Joey Wahler (Host): This is WakeMed Perspectives, a limited podcast series focused on the proposed strategic combination of WakeMed and Atrium Health. Our guest is Steve Smoot, President of the North Carolina and Georgia Divisions at Advocate Health, of which Atrium Health is a part. Thanks so much for joining us. I'm Joey Wahler. Hi there, Steve. Welcome.

Steve Smoot: Yeah, welcome. Thanks, Joey. Glad to be with you.

Host: Great to have you aboard. We appreciate the time. So, just to make sure everyone is on the same page that's joining us, a recent healthcare announcement generating that significant interest across the state. So, we're discussing Atrium Health's planned combination with WakeMed, a significant step toward expanding access to care, enhancing mental health services, and strengthening healthcare for the communities that both organizations serve.

So, we're exploring the vision behind this partnership and what it could mean for patients across the region. So that being said, first, Steve, before we get into all of the above, what initially drew you to healthcare in the first place? We often like to ask our guests that.

Steve Smoot: I have been a healthcare executive for over 30 years, so this is a journey that started some time ago. And I had the opportunity coming out of high school to take a couple of years to go do some service work, and that really impacted my life. I realized I had an aptitude and a desire to be in business, but I really wanted it to be in something that was really meaningful.

And luckily, I had the chance to shadow a healthcare executive who's been a mentor of mine throughout my career, and the lights went on. And instantly, I realized this is the industry I wanted to be in. You know, we're helping people at their most vulnerable times, both at the beginning of life and end of life in many cases. And I just don't feel there's anything more meaningful that I can be in. And so, I've been driven to systems that have really been mission-oriented. I spent a lot of my career in Utah for a company called Intermountain Healthcare, and then the last seven years, which is really meaningful, with a Catholic healthcare system that's based out of St. Louis, Missouri, and very mission-focused.

And so, as I looked to join Advocate Health or Atrium Health, as we're known in North Carolina about a year ago, the focus on mission and our for-all mission was a critical thing that drew me in, and I have not been disappointed with Advocate as I've joined them a year ago.

Host: And with the last part of what you just mentioned, Steve, you led me beautifully into my next question because Atrium Health has a strong name in North Carolina, to say the least already. But what's most important for those joining us to know about its history and mission that you alluded to there?

Steve Smoot: First of all, probably good to understand, because this all feeds into the discussion that we're having about WakeMed. We are one of the largest not-for-profit healthcare systems in the country. We really, as you mentioned, we pride ourselves on being a for-all system. And when we say for all, we really mean it, that healthcare needs to work for everybody.

Regardless of where you live, you could be in a rural community, in a downtown Chicago neighborhood, in South Atlanta where we're going in right now, or in Raleigh. And all the parts of Raleigh, which is really important to us. Regardless of your insurance status, the complexity of your needs, whatever you need, we're there for you. That's our for-all mission. And really, our job is to remove barriers, expand opportunities, and ensure the benefits of innovation, expertise, and compassionate care reach every community we serve.

Atrium Health, which is who I represent, really serves more than three million patients across the Southeast. And in North Carolina alone, we have 386 sites of care with 30 hospital locations. As a leading academic health system, which some people are surprised to learn that about us, Atrium Health is anchored by Wake Forest University School of Medicine and one of the nation's largest provider-led clinical trials networks.

And if I can just pause on that for just a minute, the best example of that is we've all had friends or family that have suffered from cancer, and it used to be if normal treatments or regular treatments weren't working that you wanted to get them into clinical trials, you'd have to travel great distances sometimes, sometimes to Washington, D.C., Or to Baltimore. And this will allow us to bring those clinical trials right close to home, whether you're in a rural community or in a nice community like Raleigh.

Atrium Health is also nationally recognized for both pediatric and adult care by US News and World Report with leading programs in cancer, heart and vascular, neurosciences, transplant, and behavioral health. And you've probably heard already, cancer is really what first brought us together with WakeMed as we responded to an RFP to help them with those services. Atrium Health leads North Carolina with 10 A grades for patient safety from the Leapfrog Group. It's an agency that represents health insurance companies. We have the most A grades of any health system in the state of North Carolina.

And really, as I mentioned before, about the time I was interviewing for this job, Advocate was announcing that they were going into South Chicago to build a hospital when others were running out. So, we are very committed to our for-all mission and making sure that healthcare is accessible to all.

Host: So when you look at WakeMed, Steve, what was it most of all that stood out making this the right opportunity to partner up with Atrium Health?

Steve Smoot: Yeah. You all know WakeMed that are in this community. And as I describe the great things that Advocate's doing, we could say the same things about WakeMed. They share our for-all mission. WakeMed has built tremendous trust in this community by caring for people throughout every stage of life, every circumstance, and that's exactly the kind of community-centered approach we value.

It just felt like the right partnership because we share a common belief, and that's that, as I said, healthcare should be accessible, affordable, rooted in the needs of the communities we serve. And it's clear that WakeMed has been following that same belief.

Host: Well, naturally, regarding this combination, Steve, many patients are wondering, will my healthcare now cost more? So, how do you address that?

Steve Smoot: I'm proud of our community and our patients for asking that question. All of us ask it. I'm not immune to the cost of healthcare in my own family. I just welcomed two new grandchildren from two of my daughters into the world here in the last month. And while that's exciting, I also realize how expensive it is. And a lot of it has been because of the amazing innovations that we have in healthcare. But healthcare is just expensive, and we need to be focused on that.

There's two things that I probably want to really point out. Part of the reason that Atrium that has grown into Advocate, has looked for partners to grow together with is it gives us economies of scale to really reduce cost and pass those savings onto our patients, and we've successfully done that. In the last five years, as we've come together with Advocate Aurora in the Chicago-Wisconsin market and expanded into Georgia, it's allowed us to find $1.5 billion in savings while we look for ways to have better purchasing power on behalf of our patients.

Our goal, though, really, with this combination, is to really make care more affordable, not less. And one of the first things we committed to is expanding financial assistance eligibility for WakeMed patients. Today at Atrium, for example, a family of four making about 100,000 a year would pay nothing for their care, while families earning up to roughly 132,000 receive substantial discounts. And I know while that sounds a lot in our current market, for a family of four, that's still a income that's hard to live on. So, we're proud of the fact that we can provide that kind of support.

Through this partnership, we would expand those policies, making care more affordable for more people immediately and reducing financial barriers for families across the community. And it's not just a promise or a commitment we're making. We're bound by this in the agreement that's being put together.

Host: Well, I'm sure those joining us are definitely more comforted hearing about those financial benefits. So, the cost aside, if this all moves forward, what are some of the biggest other benefits that patients and families in Wake County could expect?

Steve Smoot: A lot of the benefits that they would benefit from is similar to the program that we did with our oncology program. WakeMed had a wonderful cancer program already in existence, but they realized that there was more services that they could provide if they had a larger organization with more resources that could be applied to the communities that we're serving, and that's why they put an RFP out, and we've been able to do some wonderful things together.

So, you'll have state-of-the-art cancer treatment with the national clinical trials that I mentioned. We have an amazing heart and vascular program that we can work together with. And by the way, it's important to point out, we don't always come in with all the answers. We also learn a lot, and that's really what we are trying to do, is to share best practice and then have it spread throughout our entire organization and spread quickly because of us being together and organized.

Host: So Steve, some have also expressed concern that WakeMed could lose its local identity because of local decision-making authority here. That being said, how will WakeMed continue to be governed and accountable to the people of Wake County if this combination moves forward?

Steve Smoot: Yeah. Great question, Joey. And I'm actually probably the best person to address this given the fact that I'm new to Advocate, so I'm seeing these new relationships that come together, and I have accountability for most of the organizations that have joined us recently. So, I have accountability for Wake Forest at Winston-Salem, still have accountability for the Charlotte market, for our rural communities, and then Macon and Floyd, Georgia.

And so, I've been able to see firsthand our focus on benefiting from a system, but really listening to that local voice. And this agreement really protects local governance and community accountability. In fact, a majority of WakeMed's board of directors will continue to be appointed by the Wake County commissioners.

There was some confusion about that. And, this will ensure that the people who know this community best continue to help shape WakeMed's future. In fact, 8 of the 14 total board members, so a majority, will be appointed by the county commission. This will allow Wake County to retain an important governance role and continue to have a key voice in decisions that affect this community.

The commitments we are making are formalized within the agreement, supported by accountability measures, transparency requirements, and public reporting. And we're really focused on strengthening WakeMed while keeping community needs and priorities at the center of everything we do, and that's what we've done in every community we go into. And when we're done with this, patients will continue to receive the trusted high-quality care they know from WakeMed's physicians, nurses, and care teams, and that will just be enhanced with this strengthened relationship.

Host: So important, obviously, to address those concerns as well, Steve. Meanwhile, mental health, of course, has become a top-of-mind topic for families across Wake County, as well as in so many other places as well. So, what does this combination mean for behavioral health access in the region, and how does Atrium Health plan to address that need?

Steve Smoot: We've all been in this world long enough to know that all of us are going to be touched by mental health, whether it's through family members, ourselves, or friends. It's an important topic. And behavioral health is one of the most pressing needs facing the country, but especially North Carolina communities today. And having access to supportive and comprehensive mental health is essential for our communities. To address this need, together, we would create the state's largest nonprofit behavioral health network with more than 360 mental health beds.

And I'll add, one of the things that we see as a level of expertise from WakeMed is behavioral health, and that we'll be able to enhance our services to the rest of the system because of this relationship. We would expand both inpatient and outpatient behavioral health services and improve access before people reach a crisis point.

Today, Atrium Health's virtual teletherapy programs reach hundreds of schools across North Carolina. So basically, in a school, if you need behavioral health, we can bring you in and get you online with a provider almost immediately. This helps students access care where they already are. This program has demonstrated measurable improvements in anxiety and depression, expanded access for underserved populations, and has helped thousands of students stay healthy in the classroom, and we've seen the downstream effects of that at our more serious levels of care. This reflects our longstanding commitment to serving as a safety net for individuals and families facing mental health challenges, and it's a mission we share with WakeMed.

Host: Certainly great for many to hear. And I want to go back, Steve, to something you touched on a little bit earlier. WakeMed has a long history of caring for everyone who comes through its doors, and you mentioned that Atrium Health does as well. So, how does Atrium approach charity care access and support for underserved populations? And how can you reassure the community and those joining us right now that that commitment won't only continue, but it'll be strengthened through this partnership?

Steve Smoot: Yeah, absolutely. And, as I mentioned, why did we want to be with WakeMed? It's because we share this. Caring for all patients, regardless of their ability to pay, is not something we had to be talked into. I mean, this is how we operate, and it's how WakeMed operates, as you mentioned. In fact, Atrium Health serves more Medicaid patients than any other health system in North Carolina, and we also provide more care to the uninsured, to those that don't have the ability to pay. In fact, we gave free care to nearly 100,000 people in North Carolina last year.

Now, I mentioned before, patients at or below the 300% of the federal poverty level or that $100,000 a year income for a family of four, they receive 100% financial assistance, and Atrium Health provides significant discounts to many families that are above that threshold but still financially tight.

The best part I like about this is nearly 90% of eligible patients are enrolled automatically, removing red tape and make it easier to get care through abilities for us to understand who may qualify for this type of service without having to put them through an extensive application process.

Last year, Atrium Health invested 2.38 billion in community benefit programs, including behavioral health, which we just talked about, housing support, food access, and other services that improve health just beyond the health that we talk in the hospital walls. Through this partnership, those commitments will continue and really only expand.

Host: Couple of other questions for you, Steve. First, you've done a great job of explaining many of the services and costs that'll be maintained going forward. But how about combining WakeMed's local expertise with Advocate Health scale and resources to create new opportunities and new benefits for the patients and communities that WakeMed now serves?

Steve Smoot: It's one of the reasons that I really enjoy having new partners join us. And this partnership brings together WakeMed's deep community knowledge with Advocate Health's scale, expertise and innovation, creating opportunities to learn from one another and strengthen care for patients. And I mention this in every combination, we have found that we learn so much from the organizations that join us as they also learn from us. The best ideas come from working together. Together, we can invest more in facilities, technology, research, workforce development, more than either organization could achieve alone.

And so, patients will benefit from expanded access to specialty care, clinical trials, virtual care, and leading-edge treatments. And really, most importantly, by combining our strengths and sharing best practice, we can improve access and bring more advanced care closer to home.

Host: Well, Steve, as you well know, we certainly don't want to forget during this conversation the people in the trenches, as they say. So, what would this combination mean for WakeMed employees and the healthcare workforce in Wake County?

Steve Smoot: Yeah. And Joe, I appreciate you saying it that way because the reality is we can build the nicest hospitals and provide the most amazing equipment. But really, what we're about are the providers, the nurses, all the caregivers that take care of our patients. That's who we are as an organization. And this agreement includes plans to create more than 3,300 new healthcare jobs in Wake County over the next five years. Those commitments represent our starting point, not our finish line.

Atrium Health's initial commitment, but our approach has always been to build on those commitments and pursue additional opportunities to strengthen care, grow the workforce, and serve the community, and we've done it everywhere we go.

We also recognize that great care starts with investing in the people who deliver it every day. Atrium Health has a strong track record of investing in its teammates because a strong workforce is essential to serving patients and communities well. In fact, this year alone, we invested an additional 776 million in our workforce compensation across North Carolina, helping keep them up to speed with the inflation.

This reflects our commitment to attract, retain, and support exceptional teammates. Through this combination, WakeMed teammates would gain access to expanded career growth, education, leadership development, and advancement opportunities that they may not be able to do on their own by joining one of the largest leading nonprofit health systems.

Host: And then in summary here, Steve, you've done such a comprehensive job of breaking down a lot of the advantageous details here. But when you put a bow on it all, what are you most excited about here? What are you most pumped up about when you go to work every day right now about this proposed combination?

Steve Smoot: I've thought a lot about that and probably the thing I'm most excited about is the ability to join with some amazing people. Every time I come to systems like WakeMed, and especially WakeMed, you just have some incredible individuals that are working there, and I'm excited to learn from them and grow together.

I'm really excited about the opportunity to expand access to care, specialty services and behavioral health like we've talked about, supporting more people across North Carolina, a state I'm learning to love. Advancing innovation, research, medical education, clinical trials, so patients can access leading-edge care closer to home.

Creating a future where more patients receive world-class care regardless of their ZIP code or financial circumstances. What excites me most is the opportunity to look back five years from now, we always do this, and know that Wake County is stronger because of this partnership. That's how we think about every organization that joins us.

Will patients be better served? Will access be greater? Will the community be healthier because we're involved? We've seen that impact in communities like Winston-Salem and Macon, where we've invested, grown, and expanded access over time. And really, our goal would be the same here, to build on WakeMed's already strong foundation and help make Wake County even better than it is today. That's what I'm most excited about.

Host: All right. Well, it is exciting indeed. And folks, we trust you're now more familiar with the excitement and all the rest that comes with this proposed combination between WakeMed and Atrium Health. Steve, congrats on helping to get everything to this point. I'm sure that's been quite the endeavor in and of itself. Best of luck going forward. And I would be remiss if I did not congratulate you on what you mentioned earlier. Two new grandkids from two different daughters and almost simultaneously coming into the world it sounds like. So, is it safe to say that this WakeMed Atrium venture is not the only combination you're enjoying right now?

Steve Smoot: Exactly, Joey. Thank you for that compliment. Appreciate it.

Host: Absolutely. A man with his hands full, folks, to say the least, both professionally and otherwise. Well, to learn more about WakeMed, Atrium Health, and the future of healthcare in Wake County, please do visit wakemed.org/wakemed-atrium-combination, or just keep tuning in right here for this limited podcast series, WakeMed Perspectives.

If you found this episode helpful, please do share it on your social media. I'm Joey Wahler. And thanks so much again for being part of WakeMed Perspectives.