Steve Lawler, President & CEO, North Carolina Healthcare Association

Steve Lawler, president and CEO emeritus of the North Carolina Healthcare Association (NCHA), talked to Invest: about the workforce challenges that the healthcare sector faces, the importance of expanding Medicaid to increase access to healthcare in rural and poor communities, and the role that local hospitals and health systems had in achieving that expansion. Lawler, who is retiring this year, passed the reins of NCHA in November to former North Carolina Labor Commissioner Josh Dobson, now serving as the Association’s president and CEO.

What are the key highlights of North Carolina’s healthcare system from your perspective?

I have been involved in healthcare for 42 years in various roles and places, with each of them having their own challenges and blessings. Most of my career in healthcare has been in North Carolina, so I have seen the local healthcare landscape change significantly for the better. Not only do we have some of the finest hospitals in the nation, but we are also a Top 10 state in patient safety, according to Leapfrog Group, and People Magazine recently named North Carolina a top-performing state. We are also a Top 10 state in terms of keeping healthcare costs low. Our cost per person per year is an indicator that people can get high-quality care as well as affordable care in North Carolina. 

We also prepare some of the best healthcare professionals in the country thanks to having great medical and nursing schools and a good community college system. I am proud that North Carolina continues to be a place where people choose healthcare as a career and where hospitals and health systems are delivering high value. Folks here go the extra mile to ensure that people are cared for. The expansion of Medicaid is a great example of the commitment of hospitals, health systems, and healthcare professionals. 

What are the key differentiators that make the North Carolina health system unique?

Healthcare in North Carolina is a competitive field. When people in Charlotte or the Triangle compete for patient loyalty, they do it to be the first choice for people in need. Nevertheless, those competition walls come down when people need to come together to do hard work, as happened during the COVID-19 pandemic or getting Medicaid expansion across the finish line. It is not uncommon to see people from lots of different organizations in the same room solving problems.

The fact that we are fiercely competitive sharpens organizations’ skills and helps people focus. But when it comes to doing what is best for a community, people are rolling up their sleeves and working together to overcome a pandemic, expand healthcare coverage for 600,000 people, or adopt best practices for infection prevention. The fact that people put patients and communities first is a reason why the results for North Carolina are so good. 

What are the most important challenges that the healthcare sector in North Carolina faces and how is the association navigating them?

We are working to bring the joy back into the healthcare workplace. This is an in-demand and vital sector, so one of the challenges is attracting great talent to join the healthcare workforce. We focus on connecting to people’s purpose. If someone’s purpose is to make a difference and they care deeply about helping others, there is no better place for it than in healthcare. It is all about growing our workforce. 

As North Carolina grows and we aim to attract more businesses and industries, we need to grow our health systems and our talent base to keep up with that. We must keep up with not only today’s demand, but also future demand. We are working with our school systems, community college, and universities to achieve that. We also love converting people who already have had a career but want to do something else that is meaningful. Those folks make great healthcare professionals as late careerists.

Moreover, we want to create a safe environment for people to come to work and for patients and families to receive care. We have seen an uptick in workplace violence in hospitals and health systems, so we are committed to creating a place of healing and hope where people feel safe. It takes a lot of time, energy, and effort to create an environment that is conducive to safe and good care and that is a safe place to work. We have a lot of work to do together societally to reinject civility and kindness into our everyday work. That starts with hospitals and health systems being kind and compassionate,but also includes being thoughtful and wise in terms of how we build processes and systems to mitigate risks.

How are healthcare providers working to increase the affordability of healthcare in the region?

Our hospitals and health systems are working every day to come up with new and innovative ways to make healthcare cost less. That happens when we connect with an individual with a medical condition and help them manage it. That is good for employers as it reduces absenteeism and costs the patient less because they manage it in a more cost-effective setting. Expanding that to a broader population is how we will succeed in reducing the cost of care. 

We are also working with others on medical debt. The fact is most people with medical debt have insurance, but the ones who deal with medical debt are typically lower income workers who have plans with high deductibles and a narrow provider network. We are working with the chamber of commerce as well as with health plans and physicians to design something that mitigates risk for people facing medical debt and to increase health plan literacy.

What initiatives or programs of the NCHA have been successful in improving healthcare delivery and community health?

Certainly, Medicaid expansion. Having grown up in eastern North Carolina and spending most of my time in small towns, I am aware that expanding coverage is a big deal. It has a compounding benefit not only in communities but also for hospitals. Many people have been receiving healthcare in emergency departments because they had nowhere to go before and had to put things off. Medicaid expansion gives people access to care on the front end, which increases their chances of success substantially. It also allows us to help them manage their care in a setting that is less costly. That is a win for both individuals and taxpayers.

One of the things that made Medicaid expansion work here is that hospitals agreed to pay the non-federal share of the expansion costs whereas in other states taxpayers are funding expansion. That was a major contribution by hospitals and health systems to get expansion across the finish line. Additionally, we are drawing down additional federal dollars to support Medicaid patients, which has been essential to keeping rural safety net hospitals open. Running a small hospital is tough, especially if it is in a rural area and an economically challenged community. Nevertheless, that community deserves good healthcare.

Finally, North Carolina had one of the lowest mortality rates throughout the COVID-19 pandemic thanks to the thoughtful work and superhuman effort of our healthcare community. The fact that we did as well as we did and that hospitals and health systems stood together made a difference. The industry learned from this challenge and then applied that learning. If we have to experience something similar again, we will be better at it and better prepared. That should be encouraging for all North Carolinians. 

What are the top priorities and plans for the North Carolina Healthcare Association for the next three to five years?

The Association and its membership are committed to making healthcare a great place to work. Another priority is continuing to see North Carolina move up in rankings for quality, patient safety, and cost. As that happens, we will be great partners for the chamber of commerce and other folks who are attracting business since people think about good schools, good healthcare, and workforce when choosing a state for businesses. 

We will also continue to lean on how to do better for people who struggle with behavioral health issues and to do a better job of coordinating with other organizations so people do not fall through the cracks. Finally, we will continue to work with our elected officials to make it easier for hospitals, health systems, doctors and others to practice medicine and take care of folks. Charlotte already is a destination for healthcare thanks to great institutions that are attracting people from out of state to receive their care. Therefore, we need to foster an environment that reduces administrative burdens and enhances people’s ability to take care of folks.