Health, wellness, and the future of Charlotte

This summer, I had the opportunity to intern at Care Ring – a wonderful nonprofit healthcare organization in downtown Charlotte. Each year, the Levine Scholars program at UNC Charlotte sends one student to Care Ring for approximately five weeks to get a solid glimpse into the nonprofit realm and what Care Ring does for the Charlotte community. I must say, after my about twenty-five days of working at the organization, Care Ring is a crucial puzzle piece in solving the healthcare dilemma that faces Charlotte (and the entire state of North Carolina).


            During my first week or so, I was hesitant about doing things – am I doing this right? Could I be doing it better?  What if they don’t like me? I have never worked a “9:00-5:00” job prior to this internship, so I was pretty overwhelmed by diving headfirst into it all. Nonetheless, I quickly acclimated to the environment and soon realized everyone was so welcoming, encouraging, and helpful.


            My first project consisted of identifying a food desert between I-77, Billy Graham Parkway, and Wilkinson Boulevard; essentially, in this triangle, fresh food was pretty scarce. Using Google Maps, I mapped out all of the clinic and Physicians Reach Out (PRO) patients that resided within or around this area. Knowing someone lives in a food desert alone can reveal so much information about that individual – why they are not eating well, why they are gaining weight, why fruits and vegetables and other fresh produce is not a part of their diet, and more.


            Next, I delved into the Physicians Reach Out realm of Care Ring. In PRO, specialty care is available at no cost (in addition to primary care, hospital admission, and lab testing), which extends to dentistry. Unfortunately, the dentistry side of PRO is currently facing challenges in rallying dentists and eliminating the waitlist for PRO patients. My next project involved creating a dental patient survey, a “Share Your Story” form for patients who have seen dentists, and a phone script to use when contacting patients about the survey. A vital part of Care Ring is utilizing patient stories, which are the most impactful tools in getting people, doctors, funders, and more to understand the importance of Care Ring’s work. However, there is a small hole in the dental part. As a result, I created these forms to specifically target dental patients that used PRO to aid in hearing how dentists have changed the lives of our patients – and, hopefully, these can be used in getting non-participating dentists to join PRO.


            Another instrumental part about Care Ring is the bilingual staff members. The amount of Spanish-speaking Charlotteans has quickly increased over the years (in addition to many other languages other than English). These members of our community need somewhere to go for their health – and Care Ring is that place for many. As a result, Care Ring’s need for translators or bilingual physicians has also risen. For another project of mine, I contacted all of the offices of the physicians that Care Ring uses to see if the physician themselves speak another language. Unfortunately, many of the physicians do not speak another language – although, if he/she does, it was likely Spanish or an Asian-originating language, as I discovered. Fortunately, however, many of the places can provide their own interpreter for patients and, if they cannot, then Care Ring can. Needless to say, Care Ring is not only a place for the underserved English speakers of Charlotte, but those of any race, ethnicity, or language.


            In addition to these projects, I did two more – one on durable medical equipment companies (in seeing if any companies in the area provides charity care for those who are uninsured) and one on hospital admissions (in analyzing data about the most common diagnoses on patients who go to the hospital and other similar data). I was also able to attend several meetings with many of the staff:  one on MedLink (an overarching organization that brings together all of the healthcare resources in the area), one on Nurse-Family Partnership and its potential in expansion, and several others. On my last day at Care Ring, I was given the opportunity to shadow Dr. Sailer in Care Ring’s Low-Cost Clinic, which gave me a fascinating view of how clinics operate, the clients they serve, and the many health issues that people face. One of my favorite parts of the internship included going to a community fair called National Night Out. I attended with the community liaison, who is also the Affordable Care Act Navigator for Care Ring. Essentially, we setup a table which information on the programs in Care Ring and the services they provide. About 300-400 people in the community came to the event to survey the tables and see what resources are available for them. I really enjoyed this event because I was able to directly interact with the client base, as well as inform people of the aid that is available.


            All in all, my experience at Care Ring was a great one. I care about Care Ring because they care about the healthcare for those who do not have adequate access to healthcare services. I care about Care Ring because they provide services via their clinic to those who fill “the gap” in healthcare. I care about Care Ring because they care about first-time mothers, babies, and families in ensuring children are raised the best they can be. But, most of all, I care about Care Ring simply because they care – and that can go a long way.


Tyler Rapp is a Levine Scholar at UNC Charlotte (Class of 2019). During the summer of 2016 Tyler interned with Care Ring.

Take out your crystal ball, pull out your Ouija board, consult your corner palm reader if you must: What do you think health care in the United States will look like in the year 2020? What are the most important issues that will impact the health and wellness of all people in our region in the new few years? 


Back in the late 1990s, through a grant from the Robert Wood Johnson Foundation, I co-wrote a book about the future of Health Care in the United States. Released in 1999, Health Care 2020 was written while I was a research fellow at Hudson Institute.



Hudson has a long history of wading into thorny subjects and offering a contrarian point of view. Hudson’s founder, Herman Kahn, a leading futurist in the 1960s, wrote widely on a range of subjects, including the prospects of what life might be like if a thermonuclear war broke out (Thinking the Unthinkable).



Health Care 2020 was not designed to be a doom-and-gloom book. We did not set out to “Think the Unthinkable” about health care in America.



But we did aim to produce a sober reckoning on what America’s hodge-podge “system” of health care might look like in the year 2020.



The ideas we presented and the scenarios we laid out hit the mark in some ways (predicting new drug cocktails for diseases like AIDS would come along to prolong life), but missed the boat on many others (we thought the employment-based tax exclusion would be repealed and replaced by a universal credit for health insurance purchases by 2020).



Today we are only a few years away from 2020. We have much more clarity on what health care will look like in the US in a few years.  And yet in some ways we have extraordinary uncertainties:


-          Will the Affordable Care Act become embedded in the US health system in coming years, or will there be a repeal of the ACA and some replacement program offered?


-          As our society continues to age (boomers are now entering retirement age at a fever pitch), will we have the resources to care for these soon-to-be ailing boomers through Medicare as it is currently constructed?


Since our book came out in the late 1990s, the very concept of health and wellness has taken on new dimensions, as we now have a much greater appreciation for the powerful impact social and environmental issues have on health and wellbeing, regardless of the kind of insurance one might have.


So, my question for you:


-          How will we tell Charlotte’s Health Care 2020 story?

-          What are the most important issues impacting the overall health and wellbeing of all people in our region?

-          What are the biggest gaps in care in our region, and what can we do together to create an environment that maximizes the likelihood of good health for all?


I’d love to hear your thoughts!


Give me a buzz, set up time for a coffee or (depending on the time of day) beer conversation with me -- I spend a large part of my life at 7th Street Market so happy to meet you there.


Or come visit me in our uptown Charlotte Care Ring offices to see how we are providing care to those in need.

The best late summer running event in Charlotte is only weeks away.


The OrthoCarolina 10K Classic arrives Saturday, August 20.


But this is much more than a race.


Food trucks, local craft beers, plus some of the best race swag you will ever find make this a must do for folks in the Charlotte region. (Last year’s “I Run For Beer” shirt is one of my most prized possessions.)


Care Ring is fortunate to be a beneficiary of this year’s event. If you are thinking about running, as a Care Ring supporter you can get $10 off your registration fee! Use PROMO CODE “carering10” at checkout—valid until 7/31. SIGN UP HERE.

Over the years I have wrestled with how to articulate our value. I once decided to strike the entire “non-profit agency” description from our elevator speech, suggesting a new tagline for us: Care Ring is a poverty-fighting, life-affirming, people-loving organization.


We are poverty-fighters, we affirm and give dignity to every life we care for, and, yes, we love people, especially those who have fallen on difficult times in their life and have few places to turn for care. 


But at the end of the day, how can donors who support our mission know they are getting a good return for their contribution? How can we demonstrate that investing in Care Ring brings significant savings to the community?  


One way to look at impact is from a purely financial perspective, emphasizing the monetary savings to our community that result from investing in Care Ring. For each of our signature programs, we have developed a formal return-on-investment figure to capture our financial value.


-          Primary Care for People With Modest Resources


  • Our Low-Cost Clinic provides high-quality preventive care to 2,600 uninsured and underinsured neighbors each year. Our clinic team treats chronic illnesses and offers wellness checks, health screenings, employment exams, vaccinations, and health education. We estimate we save the community more than $2.5 million each year through reduced Emergency Department visits due to the care we provide in our clinic. The ROI for our clinic comes out to $6.36 for every $1 invested.


-          Comprehensive Healthcare for People Most in Need


  • A network of 1,600 volunteer medical professionals donate their talents through Care  Ring. Through our provider network, we provide access to primary and specialty care, labs, and diagnostic tests to 4,000 low-income, uninsured people in Mecklenburg County each year. Doctors and dentists participating in our program donate more than $10 million each year in uncompensated care, and this program generates an annual ROI of $31 for every $1 invested.



-          Community Health Nursing


  • Care Ring’s home visiting program, Nurse-Family Partnership, is designed for moms with limited resources who are pregnant for the first time. Each mother is partnered with a registered nurse from pregnancy through her child’s 2nd birthday. These new moms gain tools to provide their children a stable home and discover a path to self-sufficiency. NFP is an evidenced-based program, with an ROI of greater than $6.00 for every $1 invested.


The real life stories we hear from our patients – stories I get to hear nearly every day – are about changed lives and the transformative power that comes from reaching out to care for folks during hard times.


What our ROI “stories” are able to show is that while we are a poverty-fighting, life affirming, people-loving agency, we also do our work with a clear eye on the financial return on investment we bring to donors and to our community through our work.

...before becoming executive director of a nonprofit.



July 1 marks my four year anniversary as executive director of Care Ring.


It’s been a thrilling run, mostly cheerful, sometimes heartbreaking, full of equal doses of optimism and anxiety.


We’ve been growing these last few years, doubling our employees (20 to more than 40 today), enhancing our annual budget (from $2 million four years ago to $3.5 million in our upcoming fiscal year), increasing our impact (going from 4 nurse home visitors to very soon 10), and measurably improving more lives (including hundreds of Charlotteans now under our care in a rapidly expanding chronic disease management program).


I am wired for growth, and have enjoyed seeing us start to realize our potential. I recall a mentor, Novant CEO Carl Armato, once remarking that if you aren’t growing you are dying. (I will be happy to share with Carl next time I see him that Care Ring is definitely full of life!)


Seeing the early returns from the hard work of the staff and the confidence of the board in our recent growth is gratifying.


But as much as I would like to say I could see this coming all along, that I had a perfectly calibrated vision for the future and our place in it, the truth is I didn’t come into this with the skills and insights in place to make this happen.


I had to learn it, and re-learn it, every day.


I still do.


I had to figure my way forward from the beginning, and still four years later feel very much like a rookie every day (nod to the remarkable Andi Stevenson for her recent excellent TedXCharlotte talk on the importance of experiencing life with the eyes and openness of a rookie).  


I came into this role with a variety of experiences that I (and presumably the board that hired me) assumed would serve well in this role, including a background in fundraising, grantmaking, and an appreciation of how public policy impacts individuals with limited resources.  


Looking back now, there are countless things I wish I had known about leading this agency before jumping into this adventure. Here are eight lessons I have learned during these first few years of running Care Ring, observations that I wish I had known more about when I first started, and that I think are applicable to anyone stepping in to lead a nonprofit agency:


1. Know your agency DNA


Quickly internalize how the agency got to where it is – who were its trailblazers and community life changers? For Care Ring, all roads lead to its founder, a visionary nurse, Maribelle Connerat, who more than 60 years ago embarked on a mission to provide excellent, dignified, preventative, accessible and affordable care to ALL who needed it, regardless of their situation.


2. Know yourself


I have developed a pretty good eye for many of the emerging issues in the nonprofit world, and yet, even four years in, not a week goes by that I am not confronted with and often bewildered by some new HR ruling, tax implication, financing wrinkle, promising health care intervention or some other issue that lands on my desk for a decision. To succeed I have to be surrounded by excellence – highly capable individuals with unique skills must be at my side, as there are large gaps in knowledge and experience where I will have to lean on teammates for assistance.  I also have to work to improve my blind spots, and must take every opportunity to enhance skills and improve my leadership. (The Blue Cross Blue Shield of North Carolina Leadership Academy, which we were fortunate to participate in last year, is just the kind of opportunity executive directors should embrace when presented with a chance to participate.)


3. Chief Storyteller


Perhaps the most important role of an executive director is serving as chief storyteller, primary spokesperson, the essential voice describing the agency and its value. Board members are excellent at extending the agency’s message to the community, and staff can help in countless ways to share the good news about your work, but the executive director is THE voice, and you must get your pitch down and get your best suit cleaned, and be ready each day to testify. You are on call, 24-7, and when something big breaks, good or bad, you will be the one talking. So get ready.


4. To solve the problem you have to understand the problem


Care Ring is in the business of healing the sick. We do this, caring for thousands of our neighbors in need every year. But our even bigger job is to help make Charlotte great for everybody, regardless of their station in life. We do our work through health and wellness services to those with limited resources. We provide health care to those who are hurting at our shop uptown, in one of the clinics of one of the hundreds of doctors and dentists who give their time and talent to volunteer with us, or in the home of a young mother just starting her family. We are a health care agency, but the real problem we are trying to solve is poverty and the distressing lack of economic mobility for those with limited resources in our community. This causes far too many of our neighbors to live unhealthy lives, in unhealthy environments, so they need groups like Care Ring to be their advocate, provider, and place for hope.


5. In the nonprofit world, never go it alone.


Nonprofits play an essential role in neighborhood building and creating vibrant places – they are a community’s connective tissue, linking folks who care to problem solving opportunities. Nonprofits play an important role --- but to do our work we have to partner with others to achieve lasting success. We rely on public funding and public agencies to accomplish our goals. Private philanthropy is a primary fuel our business needs to hum. We rely on nonprofit partners across the spectrum of services – housing, after school programming, children’s rights and advocacy, food security, and so much more – to do any of our work. We cannot achieve anything by ourselves. We can make miracles happen when we work in partnership with others.



6. Just like your personal investment portfolio, relentlessly, aggressively DIVERSIFY your funding


Just like the danger of putting all of your investments in a single stock, nonprofits can become overly dependent – and potentially at great risk – if they rely too heavily on a single source for funding. When I first arrived, our nurse home visiting program was funded almost entirely by a single, incredibly generous, long-term commitment from a highly-respected major private donor.  We had to find multiple, new significant sources of support to sustain and grow this remarkable intervention. Today the private donor represents less than half of the support for this program, as multiple alternative sources (the United Way, Mecklenburg County, Smart Start, the State of North Carolina and many others) have stepped forward to help us diversify our funding sources and no longer rely solely on a single very benevolent donor.


7. Nonprofit ≠ Non-business


Some may envision day-to-day life in a nonprofit as easy going and immune to changes in the market.  Lacking the rewards (and penalties) of a private business having to slug it out with competitors every day, some may imagine a stress-free nonprofit life. Nothing could be further from the truth. Nonprofits do not exist to make a profit or please shareholders, but every nonprofit is a business, and to be successful they have to be eternally aware of their environment and constantly assess their business plans and strategies for the near and long term. Health care in particular – with ever evolving rules for Medicaid and dramatic changes in health care delivery and care management as just a few examples – requires savvy analysis of opportunities and threats to operations.


8. Bang your drum…twice as hard and every chance you get


Nonprofits can do extraordinary things to change lives, improve the environment, make communities better. We are dreamers and believers in a better world.  And yet almost all nonprofits are seriously hamstrung in sharing their amazing stories with the public. Lacking hefty marketing budgets and running shoe-string, pick-up-that-paperclip-cause-we-don’t-have-money-for-another-one operations, nonprofits are often greatly challenged in getting their message out to the folks that so desperately need to learn about their power. Donors and potential donors need to hear about the cool, amazing, jaw-dropping stuff nonprofits do. Nonprofits can’t just assume folks will figure out our awesomeness through some magical fairy dust. We have to tell them, and tell them again, and tell them in new and emerging ways how we are doing remarkable work. And we have to do this at the risk of looking like we are overly patting ourselves on our back. We’ve got to take advantage of social media and any other free media to get our mission message out to as many folks as possible. As an example, I started this blog after a year as executive director, and in the last three years it has attracted over 110,000 visitors interested in learning about how we are improving health and well-being for those with limited resources in Charlotte. This is a start, but I need to do more to get the Care Ring message of empowerment and hope for those with limited resources out to more people.


So there is much I didn’t realize I was jumping into four years ago – including leading-edge board and staff management practices, how to improve the budgeting process, the critical importance of building peer support groups, and much more.  Perhaps the most important thing I didn’t realize is that while many days will be tough, and most days will be exhausting, every day will be meaningful.


It is a blessing and great privilege to do this work serving others.

Latest comments

30.06 | 16:11

Thank you Chris!

30.06 | 15:48

Great article Don! Thanks so much for sharing your learning!

28.04 | 12:55

We are so excited to have you as our Community Partner!

30.01 | 02:58

Very interesting blog, looking forward to more wonderful!