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Between October 1 and January 1 Americans will be intently focused on the Affordable Care Act (ACA). For most of us, it will be with a mix of anticipation, trepidation, excitement, frustration, hope, fear, and undoubtedly confusion.
Dr. Nancy Fey-Yensan, dean of the College of Health and Human Services (CHHS) at the University of North Carolina at Charlotte (UNC Charlotte) has studied and prepared for the ACA. As the overseer of 3,000-plus undergraduate and graduate students who will soon work in the new health care order, she understands better than most its promise and its peril.
Lighting the Way
Although she has concerns, Dr. Fey-Yensan is an advocate of ACA.
“The Affordable Care Act is shining a light on care-for-all,” she attests. Until the congressional debates of 2009, few considered care-for-all a realistic part of the American dream. The cost of caring for uninsured millions made it appear impossible.
“But,” says Fey-Yensan, “the societal costs of not caring-for-all are greater than the cost of doing something. Health is central to America’s success. Without good health,” she maintains, “education suffers, jobs are lost, and families fall into poverty.
“I’ve been in health care for 30 years and there has been a growing concern that health care needs to be proactive, comprehensive and accessible to all,” she says.
The War on Poverty that began in the ’60s kicked off those conversations, but it took a change in outlook to move the United States from a concern for economic opportunity to the Affordable Care Act.
“We have moved away from a health outcome perspective to a patient outcome perspective,” comments Fey-Yensan. “The old emphasis was on making medical procedures more effective and developing best medical practices. With the cost of a day in an American hospital averaging $2,000, that can’t go on,” she emphasizes.
Today doctors and hospital administrators pay attention to patient satisfaction, quality of life and informed individual decision-making. Many physicians are now compensated on the basis of patient outcomes. As Fey-Yensan says, “We are thinking more now about how to make individuals and families healthier and how to keep them out of the acute care system.”
The heart of the ACA is primary care—checkups and prevention. That is the starting point, the floor for the ACA’s minimum standards. In order for a health plan to be approved for uninsured individuals under ACA, it must have a strong benefit package and limited out-of-pocket costs.
The ACA’s Essential Health Benefits package ranges from wellness and pediatric oral and vision care, the prevention piece—to emergency services and hospitalization, the acute care benefits. The minimum standard for deductibles and co-pays is a 60/40 cost sharing, the so-called Bronze level. It’s the plan with the lowest premium and the highest out-of-pocket cost. For a higher premium, individuals may opt to have their plan pay 70 percent (Silver), 80 percent (Gold) or 90 percent (Platinum).
New Models and Methods of Care
“An important part of the ACA is that now there will be benchmarks for success. Organizations that meet those benchmarks will be rewarded,” explains Fey-Yensan. “The benchmarks are related to quality of care, safety and cost.” For example, recurring, redundant and unnecessary medical tests may be one irritant that benchmarks eliminate.
A novel way to achieve quality, safety and cost savings is the “medical home” model of care. The ACA supports this coordinated, proactive, patient-centered approach. Key to the medical home is a team of providers working together to meet a patient’s health care needs.
Much like hospice care for the past 40 years, medical home teams include physicians, physician’s assistants, nurse practitioners, nurses, nutritionists, pharmacists and social workers. Medical homes have extended office hours, communicate regularly with patients over the phone or Internet, and rely on shared data from electronic medical records.
In his keynote address at the 2012 Charlotte Chamber of Commerce Health Care Summit, Harry Reynolds, director of health industry transformation for IBM went so far as to say, “We will not work with an insurer that does not offer medical home.”
Teams dominate Fey-Yensan’s conversation. There’s good reason. She explains that, with 55 million previously uninsured Americans soon to be seeking community-based medical care, there are not going to be enough medical doctors to serve them. In the future, medical doctors will supervise interdisciplinary teams and provide less face-to-face care.
Ready to fill the M.D. gap are two new professional degrees offered by CHHS. The newest, a Ph.D. in public health sciences, debuted in August 2013. It follows closely the college’s Ph.D. in nursing practice which was approved earlier this summer. The latter degree is designed to take the place of the nurse practitioner. These 21st century professionals will be trained to work in non-traditional settings where inter-disciplinary, culturally competent teams make many of the clinical decisions typical of 20th century physicians.
CHHS coordinates the education of four disciplines at the bachelor, master and doctoral levels: Social Work, Public Health Sciences, Nursing and Kinesiology. Students wishing to start early and blur the lines between their related disciplines can apply for the college’s Health Connection program.
Beginning freshmen year, those accepted into Health Connection take classes together, participate in community service, develop teamwork skills and live together in the same residence hall. When they graduate, these social workers, nurses, occupational therapists and policy advisors will not only communicate with each other, but they will also fully understand and appreciate what the other is saying.
Big Data is a Big Driver
“Data drives everything we do,” says Fey-Yensan of her evidence-based curriculum. And Big Data is the biggest driver of them all. Big Data is revolutionizing every aspect of medicine from the laboratory bench to the bedside.
Google, Facebook and Target are not the only ones to mine terabytes of customer data. Hospitals, insurers and researchers are already sifting through mountains of medical data on electronic medical records, MRIs and CT scans. Their goals are to make sense of health care data, improve care, identify value, reduce costs and cure diseases.
In 2012, CHHS teamed with UNC Charlotte’s College of Computing and Informatics to develop the first Health Informatics Professional Science Master’s program in North Carolina.
“This degree is to train people with solid skills of technology and analytics while being expert in the business of health and health care and making the two work together,” explains Dean Yi Deng of the College of Computing and Informatics. Half the curriculum comes from Dr. Deng’s faculty, half from Fey-Yensan’s. Their motto seems to be, ‘We don’t work in silos anymore.’
For the past eight years, CHHS has graduated close to 50 Ph.D.s in health services research. This Big Data degree combines such diverse disciplines as biostatistics, epidemiology, sociology, social work, economics, medicine, nursing, public health, engineering, management and policy studies.
Recently, CHHS researchers have reached across the campus to the College of Business and the College of Liberal Arts to form a Health Informatics and Patient Outcome Collaborative. With colleagues in health economics and public policy, they are studying what was once the murky topic of heath care quality. There is a lot at stake. Quality measurements are playing an increasingly important part in determining physician performance incentives.
“The combination of Big Data and health care probably creates one of America’s most sought after professionals in health care right now,” remarks Fey-Yensan.
The Affordable Care Act is far from legislative perfection. There are a number of flaws that it acquired in its journey through Congress and after its examination by the North Carolina legislature. Three of them cause concern for Dean Fey-Yensan.
In March, Governor McCrory signed legislation that took North Carolina out of the system of state-run health care marketplaces or exchanges. These are real and virtual places where uninsured individuals and small businesses can shop for health insurance. North Carolina is one of 33 states that, for now at least, do not have their own program. The state will operate as a Federally Facilitated Exchange for 2014.
In July, the North Carolina Department of Insurance (NCDOI) approved rates for three private insurance companies that intend to sell plans to North Carolina’s 1.5 million uninsured: Blue Cross and Blue Shield of North Carolina, Coventry Health Care of the Carolinas and FirstCarolinaCare.
If North Carolina had a state-run exchange NCDOI’s approval would be sufficient. “Since the federal government will be operating the Marketplace in North Carolina, it will make the final decision as to which plans may be sold though the Marketplace in this state,” said the NCDOI in a July 30 press release.
“For folks who have to go out and shop around for health insurance, they really should have a broader market to choose from,” claims Fey-Yensan. And she says, since only Blue Cross Blue Shield will have a presence in every county, “What that means is that for some folks there won’t be a choice.”
Those seeking individual and family coverage and a government subsidy may face a long and tedious application process. Help in staying afloat in that sea of paperwork is to come from unbiased enrollment counselors aptly named Navigators under the Act.
California expects to hire 21,000 Navigators—some proficient in Spanish, some from faith-based organizations and some from non-profits. Nationwide, estimates for the number of Navigators needed run as high as 175,000. All will be full-time state or federal employees trained in taxes, insurance and the fine points of the law.
Some worry that the application process will be so burdensome that even with help from Navigators many uninsured will opt for a fine. Insurance companies have a different concern. They assert that the uninsured will be confused between Navigators and the more familiar insurance agent and broker since ACA requires that Navigators cannot be health insurers.
“The problem is that there will not be enough Navigators,” maintains Fey-Yensan.
To fill the gap, Certified Application Counselors and In-Person Assisters may be added to the mix. These latter groups have had years of experience working with applicants for Medicaid and the Children’s Health Insurance Program.
In the next month, local groups like Legal Services of Southern Piedmont and MedAssist will play a role in closing the information gap. “We are part of a consortium of 10 agencies and on August 15, we were awarded a grant to become Navigators,” says Kelly Musante of MedAssist.
Graduate students from UNC Charlotte are also planning to help, but they have too much on their plates to be full-time Navigators. According to Cicily Hampton, a public policy grad student, there is a university-wide steering committee working on immediate volunteer efforts as well as long-term involvement. Hampton points to a problem many of us share: “Those obtaining health care insurance for the first time may not understand co-pays and deductibles.”
There are two ways the Affordable Care Act envisioned the expansion of health care coverage. One was through standardized individual health care plans. The second was the expansion of the Medicaid program for low income Americans. It is this second tier expansion—or, more accurately she says, the lack of it—that concerns Fey-Yensan.
“North Carolina is one of 15 states that voted not to expand Medicaid. We still have 700,000 people who will not be eligible for Medicaid, all under the age of 64. These folks are going to be in trouble.” She explains that states that expanded Medicaid realized that, without expansion, low income Americans would continue to use the hospital emergency room for primary care.
Closer to home, expansion would have had a direct impact on UNC Charlotte’s students. “An increasing number of jobs would have come from Medicaid expansion,” says Fey-Yensan. “Expansion would have been an economic driver for North Carolina.”
The future of the Affordable Care Act depends more on colleges like UNC Charlotte’s Health and Humans Services than it does on what happens in the next three months. Look down the health care highway five or 10 years. In that more expansive view, Charlotte will witness the explosion of enrollment at the College of Health and Human Services, already the fastest growing school there.
“The demand for primary care providers who are not medical doctors will be huge,” maintains Fey-Yensan.
When the dust settles, Charlotteans may come to realize that it is not only cost-effective to be seen by non-M.D.s, but also more personal, holistic, satisfying and health-promoting.
Five or six heads may turn out to be better than one.
Like the Affordable Care Act itself, we may need to live with that idea a while. But those heads belong to the professionals graduating from Fey-Yensan’s programs and they are leading the way forward in American health care reform.
When Jim Snyder first came to Charlotte, he didn’t know anybody. But he felt it important on becoming CEO of ODELL to reach out to Charlotte’s decision-makers.
Much to his surprise, each and every one he called readily accepted his invitation to meet. To say he was impressed is an understatement. It spoke for itself about the quality leadership of the firm’s founder and the good name and reputation the firm had developed over the years.
Arthur Gould Odell Jr. of Concord founded Charlotte-based ODELL in 1940. “He was part of the group of community and business leaders that created the vision and foundation of the Charlotte we enjoy today,” offers Snyder.
“ODELL has never been just an architectural firm,” continues Snyder. “We have always believed in being a stakeholder and steward of our community, helping to influence creating special places to live, work and play.”
Indeed, founder Odell worked alongside business and community leaders such as John Belk, Hugh McColl, Bill Lee, Ed Crutchfield and other visionaries to grow Charlotte into an important southern city. In the early 1970s, he developed the city’s first comprehensive Master Plan. Today, Charlotte’s uptown, medical centers and sports arenas reflect the vision of that Master Plan and all reflect close to 75 years of Odell’s and the firm’s continuing impact.
Most of ODELL’s design projects are familiar household names: Bojangles Coliseum, Ovens Auditorium, Time Warner Cable Arena, the former Charlotte Coliseum, Independence Center, Bank of America Plaza, Charlotte-Douglas International Airport, the first Charlotte Convention Center, University of North Carolina at Charlotte, The Federal Reserve Building, Westin Hotel, 525 North Tryon Plaza, the original Knight’s Stadium and now, the soon to be completed BB&T Ballpark, to name a few, plus numerous projects for the Carolinas HealthCare System—from the original bed tower built in the 1950s to recent buildings—as well as the Novant Health Care System.
Together, these projects form a timeline of Charlotte’s progress towards becoming the banking, health care, international transportation, hospitality and professional sports city that it is today.
Building Up to Success
From its founding, ODELL has maintained its headquarters in Charlotte. The company opened its Richmond, Va., office 35 years ago. Snyder, with ODELL for 27 years, ran the Richmond office as president until relocating to Charlotte two years ago. He was named chairman and CEO of the entire firm in 2008.
The firm’s footprint was enlarged again in 2011 with a client-driven expansion to Houston, Tex. “Now, we are in the three strongest growth states in terms of economic development,” claims Snyder. Overall, the firm expects to reach $15 million in revenue in 2013. Over half of its 76 employees are licensed architects. Eight principals lead and direct the firm’s activities and include (in addition to Snyder and Woollen) Brad Bartholomew, Terry Moore, Bruce Brooks, Max Gray, Richard Morton and Dale Hynes.
ODELL’s work in Richmond is represented by a similar list of landmark places, and spans Florida to New York in work for the Bon Secours Health Care System. The firm’s major client in Houston is the Memorial Hermann Health Care System, part of the largest health care system in Texas.
Other projects around the country include the world-recognized BOK Center in Tulsa, Okla.; the RBC arena in Raleigh, N.C.; the Bi-Lo Center in Greenville, S.C.; the Raleigh PNC Arena; and the North Carolina Blue Cross Blue Shield Headquarters in Chapel Hill. International projects range from the Middle East to India to Latin America to China and represent approximately 10 percent of ODELL’s work.
ODELL offers integrated architecture, planning, engineering and interior design services. The firm is structured around market sectors as opposed to geography. Aptly named Heal, Work, Play, Move, Learn and Live, the firm focuses on the design of environments supporting health care, corporate and commercial business, sports and entertainment, aviation, higher education and senior living and multi-family residential clients.
“I am the director of Play,” laughs Woollen, obviously delighted by the concept and play on words. “It’s a great job.” Woollen also heads up the office in Charlotte. The firm’s architects primarily work in one market sector although they are very active in the various locations where the firm has presence. Moore leads the Work sector; Brooks leads the Heal sector and heads up the office in Richmond. Health care has become nearly 70 percent of ODELL’s business.
“Instead of being reactive, waiting for work to come to us, we seek opportunities for providing transformational ideas to help move important projects along,” says Woollen.
“Strategic partnerships and collaboration are key,” adds Snyder. “It’s not just about now—it is looking beyond today in creating special places informed by the client’s vision designed to optimize the enterprise.”
Hitting Some Home Runs
Woollen’s job has been especially exciting through the design and building of the new BB&T Ballpark which is scheduled for completion in the spring of 2014.
“We are thrilled to be a part of bringing the Charlotte Knights to uptown. That it will be in our own neighborhood is particularly rewarding,” says Woollen. ODELL was also the architect of the current Knight’s stadium located off Interstate 77 in Fort Mill, S.C.
In the 1980’s, Knight’s owner George Shinn anticipated rapid growth in the South Charlotte area that would leapfrog the state line. “His assessment was that the area would grow a lot faster than it has,” says Woollen. That property is now scheduled for redevelopment for a distribution and mixed-use development.
The trend now is to build sports stadiums in center city in creating unique mixed-use live, work and play destinations.
“The new ballpark will be much more user friendly with superior sight lines, amenities, two club areas, more picnic terraces and easy access,” continues Woollen. “Because of the ballpark there will be new development along 4th Street and along Graham Street which will continue to revitalize the Third Ward.”
Several features make the new ballpark unique, according to Woollen. A pair of dugout suites at home plate provide for a worm’s eye view where he says, “You’ll be looking at the field like a catcher or umpire does.”
The lower home plate club will hold approximately 900 people and will have fixed bars, indoor and outdoor seating. The other will be able to accommodate 300-400 people for game days and other catered functions. “It will be busy every day of the year,” anticipates Woollen, proudly.
Construction of the stadium is 65 percent complete. The first game is scheduled for April 11, 2014.
ODELL entered the Play sector in the mid-1950s with the design of what is now the Bojangles Coliseum. The firm also designed Ovens Auditorium next door. Next came the Coliseum on Tyvola Road in 1984 which was replaced in purpose 22 years later by the Time Warner Cable Arena in uptown. In between those, ODELL designed the Barnhardt Student Activity Center at UNC Charlotte.
“It’s a more specialized field now,” says Woollen. “When we were working on the Coliseum, I knew that I could do this for the rest of my career.” Undoubtedly, ODELL has been a huge player in preparing Charlotte to be a center for professional sports.
Like most others in the building and construction industry, ODELL was impacted by the downturn in the economy. “It sure wasn’t a very good time to become CEO of an architectural design firm—when the bottom fell out of the economy,” states Snyder referring to his taking over the reigns in 2008.
“The reason why we’ve done as well as we have is that we have changed our firm by adapting our business model to the times and we are relationship-minded in everything we do. Consequently, with our 90 percent repeat business track record, our clients believe in us as much as we believe in them.”
Both the diversification and specialization of the firm were also important factors, according to Snyder and Woollen. “If anything has changed all our lives, it’s 2008,” says Snyder. There were lots of very reputable firms that are not here any more. Firms that see change and embrace change are the ones that will weather the future.” This is true whether referring to the economic climate or competition, according to Snyder.
“Most architectural firms are small; with less than 10 staff. The 1,000-plus firms are unusual. However, at 76, our staff is strong across our footprint. We are considered a large firm,” continues Snyder. “But in our particular market sectors, the competitors are usually 10 times bigger than we are. When we compete for projects in our markets we have to be more creative and savvy in terms of how we respond; we have to be able to respond and adapt very quickly,” continues Snyder.
Woollen sums it up: “We’re the swift boat; our competition is the cruiser.”
Design for the Future
Snyder was raised in a military family that moved around a good bit—from Kansas to Europe, Texas and Bowie, Maryland. “I was an artist—a sculptor—and there was very little creativity around me as I was growing up,” remembers Snyder.
“My father said if I wanted to pursue art, I could pay for my own education. He recommended that I go to Texas A&M and join the military to serve our country like my brother did. So, I did. I joined the Corps of Cadets and ultimately discovered architecture.”
Owing Uncle Sam some time after graduation, Snyder worked for the Surgeon General of the U.S. Army stationed at the Pentagon and designed hospitals all over the country as well as in Asia and Europe. “I learned how hospitals work from the nurses, physicians and clinicians from the inside out. We hired ODELL to design a project for us and that’s how I came to know the organization.”
Snyder came on board at ODELL in 1986, the same year Mr. Odell sold the company to seven partners. “We bought the last partner out a few years ago,” says Snyder. “Mike and I, along with Brad, Terry, Max, Bruce, Dale, Richard and our senior team—we’re third generation partners.”
“When I think, I diagram. I think through my hand when I draw,” continues Snyder. “There are few things that people do to create peace of mind—that’s what my art does for me. When I draw, I don’t think about anything else.”
Still, Snyder didn’t connect the dots until graduate school spending time in Chicago exposed to the works of master architects. “I realized what architecture is all about. It’s a journey you’re on to develop your ideas about how space can enhance and influence the lives of those who experience the space.”
Snyder moved to Charlotte in 2011. His partner, Max, had called him up and said, “Jim, it’s time you came to Charlotte.”
“Charlotte is a great, great city, says Snyder. “You won’t see anything like our urban environment anywhere else for the size we are.” Snyder has both a son and daughter, both schooled at the University of Virginia.
Woollen grew up in southeast Charlotte. He acknowledges, “That area was very rural then—not much architecture to look at.”
As a boy, Woollen loved to hang around construction sites and watch the builders, especially the carpenters: “I would gather scraps of wood and go all over the neighborhood building treehouses. The first time I saw a modern building, I freaked out—loved it! From then on, I admired all things modern—buildings, cars, art, clothes.”
Woollen graduated from North Carolina State University and started with ODELL in 1981. In the mid 1990s, he was recruited away by another firm and moved to Florida for 12 years where he worked on the Miami Heat arena and then to Dallas to work on sports and entertainment projects domestically and internationally including a great project for the Dallas Cowboys.
“Over time, several of our former partners tried to recruit Mike back to the firm,” says Snyder. We finally did in 2010. I feel really great about Mike being with us in Charlotte.” Woollen is married and has a daughter and granddaughter who reside in Charlotte.
“I tell people I meet all over the country Charlotte has boundless aspirations. After the bright light that shined over Charlotte for the DNC, now the conversation is about bringing home the Super Bowl,” exclaims Snyder. “There are many communities this size that wouldn’t dream of that; this community dreams of that and more each and every day.”
The firm is also involved with the city now to redevelop the Bojangles Coliseum to create an amateur sports destination.
“This brings in tens of thousands of kids,” says Woollen who envisions a renovated arena, new indoor facilities, hotels and other developments around the project.
“I’ve witnessed an energy and pride in ODELL that I’ve never felt before,” says Snyder. “We believe in and inspire each other to do great things. Our passion is in making a difference.”
“It’s more about the whole than yourself or the part,” he continues. “We believe that being active leaders in our community is truly important to our enterprise. If we’re part of a dynamic, growing, aspiring community, there is opportunity to create wonderful places.”
Based on its success and longevity, the ODELL firm will always be a stakeholder and steward of Charlotte.
Photo: Fenix Fotography
It may sound odd to call an insurance broker a boutique firm, but it’s the preferred term for Alan Wise, president of Charlotte’s Trinity Insurance Group.
“We offer customized insurance solutions for our clients,” says Wise. “We are a strategic, consultative partner and we operate our business with a high-touch relational approach. Trinity is a boutique agency.”
Trinity offers insurance products in three areas: employee benefits, property and casualty, and 401(k) retirement plans. Wise describes it as a middle-market firm, a company that works with businesses who employ from 50 to 2,000-plus employees, meeting a “huge growth opportunity.”
While large insurance brokerages siphon off the big companies and the small mom and pop shops take care of smaller businesses, Wise says mid-sized companies are seeking the services plus extra guidance that they can’t afford to have in their own staffing.
“We work to demystify how brokers are paid,” says Wise. “We offer an a la carte cost ‘menu,’ or fee-based services, so that we can be transparent and build the programs our clients need. We charge only for what they need.”
With its footprint in Charlotte, Trinity also has clients in Greensboro, Raleigh, Spartanburg and Greenville. Most clients are from the Carolinas with some national clients in Texas, Florida, Kentucky and Atlanta, Ga.
“We have the resources of the large national brokerages and the touch and feel of a local firm,” says Wise, who credits it with much of their success to their customers, clients and employees.
Trinity works with about 200 clients, Wise says, and about 20 of them have been with Trinity for 20 years or longer, earning a place on the Trinity’s new Wall of Fame, a display space in the office that includes photographs and descriptions. Wall of Fame clients are treated with “cupcake ceremonies,” annual celebrations of the partnerships. Trinity brings cupcakes and milk to clients’ workplaces for employees.
“It’s a good way to pause and say thank you,” says Wise, who boasts the firm’s 99 percent client retention rate, expecting the number of Wall of Famers will continue to rise.
Building a Firm Foundation
Starting with just a handful of employees in 2001, Trinity was opening in a tough business environment surrounding the 9/11 tragedy. But Wise says he had planned in advance and was able to bring with him several larger clients to help carry the young company. In just one and a half years, the company grew to 30 employees.
Each client at Trinity has an account manager and support team. One of those clients is Warco Construction, Inc., a business that began working with Wise more than 20 years ago. Hans Warren, CEO of Warco Construction, says the people who work at Trinity are one reason why he appreciates working with the insurance broker.
“Trinity is a smaller firm that has experienced fewer turnovers in its personnel,” says Warren. “We have been dealing with the same representatives for many years.”
“In fact,” Warren acknowledges, “they attend our company picnics and outings in an effort to get to know our employees and be available to them.”
Wise says that employee retention is an important metric at Trinity. “In 12 years, only one employee has left the company. Bonding and community service days encourage employees to believe they are ‘part of something bigger,’ and provide value-added service to customers,” he affirms.
“This is how we carry out our core values which include serving our customers, employees and carriers in a way that brings glory to God,” says Wise.
Those values and exemplary service also extend to the Charlotte community where Wise, as a member of the Charlotte Leadership Forum, helps mentor young leaders in the community to be leaders in their families, occupations, communities and churches.
In 2008, Wise’s former college roommate Harry Floyd joined at Trinity, and brought his expertise in CPA processes to help build deliverables for the growing company.
“We had a vision for the company,” says Floyd. “Business is always changing, so we needed a dynamic business model. We brought a unique service model to the table. We will listen, learn and surround ourselves with successful practices.”
Floyd emphasizes that Trinity works hard to court new customers and show clients that they are valued within the company. “The competitive insurance market in the Charlotte region means that clients make decisions based on the capabilities of the firm and the right fit of the people,” he assures.
Initial client meetings focus on the culture, resources and capabilities of both firms to see if there’s a “good fit,” between them. Trinity spends time “learning about the client’s issues and concerns, not just quoting insurance prices,” describes Wise. “Our goal is to consult and provide advice and counsel to our clients. Our clients want to find out the best way to provide services for their employees and they are looking at the value of adding differentiated services.”
“How can we help you? What are the services you are looking for in a brokerage?” questions Floyd. “Marketing is a part of what we do, so after we learn about the client company, we can show different products with different prices.”
Trinity provides consulting services in three main areas: benefits work which comprises about 60 percent of the business, property and casualty work which comprises approximately 35 percent, and 401(k) and retirement planning, a new line of business they’ve begun this year.
Trinity analyzes the risk of the company, looking at the benefits and the property and casualty lines to determine the company’s exposure. After reviewing the loss control and claims management, Trinity looks at how the processes can be improved.
For health benefits, that might be in offering wellness programs, reviewing plan benefits, or communicating with employees. For property and casualty, that might be reviewing loss control and claims management. For 401(k) or retirement plans, it might be looking at employee education and compliance issues.
“By operating as a fee-based company, Trinity can craft and price 13 or 14 service items and build a program around the client’s specific needs,” Wise says.
“We are very transparent with our pricing,” he continues. “Our goal is to match what you want with what we have and price it fairly for both parties. We want to demystify the broker commission process. We work especially hard to ensure that each and every one of our clients has positive experience.”
Making Sense of the Affordable Care Act
The Affordable Care Act poses potential hurdles to mid-size companies as they work to implement the new requirements to provide health insurance. Trinity can help, says Wise, by providing counsel about the changes in the law.
“There is great concern in the business community about this new health care act, which gives employers and employees the opportunity to review coverage, care and premiums,” says Wise, “and, it comes down to two main issues: quality care and choice.
“What will the exchanges offer and what kind of subsidies will be available?” asks Wise. “How can I educate our clients to make good choices—both for their companies and for their employees?”
Employees are the most valuable asset for any company, according to Wise, so it makes sense to spend the time to both educate them about their health and offer valuable benefits to retain them. A new wellness program, he says, can be put in place in three to five years, including design, implementation and execution.
“Trinity is able to offer a comprehensive solution for companies,” assures Wise.
Trinity offers year-round support for health care benefits including business analytics, planning, wellness measures, and communication portals for employees, and compliance monitoring to help provide and measure the effectiveness of employee health benefits.
Wise acknowledges that, “one size doesn’t fit all in wellness.” He touts the Trinity Health Quotient, which is a product developed in-house, which uses biometric employee data to provide individual health assessments for employees, making them more aware and accountable for their health status. Employees receive a personal health report and measures to help monitor their own health concerns such as weight management, smoking cessation, hypertension, or heart issues.
“Technology is an important part of the mix,” affirms Floyd, “Picking the right technology can help employees with enrollment and engagement around health benefits and healthy lifestyle choices.”
It’s important to get employee buy-in to help control health care costs, explains Wise, since 75 percent of all health care costs are related to lifestyle.
“Robust educational measures can help drive behavior and lower premiums,” he says. “When we help high-risk employees manage their conditions, we help them improve their health, and that improves the health care costs to the company.”
It can also lead to employer incentives that could be used to prompt healthy lifestyle changes. They might include a lower premium cost to employees who lose weight and have lower hypertension, for example, or a contribution to a charity for improvements in lifestyle conditions.
Warco Construction uses Trinity for its group health, dental and vision benefits.
“Trinity is important each time we come up for renewal,” says Warren. “They help us navigate the increases in health care expenses by sharing different options we us so we can pursue both plan designs and carriers.
“Whenever questions or concerns arise about claims, they do an excellent job in supporting our staff and employees,” he says.
Maximizing Value by Minimizing Risk
Property/casualty insurance, says Wise, helps companies protect their investments. Property insurance helps protect a company’s physical property, while casualty insurance helps protect the company against legal liability for potential losses caused by injury to people or damage to property.
Understanding the choices in environments where risks change and compliance is the service provided by Trinity. Trinity can provide advice based on staff assessment that includes engineering and environmental experts.
“We work hard to help clients make good choices—first when it comes to choosing the carrier, and second when it comes to working out claims with the carrier,” says Wise.
Edifice, Inc., a general contractor for construction based in Charlotte, uses Trinity to cover its general liability issues. “Alan has been a great business partner,” says Eric Laster, president and CEO, who has worked with Trinity for 20-plus years. “We moved with him when he formed his business.
“He’s handled my liability coverage and managed my health care,” says Laster speaking for his firm of 55 employees with annual services of $125 million. “Year after year, Trinity has provided health insurance and worked to manage the continuing and escalating health care costs.”
“If you are not happy with a carrier’s action, we’ll be the intermediary, the person who is there to solve the problems in a high-stress environment,” explains Wise. “We are the servicing arm.”
“I’ve found Alan Wise to be an honest, resourceful and creative partner,” attests Laster. “I would recommend him to other businesses.”
With its new full service retirement planning division started in January, Trinity now helps its clients design and provide employee benefit plans. Meeting regulatory requirements is a necessary part of the review process, and Trinity, with its fee-only service, can offer non-biased consulting on current plans, says Wise.
Service is the key differential, maintains Wise, and helps drive all of Trinity’s actions.
“We have a service heart,” says Wise. “Our DNA is around serving and helping others to achieve their goals and dreams. Trinity is a conduit for our clients. To the extent that our clients are successful, so will we be successful.”
Physicians Choice Laboratory Services, or more briefly known as PCLS, is built on a foundation of synergy, vision and endless possibilities. These core values are why this cutting-edge laboratory exists today—literally.
When Philip McHugh Jr. first set out with software developers Marcus Sowinski and Doug Smith, their goal was to create a company that would help laboratories improve their efficiency and their relationships with the doctors they served. They had no intention of starting a lab themselves, but rather to subcontract with laboratory partners.
Out of the seven labs they approached, only two said yes. McHugh describes the relationships with both as “very challenging,” and says, “After six to nine months of working that way, we made the decision to open our own lab.” From there, PCLS was born.
Today, PCLS is a premier clinical laboratory offering a wide spectrum of services ranging from testing and therapeutic monitoring to specialized programs.
“I’m just a regular person who saw an industry and relationships [with doctors] that could be better,” remarks McHugh. While McHugh’s been successfully starting businesses since he was 17 years old, he had no lab experience when he co-founded PCLS.
“I’m a big believer that it’s sometimes the person on the outside who can give a fresh look at something and do exciting things,” he explains.
That philosophy and vision led McHugh, president and chief creativity officer, to build a strong leadership team starting with Joe Wiegel, who had a sales background and had sold PCLS its first laboratory instrument. Wiegel came on board first as a consultant and then as a recognized co-founder and president of operations.
The team also included Mark Roth, vice president of operations. Reflecting on the early days as one of the company’s first employees, Roth recalls, “When we started out, there were very few of us, so everyone multitasked. It was like ‘all hands on deck.’ We all had the same mentality—do whatever we need to do to survive.”
Then, the company then literally expanded overnight. After landing a large client, it went from being a 5-10 samples a day operation to 50-100 samples a day operation.
“The 10- to 20-fold increase in business early on was a big deal,” adds Roth. “We definitely had to learn on our feet, but it helped us understand where we needed to be in terms of reporting and customer service.”
The company’s accelerated growth is attributable in large part to the advent of more powerful prescription drugs whose metabolic effects are not fully understood, and also to an increase in their abuse.
“There is a heightened need for testing to make sure people who aren’t supposed to be on drugs, aren’t in fact on drugs,” says Roth, “as well as to measure some of the unknowns about how the body is metabolizing these powerful drugs.”
Since 2009, growth at PCLS has continued to accelerate at an unprecedented pace.
“We were on a hockey stick growth pattern,” says Wiegel, remembering when he joined the PCLS team full-time and joking, “We were growing so fast that I spent my first three months hiring staff and finding parking spaces for them to park their cars.”
Synergized Health Care
A primary goal of PCLS is to be a strategic partner for physicians and provide more than just reliable test results. They also want to help streamline operations and costs with proactive management solutions.
PCLS testing services include toxicology, genetics and cytology. The company also offers specialized programs ranging from pain management to cardiology, with the goal of improving and streamlining patient care.
A unique faction of the larger lab market, PCLS differs from a traditional lab by specializing in toxicology and performing urine and oral fluid drug testing for substance abuse programs and clinicians supervising patient pain management. It is also one of the first labs to offer Synthetic Cannabinoid testing and to test oral fluids and bath salts.
Through innovation, PCLS has successfully created synergy between its two service lines. One includes supporting the pain management and narcotic prescription base to help a doctor ensure a chronic pain patient is compliant with their prescription medicine.
The other entails providing personalized medicine—known as pharmacogenetics—to examine how an individual body metabolizes a specific drug and help doctors understand if the drug is going to provide the beneficial results they hope for. PCLS methodologies can detect more than 50 drug compounds and metabolites.
Quality service and the differentiators built into its service help set PCLS apart from its competitors. A broad service menu includes IT connectivity solutions, fast turnaround time on lab tests, and a live customer service center. They also have the capability to run history on a physician’s patient population and assist physicians with compliance.
“We go at this by trying to identify what value-added services we can bundle up with our testing to help the doctor provide better care,” explains Wiegel. “If we’re going to have any chance to survive in this turbulent world of health care, that is the one stable ballast that will help us navigate these waters.”
One of the ways PCLS ensures quality service and efficiency is by building a strong team and providing thorough compliance training for employees. The average Science Department employee goes through six months of training before working independently.
It also teams up with institutions like York Technical College to help with technician training. PCLS is currently working to leverage a similar workforce partnership with the North Carolina Research Campus.
In addition, the company recruits specialized roles, such as Brent Dixon, Ph.D., NRCC, chief scientist at PCLS and a leading expert in mass spectrometry, which tests how patients metabolize medicines to help prevent adverse drug reactions.
“In the clinical world, mass spectrometry is not necessarily used as routinely as other traditional clinical techniques,” says Dixon. “I was able to come in and increase throughput through automation and through reducing the runtime for each sample. We have also trained the staff to operate instruments more efficiently and consistently.”
“Without adding any new equipment or staff, we were able to process twice as many samples with our existing equipment, and thus continue our marketing and growth,” marvels Roth about Dixon’s expertise.
“I truly believe that it’s the leadership of Joe, Mark and Brent, and looking at things in a different way that can lead to exciting things,” adds McHugh. “To me PCLS is all about finding the right people, with the right vision and focus on the goal, and keeping everyone energized. If you can do that, then your future is endless.”
Ahead of the Curve
In just four years, PCLS has transformed from just three employees and 400-square-foot office to 220 employees and a brand new $24 million 104,000-square-foot facility modeled after the Mayo Clinic Laboratory. Previously spread among seven office buildings in south Charlotte, the entire company is now based in Rock Hill, S.C., and is the first occupant in the city’s Riverwalk Business Park.
“We are well ahead of our growth pace,” says Wiegel of PCLS’ plans to have 364 employees by 2017.
The PCLS state-of-the-art lab includes Ultra-High Performance Liquid Chromatography in tandem with Triple-Quadrupole Mass Spectrometry (LC-MS/MS)—the most advanced technology in the drug testing world.
“Investing in new technology is one of our strong points,” comments Wiegel. “We’re not afraid to invest in new technology that looks promising before it’s proven to be promising.”
Adds McHugh, “By building a new facility, we loaded up on the technology to anticipate what we need in the future as best as it’s available today. Once you lay this foundation, there is so much you can do on top of it. It’s endless. It’s exciting. It’s fun. It’s creative. It’s right in line with PCLS.”
Case in point is the new PCLS Live that is currently being rolled out. Inspired by FaceTime and in line with its goal of improving physician relationships, PCLS has created a sophisticated system whereby a doctor can push a button and ask questions via phone or video to one of its laboratory technicians.
“We want doctors to have the best relationships with our laboratory for great patient care,” emphasizes McHugh.
The company is also committed to achieving constant compliance to ensure effective patient management and secure data for the clients in the 39 states they serve. COLA-accredited, PCLS uses testing methodologies that must pass exacting standards for each drug tested in association with the College of American Pathologists (CAP). Its quality system also meets and exceeds the requirements of the Centers for Medicaid and Medicare Services (CMS) and the Clinical Laboratory Improvement Amendments (CLIA).
Committed to staying ahead of the curve on testing, PCLS sometimes faces science outpacing bureaucracy when it comes to how to pay for certain services and how to handle data sharing.
“Science is moving on a high speed rail and bureaucracy is on a horse and buggy,” says Wiegel. “We hope that we’re reaching a tipping point where there’s enough knowledge in the marketplace on the side of the doctor and the side of the patient that demands will start requiring bureaucracy to be faster.”
For services such as genetic testing where one test could be used across multiple applications, there is no way to know if that test has been performed on a particular patient.
Adds Wiegel, “The more we get involved in genetic testing, the more urgent the need becomes to archive and keep track of this data. The question is, who is going to deliver those services to the industry…and there is no good answer to that because of patient privacy issues. Right now our approach is to work on services that help the doctor that don’t put us as risk of violating patient privacy.”
Broader Spectrum of Services
As part of its path for continued growth and success, PCLS will continue to add more services for doctors as well as increase testing. This includes launching a Women’s Health initiative and Cytology Branch later this fall to help curb prescription drug abuse in pregnant women.
“Prescription drug abuse is a real thing and there are a lot of neonatal cases where they are basically born addicted to the narcotic. The cost of delivering care to these infants can be 20 times the cost than treating a baby not impacted at birth,” says Wiegel.
“We think there is a real need and real business opportunity in working with ob-gyns to provide screening and patient advocacy,” explains Wiegel, adding that they would like to work with ob-gyns to implement both routine medication testing and testing for drug and alcohol abuse. If a patient tests positive, they will have access to the PCLS Advocacy Program.
“The idea is to keep the patient clean during pregnancy to produce a better health outcome for the child when born and reduce the total costs on the system,” adds Wiegel.
“We are constantly pushing efficiency improvements on our core values by adding more tests and tons of automation,” comments Roth. “Much of our company metrics are based on how much testing we can do with the resources we already have.”
“You’re never done when you’re done,” says Wiegel. “With a lot of things we are doing, our energy is going into expanding those and bringing them to a wider set of doctor customers.”
Photo: Fenix Fotography
Charlotte-based OrthoCarolina has positioned itself to provide high-level, cost-conscious service driven by the economics of U.S. health care and the Affordable Care Act.
OrthoCarolina provides a continuum of care: physicians who are specialists in foot and ankle, hand, hip and knee, shoulder and elbow, spine, sports medicine and pediatrics as well as such services as physical therapy, MRI and post-surgical support.
The regional practice has grown to 130 doctors, nearly double since Charlotte Orthopedic Specialists and the Miller Orthopedic Clinic merged in 2005, partly by adding six other practices in the past five years. It employs more than 1,000 people.
That size provides the economies of scale, top-quality staffing and opportunities for innovation that can address inefficiencies in care delivery, says Dr. Dan Murrey, the firm’s CEO.
In particular, OrthoCarolina leverages technology and patient engagement to establish a track record of affordable, successful care that will be vital to success under bundled-payment plans facing the scrutiny of payers and accountable care organizations.
“Orthopedics is sort of on the front end of the experimentation that the Affordable Care Act anticipates,” Murrey says. “We’re mostly in the business of improving quality of life and reducing pain. The treatment of orthopedic problems tends to be pretty episodic. A lot of entities around the country are experimenting with what are called bundled-payment programs.
“We’re building the tools so we’ll be able to do that and go to the public and say ‘This is what you’ll be able to expect from us if you come to us with carpal tunnel syndrome or knee arthritis.’ We want to be more transparent not only about the outcomes, but what the cost of care will be.”
Federal rules aside, cutting costs is crucial for convincing employers to continue providing health benefits, Murrey maintains. Per-capita costs have doubled in the last 10 years, and health care accounts for 18 percent of the GDP.
“We realize that health care costs are a huge problem for the business community. It’s a real drain on businesses to have to pay as much for health care as they currently have to pay, and those costs have gone up dramatically,” Murrey continues.
“What we’re hearing from employers is that they were paying more and more. But without quality outcomes reported, such as return-to-work rates and quality-of-life measures, they didn’t know what they were buying.
“Every year, if they are paying 10 percent more, our fear is that employers will get out of the health care business altogether.
“We felt that for those economic reasons we had to respond. The Affordable Care Act put some structure to it, but these were changes that needed to take place anyway, regardless of whether the Affordable Care Act passed or not. It was becoming unsustainable for the economy and for the businesses.”
Benefits of Scale
OrthoCarolina’s growth in recent years enables it to make the investments necessary to address these problems.
“We’ve increased our size and our footprint to as far as two hours from Charlotte,” Murrey says. “Our overhead has progressively gone down as we’ve grown. One way it’s happened is that for medical practices, there’s a lot of capital investment, especially in information technology and electronic medical records.
“I think we have a real opportunity, having the concentration of orthopedic specialists we have and the volume of patients we have. We can devote time to enhancing protocols.”
OrthoCarolina’s scale enables it to keep legal, human resources and IT support in-house, saving more costs, and its numerous locations keep talented specialists busy full-time, enhancing patient care.
“We have subspecialty centers,” Murrey explains, such as concentrations of surgeons for hip and knee replacement, spinal surgery and hand surgery. “That probably has a greater benefit from the patient care standpoint, for patients to get the benefit of all the people in that subspecialty rather than an individual doctor if they have a challenging or controversial case.”
The firm has used electronic records for more than a decade now, which avoids the needless duplication of services, and adopted a data analytics tool five years ago to reduce costs.
“We’ve done some things to really try to drive down the cost of care for patients,” Murrey says. Among other things, OrthoCarolina has opened five orthopedic urgent care centers so that patients can avoid emergency room visits when they need help at night or on a weekend.
“They’re seen for the cost of an office visit rather than emergency room charge,” he says. “People know if they’ve injured an extremity. They can generally decide for themselves to go to an orthopedics facility.”
As the soaring cost of health care has generated increased cost-shifting to patients, they have become more engaged in their own care, Murrey acknowledges, and OrthoCarolina has elevated efforts to assure patient satisfaction.
“Patients historically have not paid for their own health care,” Murrey says. “Now, as people are experiencing higher copays, higher deductibles, they’re getting more involved in the pricing decisions. I think that’s been a positive thing. It’s forced everybody to be responsive. Physicians want to be responsive to their patients. The cost of care is now a part of satisfying patients that previously was not a big part of the equation.
Quality Care Experience
“We’ve done a fair amount of work in trying to standardize what we do and report the outcomes. Currently we use a database that allows people to input their health information directly into their medical record through an email link or an iPad in the office. We’re now starting to add to that, to add modules to educate them about their disease process or the surgical procedure they’re contemplating. We can report out what their progress has been.”
Several years ago an internal, cross-functional process improvement team started looking at patient complaints, both solicited and unsolicited, to generate improvements.
“We processed all that information and mapped out the care experience so we could see where the breakdowns were,” Murrey explains. “We’ve since expanded that program to include patients and their families. Over the summer, we shadowed over 500 office visits, care experience and surgeries with patients to get their take on what was good and what wasn’t good.
“We’re taking all the data we accumulated over the summer and creating action teams that will include not only our staff but also some of those patients to find solutions that will be preferred solutions for them. Those are the kinds of things we need to be doing—looking at the world through our patients’ eyes. The patients will tell us what they need.”
Transparent pricing in bundled care is a key to bending the cost curve in a field where even physicians sometimes don’t know the cost of service until it appears on the bill.
Murrey says now, “You know what the price is up front. There aren’t these surprises and bills that come for months and months afterwards. The provider makes sure you get exactly what you need, not more or different.
“We have to be a lot more intentional about the entire episode of care—not just what we do as surgeons, but all the other things you might interact with during your surgical episode.”
Consumers have found pricing of medical procedures is so arbitrary that “medical tourism” is growing—Americans going abroad for procedures like knee and hip replacements at a fraction of what the cost in the United States.
“There’s no question that the costs of implants are way too high,” Murrey says. “We’re working to try to reduce those costs as well. We believe that there’s a lot of opportunity to reduce supply costs and implant costs in orthopedics. The incentives haven’t been set up to do that. What we like about this new way of pricing is it forces everybody to take a hard look at the added value.
“Spending more does not always generate better quality. Even though we spend more than any other country, our life expectancy is not as high as dozens of other countries. We’re probably not getting value for all we’re paying. We’re trying to do what we can to figure that out and advocate for patients.”
The goal, Murrey says, is a care experience that starts when the patient calls. The practice provides the appropriate and necessary care for the person’s needs and circumstances, a navigator helps guide the patient through the process, the physicians’ track records and the costs are transparent, the patients get progress reports, and the practice engages the patients to help improve the system.
“I think if we offered that package of improvements to people, they would be excited to have it,” he says.
The Anatomy of the Practice
OrthoCarolina’s prides itself as being one of the nation’s most comprehensive orthopedic practices. It provides advanced specialty care and general orthopedics, supported by physical medicine and rehabilitation, physical therapy, advanced imaging, an occupational medicine program and orthopedic urgent care centers.
The origins of the practice are well-storied. For more than 80 years the predecessor groups of OrthoCarolina have provided quality orthopedic care to patients in the Charlotte region.
In the 1920s, Dr John Stuart Gaul, grandfather to the current Dr. Gaul III, pioneered an orthopedic practice rehabilitating wounded soldiers from WWI, and earning a General Washington Offices Award of Merit for his dedication. Nearby, Dr. Oscar Lee Miller was also starting a practice that would grow to become the Miller Orthopedic Clinic.
During the ’40s, prior to the development of the polio vaccine, Drs. Miller and Gaul worked to manage and treat the effects of polio throughout North Carolina, and share the knowledge and techniques with others, locally and internationally. Both practices continued to grow through the ’50s, and in 1955 a third orthopedic group, the Charlotte Orthopedic Clinic, was established resulting in 17 orthopedic surgeons in Charlotte and the surrounding communities.
The ensuing decades saw expansion of the practices with residency programs as well as the first surgeries at the Orthopedic Hospital of Charlotte. The expansion continued into the ’90s as the practices strengthened ties with community hospitals, while simultaneously striving to remain independent.
In 1993, Gaul Orthopedic merged with Charlotte Orthopedic Clinic to form Charlotte Orthopedic Specialists (COS), and late in 2004 the Miller and COS practices merged to form the present day practice.
Murrey expects that OrthoCarolina will continue to grow, through alliances as well as expansion and acquisitions, so that people in more communities can enjoy the advantages.
“What we’ve been able to achieve is to bring some of these procedural advantages or technological improvements to a lot of communities that didn’t previously have them or wouldn’t have been able to afford them,” he says.
“I think there are other opportunities to do that. The groups that have invested in infrastructure and have the kinds of governance that allows them to do those things make good partners as we work through this pretty massive transformation that health care is going to go through in the next decade.
“If we can figure it out together and get a solution that works, others shouldn’t have to struggle through it on their own. I think we’ll continue to grow. I think we’ll see more groups coming together,” Murrey affirms.
The shift from fee-for-service to new care models, including implementation of the Affordable Care Act, will take time but offers promising possibilities, he points out.
“We were not incentivizing the things that are desirable,” Murrey says. “This gives us an opportunity to create some changes in the system that ultimately could benefit the people. It’ll take a generation to figure this all out and make the changes that are necessary, but I think all in all it’s going to move us in a direction that’s going to make us more responsive to patient needs. At least we have the opportunity to do that.
“I think it’s incumbent on the physicians in the community to lead that process. If we don’t take a leadership role in doing it, we’re letting our patients down. We’re intent on being leaders in that.”
Under the header of “Not Your Father’s Biology,” the National Research Council (NRC) issued a report entitled A New Biology for the 21st Century. In it, the writers coined the term “New Biology” to describe the dynamic needed for the life sciences to address some of our nation’s most pressing problems—in loss of ecosystem services, alternatives to fossil fuels, and individualized health care.
The writers see this New Biology initiative as a sea change: “Biological research is in the midst of a revolutionary change due to the integration of powerful technologies along with new concepts and methods derived from inclusion of physical sciences, mathematics, computational sciences, and engineering. As never before, advances in biological sciences hold tremendous promise for surmounting many of the major challenges confronting the United States and the world.”
The NRC report advocates addressing our nation’s most pressing problems in the areas of food, climate, energy and health—sectors that in their larger aspects represent 50 percent of the U.S. economy. It makes clear the need for biologists to reach across the hierarchy of science allying themselves with physicists, chemists, computer scientists, engineers and mathematicians in multi-disciplinary teams to solve the most urgent multi-disciplinary problems.
The NRC anticipates that lines between disciplines will be blurred; physicists and mathematicians will study cell structures and living systems while biologists develop data mining programs and design homes. As you’ll see in a case study discussed later, Dr. Cory Brouwer of the P2EP Project at the North Carolina Research Center has already made the leap with one foot in genomics and the other in bioinformatics.
Businesses are unknowing practitioners of the New Biology as they increasingly cross industry sectors seeking more scientific and efficient methods of operation to produce food for the global marketplace. For example, in the agribusiness sector, Circle S Ranch in Union County uses ecologically friendly, sustainable operations in raising live poultry. Similarly, Simpson’s Eggs subscribes to science-based farming methods designed to ensure hen welfare. These companies are profiled in companion agribusiness profiles in the magazine.
Food: Plant Pathways and Plant Genomics
Plant pathways and plant genomics are expected to be leading players in the biology of the future. Americans may not realize the extent of the world’s food shortages. The Food and Agriculture Organization of the United Nations estimated that 923 million people were undernourished in 2007, the most current data for the NRC report. The New Biology promises the world faster growing, less expensive and more nutritious sustainable plants.
Genes of these super-efficient plants will be identified through quantitative trait mapping. Using what the NRC report calls genetically informed breeding, the genetic sequence of millions of plants can be determined from seeds and seedlings, not after their full life-cycle rotation.
Biologists are now considering breeding plants with an alternative photosynthesis pathway. Dry climate plants are less efficient in turning carbon dioxide into carbohydrates. If they were bred with a more conventional photosynthesis pathway, the adaptation could increase photosynthesis rates in most of the world’s food crops.
Within genomics is the sub-specialty of metagenomics or environmental genomics. Its purview includes temperature, moisture, light, viruses, bacteria, insects, fungi, birds and other factors. Studying plant-insect or plant-bacteria interactions could prove beneficial to crop yields. There is much to learn from these associations.
“Ninety-five percent of all bacteria on earth are invisible to us,” says UNC Charlotte’s Lawrence Mays, chair of UNC Charlotte’s Department of Bioinformatics and Genomics. “That’s because we can’t culture them in a petri dish.” But genomic scientists can extract DNA from bacteria samples and examine their genetic profile. The field has built up a sizable library of its bacteria findings.
Climate: Major Environmental Issues
The New Biology faces two major environmental issues: diagnosis and treatment. No single federal agency, scientific community or philanthropic foundation can develop a comprehensive set of tools to diagnose our ecosystem. At present there are eight federal agencies and departments that monitor our air, water, forests, soil and carbon dioxide levels. Even with that level of scrutiny there are mismatched datasets that make it difficult to detect trends or make comparisons.
In regard to treating at-risk ecosystems, the NRC report does not quibble: “We do not currently have the tools needed to manage the biosphere.” There has been some progress in removing carbon from the atmosphere and in the growing subfield of restoration, but here the New Biology is in its early stages.
Long-term and effective measurement and repair of our natural resources will require the combined efforts of biologists, engineers (civil, environmental and systems), mathematicians, modelers and computational scientists.
Energy: Biofuel Alternatives
Most of the worldwide increase in energy demand is coming from rapidly developing economies like India and China. Three-quarters of their needs are met with fossil fuels. Worries about fossil fuel depletion and pollution are longstanding.
Old Biology reminds us that the world’s first fuel was plant material, now referred to as biomass. The challenge for New Biology is to find plants that produce the most biomass with the least input of fertilizer and water and the least impact on the land needed to grow food. Corn accounts for most of the biofuel produced in the United States.
“In parts of the American Midwest, 100 percent of the corn crop is used to make ethanol,” says Brouwer.
The New Biology regards corn as a first generation biofuel. Second generation biofuels with higher alcohol content are now within reach. Crops in line to take away corn’s crown are sugarcane, sweet sorghum, switchgrass and miscanthus. Agricultural and forestry byproducts are also in the race.
Health: The Big Question
Present day health and medical decisions are often based on probabilities. We abstain from high calorie, high cholesterol foods because of the high probability of heart disease. Probabilities are derived from populations and apply to some, not all, people. Understanding how an individual’s unique set of genes and an equally unique environmental history relate to the person’s health risk, disease susceptibility and response to treatment “is a challenge well beyond current capabilities,” according to the NRC report. In other words, neither genomics nor the New Biology is presently in a position to answer the smoker/athlete question.
New variables have been found that make the question even more complex. Altitude, diet, exercise, exposure to sunlight and chemicals, as well as air- and surface-borne viruses and bacteria all influence the connection between our genes and our traits. New Biologists now think that the genes of each microbe that lives and works inside us also influence our development. Few of those connections have been studied.
Despite the sheer complexity of this vast web of interconnections, genomic scientists have made progress. They have identified large numbers of human and microbial genetic variations and environmental factors that are associated with specific diseases. However, association or correlation does not mean causation.
Causation will inevitably follow and genomics will move us from treatments based on statistical probabilities to treatments based on each individual’s specific circumstances. Individualized medicine and individualized nutrition are on the horizon. Experiments using fruit flies, Arabidopsis, mice, sea urchins and other model organisms will uncover networks, systems and pathways that are similar to humans. The journey of a thousand miles begins with a few genomic baby steps.
The gap between research and application in biology and medicine is extraordinarily long. We are dazzled by advances in technology and frustrated by decades of tiny steps in biology.
Yet the tortoise slogs forward. Scientists once thought that one gene mutation caused one cancer. They now follow a finite number of pathways from genes to disease. The Plant Pathways Elucidation Project and other collaborations emphasize nutrition and disease prevention, not crop productivity. The humble Arabidopsis is doing its part to move society from treatment by probabilities to individualized medicine.
Case Study: NCRC’s P2EP Project Fuses Plant Science With Human Health
The NRC report writers make clear that plant pathways and plant genomics are expected to be leading players in the New Biology. Genomics is the study of genetics and biology.
Genomics examines the interplay of genes with each other, the environment and human lifestyle factors. Genetics, on the other hand, looks at specific genes and traits and how they are passed between generations. Genomics may be able one day to unravel why a cigarette smoker who abhors exercise and overindulges lives to be 90, while a non-smoking health-conscious marathon runner dies at age 40 of a heart attack. By including variables such as diet, exercise and smoking under its research umbrella, genomics may one day be able to prevent cancer and heart disease.
Genomic scientists moved closer to cancer prevention when they discovered that a wide array of genetic mutations grew and developed into the same cancer in different patients. Different mutations, different people, the same cancer and a finite number of pathways between genetic glitch and disease. That discovery had immense practical significance.
“Rather than designing dozens of drugs to target dozens of mutations, drug developers could focus their attention on just two or three biological pathways,” suggests the National Human Genome Research Institute. “Patients could then receive the one or two drugs most likely to work for them based on the pathways affected in their particular tumors.”
That personalized approach to better health is one of the factors motivating Dr. Cory Brouwer and his team at the North Carolina Research Campus in Kannapolis. Brouwer is an associate professor of bioinformatics and genomics at the University of North Carolina at Charlotte (UNCC) and part of the P2EP leadership team. His current interest concerns pathways in plants, and the labs at the North Carolina Research Campus proved ideal for this type of research. Brouwer’s mission is to learn how plants can produce better nutrients.
Brouwer envisions a personalized nutrition. “It should come as no surprise that our nutritional needs are different from person to person because of our genetics,” he said. “We may someday sit down with a nutrition consultant who informs us that, based on the sequence of our genome, we need to be eating veggies with vitamins X, Y and Z and probably none of M, N and O. All vitamin supplements would become My-One-A-Day.”
Brouwer hopes to achieve that goal through the Plant Pathways Elucidation Project or P2EP (pronounced “Pep”). The $1.5 million, four-year collaboration was launched this summer. Participating are UNC Charlotte’s Bioinformatics Services Division, North Carolina State University’s Plants for Human Health Institute and UNC General Administration. Industry leaders include the David H. Murdock Research Institute, Dole Nutrition Research Laboratory, General Mills and the N.C. Research Campus.
The program addresses the overarching theme of “plant pathways” which are a series of chemical reactions in plants that help them to make the compounds they need to survive and adapt to environmental stressors such as disease or climate change. Each chemical reaction forms a part of a “pathway” to the formation of a specific compound, because it’s the natural path a molecule takes when changing from one form to another.
Ultimately, the pathway leads to a new product like an amino acid, phytochemical or a type of fiber. Having been created to help a plant survive its own health risks, these newly formed compounds are often beneficial to human health when consumed. A primary goal of the P2EP program is to identify and map plant pathways in food crops—that is, decode the steps taken to produce the beneficial compounds—and better understand how they function. The P2EP project will conduct research on four foods—blueberries, strawberries, oats and broccoli—and mine data to generate a research knowledge base.
“We’re mainly interested in metabolic pathways for this project,” says Brouwer. “These are a series of chemical reactions that occur within the cells. We elucidate the pathway by identifying the specific enzymes and chemical reactions that the plant is using to produce compounds important to nutrition.”
Presently little is known about plant pathways. It’s surprising that neither nutrition nor edible plants have been the main focus of plant science research. Factors that affect plant yield like disease and drought resistance have always topped the research agendas, not nutrition.
The flowering weed, Arabidopsis, has been the model organism for genomic research, not the four P2EP plants. Like the fruit fly of biological research, Arabidopsis is small and grows quickly. It also has a small number of genes and was the first plant to have its genome sequenced. Despite its fame, Arabidopsis is inedible.
Tools for Agribusiness
Missing from previous plant genomic research have been the tools needed to produce nutritious fruits and vegetables. “Genomic sequencing is of no use to plant breeders until we connect those sequences to traits and markers that fruit and vegetable breeders can use,” Brouwer points up.
Of the four plants studied in P2EP, oats may be America’s most neglected crop. Although it is the vital ingredient in cholesterol-lowering oatmeal and General Mills’ Cheerios, oats are no longer produced in the United States. They are raised only as a rotational crop in Canada. Corn and soybeans dominate U.S. agriculture.
Beyond identifying and mapping plant pathways in food crops—decoding the steps taken to produce the beneficial compounds and understand how they function—the project is already producing terabytes in a knowledge base which Brouwer says will require “bioinformatics expertise and high performance computing to do the analysis that will lead to new and exciting discoveries.”
Generating a knowledge base dedicated to plant pathways research from around the world first requires compiling the data to populate it, and that’s what Brouwer’s project is accomplishing. “The knowledge discovered within this project will be made available online to the public and the scientific community,” he says.
“The Plant Pathways Elucidation Project represents the way big science can solve big problems for society—collaborations across disciplines involving industry and academia,” concludes Brouwer.
Mary Ann Lila, director of the North Carolina State University’s Plants for Human Health Institute at the North Carolina Research Campus and a member of the P2EP leadership team, sums it up: “By answering the questions of how, why and what healthy plant compounds are produced, we’ll be able to advance scientific research, create opportunities for industry and consumers, and ultimately enhance human health.”
There’s a lot happening uptown. The outline of the BB&T Ballpark continues to reshape the skyline of Third Ward, and nearby Romare Bearden Park is expected to open at the end of the month.
Charlotte center city continues to be a leading Southeast business hub with the more recent additions of Chiquita Brands, Chobani, Tire Intelligence and Heels.com.
Uptown is quite the center for higher education featuring colleges and universities, home-grown and satellite campuses, as well as schools of law, nursing, health sciences, divinity, and hospitality.
In the past year center city added more than 350,000 square feet of new office space, and $300 million in residential projects are currently in progress.
In the heart of all this dynamic growth is 7th Street Public Market. Located in First Ward between College Street and Brevard, 7th Street Public Market is carving out its own unique role in uptown.
Exposed pipes, industrial lighting and concrete floors give the 13,589-square-foot 7th Street Public Market an open, urban cool feel and creates the perfect backdrop for its 18 vendors who offer products ranging from organic and local produce to wines and beers, cheeses, specialty salts, vegan body products, fresh meat and fish, teas and spices, chocolates, fresh flowers and baked goods.
The Market also hosts several eateries where customers can enjoy coffee, pizza, sushi or sandwiches made from artisan breads baked on site.
A Place for Everyone
Adjacent to the current last station of the light rail, the 7th Street Public Market is a natural stopping place for commuters to grab an early morning cup of coffee or pick up healthy snacks. Mike Restaino, 7th Street Public Market’s executive director, attests to the many different groups of people that transition through the Market daily.
“During the weekdays, the early crowd consists of ‘grab and go’ professionals,” Restaino explains, “but by midmorning I see a huge influx of either families, or mothers and their girlfriends with babies. It’s a large, open space so families feel comfortable bringing in strollers, and it’s near ImaginOn so people come here before or after their ImaginOn visit and kids love to sit outside, have a treat and watch the trains come in.
“Then there’s the lunch crowd of uptown workers, and in the afternoon we get another family crowd. At night, it’s the people from work again or residents from First or Fourth Ward who want to come to a location where they can just relax and eat with their friends.
“It’s also turning into a destination for business meetings,” Restaino adds. “One businesswoman, who does recruiting for a local bank, conducts all her business interviews here at the Market.”
7th Street Public Market continues to grow; 2013 revenues are up roughly 70 percent over 2012, and two new vendors came aboard this past year. Restaino comments that all of the Market vendors are either hiring or expanding.
“Some businesses like Not Just Coffee are now expanding to two other locations, and because of its phenomenal success, barChocolate has recently hired both chefs and accountants.” Affirms Restaino. “We’re getting the sense here in the Market that we are ready to give back to the community in the form of an economic engine.”
And giving back is key because 7th Street Public Market is a market with a mission.
A Place for Wellness
“7th Street Public Market is a nonprofit,” explains Restaino. “We’re a 501(c)(3) whose primary mission is to support wellness and healthcare by supporting local farmers and food vendors and artisans to promote better eating.
“Buying local, eating local and educating people about how they can use the fruits, vegetables, meats and other products available at the Market can lead to a better, healthier lifestyle.”
The Market’s mission fits well with the goals and businesses of its founding sponsor, Blue Cross and Blue Shield of North Carolina, and its presenting sponsor, Carolinas Medical Center.
Ellison Clary, director of Charlotte Community Relations for founding sponsor Blue Cross and Blue Shield of North Carolina, agrees: “Blue Cross Blue Shield was looking to play a major sponsor in something like this Market because we’re all about healthy lifestyles, life improvement and fighting obesity. The Market does all three.”
One of the 20 stations for Charlotte B-cycle, the largest urban bike share program in the Southeast, is outside the Market. Blue Cross and Blue Shield of North Carolina provided the grant for the program.
“In the future there’s going to be a park across the street from the Market,” Clary continues. “The park, the bike share program, and the Market—all of these make perfect sense for us.”
7th Street Public Market has 14 supporting sponsors: Allen Tate, Bank of America, Blue Cross and Blue Shield of North Carolina, Carolinas HealthCare System, Charlotte Center City Partners, Compass Group, Conder Flag, Foundation for the Carolinas, Grant Thornton, Johnson & Wales University, OrthoCarolina, Parker Poe Adams & Bernstein, Rodgers Builders, and Winstead Attorneys.
Supporting sponsors are active in the Market’s fundraising Farm to Fork Dinner Series. Restaino explains, “We have four dinners a year where businesses can bring associates and clients or solicit business. They can give them a special night out that’s different from a steakhouse or restaurant.
“The Market is a very different environment and as you can imagine, the food is wonderful. It’s a positive, high energy kind of experience and guests realize they’re doing something good to support the Market.”
Outside parties have also discovered the Market as a unique venue. “We’ve hosted the Latin American Chamber of Commerce’s Tapas Night and in July, the French American Chamber of Commerce held their Bastille Day celebration here.
“It was unbelievable, with jugglers, accordion players and a performer on stilts. For the first two hours, it was open to the public who could buy tickets and try all the French culinary treats like crepes and macaroons and quiches that our vendors had specially prepared.
“At one time that night we had over 300 people here. Every table was full. There was music. It was pure energy. People are beginning to see that the Market can be a tremendously dynamic place.”
Supporting sponsor Charlotte Center City Partners is heavily involved in helping the Market with the dinner series. The organization, whose goal is to facilitate and promote economic and cultural development in Charlotte’s urban core, also provides the Market with assistance in areas of marketing, promotion and operational administration.
“Charlotte Center City Partners has always been invested in the vision of a green market in Center City,” explains Lelia King, Charlotte Center City Partner’s director of communication. “7th Street Public Market is exactly what we need here.”
King cites the growth of 20 to 30 year olds moving into uptown. “People who live here, people who work here and the roughly 11 million visitors to the city annually are all a huge customer base for the Market,” she adds. “It’s the kind of place people want in the city.”
A Place for Growth
7th Street Public Market not only provides a unique experience for its customers, it also provides a unique opportunity for its vendors. Restaino explains, “The second mission of 7th Street Public Market is to be an incubator for new businesses. We work with new businesses to see if they have a viable business plan.
“I’ve also talked with the board recently to see if there are further opportunities, from an educational standpoint, to provide these businesses with information on systems, technology, accounting or insurance. We’ve been brainstorming to see how we could provide these resources to them.
“What’s unique about the Market’s business model is that we are looking for business synergies. Prospective vendors go through a selection process to determine not only their viability but also to determine if they can ‘lift’ the Market. Their business has to fit within the mission of the Market and work well with the other businesses here.
“For example, I didn’t really envision a vegan baker for the Market, but after listening to the customers, I knew that having Novel Sweets here would be an opportunity to service the market and educate the consumer about a different business. The businesses here all have tremendous knowledge about their products that they can share.
“The synergies here are really special. The vendors support each other. Novel Sweets uses ingredients from Salts of the Earth. Homeland Creamery, with their local dairy, supplies the milk used at Not Just Coffee. Local Loaf uses Homeland Creamery products for their baking.
“Not only do these relationships create camaraderie among vendors, but it also helps each other financially. It’s a unique environment that goes back to the business selection process.”
Local Loaf was chosen as a vendor from among 15 applicants. Owner and Executive Chef Adam Spears always had the goal of starting his own business and after graduating from Ohio State and getting his culinary degree from Johnson & Wales University he worked in town with Chef Charles Catering as well as Global Restaurant and Heist Brewery.
When it came time to realize his goal, Spears says the 7th Street Public Market was a natural choice. “When I moved here I started baking breads and traveling to farmers’ markets. I loved selling one-on-one to customers so I purposefully targeted this market for my first business.
“The Market allows me to have a good rent price, a great location and the ability to work with multiple talented vendors to make what I do a success.
“The best thing about the Market is the partnership we have with each other. It’s definitely a community atmosphere.
“There’s a mentality that all of us here are stepping out on our own with everything that we have and putting it forth to give the customer the best opportunity to get not only great foods and products but also a great atmosphere.”
The aspect of community was important to Restaino too, who comes to 7th Street Public Market after more than 40 years in retail with industry successes like Belk Store Services, Goody’s Family Clothing and JC Penney.
“I thought everything within these walls could make a great urban community market. I had a vision of what it could be,” says Restaino.
Restaino, who lives uptown and serves on the board of directors of The Friends of Fourth Ward, The 10th Street Townhome Association and the nonprofit Joedance Film Festival, wanted to make a difference.
Initially, Restaino thought his comprehensive experience in areas like store management, marketing, sourcing, buying, importing, logistics, compliance and store presentation would be the primary tool he would use to grow the Market.
“I talk to the vendors on a daily basis to give them suggestions on visual presentation, assortment mix or inventory control, and some have come to me and asked for input about the right time to expand or advice on what might support their brand.”
But Restaino has found that his people skills have been the most helpful. “The Market has 18 vendors. That translates to 18 different personalities I need to motivate and to make sure we’re all pointed in the same direction. I also have to successfully work within our board and with our sponsors to support our vision for the Market and to be the face of the Market within the community.”
The Market has become a destination place for the community by hosting special events every Saturday like July’s Firefighters’ Pancake Breakfast, the upcoming Cookie Crumble and the season-long Green Market Saturdays with an expanded array of vendors and themes like ice cream, camping or peaches.
“When people learn how the community is benefiting from the Market, I’m hoping that more individuals and businesses might want to become more engaged in the Market, maybe even as sponsors,” says Restaino. “Our hope is that 7th Street Public Market becomes an iconic location in uptown Charlotte.”
Photo by Fenix Fotography www.fenixfoto.com
‘Tis the Scottish way for business people to proceed with caution and to minimize risks, according to Peter Wilson, president of Great Scot International, Inc. Nevertheless, he and his son James are braving the sometimes unpredictable world of importing to bring Scottish products to a welcoming American audience.
According to the 2000 Census Report, some 11 million people claim some heritage connection to Scotland or Ireland. There is a heavy concentration of Scots and Scots-Irish in the Carolinas and neighboring states.
Great Scot International, Inc., based in Charlotte, was started in 1997 and specializes in supplying food products like shortbread, oatcakes, heather honey, candies and beverages (including the iconic Scottish soda, IRN-BRU), as well as tartan (plaid) fabrics and apparel all manufactured in Scotland.
Food items are made from all natural ingredients with no artificial flavoring or coloring. Tartans are woven from pure new wool and non-wool fibers. “We have the largest range of tartan fabric and apparel in the
“There is a vast market out there for Scottish products—lots of people that have a huge passion for all things Scottish, whether it’s the Highland games, music, clothing or food. There are dozens of retailers throughout the U.S. selling Scottish, Irish and Welsh merchandise and we are suppliers to a good majority of these companies.”
Great Scot—Great Products!
With a growth rate of almost 30 percent for the past couple of years, Great Scot International earned $1.1 million in revenue last year. Representing 60 percent of revenue, food products are the larger side of the business.
“The food business counts on repeat sales,” says son James, the company’s vice president. “It’s tough to get a place on the shelf in extremely competitive markets, but once you get it, it’s easier to keep it.
“The tartan business is dependent on the ‘Scottish goods’ vendors we supply across the country. However, there is a growing demand for tartan fabrics from the likes of interior designers and wedding planners. In some cases we have done custom design and weaving. We are always on the lookout for other opportunities outside the Scottish market.”
On the food side, most customers are large-scale distributors supplying stores such as Harris Teeter, Wegman’s and Publix supermarkets.
“Business generally goes through big distributors and works down to small retailers,” explains James. “We also have many independent grocery stores. It’s quite a big market that is growing through word of mouth.”
The company currently markets 15 imported food brands.
The largest customer for the company is Amazon.com, which began doing business with Great Scot International in 2010. “We accept weekly orders from Amazon and currently deliver to nine fulfillment warehouses,” says Peter. “Amazon.com started with us by ordering $200 worth of Nairn’s Oatcakes a week. It now accounts for over $200,000 in revenue per year and currently purchases over 100 SKUs. The Amazon account alone is almost a full time job,” says James.
You may not know the brand IRN-BRU, but it is Scotland’s top selling soda, Scotland being the only country in the world where Coke has not held the No.1 position.
“Latching on to the IRN-BRU product, a $400 million dollar brand in the United Kingdom, was the turning point—it moved us to a different level on the Scottish food side,” acknowledges Peter.
The soda beverage is specially formulated for the U.S. because they use a food colorant in Scotland that is prohibited in the U.S. by the FDA. Great Scot International is the sole supplier of IRN-BRU in the U.S.
Great Scot International textiles find their way to a diverse sales base including suppliers, manufacturers, retailers, universities, municipalities, and interior designers. The company is the
“We just finished up a project where we supplied the tartan fabric for a small piece of a shoe being marketed by a well known women’s clothing store,” reveals James. “Every year there is an interesting high-number job that helps the bottom line,” adds Peter.
“We also do a lot of custom weaving of plaids that are not otherwise commercially available from any mill,” says Peter. He describes a project underway for Winthrop University, which has recently registered a new tartan design. The company has completed work on projects for UNC Greensboro, Furman University, Presbyterian College in Clinton, S.C., and the Department of Homeland Security Office of Field Services’ Honor Pipe Bands. Harley-Davidson is another well-known customer.
Many American states also have their own tartans. Over the years Great Scot has woven The Carolina tartan,
Great Scot International completed a recent project for the Cypress Presbyterian Church in Vass, N.C. Tartans for the names of the founding fathers of the church— Cameron, Johnstone and Keith—were all woven into one pattern.
“Early on I saw the value of going out to the Scottish games with the tartans in tow,” says Peter, proud of his initiative. “It was a simple marketing technique—face-to-face. I’ve worked with several clans who’ve commissioned me to weave designs over the years. Pretty much every state puts on Highland games where you can find upwards of a hundred clans with different names and over 20,000 visitors. It is a very targeted audience.”
In light of the various products Great Scot offers, the company markets its products on the additional retail websites of www.IRN-BRU-usa.com, www.thescottishweaver.com; and www.thescottishgrocer.com.
James clarifies the importing process for Great Scot International: “Suppliers in the U.K. are not always knowledgeable about exporting. We have to make sure that the documentation meets with the correct format and that every item has the correct tariff code.” Containers are not released for shipment without correct documentation.
Great Scot had been using a contract warehouse in New Jersey, but three years ago moved from office premises to their current headquarters so that they could bring in shipping containers directly, says Peter.
As a small part of the business, the company offers a special import service (or co-loading) on their monthly containers as space permits. This works well for U.K. companies who may have only a pallet of product to ship. Cargo is then shipped to its final destination within one-to-two days of receiving. Some customers also load some Great Scot International products with their shipment. The logistics, for now, are handled separately by a company called Compass Imports, but the
Great Scot International pays for its goods in British sterling. Peter explains that the rate of exchange can be challenging when pricing products.
“The trouble is, you can’t keep changing prices on your customers, so you have to look a year ahead and settle on a price and a rate of exchange. With forward planning it is possible to lock-in a rate through purchasing tranches of British sterling for a 90-day window.
“My strategy is, even if the rate looks great at the time, add another 10 percent. Unless there is an astronomical monetary crisis, you should be alright.”
Working with the U.S. Food and Drug Administration (FDA) can also be tricky, according to the Wilsons. With the introduction of the Bioterrorism Act, every overseas food supplier must register with the FDA before they can export anything. The FDA also reserves the right to audit their premises.
Last year, the FDA put a ban on anything that had raspberries in it due to a certain pesticide forbidden in the U.S.
“A representative from the FDA came and witnessed us smashing up the bottles of raspberry preserves,” says Peter. “Our supplier was not aware of the ban and did refund us. Currently we are having an issue with mustards.”
This type of regulation can halt a shipment without consideration of spoilage. The full burden of proof is on the importer, according to Peter and James.
Shipped to America
During the 1970s, Peter was invited to participate in an Environmental Protection Agency program at Clemson University. He went there to be an assistant to a professor, but was also encouraged to enroll in the graduate program for environmental engineering.
There, he met his wife Suzanne, whom he took back to Scotland where she would survive 14 Scottish winters. In
“I thought my future was going to be in my father’s business until he sold out to a new owner,” says Peter. But, in 1993, an opportunity came along for him to take on sales and project management in the U.S. for the business, and he chose Charlotte as a base of operation.
“I knew that I would be traveling and needed an airport that readily offered domestic and international flights. I started with a phone and a fax line in a friend’s garage until I bought a home in the SouthPark area,” remembers Peter.
“But by 1997, I was ready to do my own thing, though. The decision to start my own business was driven by the growing potential of the Internet. So, I began to put together my interests in selling Scottish food products, tartans and giftware online. Working from home I handled all the purchasing, packing and shipping orders through UPS at Office Depot. At the end of the first year, I had barely made $30,000, but it was progressing.”
Slowly but surely he built up the product lines and sales connections, as well as the Internet presence for Great Scot products. Since early 2000 the business has grown more on the wholesale side which now represents about 65 percent of its revenue.
Great Scot was fortunate to hold steady during the downturn in the economy, according to Peter. “We are addressing a niche market with both indulgent food products and ‘heritage’ tartans,” says Peter. “We measure by looking at our customers—most are vendors, and they seemed to survive themselves; sales a bit down but they did okay.”
Great Scot International finances working capital during times of increased buying, such as for the holidays, with a line of credit. The company has not had to obtain any major loans other than personal investment, says Peter.
Four full-time employees, including Peter and James, make up the small staff.
“When you work in this company, you have to be prepared to work outside of a single job description,” confirms Peter.
“My office manager, Becki, has been with me for 10 years and is greatly admired by our customers. When we moved to our warehouse over 3 years ago we hired a young man who has done a great job in running the warehouse and order fulfillment. “We are like a family.” Two other part-time workers handle IT issues and bookkeeping on a contract basis.
Peter says he doesn’t even think of retirement.
“I will be 64 this year and can sing the Beatles song,” he chuckles. “As long as health holds out, I would like to continue.
“I’ve turned a lot over to James. I used to do all the ordering of product; now he does. Becki, too, is in for the long-term,” says Peter. “We’re a team; passionate about what we do.”
Future plans include continued growth and focus on Scottish made goods and becoming America’s No. 1 source for quality tartan fabrics.
Photo by Fenix Fotography www.fenixfoto.com