Healthcare

With one of the most vibrant healthcare sectors in the country, Charlotte is ready to emerge from the dark days of the pandemic, even as it continues to deal with challenges that include affordable and accessible care.

Brighter days:

A positive outlook and a burgeoning life sciences hub point to a healthy future

Charlotte boasts one of the country’s most vibrant healthcare sectors, including powerhouse groups like Atrium Health, which has 42 hospitals, 1,500 care locations and 55,000 employees under its umbrella. The field is wide open as well, which can be seen from the continued interest of outsiders: Centene Corporation, the health insurance giant based out of St. Louis, will invest $1 billion in Charlotte, bringing up to 6,000 jobs, in the next decade. Other examples of the sector’s rising star in the region include Wake Forest School of Medicine’s highly anticipated campus that is being built in the city of Charlotte and expected to open in 2024.

The COVID-19 pandemic put the sector in the spotlight as never before, which highlighted both its successes and failures. In Charlotte, it was found that hospitals had plenty of capacity in terms of hospital beds but not nearly enough trained clinical staff to deal with the influx of patients suffering from COVID-19. As the caseload went up at different points over the course of the pandemic, Gov. Roy Cooper had to order the temporary cancelation of non-emergency procedures at the state’s hospitals.

But the vaccine rollout has been a clear success, achieved in Charlotte with aplomb, speed and minimal waste, an accomplishment in itself considering the storage requirements of the various vaccine types. In Mecklenburg County, for example, Deputy Public Health Director Raynard Washington told the Charlotte Observer in March 2020 that no viable doses had been lost as a result of human error, although the Observer also reported that at least 44 doses were deemed “not suitable for use” because of defects.

Landscape The availability of medical care, while above the national average, is beset with problems familiar to the rest of the country: 16% of North Carolinians are without medical insurance, with 120,803 in Mecklenburg County alone. The North Carolina figure is the ninth-highest in the country. According to a national ranking, North Carolina slipped from 31st in 2015 to 36th in 2019. As well, it exceeds the national average in adult obesity, heart disease, HIV diagnosis, infant mortality, death from firearms, and opioid overdose rate. With different approaches vying between a Democrat governor and a Republicanled Assembly, healthcare is in a state of limbo at the moment, with neither improvement nor deterioration.

The major healthcare providers in Charlotte are ( )

Tele-success

Telemedicine has become a fundamental element in patient care post-COVID

Dr. Dale Owen

CEO – Tryon Medical Partners

How does Tryon Medical stand out as a doctor-owned facility? To the best of our knowledge, we are the first and only large multispecialty group to have extracted itself from a major healthcare system successfully. We had about 115,000 patients attributed to us at Atrium when we were owned by the hospital and part of their system. As of February 2020, we’ve increased that to 152,000 registered patients, amounting to approximately 20% of the adult population in Mecklenburg County.

How has telemedicine been received among patients and providers? We had about a 2% use of telemedicine before COVID-19 hit. Now, we have expanded telemedicine to become a fundamental way we can serve patients, in many cases more efficiently. It’s crystal clear there is quite a variation and degree of use of telemedicine. Some large hospital systems are seeing 30% of their current in-office patients, the remaining 70% is through telemedicine. We are seeing 80% in-office. We are able to do so because we created safe harbors. We are testing all of our physicians and staff for COVID-19 every three weeks to create a safe and secure feeling for patients when they need to come into our clinics for their appointments.

One of the reasons telemedicine was not being used as much previously is that not enough people knew enough about it and the remuneration for it from insurance companies was typically 20% of the payment for an in-office visit. When Medicare and the payers came onboard to make it on par with regular insurance payments, that allowed physicians to keep their doors open during the early months of the COVID-19 virus. What we really need is for insurance companies and payers to validate that telemedicine will continue to be funded at the same level as in-office visits in the future. Both telemedicine and in-office visits need to continue, post COVID-19. We need the flexibility to use both when the situations warrant it.

What are Tryon Medical’s plans for the coming year? We have to remember that 10% of independent practices across the United States have already declared bankruptcy during COVID-19. Forty percent are at risk, out of which 25% are dangerously close to bankruptcy themselves at present. Tryon Medical Partners has done extremely well since we left the hospital system and became independent in 2018, but we cannot rest on our laurels. We must have all of our core principles and core parts of our business humming to weather these challenges. Other than COVID-19, the big thing is adaptation and access to the needs of the patient.

Lindsay Muns

CEO Charlotte Radiology

How does Charlotte Radiology fit into the health sector in Charlotte?

The company has been around for over 50 years and throughout its evolution we have always been a partner of Atrium Health, formerly known as Carolinas Health System. We’re the exclusive radiology provider in the majority of its market. In 2018, Charlotte Radiology became the founding practice of US Radiology Specialists, a radiology roll up in conjunction with private equity firm Welsh Carson. We retain a tremendous amount of local autonomy and control, and this partnership allows us more headroom and resources to navigate some of the headwinds that healthcare faces. We serve 19 hospitals in the greater Charlotte market and we have 16 breast imaging centers that we wholly own, one of which is mobile.

How have the shortages in medical staff complicated your operations?

The majority of patient care professionals we employ are technologists. The good news is that we are not seeing a shortage mostly because of the huge population influx into Charlotte, even before the pandemic. However, radiologists, and specifically subspecialized radiologists, will become more and more di cult to recruit. There is such a demand for them across the country. It is encouraging that teleradiology is possible in terms of reading the scan and sending the results.

What are some of your near-term priorities and goals?

We are bullish, and we have plans for expansion in mammography and outpatient imaging. Everything we have seen since the beginning of January indicates that outpatient imaging is not slowing down. In-hospital scans will probably drop o slightly and potentially be below 2019 levels until the vaccine is more widespread. However, we are definitely predicting growth over 2019 and we are encouraged by our ability to manage the changing environment of the last year. ( ) the behemoths: Atrium Health and Novant Health. Atrium Health Union West, opening in Stallings, North Carolina in early 2022, will bring with it a raft of resources to the area, including 40 acute care beds, 30 medical/surgery beds, six labor recovery rooms, four intensive care rooms, 10 emergency bays opened 24 hours a day, two operating rooms, imaging services and a laboratory. Atrium has other projects in the works too, including new emergency departments in Mountain Island and on Providence Road. Novant Health is similarly expansionist, with a new hospital in Ballantyne due to be completed in 2023.

But the leading project is the Wake Forest Medical School (in partnership with Atrium) that will be opening its new campus in Charlotte. This project hopes to be a bridge between the faculty from its Winston-Salem campus and the professional expertise for which Charlotte is so well known.

Probably the biggest new trend in health over the past year was telehealth, and while not local to the Charlotte region, it has been embraced wholeheartedly by the regional health sector. Telehealth, which allows easier, remote access to routine healthcare, was already growing substantially before the pandemic struck. Once the hospitals became overloaded and unsafe for fear of contagion, the development of the telehealth market grew with exponential speed. This burgeoning market saves time and resources, and potentially lives. Atrium Health began offering telehealth services to help people battling COVID-19 and between March and September of 2020, it was able to attend to 13,000 patients remotely.

COVID impact The healthcare industry in Charlotte has been among the highest drivers of growth in the region.

Centene is expected to add thousands of jobs when it opens its new campus in the University City area in what is poised to be one of the largest economic development investments in North Carolina’s history. In addition to jobs directly related to the health sector, Charlotte is an emergent manufacturing hub in the country and among its biggest exports in this regard are pharmaceuticals and medicine.

In spite of what by many measures is seen as a bright future, the COVID-19 pandemic bruised the health sector in Charlotte in spite of the outpouring of gratitude toward medical doctors and first responders that became common after the pandemic interrupted lives and society. For healthcare providers, there were fewer office visits and fewer elective surgeries (a primary financial lifeline) as a result of the influx of

COVID-19 patients. More than 60 Charlotte healthcare providers were approved for Paycheck Protection Program loans of $1 million or more and even some of these did not survive the lean year of the pandemic. Among those practices requiring federal help were dental offices, mental health experts, specialty care practices and assisted living facilities. A large issue here was that so much of federal relief money went toward the largest institutions in the state that are already sitting on billions of dollars in reserves: of the $600 million set aside by the Provider Relief Fund in North Carolina, the majority went to Atrium Health, Novant Health, Duke Health and UNC Health Care.

This situation has transpired in a year beset by untold stress and burnout among healthcare workers. There was a paucity of medical supplies and beds that forced frontline workers to make difficult decisions while executing their tasks. At one local site, Tryon Medical Partners, doctors were working long hours, testing 150 to 200 patients a day and seeing, at the worst times, a 25% positivity rate. At Presbyterian Medical Center, there was a point during the darkest days of the pandemic when almost all of the patients were on ventilators. Adding to the stress of the situation was the fact that, due to the contagious nature of the virus, no loved ones were allowed to visit the ICUs.

Health policy On the policy front, there have been healthcare changes at the county, state and federal level throughout the year. In Mecklenburg County, many policies were put into place to combat the COVID-19 pandemic, such as stay-at-home orders and curfews. A number of these are set to expire as the pandemic subsides over the course of the vaccine rollout. On the state level there was a battle over Medicaid funding. The program consumes $3.7 billion in state expenditures, and the governor and state legislature — the governor wanted to expand the program to cover hundreds of thousands of uninsured adults — found themselves at loggerheads over how to move forward. On the federal level, this year has seen a rocky transition from Trump to Biden. The new administration is expected to bolster both Medicaid and the Affordable Care Act (ACA), known as Obamacare, both of which took a hard hit from the previous Republican administration.

Insurance market Six insurers offer coverage in North Carolina’s exchange: Cigna, Ambetter, Centene, Bright Health, Oscar and United Healthcare. The state has one of the highest enrollments for private health insurance ( ) Trey Sutten

CEO Cardinal Innovations Healthcare

What are the challenges and opportunities of expanding your network of providers?

It’s an essential point for us in terms of the care that we deliver, that we are responsible for. It’s in the context of behavioral health, mental health services. What we do is unique and di erent from physical healthcare. For us, it’s about making sure that you have a strong connection to the individual so that there is candor, honesty and transparency in what they are dealing with. It’s imperative for us that our provider network reflects our membership. We’ve been investing significant resources in the communities we serve. We hosted a radio program on a Latino channel. Pre-pandemic, we did a job fair and are now doing virtual fairs. Over the last year, we’ve added 199 providers for child welfare services. More broadly in terms of all providers, we added over 50 new general providers across 12 di erent services. That’s against a baseline of about 850. It was a large increase in the number of providers that we brought on with a specific emphasis on diversity so as to make sure that we have got that strong bond between the person caring for our members and the members themselves.

What are the main near-term goals for Cardinal?

Our main priority remains executing our plan of action. The core idea is to build out our child welfare model, getting our turnaround times in line, getting our admissions and readmissions down below 22% by June and then 18% by October. There are a lot of key priorities in terms of member care and doing exactly right by them. The other big priority for us is integrated health care, bringing together physical, behavioral and pharmaceutical; connecting the mind with the body; even going beyond that and connecting that individual to the environment. We’re getting ready for integrated care, to deliver on the social determinants of health. We lead the state in housing as an example. We’re seeing a lot more activity in the food and security space. We want to focus on all the peripheral things that make a person’s life better, make that individual healthier.

Demand changes

As demand for services affected by the pandemic returns, challenges and concerns remain

How has demand for your services fluctuated during the pandemic? Demand for outpatient surgery has returned, but we haven’t seen the return of some chronically ill patients. We have heard this throughout the state and nation and assume that they’re fearful of getting care due to the pandemic. We certainly haven’t seen the same numbers come back through our emergency room, which has been a significant swing for all hospitals. Through February 2021 we had seen a 15% to 25% drop in emergency room visits. This is concerning. We rarely have days that resemble pre-pandemic demand. We’re the first to advocate that individuals shouldn’t come to the emergency room if they can get their care through some other means. However, we want people who need the emergency room to come. How are you preparing for the anticipated shortage of healthcare workers? We’re one of the industries that is still almost fully hands-on. We’re going to have to be creative because we’re not going to have enough workers, which will involve looking at implementing technologies to automate processes and different staffing patterns. We’re also looking at our student programs and trying to attract more individuals to the healthcare community. We need to help students form a pathway to the industry, and not just for nurses because we have a variety of professions that are in need of talent. International opportunities are a possibility as well. There are a number of programs that allow us to bring in nurses and other healthcare professionals who wish to come to the United States. While we want to help anyone in our community who is looking to advance their healthcare careers, we also have to make sure we have enough staff.

What problems does the healthcare system need to address? Going forward, the entire healthcare system, including ourselves, needs to figure out how to become increasingly transparent, how to moderate price increases and how to reduce costs. At this point, almost 20% of gross domestic product is healthcare. If you went back 30 years ago, no one would have predicted that healthcare would become one in every five dollars spent. Healthcare is absolutely the most expensive thing people deal with other than their mortgage, and sometimes we’re even as expensive as that. Healthcare can’t continue at this pace. At the same time, citizens expect great, convenient care, which is hard to balance with cost. This is where telehealth or different means of achieving wellness have potential to increase healthcare quality and reduce costs.

John Green

President & CEO – Iredell Health System

( ) under the ACA. Most of those seeking to enroll qualify for financial assistance and choose the ACA because the state has not expanded Medicaid to this demographic. Since the ACA marketplace for insurers opened in 2014, it has been a relatively volatile ride nationwide, with insurers dropping out as often as they opt in. In North Carolina, for 53% of that time, at least three insurers have been active in the ACA marketplace. As far as its cost, those who get coverage through work are paying more, up 4% in 2020 and 55% in the last decade. Over the course of the last year, many insurance providers have waived costs directly related to the pandemic, though these varied considerably, and the policies were not without time limitations.

Public health For public health, 2020 was an eventful year, unlike any other. In Mecklenburg County, the novel coronavirus became the third-highest cause of death, behind heart disease and cancer. Beyond that, other health crises continue apace, with the opioid epidemic among the leading concerns. In fact, there was a spike in overdoses during the pandemic. To help combat this, Charlotte health organizations pooled $500,000 to distribute Narcan, the lifesaving overdose drug, throughout the city.

Life sciences Just as it is nationally, life sciences is a growing sector in Charlotte. The city is now home to 50 different life sciences companies not to mention a further 300 in the sector’s supporting ecosystem. This is a sector often indicative of an excellent local higher education system, which North Carolina most certainly has, as well as a vibrant health sector. Altogether, this is a winning combination for the future of this industry in Charlotte. Life sciences are also a particularly attractive destination for foreign direct investment into Charlotte at the moment, according to JLL. In a report on the sector published in March 2021, JLL rated the potential of emerging life science markets, scoring areas such as GDP growth, millennial population projections, income and growth in housing inventory. The CharlotteConcord-Gastonia region received the highest score, 93, followed by Seattle-Tacoma-Belleview at 88.3. JLL looked at 110 markets for the report.

Community and accessible care As mentioned, by a number of metrics, North Carolina has a deficiency in accessible care for many of the state’s residents, an issue that has become all the more pressing as the COVID-19 pandemic has been raging. In some ways, the private sector has stepped forward to fill this gap. For instance, at the height of the pandemic Atrium Health was able to extend its virtual health services to smaller hospitals free of charge. Further, Atrium was the only nonprofit healthcare company to win the 2020 CMS Health Equity Award. In some cases, private citizens are stepping forward. Former basketball superstar and North Carolinian Michael Jordan is a staunch supporter of equitable access to health and has already opened two clinics in the state.

Looking ahead The outlook for the health sector looks bright indeed. Even before the pandemic, it was on an upward trajectory, and this has only grown as outside companies make investments in the city and the companies already here continue to grow. The COVID-19 pandemic, while in many ways exhausting the health system and underscoring the social divisions germane to access, also poses an opportunity for collaboration, concentration and growth. Charlotte will see the benefits of a vibrant health sector as it inoculates its residents at a faster rate than many other places in the country.

The health sector in Charlotte will continue to benefit from a pro-business, corporate friendly environment in the city overall. Companies are looking to move into the region, the government is friendly and there is an abundance of skilled labor. This latter aspect is especially important in health. Here, North Carolina has a solid foundation of world-class universities that will help ensure that this sector continues to thrive in the Charlotte region.

The upcoming developments like the Wake Forest School of Medicine are incredibly important for Charlotte’s growing healthcare industry.