- Hello, I'm David Crabtree.

In just a moment, we'll be joined by North Carolina's Department of Health and Human Services Secretary, Dr.

Dev Sangvai.

Governor Stein selected the doctor in 2025, making him the 19th Secretary for Health and Human Services.

We'll be discussing his focus on improving access to care, shaping his team, and what's on the horizon.

That's next.

- Quality public television is made possible through the financial contributions of viewers like you, who invite you to join them in supporting PBS NC.

[bright music] ♪ - Hello, and thanks for joining us.

I'm David Crabtree, and we're joined by Dr.

Dev Sangvai, the 19th Secretary of the North Carolina Department of Health and Human Services.

Quite a title and quite a big job.

Thanks for being with us.

- It's great to be here.

- I'm sure you're asked this a lot, so I'll just jump right into it.

If there is a single biggest issue facing us in health care today, what is it?

- David, that's a great question, and you're right.

It's hard to think about the single issue, but when you think about individuals and health, individuals wanting to be healthy, thinking about, "How do I get to a doctor?

How do I get health care?"

One of the driving forces is affordability.

I think what we're seeing across the board is increasingly health care is getting difficult to afford, and it's not just within a community of individuals who have insurance challenges.

Even those who have insurance are talking about out- of- pockets and other expenses for which they're accountable.

It's getting harder and harder to manage.

- You manage a $40 billion state agency, a lot of that money coming from the federal government.

Nonetheless, $40 billion.

And it's not just about health care as we view health care.

This involves physicians, hospitals, medical services being rendered for people, foster care.

I mean, the list goes on and on.

When you begin your day, how do you start prioritizing?

- Yeah, another great question.

It starts by having a great team.

I have a great team with whom I work who are able to escalate issues that require immediate attention, and then we have a great team that's doing the day- to- day work.

So it is a massive agency.

You're exactly right.

It's everything from Medicaid to food and nutrition to child care, foster care.

We do all the licensing for hospitals and run the public health enterprise in the state and even things like the Office of the Chief Medical Examiner.

But it's really having a strong leadership team and remarkable group of individuals who are doing the day- to- day work.

- You talk about licensing for hospitals.

Heard a report just a few days ago reflecting, again, the growth of this area, and the report focused on Duke wanting to add additional beds in Raleigh and Cary.

Rex Hospital wanting to add additional beds.

Wake Med wanting to add additional beds.

All of this speaking to the growth, but also the aging population that is, if not in need of health care today, is going to need it in the future.

Is that just right in front of you all the time?

- Yeah, and it's interesting because the angle that we primarily take at the agency is doing exactly what you mentioned, looking at that aging population.

So the population that's 65 and older is one of the fastest- growing populations in North Carolina, a couple of reasons.

One, people are living longer, and it's an in- migration state.

And so anytime you have that type of population growth, you're exactly right, you have to start thinking about health care infrastructure and resources.

So it's this demand for health care that's really driving the need for increased beds, increased physicians, all the other assets you need to be able to deliver health care.

- You've been in office a little over a year and a half.

You have emphasized "meeting patients where they are."

So what does that actually look like when you design a health policy, particularly in rural North Carolina?

- You know, David, one of the best examples is the work we've done around behavioral health.

So if you think about behavioral health in an old, more classic sense, it was I have to go see a psychiatrist for behavioral health services.

So we've learned a couple of things.

We've learned that not every individual wants that face-to-face interface with a health professional.

Some might feel better having that with a peer.

Others may want the service provided closer to home.

We have success with mobile units as well.

So this idea of meeting the needs of the constituent where they are, it's really thinking about the multimodal way in which we can deliver services.

And it's just not health care services.

We think about it in some of the other things we do on the human services side.

We have 11 million people who live in the state, and it's not going to be a one-size-fits-all model.

- Let's talk a little more about behavioral health.

As we move on through life, things change.

The way we approach things change.

I think back to my childhood, which included a father who struggled mightily with depression.

The stigma around depression for his generation and mine, far greater than it is today, I think.

Am I right in that?

- Yeah.

I think what you're noticing now is a destigmatization exactly, as you mentioned, this idea that it's okay.

It's okay to have a mental health need.

It's okay to ask for help.

In fact, this idea of destigmatizing has been a big part of the First Lady's agenda as well, really thinking about how we make sure people feel comfortable asking for care, because that stigma can often mean, "I don't want to ask for help."

And so by making it okay to ask for help, we're actually seeing individuals come and get that help.

It's about one out of four.

One out of four individuals in North Carolina will say that they have a mental health issue.

So it's a fairly prevalent challenge.

- Are we seeing that rise in younger people?

And if we are, is it because they are talking about it?

Has it always been there?

Or are there just new pressures, social media being right at the top of the list?

- All of the above.

We're certainly seeing it in youth, but I think we're also more aware of what it means to reach out to youth who need help.

And social media can have real benefit because I think there are those individuals out there who are encouraging individuals to get help through their social media platform.

But we know that social media also brings a lot of pressures to youngsters and it's a challenge, so it's a bit of a double-edged sword.

- I want to get to several other questions around the work that you're doing.

But first, a little about you.

When did you know you wanted to be a physician?

- Yeah, it's a great question.

So I grew up in a medical family.

My father's a retired general surgeon, so I knew when he told me.

No, I'm just joking.

I've always known that I wanted to be in that space where you're really dealing with science, you have the ability to help people.

And it was probably sometime in middle school, high school, or later perhaps around high school where I really thought that that was going to be the pathway for my career.

- So you grew up in a medical family.

You heard the jargon, you heard the vocabulary all your life.

I have friends whose dads were doctors and they said, "I don't want that.

I don't want to work that hard."

What was the tipping point for you?

- I think the tipping point, in fact, I know the tipping point was really when you get to see the impact that you can have on an individual level.

You know, careers, we often think about what you can do in that space, the kind of impact that you can have on the type of individuals who use your services.

But health care, particularly the work of a doctor, it's uniquely human.

It's that interface of one person working with another person and the ability to have impact.

That's when I knew this was a pathway for me.

- And where did you grow up?

- Primarily in Ohio, but I've been in North Carolina for 25 years, so I'm a Tar Heel for sure.

- You're a Tar Heel who worked for Duke.

- That's right.

That's right, yeah.

- Is that what was the work at Duke Medical Center what brought you to North Carolina?

- It did.

I came to Duke in the early 2000s to work there, but also wanted to extend my education, so I went to the MBA program at Duke.

They have a health care MBA in health sector management, and I really wanted to further my education down that pathway.

- You were the president of Duke Regional.

- Yes.

- What's the one thing you learned there that you wish you had known when you first became a health care leader?

- Wow.

You know, there's so many things my tenure at Duke Regional taught me, but it really taught me that people are very proud of their community hospital.

They're very proud of the hospital that's in their community, and the possessive nature with which individuals describe, "This is my hospital," and I remember when it was Durham County General Hospital, for example, or I remember when Duke took over, that degree of ownership and that sense of pride.

I hadn't anticipated it before taking on that role, but it became clearly evident shortly after becoming president.

- It is remarkable here in the Triangle and all the surrounding counties that we have the level of health care we have.

It's real easy to take it for granted.

- Absolutely, and sometimes you don't even realize what you have, but you know, David, you don't have to go too far from the Triangle to realize how different it is, particularly if you head to the eastern part of the state and quite honestly even to the western part of the state where you have hospitals that are struggling to stay open.

You realize as doctors are retiring and closing down their practices, there isn't a pipeline of physicians coming in to fill it in.

So while we're fortunate in the metropolitan areas like the Triangle, I think we have to be conscious of the 3 million people in North Carolina who live in rural areas who don't have that level of access.

- You know, I worked in eastern North Carolina many years ago.

I was based out of Beaufort County, and we had a small hospital there now, but you push out just to the contiguous counties, out into Washington County, Green County, on down to Hyde County where a small hospital is closed.

It's really difficult, and people who live there would say, "Do we not matter?"

What do you say to those folks?

- Yeah.

Well, first of all, I say you do matter.

You do matter, and there are a number of things that we're doing at North Carolina DHHS right now that's really focusing on those rural communities.

How do you bring access back to ensure that individuals can get to a primary care provider?

And then when you do need more high-acuity services, there are ways to get to those types of services.

So that's exactly what we're focusing on.

- How do you keep it affordable, particularly in those areas where incomes traditionally are going to be lower than what you would have in the urban areas?

- Yeah, most definitely.

As we talked at the kickoff of the program, you know, affordability is such a challenge.

The way you keep it affordable is you have to make sure that individuals are insured.

You know, our system in the United States really creates a difference between having insurance versus not having insurance and being able to access healthcare.

That's why things like our Medicaid program and Medicaid expansion have been so transformative in the state because we've gone from a situation where if you look at Medicaid expansion, for example, 700,000 individuals can now access healthcare in a more regular fashion because they're able to be a part of that expansion population.

- You know, that's one of the topics where I remember for 10 years there was a push in this state for that expansion, and it became somewhat political.

There's no secret about that.

From your perspective, what were the opponents missing in the argument?

- Yeah, I think any time you want to add services, there's this concern around cost, and I think what was missing was a larger understanding of what really the benefits are, not only from a healthcare perspective but an economic perspective as well.

So I give a tremendous credit to my predecessors, to the General Assembly who had the wisdom to sort of think through several years down the road what really happens if we expand Medicaid.

So I think it was a real blessing that like minds got together and said, "Let's hammer this out."

The model we have in North Carolina is a partnership between the federal government, state government and hospitals.

So it really had those major stakeholders coming together to say this is the right thing to do.

- Okay.

You've seen healthcare from the exam room, from a hospital executive suite, population health, now state government.

No matter how good a system is, it can always improve.

Fundamentally, what needs to be improved?

- There are so many opportunities to improve what we're doing in healthcare.

I think the one is coordination.

The one we often think about is coordination.

How do you coordinate among healthcare providers?

How do you coordinate among healthcare systems?

Some of that is data sharing.

Some of that is the ability for individuals to say "if I get healthcare in one part of the state, how easy will it be for me to get healthcare in another part of the state?"

We know there's a lot of repeated healthcare simply because people don't have the information in real time that they need to be able to have.

So this absence of coordination I think is a challenging one, and it doesn't take long for us to think about our own stories of trying to work within the healthcare system.

And you sometimes think to yourself, "Why can't the right hand know what the left hand is doing?"

Sometimes I go to my own doctor and fill out the same forms in every visit.

So it's this, how do you coordinate things in a way to just bring efficiency?

- So what do you say to that doctor when that happens to you?

- Well, I say, "Why am I filling this form out again?"

And they will often cite regulatory reasons.

So you have to look and say, "Well, are we a part of the regulatory burden that's requiring physicians and other healthcare providers to continuously have people fill out the same forms?"

- And that's one of those things that can drive cost up.

- Absolutely.

- So if you make it more efficient, I would presume it doesn't mean the cost would necessarily decrease, but they might not increase at the same rate.

- Right, that's right.

And I think one of the other opportunities around efficiency is if you get the waste out, you get a higher level of productivity.

And so maybe doctors, hospitals, and other providers can see more patients, for lack of a better term, which also helps with things like access.

- You mentioned data sharing a moment ago.

And when I heard the word data, the first thing that came to my mind was AI.

We know that AI is being used in the medical community.

It's being used in research in ways that we couldn't have dreamt of even six months ago.

I mean, it's moving that rapidly, but it's also creating some problems.

So let's talk about particularly around coding that we hear from insurance companies as a major problem.

Does that land on your doorstep as well?

- Well, I'm part of this group that Governor Stein put together called the Healthcare Affordability Commission.

And so Treasurer Briner and I co-chair this group.

And among the things we're looking at is what's driving cost in North Carolina.

And the issue of AI has come up.

And coding is part of that conversation.

And we see it both ways.

We know that physicians and other providers have identified AI to help refine the manner in which they submit a claim, which would then could suggest, hey, I need to get paid more for the service.

We know that insurance companies are also using AI to identify areas where maybe something isn't accurate in the claim and I need to reimburse the provider less.

So in some ways, it's kind of scary because you have AI battling AI in some ways.

And it's the making of a great Hollywood movie in some ways when you think about what the potential is.

And I think we just have to be honest about what's happening with the use of AI.

And I think in both of those instances, other cases we see in healthcare, it's a tool, but it's not a substitute for human interaction.

So how much do you use that tool, whether it's in coding or anything else?

And then how much of that do you need to second guess or supplement with a human interaction?

- You mentioned the insurance companies.

I presume there will always be a given degree of tension between those of us who are customers of an insurance company and then what the insurance company is up against just to stay in business.

And then we hear about profits that are being made.

And then we hear about problems that exist.

But until we experience one of those problems, we go on with life.

So there again, the balancing act for Health and Human Services around all of this has got to be more than most of us can even begin to comprehend.

- One of the things I remind myself of is all of the services that we provide, whether it's in licensing, whether it's in public health, food and nutrition, or Medicaid, at the end of the day, there is a constituent that's relying on the work that we're doing.

And so I always try to focus on the constituent's perspective to help understand what is the decision in front of us?

How do we make sure we make the right one?

And then what can we learn from this particular constituent interaction that can help inform us for future ones?

- Let's switch gears for a moment and talk a little bit about foster care.

- Sure.

- How many children approximately today in foster care?

- Somewhere around 14,000.

- 14,000?

- In North Carolina.

- In North Carolina.

- Right.

- Children that, I don't wanna use the term, are bounced around.

I know people use that vernacular at times, but children are moved for various reasons in foster care.

And there's this constant desire to reunite children with their natural parents as well.

Talk a little bit about that, if you would.

- Yeah, it's one of the most heartbreaking elements of the work that we do, is really to see that child who just can't find the stability that they need at such a formative time in their life.

And so there are a couple of things that we've done.

We're working more closely with the counties that run the foster care system in their counties, trying to better understand best practices, trying to better understand what we can do as a state agency to help.

There are two things we've done that I think are really helpful.

We recently launched a software platform called Path NC.

It is an incredible tool, which is now gonna allow agencies from one county to communicate with another county.

And it may surprise you that two years ago, if you were a child who was in foster care in Orange County, the foster care system in Wake County would almost have no line of sight to who you are or what you were going through.

Now we have a system where the documentation is uniform.

So in any of the 100 counties in the state, with the appropriate access and so forth, anyone involved in the foster care system can better track and trend what's happening to a child.

- I have to say, living in this area with all the high tech we have, how could that have been?

That there was that inability for one county to another to be able to talk.

- I think that's really a symptom of some of the larger challenges we have is many county governments, even the state government, and in some cases on the federal side, what do we need to do to modernize?

I mean, it's really a modernization effort to go from paper and pen into an electronic system.

And once you create anything that's electronic, you create the ability to share information so much faster.

It's not to share information wasn't shared in the past.

I mean, we had fax machines and all those other things, which at one point we probably thought were remarkable.

So it's all about how do you modernize these systems to get with the times?

- Is it the challenge it used to be to find those who qualify to be foster parents?

- Not as much.

I think what we're learning is you can help individuals understand what it means to be a foster parent, but really the focus is on exactly what you mentioned, this idea of reunification.

What do we need to do so that the biological parents are in a position to be able to take care of their child?

So we're really focusing on this whole idea of reunification as a way to make sure that that number gets smaller every year.

- I heard you give a presentation one night following a dinner, and you talked about a lot of the things we've discussed today, but the one thing that sort of got not a gasp, but a response in the room was, you told us you applied for this job that you have today online.

- I did.

- The governor didn't come looking for you, you went looking for the job.

- Right, right.

- What an experience.

- It was an incredible experience.

And in some ways, I can't even believe I'm sitting in this chair right now.

So I thank the governor for trusting me to have this position.

But it was, indeed, it was the governor had, "Hey, come work for the Stein administration on a website."

And I said, "All right, let's see where it goes."

- That must have been quite an application to fill out.

- It was, it was.

And it was a fairly robust interview process.

But what I was really excited about as I went through it was to see his vision and his passion for North Carolina and how it really mirrored and matched the same type of vision and passion I had for what we wanted to do in healthcare.

- You know, in full transparency, the Department of Health and Human Services is a part of the ex officio representation on our board of trustees here at PBS North Carolina.

Traditionally, we've had someone from your office represent the department at our meetings, but you decided to come to the last meeting.

And afterwards, you talked with me about the importance of PBS, what it meant in your life, and your own PBS story.

- Absolutely.

I get invited to a lot of meetings, opportunity to serve on a number of boards.

And so when this came up, I said, like you mentioned, I wanted to come to the meeting.

And it was nostalgic.

PBS was a big part of my childhood.

I remember shows like Electric Company.

You know, I come from an immigrant family.

And so, at least for my mom, English wasn't her primary language.

And so she learned English in large part through Children's Television Network and Corporation for Public Broadcasting.

So it's those type of programs.

So I thought about Electric Company, Reading Rainbow, I had a chance to go down your hallway of all the shows.

And then I kind of think about the shows my children also watched as they were growing up.

So I'm a big fan of it.

- We are grateful.

Your mom immigrated from?

- So my parents immigrated from India in the late 1960s.

Yeah.

- Wow, what a story.

One more thing around public media.

Our mission is to provide information to people who may not have had this information before and may not have access to this information or beyond what we do.

When you look at our mission, and you've just affirmed it to a degree, but what would you say to encourage us when we are up against budget cuts and loss of federal funding, rising cost of doing business, inflation, and we want to keep that public mission front and center with our own challenges?

- Sure.

You know, I look back at the 19 months that I've been in this job, and I have an incredible number of stories of individuals who have thanked me for the work that we do.

And it's the type of thanks that you know that they're sometimes hesitant to share publicly.

So for example, in public health, it's a lot of public health debate on a number of things that we do, but I will routinely hear individuals say, "Thank you for doing that because you're a trusted source, "and we trust you.

"We trust the North Carolina Department "of Health and Human Services."

I think the same thing is true for PBS.

You're a trusted source.

The work you do around emergency management, very trusted.

And I have to say thank you for Healthcare Heroes because that's another level of trusted information that we're getting out to the public.

- Thank you for mentioning Healthcare Heroes.

In case you haven't watched that program, it's sort of a game show format with children, teaching them about potential careers in science and health and healthcare.

And the partnership is with the Department of Health and Human Services.

So we're grateful for that.

Doctor, thank you for your time and your insight.

Come back and visit with us again.

- Anytime.

Look forward to it.

- And thank you for joining us.

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Who invite you to join them in supporting PBS NC.