Q&A: Novant Health's Carl Armato details how living with diabetes shaped his leadership

Novant Health, an integrated system based in Winston-Salem, N.C., serves the Carolinas, Virginia and Georgia with 15 hospitals and more than 500 outpatient locations. Carl S. Armato has served as CEO of the enterprise since 2012, but he's faced a far more difficult challenge since he was just 18 months old—living with diabetes. To share the story of his struggles as well as his many triumphs, he published a book this year titled A Future with Hope: An Inspiring Guide to Overcoming Diabetes. Armato spoke with Assistant Managing Editor David May. The following is an edited transcript.

MH: What do you think needs to be addressed regarding care for diabetes?

Armato: I'll start with why I wrote it. I'm going to tell you the exact moment I decided to do it. I was at an event where I had the privilege of being honored by the Triad Juvenile Diabetes Research Foundation, where I shared my 50-year journey with Type 1 diabetes. I was diagnosed at 18 months old. I'm 53 now. There was a line of young people after the event. They ranged between 18 and 25 years of age. After the event, a young girl came up to me with tears in her eyes saying that she hadn't heard anyone be so positive about thriving with Type 1 diabetes.

It was at that moment that I decided to write the book. For years, I had been taking notes about my experiences. I was worried that later in life, if I wasn't around, if I had grandchildren or great grandchildren who might be diagnosed with Type 1 diabetes … I wanted to make sure that they had an opportunity to read about my experiences that they may not be able to learn in a physician's office or in diabetic education training.

It was that young girl, when she came to me with tears, that made me believe that my story could help others today. It was about providing an opportunity for individuals to really let them know that I knew what it felt like to wake up every day and have diabetes. What it was like to monitor blood sugar, really watch what I had to eat. I wanted to have people see that even as CEO of Novant Health, that I acknowledge the fear and anxiety that Type 1 diabetes can involve.

It was about hope for people to realize their dreams, particularly if they have Type 1 diabetes.

MH: What can your fellow healthcare leaders take away from your experiences?

Armato: Having this lifelong condition has given me a unique perspective. It makes me look beyond spreadsheets, beyond the financial impact of decisions. I'm looking at decisions through the eyes and lens of a patient and someone who has a chronic disease. I'm not just an administrator.

It's helped me to cultivate a culture of transparency because I've made myself more approachable and more vulnerable as people have become aware of my diabetes over the years. It's been an ongoing dialogue where team members and employees throughout Novant Health can see the human side of me, and can also see the openness and authentic transparency in having conversations about the need of patients.

MH: Are we doing enough as a healthcare system to address some of these chronic health issues and social determinants that play into them?

Armato: We serve more than 90,000 people with diabetes. That's Type 1 and Type 2. Novant Health conducted a “search and rescue” to find people who had diabetes but weren't yet diagnosed. We tested the majority of hospital admissions and uncovered more than 6,000 undiagnosed cases of diabetes, obviously mostly Type 2. Many of those patients are being treated at our ambulatory settings. I think they're healthier today because our health professionals went the 
extra mile.

To your point, there's the whole social determinants of health. We have just recently partnered with a number of organizations, including the Mecklenburg County Health Department, to start looking at ZIP codes where we believe that individuals have been underserved. We're going after reducing healthcare disparities.

MH: In the aftermath of the elections, what do you think about Medicaid expansion in your home state?

Armato: We're all in on Medicaid expansion. We're still active in government relations and talking to our legislators about expansion. I'm still very concerned with how divided our legislators are both in North Carolina and other states we operate in. I'm not very excited about (the prospect for expansion) yet because I don't know if they'll get there, but Novant Health is trying to find a way to find some common ground with both sides.

MH: Looking more broadly, consumerism is driving a lot of what's happening in healthcare. You just opened a new hospital in Mint Hill. Why a new hospital there? Why not outpatient or urgent care?

Armato: We've built ambulatory-care facilities. It's been our new model of healthcare. We've actually reduced the number of beds at the big flagship hospitals because 80% of what happens in those facilities is a lot more ambulatory activity.

If you need hospitalization, generally we have anywhere from 50 to 100 beds that we relocated from some of our flagships to be more convenient for the communities we're serving.

MH: You're also partnering with an outside company for some urgent-care clinics, right?

Armato: Correct. We just partnered with GoHealth. We're planning to initially open 15 urgent-care clinics in the Winston-Salem and Charlotte areas but continue expansion into 2020 and beyond. We're looking for opportunities to ensure that if people decide to go to an urgent-care center, they have their own clinics. We're also looking at how we can take Novant Health electronic health records into those settings so that we can help individuals access healthcare down the road as they need it.

MH: It looks like you've found the EHR a very powerful tool. You used it for the search and rescue. Now you're highlighting it here with the clinics. What do you hear from your doctors? Has there been any pushback?

Armato: We're probably an outlier when we talk about physicians and EHRs. We built an administrative physician partnership and have been cultivating it for years, where physicians have been actively engaged in decisionmaking. An example is, they helped build and designed our Epic system. We started with our 550 clinics; 60% of them are primary care. Then we let them roll that out.

When we did our last survey, they're at the 98th percentile of satisfaction with the electronic health records. That's why I tell you we might be an outlier. They designed it. They implemented it. Then they built it through the eyes of a consumer.