BACK TO WORK MUCH FASTER.

TODAY, OUR FOCUS IS MUCH MORE ON EARLY DIAGNOSIS OR PREVENTION, AND SO THE FOCUS IN THE SHIFT OF THE WORK AND THE BILLINGS THAT WE'RE DESIGN ARE MUCH DIFFERENT THAN THEY WERE EVEN FIVE YEARS AGO.

AND SO I THINK THAT IS BETTER FOR OUR COMMUNITYIES AND FOR THE PEOPLE THAT WE SERVE.

>> IS THE VIRTUAL CARE HELPING TO ALLEVIATE ANY OF THE LABOR SHORTAGE?

PARTICULARLY IN NURSING WHERE NURSING HAS BEEN NUMBER ONE IN TERMS OF THE OCCUPATIONS WHERE WE'RE SEEING A SHORTAGE IN THE CAROLINAS.

SO HAS THE VIRTUAL CARE HELPED IN THAT REGARD?

>> ABSOLUTELY IT IS.

IT IS MAKING A DIFFERENCE THERE AND I THINK THERE'S MORE WE CAN DO THERE.

WITH VIRTUAL CARE, WITH ALSO USING OTHER TECHNOLOGIES.

USING ROBOTICS, USING AI, USING ALL THE OTHER TECHNOLOGIES, I BELIEVE WE'RE JUST BEGINNING TO LEVERAGE THOSE TECHNOLOGIES SO THAT THE THINGS THAT ARE REPETITIVE, THAT WE HAVE-- OR THAT HAVE BEEN VERY MANUAL THAT ARE TAKING OUR NURSES AND OTHER CLINICIANS AWAY FROM THE BEDSIDE , INTEREST THE WORK THAT -- FROM THE WORK THAT INSPIRES THEM AND IS THE REASON THEY WANTED TO BE A NURSE IN THE FIRST PLACE, IF WE CAN TAKE THAT REPETITIVE, MANUAL WORK AND REPLACE IT WITH TECHNOLOGY SO THAT WE CAN PUT OUR PEOPLE BACK AT THE BEDSIDE DOING PERSON-TO-PERSON WORK, THAT INSPIRES THEM AND ELIMINATES SOME OF THE BUSY WORK AND THE MANUAL OR REPETITIVE WORK TO BE DONE WITH THE TECHNOLOGY AND WE CAN ALLEVIATE SO SHORTAGES AND KEEP PEOPLE THAT HAVE LEFT HEALTHCARE BECAUSE THEY WERE OVERWORKED OR UNINSPIRED.

I THINK THAT CAN MAKE A BIG DIFFERENCE.

WE'RE JUST BEGINNING TO TOUCH THE SURFACE OF THAT.

>> Chris: I DON'T WANT TO LEAD YOU ON OR PUT ANY WORDS IN YOUR MOUTH, THE IDEA OF FIXING A PARTICULAR CHALLENGE IN BUSINESS, LIKE THE TALENT IN THE HEALTHCARE WORKER, DR. PAT COLIE FROM MUSC, DR. BILL ROPER FROM MUSC SAT IN THAT CHAIR IN THE LAST FEW MONTHS AND BOTH SAID WHEN TALKING ABOUT THE LARGER BUSINESS MODEL AROUND HEALTHCARE PROVIDERS, HOSPITALS, THAT IT WAS NOT SUSTAINABLE.

THAT WASN'T THEIR DIRECT QUOTE, BUT THE IDEA IT WAS DIFFICULT, REGULATORY, TRANSPARENT PRICING, OVERSIGHT, HOW PEOPLE FEEL ABOUT IT KIND OF GET INTO RURAL AREAS HOW DO YOU MANAGE-- HOW DO YOU MANAGE A HOSPITAL KNOWING THAT THE CHALLENGES SCHEMASSIVE?

>> THEY ARE.

I'M SURE IT'S NOT A SECRET TO YOU ALL OR TO OUR AUDIENCE THAT 2022 WAS THE WORST YEAR IN HEALTHCARE FINANCIALLY THAT THIS NATION HAS EVER SEEN.

MORE THAN 50% OF HOSPITALS AND HEALTH SYSTEMS IN NATION LOST MONEY.

2023 HAS BEEN A TURNAROUND YEAR AND WE'RE GLAD TO REPORT THAT WE HAVE HAD A GOOD YEAR AND MOST OF OUR HOSPITALS IN OUR STATES ARE SEEING TURNAROUND.

YOU'RE ABSOLUTELY RIGHT AND WE ARE HAVING TO TRANSFORM OURSELVES.

I MEAN, IT'S LIKE CHANGING THE TIRES OF THE BICYCLE WHILE YOU'RE RIDING IT, RIGHT?

I BELIEVE WE'RE GOING TO HAVE TO REALLY UNDERSTAND THAT MOST OF THE CARE THAT WE GIVE PEOPLE IS GOING TO BE OUTSIDE THE WALLS OF THE HOSPITAL.

IT'S GOING TO BE IN THE OUTPATIENT ARENA OR EVEN IN THEIR HOMES, AND THAT THE HOSPITALS, WE STILL NEED GOOD HOSPITALS.

THERE IS STILL SOME CARE THAT NEEDS TO BE DONE IN THE WALLS OF THE HOSPITAL.

VERY SICK PATIENTS, PROCEDURES THAT CAN'T BE DONE ANYWHERE ELSE BUT IN A HOSPITAL, WE NEED HOSPITALS FOR THAT.

WE BELIEVE THAT THERE WILL BE IN THE FUTURE MORE PANDEMICS, TRAVEL ACROSS THE WORLD HAPPENS SO SEAMLESSLY AND EASILY, THAT WE'RE GOING TO HAVE FUTURE PANDEMICS.

WE NEED HOSPITALS FOR WHEN THAT NEXT PANDEMIC OCCURS.

SO HAVE TO HAVE THAT HOSPITAL AND ITS ABILITY TO FLEX AND BE PRESENT FOR WHEN THOSE DIFFICULT THINGS HAPPEN.

BUT WE ALSO HAVE TO HAVE A SYSTEM OF CARE THAT'S ABLE TO PROVIDE CARE AT HOME.

THAT'S ABLE TO DO PREVENTATIVE DIAGNOSTIC CARE TO SAY, YOU'RE AT RISK FOR HEART DISEASE SO LET'S TREAT YOU NOW SO THAT YOU NEVER HAVE A HEART ATTACK.

>> Chris: WELL CARE.

>> KEEPING AS WELL AND HEALTHY.

I BELIEVE THAT MUST BE WHERE WE GO.

I ALSO THINK WE NEED TO LOOK AT OUR PAYMENT SYSTEM.

AND INSTEAD OF PAYING FOR EVERY LITTLE PROCEDURE YOU HAVE OR EVERY LITTLE TIME YOU GO TO THE DOCTOR, WE NEED TO CHANGE THAT AND AT CONE HEALTH, WE'VE BEEN ON THIS JOURNEY FOR 12 YEARS NOW WHERE WE HAVE CHANGED FROM EVERY VISIT OF PAYMENT TO LOOK AT WHAT WE CALL VALUE-BASED CARE OR WHAT SOME MIGHT CALL-- LET'S LOOK AT HOW MUCH IT COSTS TO TAKE CARE OF A PERSON EVERY MONTH.

WHAT'S THE COST OF CARE PER MONTH?

>> Chris: OVER A PERIOD OF TIME.

>> AND BE WILLING TO GO AT RISK FOR THAT AND SAY WE BELIEVE THAT FOR THIS INDIVIDUAL, IT OUGHT TO COST THIS MUCH PER MONTH, AND LET'S WORK AND SEE IF WE CAN DO THAT AND LET OUR PHYSICIANS LEAD THAT WORK.

WE'VE BEEN REALLY SUCCESSFUL AT THAT AND WE BELIEVE WE OUGHT TO GO THERE MORE AND MORE.

>> YEAH.

THE VALUE-BASED FEE, IS THAT WHAT YOU JUST CALLED THAT?

>> VALUE-BASED CARE.

>> VALUE-BASED CARE, IT MAKES ME THINK OF A SUBSCRIPTION TO NETFLIX OR ANYTHING ELSE.

>> SURE.

>> AND HOW DOES THE DO YOU MESSAGE THAT?

I THINK THAT'S VERY INTERESTING.

>> IT'S A LOT LIKE WHAT OUR MA PLANS IN MEDICARE DO NOW.

IT'S WHAT THE ACOs, AFFORDABLE CARE ORGANIZATIONS HAVE BEEN DOING I THINK THAT'S A GREAT ANALOGY WITH NETFLIX.

WHAT WE HAVE DONE AND PARTNERED WITH SEVERAL INSURANCE CARRIERS TO SAY, WE'LL GO AT RISK WITH YOU.

IF WE SAVE YOU MONEY, SPLIT THE SAVINGS WITH US AND WE CAN LOWER THE COST FOR THE PATIENT.

IT'S THE TOTAL COST OF CARE.

NOT JUST WHAT YOU SPEND WITH OUR DOCTORS, WITH OUR HOSPITAL, BUT WHAT THEY'RE SPENDING ON THEIR PHARMACEUTICAL COSTS WHAT THEY SPEND WHEN THEY GO TO THE RADIOLOGY GROUP OUTSIDE OF OUR HOSPITAL WALLS, WHICH REQUIRES THEM THAT INSURANCE COMPANIES SHARE WITH US THAT TOTAL BILL, RIGHT?

AND WHEN OUR PHYSICIANS ARE LOOKING AT WHAT'S IT COSTING, THEN REALLY BACK IN THAT PRIMARY CAREGIVERS OFFICE, WE'RE LOOKING AT HOW DO I KEEP THIS PATIENT HEALTHY?

HOW DO I KEEP THEM OUT OF THE HOSPITAL?

WHAT ARE THE RIGHT MEDICATIONS FOR THEM TO BE ON?

DO THEY REALLY NEED THIS EXTRA RADIOLOGY TEST?

WHAT ARE THE RIGHT TESTS SO THE GOAL THEN BECOMES TO KEEP THE PATIENT HEALTHY, TO THE KEEP THE PATIENT AT HOME.

WHICH IS REALLY WHAT WE ALL WANT, RIGHT?

>> Chris: WE ONLY HAVE TWO MINUTES LEFT.

I WANT TO JUMP IN QUICKLY.

SO GIVEN THE TYPICAL BACK AND FORTH THAT PROVIDERS HAD WITH PAYERS, DO THEY WANT TO PLAY?

DO THEY WANT TO DO THIS?

>> WE'VE HAD SUCCESS WITH EVERY PAYER IN NORTH CAROLINA WORKING WITH US ON THIS TYPE OF RISK-BASED MODEL.

SOME MORE THAN OTHERS, WHICH IS NOT SURPRISING BECAUSE IT'S A RELATIVELY NEW THOUGHT.

>> Chris: SURE.

>> BUT WE'VE BEEN ABLE TO SAVE EVERY ONE OF THEM MONEY AND THEREFORE, SAVE THE PATIENT MONEY.

>> HOW ARE PATIENTS RECEIVING IT?

>> SO FAR, THIS HAS BEEN FOR MEDICARE-AGED PATIENTS, OR MA PATIENTS.

WE HAVE A COUPLE OF PROVIDERS WHO HAVE BEEN WILLING TO TRY THIS WITH COMMERCIAL PAYERS.

>> Chris: ARE ANY COLLEAGUES DOING IT?

>> THE FIRST TO DO IT WAS KAISER , AND THEY STARTED THAT A LONG TIME AGO.

>> Chris: THEY KNOW SOMETHING.

>> THEY KNOW A LOT ABOUT DOING THIS, BUT THERE ARE OTHERS THAT ARE BEGINNING TO DO THIS.

THERE ARE A LOT OF HEALTHCARE ACROSS THE COUNTRY THAT HAVE BEGUN TO DO THIS.

IF WE'RE SERIOUS ABOUT LOWING THE COST OF CARE, PUT SKIN IN THE GAME.

DO IT FOR THE PATIENTS.

>> Chris: SORRY TO INTERRUPT YOU.

WE HAVE A MINUTE LEFT.

SORRY, JOEY.

I'M NOT IGNORING YOU.

30 SECONDS LEFT, AI, IS THAT GOING TO BE MASSIVE CHANGE IN THE NEXT DECADE?

>> WE'RE ALREADY STARTING TO USE IT SOME ON THE CLINICAL SIDE.

WE'RE USING WIT OUR RADIOLOGISTS TO MAKE CERTAIN WE DON'T MISS THINGS.

WE'RE BEGINNING TO USE IT, AGAIN TO ADDRESS THE LABOR SHORTAGES TO HELP US WITH THE SCHEDULING TO MAKE CERTAIN THAT WE'RE DOING THE BEST FOR OUR NURSES AND THEIR SCHEDULES AND BEGINNING TO LEARN WHAT ARE THE BEST APPLICATIONS.

>> Chris: YOU SEEM VERY EXCITED AND THANK YOU FOR COMING DOWN AND MAKING THE TRIP FROM GREENSBORO.

GLAD YOU ARE HEALTHY.

>> APPRECIATE THAT >> Chris: ALWAYS NICE TO SEE YOU, JOEY, THANK YOU FOR BEING PATIENT AS WE OVERLOOK YOU.

WE WILL HAVE A CHANCE AGAIN.

ANNA, ALWAYS NICE TO HAVE YOU ON.

>> GREAT TO BE HERE.

>> Chris: THANK YOU FOR WATCHING OUR PROGRAM.

IF YOU HAVE QUESTIONS OR COMMENTS, CAROLINABUSINESSREVIEW.ORG.

UNTIL NEXT WEEK, BE SAFE.

HOPE YOUR BUSINESS IS GOOD TONIGHT.

>>Announcer: GRATEFULLY ACKNOWLEDGING SUPPORT BY-- BY VIEWERS LIKE YOU.

THANK YOU FOR MORE INFORMATION, VISIT CAROLINABUSINESSREVIEW.ORG.

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