CHANGE DEFINES HEALTH CARE: From coping with the opioid epidemic and the urban-rural divide to controlling costs, North Carolina's health care industry faces multiple challenges.

• Position: HEALTH CARE ROUNDTABLE

The round table was hosted by Poyner Spruill LLP and sponsored by the city of Greenville, Poyner Spruill and Scott Insurance. The transcript was edited for brevity and clarity.

WHAT IS THE STATE OF HEALTH CARE IN NORTH CAROLINA?

GORDON Well, I think "change" is the one-word answer, that health care is changing now probably on a daily basis. Every time I talk to nurses in the field, they're telling me a new story. Some of the stories are better. Some of the stories are about innovation. Some of the stories are about growth and opportunity. Some of the stories are about stress on the workforce, stress on the patients to make choices about how they pay for their care. Some of it's about stress on the employers where nurses work and the employers where their patients work.

SELIGSON I think as we talk about health care transformation, the reality is, both at the state and federal level as well as in the private sector, the cost of health care is at the forefront of the discussions. And, clearly, one thing that started at the federal level that's impacting us on the state level is the move toward the value-based health care: Improving outcomes, improving efficiencies and promoting collaboration across the health care sector. The challenge is to make sure that we are providing the tools and data to make better health care decisions, to improve outcomes, improve efficiencies and make our citizens healthier.

BURGESS We want better care, meaning we want better outcomes. That's a given. We want better value, meaning we want to either reduce or certainly not increase the cost of care. How do you do that? You can control the amount of care given. You can affect the length of care for some of our institutional settings, the number of procedures or how long somebody is getting that care. Thirdly, you can control how much the care costs, each unit, whether it's therapy or an MRI or a surgery. The last thing you can control is the number of people getting the care, aka rationing. The question becomes which variables we tweak, monitor, deflate or increase to get to our goal of better outcomes at a controlled price.

KAMMEYER What I hear most is a general feeling of a lack of transparency. I think health care is the one thing that we consume as Americans without any regard for the costs or quality until after we've consumed it. Anything else that we buy, we know what we're paying for, what we expect the outcome to be, and what we want the benefits to be. What do we pay? What do we get? How do I know that Dr. A is better than Dr. B at shoulder surgery and has better outcomes and better value? There's no great way yet to get to that. That's becoming...