When a new hospital opens in a small town, doctors, nurses and staff are often treated like long lost cousins at a family reunion. Townsfolk welcome them, take pride in their arrival and anticipate a long and close relationship.
How would that scenario play out if the first name of the hospital were “mental” and not “medical”? What if “mental” were softened to the more descriptive, “behavioral health”? Would there be the same pride, anticipation and welcoming handshake? Yes, if the town were Davidson. No, if it were Huntersville.
Old Devils Die Hard
In 2007, Carolinas HealthCare Systems (CHS) spent $24 million to demolish the old Huntersville Oaks nursing home and rebuild a modern 168-bed facility for the elderly who needed special care.
Four years later they unveiled a plan for a section of the new Huntersville Oaks property. CHS wanted to rezone the site for an all-private rooms, single story in-patient and out-patient behavioral health center. Zoning would change from neighborhood residential to campus-institutional.
After a contentious public meeting in January 2012 that focused on public safety and traffic, the town planning board approved the CHS application on its merits. Neighborhood opposition solidified at the Huntersville town commissioners meeting in February 2012 and commissioners voted 4 to 2 against the rezoning plan. Even a 16-foot perimeter wall for the in-patient center failed to convince the skeptics.
The real cause for the no vote is as old as civilization itself—the stigma attached to those who don’t fit in. For over 3,500 years, odd behavior—hearing voices, unrelenting sadness, paranoia—was attributed to evil spirits or demonic possession. It’s hard to imagine a more fear-provoking mark of shame, the classic definition of stigma. Psychiatrists and psychologists know better now, but old devils die hard.
“I think that was a substantial reason why elected officials chose not to support building it there,” says Tom Gettelman, Ph.D., the clinical psychologist appointed to administer the new facility. “Some neighbors chose not to understand that providing an acute mental health facility actually enhances the safety of a community.”
Ever the psychotherapist, Gettelman reframed the experience. “In the end,” he says, “Huntersville allowed Davidson to embrace us.”
Davidson wasted little time moving from hello to embrace. Two months after the Huntersville plan failed, Davidson Mayor John Woods approached CHS. “We appreciate the great need for mental health facilities in our community,” Mayor Woods was quoted as saying. The very mission of the town of Davidson encourages a healthy lifestyle in a healthy environment. A behavioral health hospital fit perfectly with the community’s goals for itself.
To add a bear hug to the embrace, one of the goals of the Davidson town board of commissioners is to enhance the physical, mental and emotional well-being of its citizens. “Commissioners use that health lens with all of their projects,” says Gettelman.
The 23-acre site offered to CHS did not need rezoning nor was it in an established neighborhood. Six months before Mayor Woods visited with CHS officials, the Davidson town board had rezoned the area to allow for flex campus development, a designation that fit the new behavioral health center to a T. The purchase price of the property was not made public, but the price tag on the Davidson center was $36 million, three million dollars more than the Huntersville campus plan.
Davidson was not the only town in northern Mecklenburg County to step forward, but it was the most enthusiastic. “Davidson has been amazing,” says Gettelman. “From day one, across the board, from elected officials, the chief of police, the entire community has embraced what we want to bring. The walk matches the talk.”
What CHS wants to bring are jobs, a new staffing model and help to those suffering the perverse effects of drug abuse and mood disorders.
New Davidson Facility
For Davidson’s 66-bed, 67,000 square foot in-patient hospital, Gettelman wants to employ 45 psych nurses, 55 psych technicians, 18 master’s level therapists, four recreation therapists, three peer specialists, two pharmacy techs, and six psychiatrists. That’s more therapists and fewer nurses than is typical of behavioral health hospitals. But it is how they work together that makes Davidson different.
He also wants to divide the new hospital into three 22-bed units. Each unit has its own therapy team that works seven consecutive days and then has seven days off. The result? “Very cohesive and consistent teams on every unit,” says Gettelman. Since the length of stay at Davidson’s inpatient hospital is expected to be from five to eight days, it’s possible that a single team would manage a patient’s progress from admission to discharge.
This type of staffing model is unique among behavioral health hospitals in the United States. In medical hospitals the model has been around since 1996 and goes by the name “hospitalist.” A hospitalist is a physician responsible for coordinating a patient’s care during their time in the hospital. Although patients often complain that their personal physician or surgeon has not come to see them, hospitalists have achieved greater consistency of care, shortened lengths of stay, eliminated on-call MDs, enhanced patient safety and minimized handoff problems between shifts and departments.
Since few patients in a short term “mental” hospital like Davidson have a family psychiatrist, Gettelman’s model has no obvious disadvantages. Psychiatrists—medical doctors trained in psychopharmacology and behavior disorders and employed by CHS—will be Davidson’s hospitalists.
Treatment at a Loss
Carolina HealthCare Systems is gambling on the long-term benefits of its behavioral health care centers. Topping the short benefit list is a reduction in emergency department visits by those needing psychiatric care. In a report released in April 2013, a North Carolina joint legislative committee found that the majority of individuals admitted to a psychiatric inpatient unit or to a hospital are referred through an emergency department. The average length of stay for those in crisis was nearly 16 hours.
Two solutions to that problem have emerged—telepsychiatry and psychiatric emergency departments. Through Skype and a high definition telephone/video connection, CHS emergency department personnel can have a person in crisis interviewed by a psychiatrist at the Behavioral Health Center—Randolph 24/7.
This innovation has two benefits, says Gettelman: “The psychiatrist can determine the level of care needed and often discharge the person to home.” If the person needs to be admitted and is waiting for a bed, the psychiatrist can start the medical treatment. This often involves psychotropic drugs for which psychiatrists are medical experts.
Dr. John Santopietro, CHS’s new chief clinical officer for behavioral health services, sees another long term benefit to treating behavioral problems first. “The cost of treating diabetes is 60 percent more when treating diabetes and depression,” he was quoted as saying. “Control depression first and it makes diabetes easier to manage. Leave depression untreated and the chances are very good, says Santopietro, that the person will be readmitted to the hospital.”
The same may be says about gun-related tragedies like Sandy Hook Elementary School. Left untreated, the demons that drove Adam Lanza, Seung-Hui Cho, and others to murder continue to disrupt lives and increase the likelihood of more atrocities. Gettelman says he cannot guarantee that Davidson or Randolph will prevent another Sandy Hook, but treatment lowers the risk. “If you treat people for heart disease can you guarantee they will not have a heart attack?”
There are long term business implications to what Gettelman is doing at Davidson. Absenteeism, poor productivity, bad attitude and workplace violence may be crisis-induced or the psychological consequences of chronic and untreated depression. These business costs are estimated to be two to three times higher than what it would take to treat these problems at a facility like Davidson or Randolph.
In the short term, behavioral health is hardly a money maker. “Psychiatric facilities don’t make money,” says Gettelman. “CHS expects to lose $3 to $5 million a year at Davidson,” he adds.
The reasons go back 50 years. In the 1960s, states began deinstitutionalizing their long-term “mental” patients. New drugs, new federal laws and new ideas regarding humane care provided the stimulus for change. Local communities were expected to absorb the now released patients with some help from the federal government and no help from the states.
The beds at the Davidson hospital are state beds that were transferred to CHS from Broughton, the state mental hospital in Morganton. While North Carolina is willing to make the transfer, they are not willing to provide any financial support to private businesses like CHS to build community-based in-patient units.
Communities and businesses willing to take that risk and build or retrofit existing hospital units for psychiatric patients soon discover that insurance reimbursement for those patients does not cover costs. “You can have a billion dollars of insurance coverage,” says Gettelman, “but an insurance company can deny coverage because in their mind, inpatient care is not medically necessary.”
The sad facts are that community mental health needs private businesses to build and staff local or regional clinics, but at a financial loss.
Crossing the Divide
While it is the inpatient program that draws most of the attention, Davidson’s outpatient clinic is where many inpatients are referred after discharge. Outpatient services provides the support, medication management, counseling and eventual dismissal after inpatient’s quick stabilization. The outpatient staff is not a seven days on/seven days off team like the inpatient side, but there is one element that glues them together: “Everyone is trained in the methodology of cognitive behavior therapy,” says Gettelman.
This form of therapy has become one of the most widely used therapy approaches in the United States. It rests on the assumption that faulty cognitions—maladaptive beliefs, unrealistic expectations and distorted ways of thinking—are the cause of abnormal behavior. The therapist’s job is to explore and reinterpret thinking errors like “I’ll never get a job,” “The boss invited me to lunch, so I guess I’m going to be fired,” and “Every time I try to have fun it turns into a nightmare.”
Complimenting cognition is a strong behavioral component. The therapist is a teacher, role play leader and social skills trainer. The goal is for patients to unlearn inappropriate cognitions and behaviors and replace them with those that are effective and normal.
Cognitive behavior therapy fits perfectly with the environment Gettelman is attempting to build at Davidson. It reduces the stigma attached to treatment—everyone has unacceptable and strange thoughts—and is respectful of the ways we arrive at our faulty thinking. There is no probing the unconscious or the first five years of life. The emphasis is on thinking and doing in the here and now.
After Davidson is built and operating, what’s next for Carolinas HealthCare Systems? Possibly its most influential and difficult task lies ahead. Gettelman says it is the integration of behavioral health with primary medical care. Only an organization with “HealthCare” and “System” in its name could pull off this much needed paradigm shift.
Dr. Santopietro provides the context for integration: “Up to 70 percent of primary care medical appointments are for issues related to psychosocial concerns. This is especially true for children.” Leaflets concerning depression could be distributed during a child’s annual physical, counselors could be employed by family physicians and pediatricians could link to psychiatrists via telepsychiatry for on-the-spot consultations.
Medicine first put a toe in the waters of behavioral health in the 19th century when the cause of a disease then called “general paralysis of the insane” was discovered. For years the hallucinations, delusions, personality changes and mood swings associated with this disorder were thought to be purely mental and out of reach for traditional medicine. When it was learned that these symptoms were the later stages of syphilis, medicine and behavioral health found at least one common bond.
Over the years, other connections were made, more recently in the area of depression. Others remain to be discovered and implemented.
“There is no health without behavioral health” is more than a mantra or cliché. The two seemingly disparate fields are joined at the brain, not the hip. Integration may be the long-awaited cure for the stigma associated with mental illness and the key to greater behavioral health.
“Hello, Mr. Williams. This is Roger Smith of Acme Widget Company. I sent you an email earlier today about our new product line, and I wanted to follow up to see if you had any questions and if we could find a time when I could stop by to visit.”
Sales reps have been making cold calls for decades, and in many such exchanges, the potential client is more interested in terminating the call than getting more information. If the message were left on a voice mail system, the sales rep might never get a call back. But Roger Smith’s call is going to be different.
Smith knows that his prospect has an interest in the new product line, because Mr. Williams clicked on a hyperlink in Acme Widget’s broadcast email to the company’s online product descriptions. He also knows which specific products Williams looked at, and he knows Williams downloaded a copy of the Acme Widget Engineering Department’s whitepaper on their newest line.
Thanks to a high-quality local business database, Smith knows he’s contacting the right manager, and thanks to an online email lead generation system, he knows his prospect has a genuine interest in the products his company’s trying to sell.
The systems that are helping Smith turn cold calls into warm calls are the refined prospecting tools offered by Business Wise, a 34-year-old business-to-business (B2B) sales and marketing intelligence firm.
Regional and Verified
Business Wise is headquartered in Atlanta, but has set up regional operations in Charlotte and the Dallas-Ft. Worth Metroplex. Company CEO Debra Kline and her late husband, Lyle Leslie, founded the company in 1980. Charlotte operations are located in SouthPark.
Business Wise provides sales and marketing professionals with an online web database that includes key data about the businesses in each local market. These data points include company name, address, and telephone number; estimated sales and number of employees; headquarters location; website; and most importantly, the names, titles and email addresses of the key contacts within each functional area of the company. The database allows a client’s sales reps to identify the right companies to target and who within each company to call.
Business Wise focuses exclusively on the three markets they serve, and this intense local focus allows the company to provide higher quality data, something they say is the key driver of their company culture. Without quality data, companies are wasting both time and money trying to find the right prospects.
“For over 30 years, our top priority has been to ensure the accuracy of our data in the markets we serve,” says Kline. “We’re not shy about saying it: We don’t research everywhere, or have the biggest database…and we don’t want to. We want to provide the best database—with the most trustworthy data—so B2B professionals in our three markets can more reliably generate leads and make sales.”
The database includes information on about 165,000 companies with 315,000 contact names statewide in Georgia, another 120,000 companies and 230,000 contacts in Dallas-Ft. Worth, and about 50,000 companies with about 100,000 contacts in Charlotte metro. For Business Wise, the Charlotte region includes 13 counties in the Charlotte metropolitan area.
The Business Wise research department verifies all company data by telephone on a regular basis. Each company in the database is reviewed at least annually and larger companies that might experience more frequent contact changes are reviewed more often. Business Wise’s local managers are also charged with knowing their markets and keeping the research department apprised of changes in their region. The database is updated nightly and available the next day.
But it wasn’t always this way. The company was founded before the Internet age, so their first products were paper-based hardbound directories. As personal computers began to work their way into business by the early 1990s, the products evolved to personal computers with CD-based delivery. The paper directories were discontinued in 2001, and the company moved exclusively to online Internet access in 2007.
While the basic information provided by Business Wise has not changed over the years, the online format offers new opportunities to identify top prospects more easily and effectively use the company’s proprietary software tools.
Business Wise sells a variety of annual subscription packages at different price levels designed to serve different client needs. The higher tier packages include expanded data exporting capabilities, email marketing capabilities, as well as larger numbers of authorized users.
“We work with clients on about three different levels,” explains Executive Vice President Lee Summey, a 10-year veteran of Business Wise. “Some clients just want to access the information for prospect identification. But other clients want a software tool that allows them to identify their target markets and send marketing emails on an ongoing basis. The third level is our latest marketing automation platform that introduces behavior-based marketing.”
Email Marketing to Marketing Automation
In addition to prospect identification, the Business Wise basic packages allow clients to send “one-at-a-time” emails. This base-level capability simply allows a sales person to follow up a phone call with an email message to the desired contact.
The next level of email marketing is what is often referred to as “batch and blast” emails, where multiple messages are sent over time to a list of prospects. But instead of blasting emails blindly into cyberspace, Business Wise applications allow precise targeting of the message, something they refer to as “drip marketing,” an analogy to drip irrigation systems that water plants with small amounts of water spread over a long period of time.
With drip marketing, a client identifies their target market based on such things as the industry, the size of the company, or the location. Whether the list is 5,000 or 20,000 email addresses, Business Wise and the client then work collaboratively to develop an integrated email marketing plan to approach these prospects on a regular basis with whatever message the client wants to deliver.
While many clients opt for a once-a-month message, others might take a different approach, like sending three or four messages to promote a specific event, such as a seminar. It’s all up to the client, based on their target market and their marketing goals. The Business Wise application then allows the client to accurately measure the response to the messaging.
“The client is able to see not just who opened the email, but who actually clicked on one of the links in the message, which links they clicked on, and what time they clicked,” says Vicky Ray Pace, the company’s area manager for the Charlotte region.
“We tell our clients to log in to the system to see who clicked through and then make follow-up calls based on that list. It basically turns those cold calls into warm calls because they have already shown interest in what you are selling,” explains Pace.
“Within the last three years we’ve probably executed more than 1,500 campaigns and sent somewhere in the neighborhood of 14 million emails across our client base,” adds Summey. “Our clients can monitor deliverability rates, activity and click-through, and they can make changes in their message and get real-time feedback.”
The newest addition for Business Wise is an expanded “marketing automation” offering — a software platform that automates the often-repetitive tasks that comprise an email marketing strategy, such as the timing and targeting of emails. It takes online lead generation to the next level.
While traditional email marketing solutions allow the client to track clicks on a hyperlink, once the client clicks on that link, where they go on the website after that is not tracked after the intial click. Did they just go to that one page and leave? Or did they then visit several other pages, indicating a greater level of interest?
Marketing automation systems provide more information on what a prospect does while on a client website, allowing the sales process to be customized further.
“Companies often refer to this behavior tracking as ‘a lead becoming sales ready,’” says Summey. “They look for certain behavioral things to happen before they consider a lead to be ready for a follow-up sales call.”
Each client can define what “sales ready” means for them. The application uses a scoring system where each client creates scores for certain online behaviors. For example, the frequency with which a prospect returns to the client’s website could be given one score value. Looking at a particular white paper could be given another score value.
Different values are assigned to each behavior, and a prospect whose total score exceeds a certain level, is considered to be sales ready. Once the prospective client is flagged as sales ready, a sales representative is automatically notified that it is time to follow up.
“Repetition in your marketing efforts has always been a key to building name recognition and trust with your future clients,” explains Kline. “Email marketing has proven to be a successful method to touch a targeted audience on an ongoing basis.
“However, most firms are not taking full advantage of email marketing because they don’t have a trustworthy source of email addresses beyond their own client list. This is where Business Wise fills the gap by providing the email addresses of their best prospects and the email systems to deliver their marketing message.”
Best Practices for Greater Success
Marketing automation allows for some very sophisticated direct marketing plans, and can offer the small business owner as much marketing power as a large corporation. But these systems are just enablers. The client still needs to be able to execute those plans, and according to Summey, that is where many companies begin to struggle.
“You’ve got to have great marketing content to go along with your plans, so we spend a lot of time sharing best practices with our clients,” he says. “With the millions of emails that pass through our system, we see what tends to work and what doesn’t, but the exact approach is going to be different in just about every case.”
One of the “best practices” programs the company offers in each local market is the Business Wise Insiders, a series of local networking groups where Business Wise clients and prospects come together to share successful business development ideas.
“It’s not like a typical networking event where you go in and swap business cards and talk or have breakfast,” explains Pace about the Insider events she hosts in Charlotte. “We actually share meaningful content. We’ll have a program and discussion each month on a sales and marketing topic that is of interest to our clients and prospects.”
Pace says that each Business Wise client gets unlimited training, both with the initial purchase, and whenever they need to learn new features or purchase a more feature-rich package. Training is done in person and they also make extensive use of webinars. For larger clients with many users, Business Wise will also come to the client site.
“For most of our clients it’s a crawl, walk, run, and soar process,” admits Summey. “Most clients ramp their way up into using these systems instead of going from zero to 100 mph all at once. There is value that can be gained with each incremental step. Do one thing first and get comfortable with that before moving into the next phase.”
“A lot of things have changed in our business over the last 34 years, but there’s a lot that hasn’t changed, too,” Pace concludes. “Our core business is still producing that high quality data that sales and marketing professionals need to find their next client. There are other data providers out there in the world, but our clients choose to work with Business Wise because the quality of the data is what really matters.”
Robbie Delaney probably wasn’t the first person who ever got an idea for a business while he scanned an in-flight magazine at 30,000 feet. He might not have even been the only one on that particular flight from Texas to North Carolina toying with the idea of starting something new, but the difference is that Delaney got off the plane and did something about it.
Just 27 at the time, with a degree in construction management from East Carolina University and working as a project engineer on a construction job in Texas, Delaney was looking for a way to spend less time on out-of-state job sites and more time in Charlotte with his fiancée, Caroline.
The in-flight article touted the success of craft breweries and predicted that the next logical step in the industry’s evolution would be craft spirits. It gave Delaney an idea—he wanted in on that next wave of success.
Delaney, a beer drinker, got the idea to make rum from his friend, Scott Huff. “But there was a big difference in our intentions,” jokes Delaney. “I wanted to start a business. Scott wanted to learn how to make alcohol.”
The article listed some serious impediments to starting a distillery: huge bond requirements and start up costs that could exceed $200, 000. Originally Delaney thought he might have to find investors but after researching the industry, its regulations and how liquor was made, he changed his mind.
“I realized I didn’t need to buy a still; I could make one,” says Delaney. “There was information online and in books but I really learned how to build it the way I learned carpentry—you look at how things are put together.”
Delaney’s original still held 35 gallons; his new one holds 150. He and his friend Jon Drexler built the new still using mostly reclaimed parts.
“The tank is an old dairy tank,” explains Delaney. “It took about three months to build and cost a fraction of commercially manufactured stills.”
The old still is now a memory, its parts cannibalized for the new one. But Delaney can still remember the day he used the old still to make his first batch of rum.
“We had close to 20 people there and I had my fingers crossed because I’d never even given it a test run so I really didn’t know what the thing was going to do.
“It started to spit and I believe the first batch got up to 85 percent alcohol which was pretty good given I’d never run a still before. Not all of it was great alcohol, but we did get some that was respectable tasting. I said to myself, ‘We can actually do this. This is going to happen.’”
The Work Before the Work
That was February of 2012, but a lot of work preceded that moment. From his years in construction, Delaney was used to obtaining building permits, but nothing prepared him for the paperwork involved in opening a distillery.
“My federal permitting was 78 pages long, mostly handwritten,” says Delaney. “It was the hardest thing I’d ever done. But you can’t even apply for a federal permit until your equipment is at least 90 percent installed, so you have to start locally.”
Delaney found 500 square feet of warehouse space in Belmont’s Riverside Complex. “I moved into a facility but I had to modify it to fit the equipment,” he continues. “I had to get a zoning permit and a building permit to do the needed construction. Once I got a certificate of occupancy from the county, I could install my equipment, and once the equipment was installed, I could start the federal permitting process.”
Delaney turned in his application for federal permitting in November of 2011 and received approval in a record two months. When he received his state permit on February 12, 2012, Muddy River Distillery became the first rum distillery in North Carolina.
In keeping with the state’s colorful moonshining heritage, legal craft distilleries are starting to pop up in many parts of North Carolina. The state’s Alcoholic Beverage Control Commission (ABC) lists 13 distilleries statewide. Perhaps not surprisingly, many are grouped in the western mountain counties best known for their moonshining history.
Delaney welcomes the new competition, preferring to see other craft distillers as a way to help grow the industry. “The craft distillers are trying to band together to influence legislation in much the same way craft beer brewers have gotten together,” says Delaney.
He’s also found camaraderie among others in the growing industry. “When I was starting out, Carolina Distillery, makers of Carriage House Brandy, gave me a lot of help on the regulation and process side,” he continues. “They were a huge influence and welcomed me with open arms into North Carolina spirits.
“Right now there’s a guy who calls me who wants to start his own rum distillery. He’s got his facility and equipment and we talk. We’re friends.”
Delaney appears to have camaraderie and support from many. Neighbor Alternative Beverage helped Delaney source sweeteners. Drexler, who helped him build the still, drew up blueprints for their new facility. Good friends painted walls and Delaney’s mom, a designer, is decorating the front showroom and tasting bar and lounge area.
At 6,100 square feet, the new space, in the same business complex, allows Muddy River space for their free distillery tours and rum tastings as well as room to grow. And while Delaney kept his day job in the first months of business, the only construction he does now is on the new facility.
“We built the floor and the wall behind the still and moved all the plumbing and electrical to behind the wall,” explains Delaney. “This used to be an old dyeing mill and it was a terrible looking place. In fact, before we started fixing it up, the show ‘Homeland’ was looking at it as a location for a torture scene because it was that creepy.”
Delaney doesn’t think it’s creepy anymore and in fact, he slept in a tent in the warehouse a couple of times last week, putting in even longer hours than the usual 16-hour long run days because of increased demand for Muddy River’s latest product.
The company’s first product, Carolina Rum, was launched in early September of 2012. At $19.95 for a 750 milliliter bottle, Delaney describes it as a mid-range white rum. Traditionally, white rum is used for mixing, but Delaney believes that his Carolina Rum brand is sweet and smooth enough for sipping.
Delaney has reinvested revenues from Carolina Rum sales back in to the business, allowing the expansion into the new facility and the development of Muddy River’s latest offering, a dark sipping rum called Queen Charlotte’s Reserve.
Queen Charlotte Reserve is aged in American white oak barrels with a medium char or toast inside and sells for $27.95 per 750 milliliter bottle. To ensure product consistency, Delaney only uses new barrels from the same cooperage for each batch.
Making a Name
Muddy River Distillery is a husband and wife operation. Delaney married his fiancée a year last July and while Caroline Delaney is often the ‘last say’ in quality control, Robbie Delaney defers to her judgment as to what batches pass the final taste test. She is also the sales and marketing side of the company. Those responsibilities include navigating the state’s ABC system.
North Carolina is one of 17 control states. All sale, purchase, transportation, manufacture, consumption and possession of alcohol in the state are controlled by the agency which consists of 165 local boards operating 418 retail stores.
Each board decides what their stores will carry so Caroline, who studied accounting at North Carolina State University, gave up her accounting job and now travels across the state, meeting with and presenting to local boards.
“The biggest thing with ABC is forming a relationship,” explains Caroline. “We tell them that we’re just normal people, not a huge conglomerate. When you’ve met Robbie and me, you’ve met our whole company. Many of the boards understand that and they will make an effort to push our product.”
“We’re in over 300 liquor stores now,” adds Robbie, “mainly in the larger cities like Charlotte, Raleigh and Wilmington, but some of the smaller boards are our biggest promoters.”
Bars and restaurants are also the focus of Caroline’s marketing efforts. Muddy River rums are now served in restaurants around the state including locally at Harry’s Grill and Tavern in Ayrsley, the Dandelion Market downtown, and at Halcyon Restaurant in the Mint Museum.
Alexander Michael’s Restaurant and Tavern and the Corner Pub, only a brief walk from the Delaneys’ home in Fourth Ward, also carry the rums and are big supporters of Muddy River Distillery.
Down the street from the distillery, The String Bean on North Main in Belmont has been carrying Carolina Rum since it was first available.
“We take a lot of pride in selling local beers and wines so when a distillery opened up, we wanted to support them as well,” says Nate Helton, front of house manager and liquor and wine buyer for the String Bean. “We’re unique because we carry so many local items in our market and incorporate local fresh ingredients in our menu. We use Muddy River rums in some of our drinks and the customers really like it. They’re very interested in trying something local.”
The Delaneys have plans for expansion into other states. “We’ve already got the permit for South Carolina sales but marketing in South Carolina is very different because it’s not a control state,” says Robbie. “Most companies work through a broker but we figured we might be too small right now to get much attention from a brokerage. That’s why we created our own brokerage and licensed ourselves to promote our own product.”
The Delaneys are also considering adding a spiced rum to their product line. In the meantime, they’re continuing to get their name out by doing events. They’ve presented at Johnson & Wales University and participated in events in Winston-Salem for the American Culinary Federation of North Carolina and at North Carolina State University’s State Club.
They’re also preparing for the Big Sip Expo in Greensboro this month. The expo showcases the products of local, regional and national beverage makers. Last year, Muddy River Distillery beat out six other distilleries for first place in the spirits category and came in second overall.
Robbie lists the winning day as a highlight for the company but admits that the event, the first for Muddy River Distillery, was intimidating.
“I walked in, looked around and wanted to run away,” he says. “There were companies there that had brought display stills bigger than our real still. They were pulling these things in on trailers and we show up with the display my mom built for us.”
Along with building displays, the Delaneys are thinking about adding an employee. “We need more marketing people,” Robbie explains, “but I really think I can sell my product best, so we’ll probably get someone to distill and I’ll go out and sell with Caroline.”
Ideas of expansion into Virginia and venturing into online sales are discussed but Robbie is clear about what’s most important. “Our goal is to be North Carolina’s rum,” he declares. “When people in North Carolina think of rum, I want them to think of us.”
When the city of Augusta, Ga., began receiving calls from residents complaining of sewer overflows, they were faced with a perplexing problem. The calls seemed to be coming from one area of town, but with over 36,000 feet of sewer pipe in that one drainage basin, they had no idea where the actual blockage was located. As a result, the city utility department would have to clean the entire basin at a cost of over $1.10 per foot.
To the rescue came InfoSense, a Charlotte-based startup that manufactures an innovative acoustic (sound waves) pipe inspection system that can determine exactly which pipes need to be cleaned. Using the InfoSense technology, Augusta spent just three to four days inspecting the pipes in the troubled area and determined that only 1,600 to 2,000 feet of pipe actually needed to be cleaned. The resulting savings from just that single project more than paid for their acquisition of the inspection system.
InfoSense is the outgrowth of a unique development partnership between UNC Charlotte and the Charlotte-Mecklenburg Utility Department (CMUD). The new technology is revolutionizing sewer line maintenance and is an example of how creative collaboration between government, business, and academia can help solve difficult problems.
In 2005, senior administrators and engineers from CMUD held a brainstorming session with the UNC Charlotte Electrical and Computer Engineering Department to discuss how the University might assist in solving a variety of issues faced by the utility. One issue that floated to the top early in the discussions was how to combat sanitary sewer overflows.
CMUD maintains over 4,000 miles of sewer pipe countywide, with over 100,000 individual segments. (A segment is the portion of the system between any two manhole cover access points, with the average segment being about 220 feet long.) CMUD was experiencing roughly one overflow per day somewhere in the system, but with so many miles of pipe and so many segments, the probability that any one section would overflow on any given day was extremely low. As a result, it was almost impossible to predict when and where a problem might occur.
On average, CMUD had been cleaning up to 25 percent of their system annually, or about 1,000 miles. But 70 percent of those 1,000 miles didn’t actually need cleaning; they just had no practical way to inspect the lines. Robotic camera systems were the most common alternative, but the cost to inspect with camera technology was almost the same as just going ahead and cleaning the pipes. So what CMUD wanted was a cost-effective way to figure out which specific segments needed cleaning, so they could focus their efforts on the real problems.
Ivan Howitt was one of the UNC Charlotte engineering professors who participated in that first brainstorming session. After several follow-up meetings, he came up with the concept of using sound waves to determine whether a pipe was dirty or clean. In March 2006, Howitt submitted a proposal for a joint development effort, and the study received funding approval in 2007.
Working with CMUD senior engineer John Fishburne, Howitt and several graduate students began working to explore acoustic technology and to prove whether the concept would actually work. The field environment is difficult because every sewer line looks different, and the variation in the ambient noise levels can be quite significant – very quiet at one spot and incredibly noisy at another.
“One of the things that is somewhat novel about this development is it was actually developed in the field, and we did very little lab experimentation,” says Howitt. “We immediately went into the field because we felt the field environment was going to be so difficult. Actually developing the algorithm in the field is, I think, one of the key reasons why we got it to work. That was the advantage of having access to Charlotte’s system. They were a great resource.”
Once Howitt and his team had proven to themselves that the concept worked, he wrote a National Science Foundation (NSF) grant proposal, which resulted in a funding grant under the Small Business Innovative Research (SBIR) program in 2009. The SBIR grant allowed Howitt to refine his algorithm and to develop a working product.
The system consists of a transmitter placed in one manhole that sends an acoustic signal to a receiver placed down an adjacent manhole. Based on the strength of the signal heard by the receiver, Howitt’s algorithm determines how dirty that pipe segment is, and whether it needs to be cleaned.
CMUD began to see the technology’s real potential, so they agreed to fund a pilot project by purchasing a prototype unit. By the end of 2010, the prototype had been further refined and CMUD purchased four more units. The product would eventually be dubbed the SL-RAT (Sewer Line—Rapid Assessment Tool).
On to Commercialization
The research and development initiative had now morphed into a commercial product, and Howitt knew he needed a company and he needed a team with business experience to complement his technology expertise. So with the help of Paul Wetenhall at UNC Charlotte’s Ben Craig Center business incubator, Howitt began working to commercialize his product. Because the initial development work was done at the university, UNC Charlotte owned the patent, but Howitt was able to negotiate an exclusive license for the new company.
A mutual friend then introduced Howitt to Alex Churchill, who would wind up joining InfoSense in early 2011. Churchill brought financial and business experience gleaned from his years in business consulting and management positions at companies like Blue Rhino and Allied Waste. Churchill was looking for a new entrepreneurial opportunity that he could get involved with from the ground up, and InfoSense seemed to fit the bill perfectly.
“Ivan had enough information to show that camera inspections cost $1 per foot and this product was in the range of $0.10 per foot to operate, so his product looked to be about 1/10 the cost of the alternative,” recalls Churchill. “I also knew he had a customer and they liked what they bought enough to buy more, so I felt this could be a real company.”
Churchill came on board as chief operating officer and immediately began working to refine the marketing and business plan while Howitt continued to refine the product with CMUD. A few months later in July 2011, the third member of the management team, George Selembo, came on board.
Selembo had an extensive background in successful startup companies in businesses ranging from student housing to wastewater treatment equipment. He had retired to Charlotte in 2010 before he even turned 40. Selembo was enjoying life and working as an adjunct faculty member at UNC Charlotte when he had the opportunity to meet Howitt and hear about his product.
Selembo bought stock in InfoSense and offered to work for free for the first six months to see if the new management team had the personal chemistry needed to run a successful new enterprise. They did.
“I had a background in startup companies, but I also knew the challenges Ivan was going to face in bringing a new technology to the wastewater industry,” offers Selembo. “I had been on the treatment side and he was on the collection side, but there’s a similar challenge there for new technology.”
Selembo, who now serves as CEO, helped the new company compete for a variety of grants, which have allowed them to fund their marketing and development efforts without giving up ownership in the company to venture capital firms. InfoSense has won grants from the NC IDEA competition, the Charlotte Chamber’s PowerUp competition, and the Charlotte Venture Challenge.
“Unlike many of the other startup companies, we had a commercial product,” says Selembo. “We actually made something and had a real, viable product, so a lot of the risk was already taken out because we were ready to hit the street and go to market.”
InfoSense officially started marketing in 2012 when they began building a national network of sales reps. The company’s sales network now covers 41 states and has sold over 50 SL-RAT units to customers nationwide. These independent sales reps also sell other products to the sewer industry, so they already had the relationships InfoSense needed to build.
“In this industry, it’s about having connections with the local municipalities,” explains Selembo. “We don’t have the broad product line to support a full-time sales staff, so we outsource sales. But we spend a lot of time supporting and training them.”
Each SL-RAT costs in the neighborhood of $20,000 for the transmitter and receiver combo, plus a carrying case. Components for the system are sourced from suppliers across the country, but all final assembly is done at the InfoSense facility on Tremont Avenue.
Each sales rep firm is provided with a demonstration unit that their reps can use for presentations, because demonstrations have proven to be one of the most effective ways to overcome initial doubts about the new technology. InfoSense says their sales close rate is almost 100 percent, and potential customers include municipalities who choose to do the inspections in-house or contractors who do such work for multiple municipalities.
“We encourage the reps to leave the unit with a customer for a week,” says Churchill. “We suggest they train the customer and let them use it. You can train someone to do this in five minutes.”
The success in Charlotte-Mecklenburg has been the springboard for their success, and they have continually improved the product based upon input from CMUD and other customers. Some of these improvements include GPS-enabling, improved menus, and making the SL-RAT more robust.
“Charlotte has been using the product for two-and-a-half years and they’ve probably done 1.5 million feet of inspections with their five devices,” says Howitt, who is now on leave of absence from UNC Charlotte. “The algorithm has actually been relatively stable over that time, but the operators have trained me on how to make the device more rugged for the environment it’s used in.”
While the initial commercial application for Howitt’s acoustic technology has been in sewer lines, the company believes the technology could find its way into other types of pipelines, including those supplying oil and natural gas.
“The advantage of the sewer systems is there are not a lot of people developing new technology for sewer lines,” says Howitt. “This is the first new technology to revolutionize the collection system operations, and we also see many more opportunities.”
“Ivan has come up with the technology and the patent is very general,” says Selembo. “It applies for applications in all pipelines, and we expect there are going to be other product developments in a lot of other application areas that are going to do very, very well for us. We don’t know what they all are yet, but we have a great, solid flagship product that is supporting all of these activities.”
The support from the Charlotte community, and UNC Charlotte in particular, has been key to the company’s great start and its bright future.
“One of the compelling things about our company is this was all developed in Charlotte,” concludes Selembo. “It’s a public, private, academic partnership that developed this technology. UNC Charlotte finds ways to get things done in this community, and they are cheering you on all the way.”
Where babies come from and the source of our drinking water are two great mysteries of life. We learn quickly enough the answer to the first question. The second lingers unresolved into adulthood and then is largely forgotten.
Groups concerned about H2O think adults need a water wakeup call, some statistic that puts the faucet in our face. Richard C. “Rick” Gaskins Jr., executive director of the Charlotte-based Catawba Riverkeepers Foundation (CRF), has a good one: If present trends continue and we fail to solve our water problems, Mecklenburg County will run out of water by mid-century.
To solve that massive problem—and Gaskins is convinced that it is solvable—the water-drinking public first needs to return to its long unresolved water question: Where does our drinking water come from?
For a few of us, it is the well in the backyard. Lisa Corbitt of Mecklenburg County Groundwater and Wastewater Services estimates that 15 percent of the drinking water in Mecklenburg County comes from wells. Thousands dot the landscape, especially in Mint Hill, Davidson and Paw Creek. Statewide well use is a lot higher. Approximately 50 percent of North Carolina’s drinking water comes from wells according to Corbitt.
For the other 85 percent of Mecklenburg County, the major source of drinking water is the Catawba River. That’s the same Catawba River that topped American Rivers’ list of most endangered rivers in America in 2008 and is currently fifth on the list. Pegged as at risk from coal ash pollution are the drinking water, recreational enjoyment, wildlife habitat and the recreational economy. It is a river under tremendous stress.
“It is important for people to understand that Mecklenburg County is unusually dependent on the Catawba River,” says Gaskins. “Most large urban areas of the United States have multiple river sources of water. But if the Catawba River gets contaminated, where are you going to find that much water? Regardless of whether it’s for drinking or industrial use, the economy starts grinding to a halt if you don’t have plentiful clean water.”
Historically, dependence on the Catawba River water supply went into overdrive during the 20th century. That’s when entrepreneurs realized its vast economic potential. Beginning in 1904 with what is now Lake Wylie, power companies began erecting the first of 14 dams along the 320-mile Catawba River. That process continued until 1963 when the dam at Lake Norman was completed. All of the dams were eventually absorbed into Duke Energy.
The dams created 11 lakes along the Catawba, from Lake James in the mountains to Lake Wateree in South Carolina. An interrupted Catawba helped insure recreation, stimulate economic growth, and increase the fortunes of Duke Energy.
While no one owns the Catawba, Duke Energy manages and controls most of it. A 2006 study found that Duke consumed almost half—48 percent—of all the water taken from the Catawba every day and not returned. In some cases, an individual power plant uses 1.5 billion gallons a day. Yes, billion. Although most of that water is returned to the river, a significant portion evaporates.
“I don’t know of any other river in the country where power plants consume that much water,” says Gaskins.
The water Duke removes is used to cool its three coal-fired and two nuclear power plants before it is returned to the Catawba. In the summertime, the water Duke Energy takes in from the bottom of the Catawba is 68 degrees Fahrenheit; the water it returns can average 103 degrees Fahrenheit.
And what about drinking water?
The water removed from the Catawba River by the 67 city and municipal public water utilities in
Water treatment plants clean and distribute water from the Catawba. After we drain and flush it, waste water treatment plants attempt to decontaminate raw sewage and gray water and, at least in theory, return cleaned water to the Catawba.
Other water consumers are agriculture at 18 percent and industry at a meager two percent. Agriculture in the Catawba basin is not only corn and soy beans, but also sod farms and ornamental nurseries. Instant lawns require a lot of water during their growth and development stages. The reason industry consumption is so low is that only a few industries are permitted to draw water directly from the Catawba. Most
Threats to Clean Water
There are major downsides to having the Catawba River so power-centric. Ash pits are one. Some refer to them as ash ponds, ash lagoons or ash basins. In North Carolina, these pits are unlined, so they are essentially massive holes in the ground where coal combustion waste is dumped. All of these unlined ash pits in North Carolina have contaminated ground water.
After years of inaction, environmental groups this year found a way forward. They threatened a law suit under the Clean Water Act, not once but three times. And it has worked.
In January 2013, the Southern Environmental Law Center (SELC), representing the Sierra Club, the Waterkeeper Alliance and the Western North Carolina Alliance, notified the North Carolina Department of Environment and Natural Resources (NCDENR) of its intention to file suit against Duke Energy for coal ash pollution at its power plant on Lake Julian, near Asheville.
In March 2013, SELC again notified the state that it intended to file a similar suit against Duke for coal ash pollution closer to home, at the Riverbend Steam Station on Mountain Island Lake on the Catawba River. The Catawba Riverkeepers were part of that suit. In June, SELC told the state it intended to sue over pollution on the Cape Fear River near Wilmington.
Finally NCDENR felt the heat. In August 2013, they filed lawsuits seeking injunctions against all of Duke’s coal fired power plants. Every Duke Energy ash pit in North Carolina was included in the state’s action.
“The lawsuits against Duke regarding ash ponds are currently in the preliminary stages,” says Gaskins. “To the best of my knowledge, Duke has not cleaned up any of the ash ponds it owns and certainly not any of its unlined ash ponds on the Catawba River.”
South Carolina Electric and Gas has reacted differently. It has agreed to clean up its ash pond on the Wateree River as a result of the lawsuit filed by SELC on behalf of Catawba Riverkeeper. “SCE&G is ahead of schedule on the cleanup,” says Gaskins.
Power plants, paper companies and industrial polluters are huge, highly visible targets for environmental groups. Going after them makes headlines. In Riverkeeper lingo, they are point sources of pollution.
But it’s the non-point sources that are North Carolina’s greatest polluters. “That’s you and me,” says Gaskins. “We want paved parking lots, big houses with huge roofs, golf courses and lush lawns. That means runoff fertilizers, herbicides, insecticides, toxic chemicals, bacteria and nutrients in our streams and rivers. All have harmful effects on drinking water supplies, recreation, fisheries and wildlife.”
Quantity More Contentious Than Quality
For all its attention in the press, water quality is not the top issue facing our area or the Catawba Riverkeepers. It’s water quantity—how much, not how clean.
Gaskins’ quote about Mecklenburg County running out of water by mid-century is founded on two hypotheses: economic growth in our area and the resulting demand for more water.
“The more parking lots we install, the more oil-contaminated water runs off to creeks and streams, not to the ground underneath the pavement. An inch of rain on a parking lot is producing 26,000 gallons of storm water runoff,” says Gaskins. “That runoff goes into the creeks almost instantaneously as compared to a natural environment where there would be very little runoff and most of the water would soak into the ground, recharging the groundwater table.”
Forests, grass, soil and trees create a steady flow to the river. Parking lots and streets—the consequence of economic growth—create what Gaskins calls “flashy flows.”
“To stop flashy flows, developers could, if we had the political will to demand it, create retention ponds next to the asphalt. Or put tanks underground to hold back the first three inches of a rain shower. It’s doable,” says Gaskins.
Economic growth will also drive demand for more power and thus more water. Gaskins’ solution: water conservation by Duke Energy. But what incentive is there for Duke Energy to conserve? It draws the water from the Catawba River at no cost. Even minimal conservation would not be cost-justified in a harsh economic world.
“If you have to spend a penny to save a gallon of water, it is costing Duke Energy money,” says Gaskins.
One of the most contentious issues facing the area is demand that comes in the form of inter-basin transfers or IBT. In 2002, the prolonged drought and expanded economic wealth led the cities of Concord and Kannapolis to request additional water from the Catawba River and the Yadkin-Pee Dee basin.
The cities wanted to withdraw a maximum of 36 million gallons per day from the Catawba River. All their drinking water came from three lakes where the combined draw was approximately 14 million gallons per day. After years of litigation, a settlement was worked out between the towns and Catawba Riverkeeper.
“We have a template for settling these issues,” says Gaskins. “It’s water conservation.” The cities that want to tap into the Catawba River have to institute water conservation programs. One such measure was that the cities require low flow plumbing fixtures in their building codes.
The result was that neither
Like non-profits everywhere, Catawba Riverkeepers Foundation has more mission than money. In round numbers, they raise around $300,000 each year with an additional $100,000 of in-kind donations from advocacy groups with a similar mission.
With those funds it hosts a soon-to-be revamped website, a newsletter, and designated Clean Up Days on the river. The group trains Citizen Patrols to identify sediment and erosion violations at construction sites. There is also a Youth Kayaking Program to get young people on the river.
“Once citizens see the problem through aerial photos or by kayak trips or field trips, they get it,” says Gaskins. “If they see pollution, they’ll be convinced.”
Gaskins and his staff are advocates for the Catawba. They speak out for its welfare at public hearings, in court and with public officials.
Chief among their allies are the Southern Environmental Law Center and the North Carolina Conservation Network. Donations from individuals and organizations make up 94 percent of CRF’s cash income. Grants and investment earnings bring in the other six percent.
The foundation came into existence as a result of concern among groups in the region that no entity was focused on the Catawba River. Local governments joined in and with the help of the Foundation for the Carolinas, the Catawba Riverkeepers was formed in 1997. The first Riverkeeper was hired in 1998.
Catawba River Foundation also relies on a cadre of volunteers stationed throughout the region. Some take an active role in serving as the Riverkeeper’s eyes and nose. Known as Lakekeepers, Covekeepers, Water Watchers and Steam Watchers, they are on the lookout for pollution. These volunteers regularly report their observations to the sole Riverkeeper on the payroll, Sam Perkins.
It is Perkins, known for his beagle-like inquisitiveness, who explores, samples and tests the waters and environs along the entire
Perkins also trains and supervises volunteers and educates the public on water issues. Perkins’ background seems ideal for this work. He has bachelor’s degrees in journalism and environmental studies as well as a master’s of science in environmental studies, all from the University of North Carolina at Chapel Hill.
Gaskins comes to his role as the
Before coming to Catawba Riverkeepers Foundation, Gaskins was in private practice as an environmental attorney. His resume includes past chair of the Environmental and Natural Resources Law section of the North Carolina Bar Association and past vice chair of the American Bar Association’s Toxic Torts and Environmental Litigation committee. One writer has described him as “a walking encyclopedia on toxic torts and environmental litigation.” He is the organization’s fifth director.
Though faced with the ever contentious issues involved with protecting water quantity, water quality and water security, Gaskins and Perkins are optimistic about the future.
“Everybody gets water,” says Gaskins. “Ultimately, people want clean water to drink and to swim in. They want to eat the fish they catch. With water, it’s us. We are causing the problem.”
On November 18, 2013, Mecklenburg County Superior Court ruled that the Catawba Riverkeepers deserve a seat at the table when the state negotiates with Duke Energy on the ash pond issue. The Riverkeepers are not in favor of a slap on the wrist, a small fine and a sweetheart promise to do better.
Perkins wants results: “We will work to see that Duke energy’s toxic coal ash in cleaned up.”
Like the Lorax in the Dr. Seuss classic, the Catawba Riverkeepers speak for the river.
Photo by Fenix Foto
A scan of business announcements of new presidents, chief executives, and appointments to boards of directors in industries as diverse as distribution, higher education, supermarket retail and health care will often turn up something in common—Coleman Lew + Associates were involved in the placement.
Charlotte-based Coleman Lew + Associates is a high-end, international, retained executive search and leadership development firm. “Our core competency is identifying, evaluating and recruiting leaders for our clients,” explains Kenneth D. Carrick Jr., president of Coleman Lew.
The firm’s mantra is “Opportunity is an open chair,” and they’ve taken advantage of quite a few as Charlotte’s largest placement firm. They are adept in executive search and leadership development, networking globally to scout and recruit the best hires. Serving a widely diverse roster of public, private, non-profit and international clients for over three decades, they’ve more than shown the complement of that mantra, “Nobody can fill our chair.”
A Generalist Approach
“We help our clients solve a leadership need,” explains Carrick. “For whatever reason, whether it be retirement, promotion, attrition, reorganization, termination or starting something new, our clients have a leadership need and we can think creatively and help them in recruiting and evaluating those leaders. We do it in a consultative capacity. We’re a partner to our clients.”
Carrick, who graduated summa cum laude with a bachelor’s degree from Catawba College and an MBA from Wake Forest University, has been with the firm for 28 years and has conducted over 200 executive searches, developing a strong client base in retail, manufacturing, education, non-profits, banking and energy.
Other focus industries for the firm include health care, distribution, construction, government and financial services but as founder and chairman Charles E. (Chuck) Lew states, “There are no limits as to what industry we can assist. As long as we understand the business or entity, we’re comfortable working with them.”
Because they serve a multitude of industries, Coleman Lew is considered a generalist firm but it began in 1979 specializing in searches for the food retail and food distribution industries.
Lew, who earned a bachelor’s degree from The Ohio State University and pursued graduate studies at
When he decided to start his own firm, Lew looked at the Southeast and Southwest as potential locations. Tampa/St. Petersburg, Birmingham, Richmond, Nashville and New Orleans were all under consideration, but one visit to Charlotte made the decision.
“I came to Charlotte first,” says Lew. “I’d never been here before in my life but I drove here with my wife and her sister and it looked like a really nice place to live. We never even looked at another city.
“Charlotte also had the best statistics,” Lew continues. “Back in 1979, there were 5.2 million people within a 200-mile radius of Charlotte and cities like Greensboro, Winston-Salem, Columbia, Greenville or the Raleigh/Durham/Chapel Hill area preferred to do business in Charlotte over Atlanta or Philadelphia, so it was actually a large market.”
Coleman Lew’s transition to a generalist firm began 17 years ago, spawned from need, organic evolution and intentional design.
Lew explains, “We had clients all over the country in the food retail and food distribution industries but we had too many clients in certain sectors and the industry was consolidating. Since we don’t recruit from our clients, that shrunk our pool of candidates.”
Some diversification grew from existing business. “Our retail and food distribution business led us to other parts of distribution,” says Carrick, “and manufacturers who hired us for our expertise in distribution would then hire us for searches in manufacturing.”
The purchase of another search firm specializing in banking and nonprofit brought those industries on board and the move into higher education was strategic and purposeful.
Both Lew and Carrick agree there are distinct advantages to being a generalist firm. “For high level positions like the next CEO of a business, you not only want to look in that industry but you want to look at ‘out of the box’ candidates from an adjacent industry or even someone with an entirely different background,” Lew explains. “Some specialized firms act almost like clearing houses where they’re placing people that have the same set of experiences and there’s no value added.
“We’ve done some searches where there is no one logical place to source candidates and so our expertise is consulting with a company or a board and figuring out what they want and where that person might come from.”
“An example might be a search for a college president,” adds Carrick. “The traditional path to college president is through the academic ranks. That would be where a specialist firm would focus. But in searches that we’ve managed, we try to think as broadly as possible. For instance, one college hired a company CEO who had a Ph.D. and another hired a fundraiser from a major university.”
“This happens a fair amount of the time, especially at high level positions,” Lew adds.
Each Search is Unique
No matter the search, it all begins with the client. “We have to know the client, their culture, what they want in a leader,” Carrick says. “It’s much more than just getting a position description. The technical expertise of a person is only a small part of whether a person is successful in a new position. They have to be able to fit and work within the culture. You have to define all that up front. Our first step with any client is listening to them and understanding.”
After fully understanding the need, Coleman Lew uses a proactive approach to identify people to meet the client’s goal followed by a comprehensive evaluation phase before candidates are presented to a client.
“We conduct an historical interview where we walk somebody through their life,” explains Lew. “We find out where they’re from, how they grew up, why they decided to go to a particular college and if they’ve made position changes, why they occurred.”
“We deal with the most complex element in an organization—their people, so instead of just looking at a snapshot like a resume, we create a movie,” Carrick says. “When we present a candidate, we give the client an executive summary. We also provide a written evaluation of seven different areas of pertinent information that the client may not pick up from just reading the resume and we spend time verbally covering each candidate with a client. We can also offer personality profiles as additional information on candidates.
“Our disciplined, thorough process allows the client to make a more informed and better choice to meet their objective than they would have been able to do on their own.
“If we do our job correctly, by the time our clients get to their finalists, all of them will have the skills to do the job. It’s then a matter of who they think fits best in their organization.”
After completing the initial vetting, Coleman Lew presents a select group of candidates who meet as closely as possible the client’s objectives and then moves into an advisory role to help clients in their own evaluation process, checking backgrounds and references and assisting in crafting the offer.
Coleman Lew is proud of their success rate. Industry-wide, only about 60 to 65 percent of searches are ever completed. Coleman Lew greatly exceeds that with completed searches at 92 to 93 percent. Lew credits their success to “people and process.”
“What we sell is our service and our judgment,” adds Carrick. “We have always been a ‘high touch’ organization. Our focus has always, unwaveringly, been on quality and that’s reflected in our business.”
Coleman Lew’s focus on quality is reflected in their involvement in The Association of Executive Search Consultants (AESC). In 2010, Carrick was selected to be director of the Americas for the elite association that represents the top 250 search firms in the world.
“We adhere to the highest standards in the industry,” Carrick continues. “That is one of the reasons about 85 percent of our business is either repeat or referrals from an existing client. We have longstanding relationships with our clients.”
Coleman Lew’s longest current client relationship dates back over 30 years. Boyd L. George is the third generation and chairman and CEO of Alex Lee Inc., the largest privately-owned food services company in the Southeast. Alex Lee subsidiaries include Merchants Distributors Inc. and the retail supermarket chain, Lowes Food Stores.
George remembers his relationship with Coleman Lew began with a cold call from Lew in 1979. “Our first search with the company was for an industrial engineer,” George recalls. “We’ve been very pleased with their service over the years. That’s why we use them today and will continue to use them. It’s been a good association for us.”
Positioning for the Future
While Coleman Lew’s core business is executive search, they understand that hiring the right person for a position is only part of the challenge facing companies. This prompted them to expand into leadership development to foster the vitality and long term success of an organization.
Coleman Lew provides new leader integration, team development and executive coaching services to maximize employees’ potential, and executive assessment to identify and develop leaders within an organization.
Their planning services help companies refine goals, strengthen their brand and strategically position themselves for the future.
Coleman Lew also offers succession planning services assisting companies to successfully navigate leadership transitions. In this case, Coleman Lew not only offers this service but is actively using it themselves as they prepare for what Lew calls the “third generation” of the company.
“A big part of our business is helping clients move into the future,” says Lew. “It’s important for us too. We’re currently in the process of succession planning and we’ve brought in some very high-powered, very competent young people to take us into the future.”
Shana Plott, Laura C. Thomas and Danielle F. (Dany) Williams are Coleman Lew’s third generation. While the search business has traditionally been male-dominated, Coleman Lew is in the forefront of the trend toward women in industry leadership roles.
“We’ve seen a greater focus on recruiting women as board members and top executives,” says Plott, a graduate of the University of North Carolina at Chapel Hill whose background includes 20 years in the search industry and non-profit sector.
“More clients are specifically requesting a diverse slate of candidates,” adds Williams who joined the firm seven years ago as a researcher. Williams graduated Phi Beta Kappa, magna cum laude with a bachelor’s degree from the University of South Carolina Honors College. Her J.D. from the University of South Carolina Law School and experience as a litigation attorney has translated well to interviewing and assessing candidates.
“Digital media is another new trend for our clients,” says Thomas, a graduate of the University of North Carolina at Chapel Hill, who assisted in founding a charter school and worked as a top sales representative in the manufacturing industry before joining Coleman Lew.
“Not only is technology changing the world of search, it’s also changing what companies need to compete. Our clients have to reach their customers in a different way now. They need people that understand ‘big data’. It’s an example of how we can help our clients by articulating and designing what this talent looks like and how to find it,” adds Thomas.
Plott, Thomas and Williams all acknowledge that as their clients’ business has grown more global, executive search has become an international endeavor.
“Many would describe us as a boutique firm and that sounds as if we’re just local and limited,” says Williams. “But that isn’t the case. In a recent search we had a $4 billion European company looking for a person to run their facility that produced wire and cable for nuclear submarines.
“Through Skype I interviewed people in Belgium, Australia, India and many other places around the world. Few people had the expertise for the position. It was a challenge but also fun to be able to put that puzzle together.”
To assist in international searches, Coleman Lew has partnered with Penrhyn International. Penrhyn is a global consortium of premier retained executive search firms that can cooperate on international assignments.
Thomas is finishing up a search in which she assisted a Penrhyn associate firm in Amsterdam to fill a U.S. position for a company headquartered in Brussels. Soon she’ll request the assistance of their Penrhyn contact in China to find someone to oversee manufacturing and suppliers in China for a Carolinas-based apparel company.
Coleman Lew’s third generation feels well-prepared for whatever the future holds. “Chuck and Ken and others have built a phenomenal firm,” Plott says. “The onus is on us to ensure that their standards of excellence continue. The bar is set very high but we will make sure that our commitment to quality and client service continues.”
Angela Overcash and Robbi Jones couldn’t be more different. One is a chemist; the other an office, accounting and project manager. One loves science; the other business.
“I’ve never had a chemistry class in my life,” says Jones, president and project manager. “But I’ve learned a lot. It all makes sense to me on paper, just don’t put me in the lab.” Overcash also serves as a project manager, but on the science side, and is the liaison between the laboratory and the client.
Together they own and run Charlotte-based Prism Laboratories, Inc., a water and soil analysis company formed in 1992. “We were from different walks of life but each of us had something to bring to the table,” says Overcash.
Overcash is originally from Kannapolis. She graduated from Duke University with a degree in chemistry in 1986 and worked with CompuChem prior to coming to Charlotte. Jones is from Marietta, Ohio, and came to Charlotte at the age of 19. She attended Queens College in Charlotte.
Their paths crossed in 1987 when Overcash joined a water analysis laboratory where Jones was working. Within five years, Jones and Overcash, along with five others, owned the company. A name change to Prism Laboratories, Inc. completed the deal.
Over the years, two of the owners left the company and Jones and Overcash bought out the remaining three. By 2006, it was just the two of them in partnership.
Through the Looking Glass
Prism Laboratories provides analytical services for drinking water, storm water, waste water, soil, hazardous wastes and brown fields. Prism Laboratories staff also test the effectiveness of remedial action and trace problems back to their sources. The company is comprised of an integrated team of environmental and administrative professionals organized to serve the analytical needs of the consulting and industrial communities.
Most clients are permitted through the City of Charlotte and various other cities and counties, for example: builders, engineers, environmental consultants and homeowners. Clients include Duke Energy, Charlotte Mecklenburg Utilities Department, Colonial Pipeline, Zapata Engineering, Ashland Chemical Company and Georgia Pacific.
Prism Laboratories is currently certified throughout the Southeast and is NELAC-accredited through the state of Florida. The laboratory is ISO certified for DoD analysis.
“We frequently get calls from builders saying, ‘We’ve got a hole in the ground and we need to know if there’s anything (bad) in it,’” says Overcash. “It stalls their crews, so it is costly and they want the information fast.”
“People also call with health concerns or feeling sick, worried about the safety of their wells,” adds Jones. “Additionally, we do a lot of work in conjunction with home sales, where bacteria testing is usually required by the bank.”
Typically, Prism Laboratories staff will be looking for coliform bacteria, a group of toxic types of bacteria in water that can make people sick. The lab looks specifically for fecal coliforms. “You don’t want to be drinking water with that in it,” says Jones.
Prism Laboratories educates people how to cleanse their wells through chlorination and with the use of ultra-violet lights and water softeners. Not all substances are harmful to people. The presence of some leads to hard water that limits the lather and suds and effectiveness of soaps. Others may build up in pipes over time.
Overcash says she is often amazed: “The federal regulations on ground water regarding what is allowed are extremely low, measured in parts per billion or even trillion gallons of water. Still, we see ground water where toxins are so concentrated, you can see inches of layers in the water sample with your naked eye.”
An example would be the chemical tetrachloryl used in dry cleaning. Much of the toxic substances are found in landfills or from industries that had pits behind them prior to regulations. Many of them dumped waste into a creek or river which carried it into the groundwater. It is known that ground water flows through aquifers and, over long periods of time, around the world.
Every kind of industry produces wastes that could ultimately end up in the water supply. In the food industry, for example, there are lots of sugar and oils. Concentrated sugar is harmful for people but it also creates an imbalance that may cause algae to grow or prevent sunlight from entering a body of water. Prism Laboratories tests for oil and grease for every industry.
They also typically test for eight RCRA heavy metals: arsenic, selenium, cadmium, barium, chromium, lead, silver and mercury. These are all metals that, if ingested, will forever remain in the human body. PCBs also do not degrade. Some water contains salts that are so heavy that they solidify or solids such as shreds of paper.
In Charlotte, testing of soil is common where there are rusty, leaking home oil tanks.
Prism Laboratories recently completed a large project to clean up a pesticide named dieldrin from a large property site that was up for sale. A lot of pesticides and herbicides are now banned but still remain in the environment. For example, toluene, used in making glues, tape, paint, gasoline and cleaning solvents is a terrible carcinogen that is still seen at significant levels.
The company also screens for conflict metals, those mined only in the Congo using child and slave labor that are used in textiles. The U.S. has banned these metals but has to test to make sure that they are not coming into the country illegally in the form of curtains and upholstery material and the like. It is a similar situation with sulphur in sheetrock coming in from China.
“All industries have some kind of wastewater prior to going to the local wastewater treatment plant. We test water going into (influent) and coming out (effluent) of the wastewater treatment plant,” says Overcash. “Sometimes we are asked to trace the material back to the industry source.”
Prism Laboratories does not have to report their findings to any body of government. “That’s up to the consultants and their clients,” says Overcash They do, however, have to report findings when drinking water is supplied to the public such as in a mobile home park or a school outside of the city limits.
Prism Laboratories also works with brown fields, places such as towns or industrial companies that have gone bankrupt or where the owner has died and there is no direct source of funds to clean up the property. Federal funds exist for this purpose of restoring properties that are meaningful to the community such as public parks.
Prism Laboratories, a $3-plus million dollar company, has reached several benchmarks in the past 21 years. A significant one came in 2006 when the company purchased a second building.
“We outgrew our first building, so when the computer service business next door decided to sell, it was like manna from heaven,” remembers Jones. Having two buildings has allowed the company to separate functions: offices are on the main floor of the more newly acquired building; volatile labs are downstairs, and there is a separate clean room for low-level mercury and other low-level metals.
The analytical laboratory consists of four departments: Metals, Wet Chemistry, Semi-Volatiles and Volatiles. The 15,000-square-foot facility is equipped with the latest instrumentation and technology for environmental analyses. “All we need now is a covered walkway between the two buildings,” jokes Jones.
Then, in 2010, the company switched to a state-of-the-art data handling system known as an ELEMENT Laboratory Management and Information System (LIMS).
“For years, scientists and lab technicians had to key in test results, a very time-consuming task,” says Overcash. “Now, the data system can receive the data directly from the instrumentation. We just had to prove that nothing got transcribed in the process. As soon as a test runs, we can see the status of samples. It has really impacted operations and efficiency.”
Jones also cites the company’s recently redesigned website which allows clients to track samples: “Clients can see their historical data which is extremely useful for them. In the future, we’ll head for the cloud,” says Jones.
Success has been accompanied by some challenges, according to the partners. “The ups and downs of the business—not knowing when business is coming is the main thing,” says Jones.
“Real estate transactions drive a lot of what we do. We were seriously impacted for about a year and a half during the 2008-2011 recession,” says Jones. The company weathered the economic downturn with a line of credit, personal loans, tightening up the budget and taking a hard look at expenses. “There were a few people who left during that time whom we did not replace, but we didn’t actually have any layoffs,” says Jones.
Another challenge for Prism Laboratories is the demand for speed. “Rarely do you have a long lead time to do the samples,” says Overcash. “It used to be a 10-day turnaround; now clients want results in five. It’s a struggle because our competition is bigger and can be quicker but we have, nevertheless, done a good job. So we took a good long look at our production line for ways to tighten it up.”
“Science-minded people don’t like to be rushed, in particular, which is good,” says Overcash. “Sometimes we have to ask clients, ‘Do you want quality or speed?’ We don’t ever overlook something because the client is in a hurry, but we try to understand that they are often in a tough spot, sitting there with equipment and crews costing them by the minute.
“Quality control is extremely tight. Anything can happen to cause us to have to do it over. Being a small business, it’s a high pressure atmosphere. We don’t compete with smaller labs; we compete with large ones,” continues Overcash.
“Many small laboratories get absorbed by large enterprises. It’s a challenge to stay independent. On the other hand, we can offer a better quality of service because we’re small,” adds Jones, citing the ability to make decisions and change directions in-house.
Laboratories are often frustrated with Environmental Protection Agency (EPA) regulations that are unachievable. “The EPA figures out the level of a chemical or substance that will harm human beings and request tests that reflect those levels. The problem is that there is no technology and instrumentation available to test for that level,” says Jones.
Prism Laboratories’ 34 employees include laboratory technicians, field technicians, project and quality control managers. One of the most important jobs is sample receiving due to short testing times. All laboratory staff have either an associates or bachelors degree in a science.
“We have a mix of employees who were hired at entry level and trained up and those who came in with previous experience,” says Overcash.” On the business side, there is a controller, an IT director and sales staff.
“Employees who handle samples are OSHA trained and put through Prism Laboratories’ own safety training program as well. Samples are treated with worst case scenarios in mind. Lab coats, gloves and leather shoes are standard.”
“It’s a fast-paced culture,” says Jones. “We never know what’s coming through the door.”
On the Prism Laboratories agenda are efforts to increase the company’s work with the U.S. Department of Defense. “With these larger consultant groups, contracts are often awarded for three years, something that would enable us to plan ahead,” says Overcash. The work typically involves cleaning up old military bases.
In response to the constant push for greater sensitivity, Jones and Overcash will soon make a couple of major equipment purchases—an inductively coupled plasma (ICP) mass spectrometer (“a hot fire is what that is,” says Overcash) and an electric conductivity detector (ECD). The ICP mass spectrometer burns metals and puts them in their elemental state.
“It knows the mass of a chemical without us having to figure it out,” says Overcash. The ECD tests for pesticides and PCBs. “Equipment and instrumentation is getting more and more sensitive. It’s like computers and smart phones—there’s always a better one coming out,” says Jones.
Together, the partners plan to maintain a cutting-edge laboratory.
Few, if any, could have imagined the advances and changes in health care and medicine that have occurred over the last century. The innovation, invention, improvement, discovery and development related to diagnostics, treatments, drug therapies, techniques and cures have been extraordinary.
Fewer still may have anticipated health care delivery systems driven by health insurance, Medicare and Medicaid, or that today professionals and consumers alike would be working hard to wrap their heads around complex changes including those being brought about by the Affordable Care Act (ACA).
Nevertheless, at any given time, there have been individuals and groups whose foresight and determination have propelled health care forward for future generations.
Among them, in 1923, were Doctors James P. Matheson, Clarence N. Peeler, and Henry L. Sloan Sr. who established the 37-bed multispecialty group, Charlotte Eye Ear and Throat Hospital (CEET) on Seventh Street in downtown Charlotte. At the time, treatment of the eye, ear and throat was a single specialty, and the hospital was the first of its kind in the nation.
“There are not many practices in the entire nation that are 90 years old,” attests Jag Gill, CEO of the now-named Charlotte Eye, Ear, Nose & Throat, P.A. (CEENTA).
CEENTA has spent a little short of a century growing its practice from three to 74 physicians; from one office to 15 offices scattered across the extended Charlotte metropolitan region. Its staff is now 600-strong and cares for millions of patients each year. Combined, the offices form a tertiary center amid Charlotte’s two major hospital systems: Carolinas HealthCare System and Novant Health.
CEENTA offers a broad range of services that include eye care; ear, nose and throat care (ENT); audiology; sleep medicine; allergy; facial plastics; voice and swallowing care; and optical and contacts.
Its subspecialties include otology, neurotology, adult and pediatric otolaryngology, vitreoretinal diseases and surgery, glaucoma management and surgery, neuro-ophthalmology, pediatric ophthalmology, oculoplastics, corneal and refractive surgery, and more.
The group offers treatments around cochlear implants, ear tube surgery, hearing disorders, hearing aid services, voice disorders, sleep apnea, allergies, comprehensive ophthalmology (including cataract surgery), and optometric eye care, among others.
“We cover all of the subspecialties of ENT that you would get in a university or academic center,” says Steven Gold, M.D., CEENTA’s chairman and president on the ENT side. “There’s really almost nothing we need to refer elsewhere. It’s the same in ophthalmology.”
The practice is expected to reach $100 million in revenue this year. Growth has been steady over the years at a rate of approximately five percent.
Assuring Quality Outcomes
Still, the large and growing practice is not immune to the uncertainty that is currently the mood of health care.
“These are turbulent times in health care,” says Andrew N. Antoszyk, M.D., president of the ophthalmology side of CEENTA. “There is a lot of confusion right now as the ACA rolls out. What coverage will be available and to whom? What does a plan include or exclude? What impact will the ACA have on hospitals, physician practices and reimbursement policies? We don’t have all the answers right now.”
Drs. Gill, Gold and Antoszyk all agree, however, in the group’s philosophy and strategic plan.
“With all the confusion with insurance companies and the ACA, there are a lot of things out of our control,” explains Gold. “But we remain firmly in control of our commitment to providing the absolute best eye and ENT care, the most compassionate care possible to the whole region.” Gold says that there is not a companywide statement or consensus regarding the ACA, but “with 70 physicians, there is certainly a diversity of opinions.”
In general terms, the Affordable Care Act calls for reforms to reduce the inordinate rise in health care costs while maintaining quality, provide access to health care to millions of uninsured Americans, utilize Accountable Care Organizations (ACOs) to provide coordinated care, create transparency of costs, employ uniform electronic medial records, shift the paradigm of health care to one of wellness, establish metrics for quality health care and outcomes, and to construct formulas for value-driven reimbursements to providers.
While most of these initiatives will first, and most directly, be driven through primary care providers, specialists will also be increasingly impacted.
“Access is important,” stresses Gold. “There are still lots of people who slip through the cracks and don’t have health coverage. The bottom line, with the start of the ACA, is that supposedly there will be millions of people who become covered. That will be a good thing. If the ACA can deliver on its promise of providing affordable insurance to all, we at CEENTA see this as a positive.” However, both Drs. Antoszyk and Gold agree that it is unclear how this is going to transpire without spending more money.
“Value-based reimbursement for providers is something that will be here,” says Gill. “Before it gets here, we have to figure out how to measure value—what quality metrics should we be measuring?”
“The quality measures that are out there now are check boxes put into a computer about what was and wasn’t done. It doesn’t really tell you much about outcomes,” explains Gold. “It’s very difficult to tell how well someone is or if one patient with diabetes is getting better care than another patient with diabetes.”
While the CEENTA execs admit that there is a long road ahead, the firm has begun this work and considers itself to be a leader among private practices. “We collect data on outcomes, conduct peer review on cases, and go over film and CT scans and compare to operative reports. Most private groups are not yet doing this,” says Gold.
“One of the most important things we have to do is determine which quality care metrics we need to measure, then come up with a robust IT system to measure that data and get it to the payors,” says Gill.
Operating the Practice
The combined education, training and experience of CEENTA physicians is beyond impressive.
Gold completed medical training at Boston University School of Medicine in 1982, followed by residency at Naval Hospital in San Diego. His fellowship was through the University of Pittsburgh.
Antoszyk received his medical degree from New York Medical College in 1983, followed by internship, residency and fellowship at Duke University Eye Center.
Gill, new this year, came to CEENTA from Dignity Health’s Medical Foundation in California where he was president and CEO. He holds a master’s degree in Health Administration from the University of Missouri and a doctorate of science in Health Systems Management from Tulane University.
CEENTA operates under a 10-physician board of directors, five from each specialty. The board directs the administration while the administration presents ideas and proposals to the board.
The CEENTA staff is comprised of physicians, audiologists, optometrists, physicians’ assistants, nurse practioners and sleep and voice specialists as well as a chief executive officer and chief operating officer and employees in marketing, accounting, human resources, IT and electronic medical records (EMR).
“The culture here is one of collegiality and patient-first focus,” affirms Gill. “That is one reason I accepted this position. As long as we put the patient first, things always come out well in the end.”
New physicians are most often recruited by current physicians as well as from small groups looking to join a larger group, especially those without EMR systems. CEENTA remains open to considering practices who are interested in joining them.
“Keeping quality employees is always a challenge,” adds Antoszyk, “but we have developed a comprehensive employee package including generous salary and benefits, flexible working hours, continuing education and health care coverage that has been instrumental in helping us retain outstanding employees.”
According to Antoszyk, the goal is to operate in a more efficient manner since 80 percent of costs are fixed: “The recipe is simple: accommodate more patients in a timely and efficient manner. We plan to address this by hiring more providers and placing them in offices close to where patients live or work so that they can be seen quickly with reduced wait time. This increased volume will allow us to enhance productivity through more efficient use of our facilities and staff.”
“Costs are going up—inflation, increases in equipment costs, rent, utilities, salaries and benefits—areas every business has to contend with including health care,” continues Gill. “We are constantly striving to provide the highest quality patient care in a caring environment and we believe we are able to succeed because we have a compassionate and caring administration and staff that supports our outstanding clinicians.”
“Things can change quickly in health care but we have a three-year strategic plan,” Gill maintains. “We want to grow, provide quality care, measure and report that quality, and remain an independent practice.”
Innovation and Invention
In 1992, CEENTA started its own research department to coordinate Phase I-IV ophthalmology and otolaryngology clinical trials. The department grew into Southeast Clinical Research Associates where CEENTA physicians further studies in age-related macular degeneration, retinal vein occlusion, diabetic eye disease, macular edema, glaucoma, cataracts, dry eye, uveitis, chronic sinusitis, nasal polyps, Meniere’s disease, and otitis media.
“We are now heavily into clinical research, doing trials with pharmaceutical companies and the National Eye Institute,” describes Antoszyk. “We are particularly proud of our collaboration with Diabetic Retinopathy Clinical Research Network (DRCRnet) which has yielded ground-breaking treatments in the management of diabeth retinopathy and has been lauded by Congress on numerous occasions.
“This network is a unique collaboration between academic institutions and private practices that identifies clinically relevant problems and then develops protocols to answer the questions.
“One DRCR study—Protocol I—has completely changed how we manage diabetics with diabetic macular edema,” continues Antoszyk.
Innovation and invention are not new to the practice. In 1952, it was Dr. Beverly Armstrong of the firm who invented the tympanostomy, or ear tube and surgery, the most common surgical procedure performed on children in the United States that requires anesthesia. The design of the tube and the procedure remain the same today.
Relationship with the Community
Critical to CEENTA are the relationships its physicians have with the region’s two health care systems, Carolinas HealthCare System and Novant Health.
“It can be difficult to maintain a balance while affiliated with each of them,” says Antoszyk. “We must consider each decision with regard to the impact it will have on one or the other hospital system. Our goal is to provide surgical and medical support to both hospitals while remaining independent.”
CEENTA also takes part in the training of doctors with medical students and residents coming through on rotation. “We work with UNC Hospitals through Carolinas HealthCare System where they have a campus for third and fourth year medical students,” explains Gold.
Antoszyk continues, “Our focus is on providing quality care for all the senses above the neck, but we’re also very involved with giving back to the community.
“Through CEENTA Cares, the firm has been able to make a difference in the community, volunteering staff time, talents and energy to projects like Second Harvest, Habitat for Humanity and Wounded Warriors.”
One of the firm’s recent projects was dubbed “Runnin’ Up Rainier,” led by Dr. Scott Jaben. Last year, he had suffered a back injury that prevented him in his attempt to climb Mount Rainier, the second highest peak in the Pacific coast range. So, as part of his training to reattempt the climb, he started his virtual climb of the 25,000 stair steps via the stairs at the SouthPark office.
He invited employees and acquaintances to join with him from home, office or gym, with a goal of raising $50,000 for the Wounded Warrior Project.
“For those at the SouthPark office, that meant five daily trips up the stairs for the three months of the fundraiser,” says Antoszyk, “building strength, stamina and character, but more importantly, contributing to the community on behalf of the firm.”
Another of the firm’s projects, the CEENTA Cares Walking Team, recently raised $3,375 for the Charlotte VisionWalk supporting the Foundation for Fighting Blindness.
“Our staff is very active in community service and we foster that,” attests Gill.
It’s flu season and Paul Walker is leery about getting a flu shot. At 75 and with a history of heart disease, the Kannapolis retiree knows he should participate in the annual roll-up-your-sleeve ritual. But Walker remembers his first flu shot in the 1970s. Three days later, he came down with the flu and missed work for six days.
“I haven’t made up my mind this year,” he says. Walker understands the risks. He knows that flu and flu shots change from year to year. So, if he decides to get the vaccine, does he also know what type of flu he’s protected against?
“No. I don’t,” he says. “I know they are numbered: 6, 1, 12; but I don’t know what that means.”
Walker’s uncertainty has merit. Flu vaccines are a gamble. A few months before flu season, scientists evaluate the data concerning the flu-like (short for influenza) illnesses around the country. They then guess which subtypes will prevail.
Of the two types of flu that frequently affect humans, A and B, the most dangerous is A. For the 2013 flu season, the Food and Drug Administration’s Vaccines and Related Biological Products Advisory Committee recommends protection against two A viruses, H3N2 and H1N1, and one B virus. Some 2013 vaccines will contain a second B virus component.
If guesses prove accurate, the United States will have a mild flu season. If the guesstimates are wrong or incomplete, we could have a replay of 2002 and 2009 when a novel and particularly nasty virus subtype emerged.
During those epidemics, scientists did not have a vaccine ready until the outbreak was well underway. Unlike measles and chicken pox, there is yet no universal flu vaccine. To defend against this massive health and economic disruption, we need accurate and rapid prediction.
The Flu Genome
Dan Janies (pronounced “Janus”) promotes a better way to understand and predict flu outbreaks. At 47, he is the Belk Distinguished Professor of Bioinformatics and Genomics at the University of North Carolina at Charlotte (UNC Charlotte). He neatly unites 21st century biology with big data.
Janies’ university appointment adds validity to the observation made by Michael Levitt when he was recently named a recipient of the Nobel Prize in chemistry. “Biology is very complicated and computers are powerful tools,” said Levitt, a professor of structural biology at Stanford University. “The prize,” he said, “is a belated recognition of the importance of the computer in biology.” More commonly, the combination is referred to as bioinformatics.
Janies believes that the way we describe the flu is outdated. He calls it a “legacy nomenclature based on weak technology.”
That legacy goes back to 1971 when two flu molecules, hemagglutinin and neuraminidase were first used to identify flu subtypes. Hemagglutinin (H) is responsible for attaching the virus to a host’s cell and allowing the virus to enter. The virus then hijacks the cell’s replication machinery to make new copies of itself.
Neuraminidase (N) allows the new viruses to enter and infect more cells and hosts. H and N were the perfect target for the flu vaccine. The H and N proteins are present on the surface of the flu virus and our immune system had no trouble finding them.
Flu vaccines stimulate our immune system to develop antibodies to H and N. If exposed to a live flu virus, these antibodies attack the Hs and Ns on the virus’s surface and, if all function as planned, we escape the flu.
The numbers 1 through 16 for H and 1 through 9 for N refer to the different types of hemagglutinin and neuraminidase. Each influenza virus is defined by only one type of H surface protein and one type of N. Within each subtype, there are also strains that arise from random mutations in the virus.
“I don’t think that way,” says Janies. For him, the entire flu genome, which contains six more genetic segments besides H and N, is the key to understanding and combating the disease.
“The genetic segments contain all the exquisite details—the building blocks of the virus. Knowing our enemy’s bricks and mortar will win the war against influenza,” he maintains.
Each living organism has its own unique genome. Virus, plant, bacteria, microbe, fungus and now human genomes are being studied and sequenced. Such work has led to a paradigm shift in understanding and treatment.
Cancer research is a good example. Some researchers have abandoned their focus on the organs where cancer arises—lung, pancreas, breast, skin—to instead focus on the cancer genome. They have found that different cancers share a number of genetic similarities. These scientists advocate treatment based on what genes are mutated, not the tissue involved.
For Janies, genome sequencing provides a much more accurate way of identifying a virus’s subtype. Once an expensive, tedious, painstaking process, sequencing costs have dropped a hundred-thousand fold.
“The H1N1 virus that our great-grandparents experienced in 1918 is a completely different H1N1 from what emerged in 2009,” says Janies. “The H still reacts to the 1 and the N reacts to the 1 antibody, but all the rest of the genes in the genome—all the internal genes—are completely different. That’s what genomics gives you—a clearer picture of what’s there. It illustrates where the legacy nomenclatures are wanting.”
“In the case of Severe Acute Respiratory Syndrome (SARS) in 2003 it took two months from detection of a novel virus to the public release of the genome,” says Janies. “For H1N1 in 2009, it was two weeks.”
Enter the Supramap
Interestingly, it is this ability to identify a particular virus by genome that made it possible to track a particular virus along with big data. Enter the Supramap.
In 2007, Janies and his colleagues at Ohio State University, the American Museum of Natural History and the Ohio Supercomputer Center developed Supramap to track the spread and evolution of pandemic (H1N1) and avian influenza (H5N1).
At the time, Janies was an expert in computational genomics at the Wexner Medical Center at Ohio State.
“Supramap does more that put points on a map—it is tracking a pathogen’s evolution,” said Janies, as the first author of the research paper on the Web-based tool that combines information about the genetic sequences of pathogens with geographic information on Google Earth, allowing researchers to predict and track where infectious disease will strike and how it may mutate.
Using Supramap, they initially developed maps that illustrated the spread of drug-resistant influenza and host shifts in H1N1 and H5N1 influenza and in coronaviruses, such as SARS.
Describing the transition of the Web service to an open-source, freely available phylogenetic analysis program, able to be used by other researchers, he described, “We package the tools in an easy-to-use Web-based application so that you don’t need a Ph.D. in evolutionary biology and computer science to understand the trajectory and transmission of a disease.
“The tool’s users can obtain a pathogens’ phylogenetic tree by submitting its genetic sequences to the system. Supramap then projects that information onto the globe, showing how diseases can mutate over space and time to infect new populations.”
In July 2012, Janies joined the faculty of the University of North Carolina at Charlotte as Belk Distinguished Professor of Bioinformatics and Genomics.
Janies, it seems, has always been the “inventive” sort. He received B.S. in Biology from the University of Michigan and a Ph.D. in Zoology from the University of Florida. He’s worked as a postdoctoral fellow and a principal investigator at the American Museum of Natural History in New York City where he lead a team that, using off-the-shelf PC components, built one of the world’s largest computing clusters in 2001.
He was attracted to UNC Charlotte by the ability to work with outside businesses and to conduct joint research and innovation.
Tracking the Spread of Infectious Disease
Seeing is believing and when you see the 3D visualization of Google Earth and influenza data that Janies and his colleagues have connected on the Supramap giving influenza height, width, depth, movement and meaning, you realize you are looking at an interactive “weather map of disease.”
“Supra, Latin for over, is a good descriptor of what the map delivers,” Janies says.
For the Supramap for avian flu (H5N1), a flu that moves within bird populations and then jumps from birds to humans, for example, Janies and his colleagues accumulated data on outbreaks among hosts such as ducks, chickens, wild birds and humans in China, Russia, the Middle East, Africa and Europe. Hundreds of thousands of cases were classified by strain, location and host.
Janies and his colleagues then use specialized software and Google Earth to project the latitude and longitude of similar flu strains onto the globe. If the movement of a pathogen is related to bird flyways, for example, and those routes are shifting because of something like climate change, it can predict where the disease might logically emerge next.
The Supramap allows any user to input raw genetic sequences of a pathogen’s strains and build an evolutionary tree based on mutations. The branches are projected onto the globe with pop-up windows to show how strains mutate over space and time and infect new hosts. That is, in essence, what Janies calls the “crystal ball.”
Disease is visualized as a “tree” whose “roots” are the common ancestor of a particular flu strain. When an ancestor gives rise to descendant strains, the tree grows higher. Intermediate ancestors and other descendents are given less altitude. Outbreaks are connected with lines reaching across the globe. Finally, date of outbreak is factored in, giving the tree a temporal dimension.
For H5N1, the “tree” grew and shrunk from 1999 to 2006, as it moved over the landscape infecting new hosts.
“The idea of this evolutionary tree of the virus,” says Janies, “is to help predict where the next outbreak of the virus is likely to occur. The map gives us a whole new way of seeing the virus in action and understanding what it is—and isn’t—doing. In the meantime, we are working on mapping other diseases, such as MERS and H7N9.”
The role birds play in the origin and spread of flu is a fairly recent discovery, going back only to the 1990s, says Janies. “Influenza has many, many strains and most live in birds. Often those strains get into mammals and humans.”
One of the central questions in influenza research was which birds were the chief culprit in the spread of avian flu. The usual suspects were migrating wild birds and chickens and ducks sold and then shipped to distant locations.
With Supramap, Janies has found that domestic fowl were to blame in Indonesia, but in other regions both wild and domestic birds are responsible. In one interesting case, a smuggled eagle carrying the flu virus was caught in customs after being transported thousands of miles from Bangkok to Brussels.
Asia heads the list of places where most flus originate, but Janies is quick to point out that H1N1 began in
“We are not doing a good job of observing flu around the world,” he adds. The World Health Organization operates the influenza surveillance system in partnership with national governments and places its limited number of observers in major cities. Flu in rural areas often goes undetected.
“Until a few years ago,” says Janies, “we just knew about influenza in Johannesburg and Cairo. We didn’t know anything about the rest of the continent of Africa. Without comprehensive influenza surveillance data, and the means to put it in context to inform inoculation programs, influenza prevention will struggle.”
When a pandemic breaks out, disease circles the globe, often leaping from species to species. Supramap doesn’t just track the spread of viruses, it tracks how the viruses are mutating as they jump into new hosts and encounter new medicines. Using Supramap, scientists might be able to stay ahead of the virus mutation curve and figure out when to switch medicines as the microbes adapt and develop resistance.
Usually one would find it challenging to weave the terms health care and man cave into the same conversation, but at Vitality Health Services in Charlotte and Raleigh, that is the conversation.
With over 40 years’ combined experience treating the physical, sexual, endocrinal and hormonal issues that all men face, Drs. Michael Trombley and Douglas Brooks set out to create something new, innovative, and exclusively for patients just like them—“for men, by men.” Yes, even the staff is all men.
In their offices, patients are greeted with a large screen TV showing ESPN SportsCenter along with a collection of blatantly gender-specific reading materials like Sports Illustrated and Men’s Health. Throw in a beer tap and you’d practically have a sports bar.
“Studies show men are less likely to go to the doctor than their female counterparts, and reluctant to take action when they don’t feel physically or mentally well,” says Brooks. “Most men know more stats about their favorite sports team than their own body. Our goal was to create an innovative and affordable practice that could reduce traditional barriers preventing men from making their health care a priority.”
“Statistically, men are three times more likely than women not to see a physician,” notes Trombley, more precisely. “It’s not because men don’t care about their health. It’s because they don’t do well in a traditional medical office setting. We offer an alternative—a place where men can feel comfortable and at ease. We don’t have Sesame Street on the TV and kids running around. We don’t have a young woman at the front desk asking personal questions that most men are never going to feel comfortable answering.”
Vitality Health Services provides men with a safe and discreet environment to discuss and treat the embarrassing stuff—erectile dysfunction (E.D.), sexual performance issues, low testosterone, weight problems, vasectomy and even basic primary care.
Both Trombley and Brooks are board certified in Family Medicine.
Trombley is a native of New York, obtaining his medical degree from the University of Rochester School of Medicine. He completed his residency in 1994 from Carolinas Medical Center Family Medicine where he served as chief resident. He first practiced as a physician at Cabarrus Family Medicine and subsequently at Lakeside Primary Care before joining up with Brooks.
He has also had associate faculty appointments with Duke Medical School and University of North Carolina Medical School, and been a travel speaker for Abbott Laboratories, Astra Zeneca Pharmaceuticals, Ortho-McNeil-Janssen Pharmaceuticals, and Xanodyne Pharmaceuticals.
Brooks is a West Virginia native, obtaining his medical degree from West Virginia University School of Medicine. He completed his family medicine residency at the University of South Carolina’s Palmetto Richland Memorial Hospital in 2000. He first practiced as a family physician with Morton Plant Mease Primary Care, the largest medical corporation in Tampa, Fla., and subsequently practiced as a family physician for Carolinas HealthCare System before striking out on his own.
Brooks is currently an adjunct professor with the University of North Carolina at Chapel Hill, serving locally as a preceptor for medical students during their four years of training.
Trombley and Brooks are 5-star physicians on wellness.com and vitals.com respectively, and both have received the Patient’s Choice Award given to only 5 percent of North Carolina physicians.
Both describe their prior practices as “traditional corporate medicine.”
“The genesis of Vitality Health Services came from our frustration over the direction of the health care industry and an attempt to return to the true patient and physician relationship and direct primary care,” says Brooks.
“We were both suffering from burnout with the current medical system,” explains Trombley. “I was diagnosing patients, but treatment decisions were being taken over by the insurance companies. It felt like a disservice to the patient. Medicine should be based on the relationship between a doctor and the patient.”
In addition to wanting to be his own boss and the freedom to practice medicine on his own terms, Brooks had always had an interest in men’s health issues, and felt there was a need for specialists in the field, just like women have gynecologists and children have pediatricians.
A recruiter helped put Brooks in touch with a small group of like-minded investors and that’s how he met up with Trombley. The two opened up Vitality Health Services in Charlotte, and the business model has worked so well that they added a satellite office in Raleigh.
Setting Themselves Apart
Making the decision to reclaim control of their respective careers, Trombley and Brooks began thinking outside traditional structure and focusing on the particular niche that they both found interesting, men’s health services. Alongside the unique “men’s club” approach to providing care, the two made a conscious decision to have an all-male staff as well, to further set their clients at ease.
Additionally, they made the decision not to bill insurance directly, which means clients pay directly and have the option to seek reimbursement from their own insurance carriers. While some might think this a concierge, boutique approach for a medical practice, it is in reality the opposite.
“By not billing insurance directly, we cut down on practice overhead and staffing, resulting in surprisingly affordable fees,” Trombley points out.
Brooks clarifies, “If we bill $100 through insurance, about $40 immediately goes to the insurance company. Then another $20 goes to pay the salaries of two more employees—a coder and a biller—that we have to hire. So why not have the patient pay us $40 directly, and keep the insurance companies and their medical opinions out of the picture.”
An initial visit to Vitality Health Services runs $300 which includes all necessary blood work and a follow-up visit. Subsequent office visits are only $100. Specific in-office procedures and treatments, such as vasectomy, are individually priced a-la-carte style. The model also works well for patients who have a flex-spending health care plan.
Trombley says, “Our goal is to show that we can provide first-rate quality care, but do so in a cost effective manner.”
In practice, for Brooks and Trombley, it’s all about putting the patient’s needs first and having the luxury of actually spending time with them.
“In my last job we were allowed 15 minutes per patient,” says Trombley. “That’s just not enough time. Here we can spend an hour with each patient. We’re dealing with sensitive and often embarrassing issues. Guys don’t just walk in and blurt out what’s wrong. It takes time for them to relax, feel comfortable and establish a sense of trust.
“By taking our time, we uncover so much more important information; it enables us to formulate a better diagnosis and better treatment plans that address all issues.”
Brooks concurs, saying, “Our patients feel like they actually have a relationship with their doctor. I would love to see a long-term study of my patients 30 years from now, because I truly believe the men I’m treating are going to live longer than those getting a 10 or 15-minute visit.”
Proactive and Progressive
Although the doctors treat more common male-specific issues like the dreaded E.D. (statistics show 40 percent of men are affected by age 40 and 70 percent by age 70), they are increasingly focused on treating more men in the relatively new area of testosterone replacement therapy. Andropause—a decline in testosterone production—is basically the male counterpart to menopause.
Both Trombley and Brooks are firm believers that low testosterone or “Low T” is often the root of many other male-specific problems like E.D., as well as being a contributing factor in more serious issues like hypertension, diabetes and high cholesterol.
Brooks explains, “Testosterone loss happens to every man. It starts in our 30s and continues from there. While women have been on estrogen tablets for 50 years, it is only now that we are starting to look seriously at male hormone replacement therapy.”
Typical symptoms of low testosterone are often reduced energy, moodiness, gain in belly fat and eventually sexual performance issues. However Trombley says the onset is so gradual the symptoms are often incorrectly attributed merely to aging. A low testosterone count is easily diagnosed with a simple blood test and current treatments run from pills to topical creams.
Although still a relatively new frontier in health care, both doctors are resolute in their convictions regarding the benefit of testosterone replacement therapy. Trombley says, “I firmly believe what we’re doing will absolutely become the standard of care. We’re just waiting for everybody else to catch up.”
He attributes the hesitation to insurance companies trying to categorize low testosterone as a disease. As the “normal” range for testosterone count (T-count) has been established as between 300 and 1,200 (all measures in ng/dL or nanograms per deciliter), Trombley says a patient with a 315 T-count will be summarily dismissed by insurance carries and most physicians as being within normal range.
“What we really need is a way to go back in time and learn what your testosterone count was at age 18 and try to restore it to those levels,” he explains. “The way we look at it in a proactive way is that if a patient has a T-count of 315, but is symptomatic, we treat him. There’s no reason to wait until he is at disease state.”
Both Trombley and Brooks can attest to the positive benefits they are seeing in testosterone replacement therapy. Trombley says, “We fix the patient’s testosterone and he suddenly feels 20 years younger, his relationship with his wife is amazing, he’s got more energy and is suddenly motivated to get back in the gym, and now naturally his blood pressure goes down, he’s not a threat for diabetes and his cholesterol is normalizing.”
As further evidence of their proactive and progressive approach to medicine, Dr. Trombley has undergone additional training in stem cell therapy as a promising treatment for erectile dysfunction.
Stem cells are defined by their capacity for both self-renewal and directed differentiation; thus, they represent great promise for regenerative medicine. Historically, stem cells have been categorized as either embryonic stem cells (ESCs) or adult stem cells (ASCs) and it was previously believed that only ESCs hold the ability to differentiate into any cell type.
Recently, however, numerous studies have demonstrated the ability of ASCs to differentiate into cell types beyond their tissue origin. Additionally, there is an abundance of stem cells in body fat which can be harvested via liposuction.
“This means that if a patient is suffering from E.D. due to loss of blood flow to the penis and has not had good results through conventional treatment, application of stem cells harvested through liposuction may be an option to increase blood flow and pressure in the penis,” Trombley explains excitedly.
Vitality Health Services is one of a handful of sites in the United States certified as part of a multicenter study for the application of stem cell research. Although investigational, Trombley is optimistic this may be a viable treatment used in offices in the future.
“Most people’s misconception is that all stem cells used in research are embryonic,” he clarifies. “Our investigational trial studies are non-embryonic and come from the patient himself. It’s a cutting-edge new approach of healing yourself, with your own cells.”
Brooks says, “I’ve never been happier since I began practicing medicine. Michael and I are two peas in a pod and finally doing exactly what we want to be doing—treating the whole male and improving our patients’ lives. It’s extremely rewarding for us and we know that it’s working because our patients keep coming back.”
“It’s such a relief to be free from an insurance company’s standard of care. We’re always looking for better options for treatment for our patients,” says Trombley. “We are ultimately committed to progressive medicine to help our patients enjoy healthier and longer lives.”