Andy Zukowski, Chief Financial Officer at ECU Health

Summary

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Becker’s Healthcare Podcast

Guest: Andy Zukowski, Chief Financial Officer at ECU Health

Date: January 21, 2026
Host: Madeline Ashley

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Episode Overview

This episode features an insightful conversation with Andy Zukowski, CFO of ECU Health, focusing on the evolving landscape of rural healthcare finance. Zukowski discusses the major economic and policy shifts impacting rural providers in North Carolina and outlines ECU Health's strategies for sustainable growth, maintaining patient-centered care, and adapting leadership mindsets amidst rapid industry change.

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Key Discussion Points & Insights

1. Introduction to Andy Zukowski and ECU Health

• Background: Andy Zukowski is the CFO of ECU Health and the Brody School of Medicine at East Carolina University.
• System Overview: ECU Health is a rural academic safety net health system serving over a million residents across 29 counties in Eastern North Carolina.
  [01:15]

  "We are a rural academic safety net health system serving well over a million residents in 29 counties across Eastern North Carolina."
  — Andy Zukowski

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2. Top Healthcare Finance Trends & Challenges for 2026

• Cost of Care & Reimbursement Pressures:
  Zukowski emphasizes the urgent need to monitor the cost of care due to tightening reimbursements, especially for rural and safety net providers.
  [01:54]

  "Cost of care is an essential metric to watch as we ensure financial sustainability, especially as we transform models of care within this environment of significant pressure as it relates to reimbursements going down..."
  — Andy Zukowski

• Policy Shifts - State and Federal:
  North Carolina faces a budget shortfall leading to a planned 10% provider payment rate reduction, in addition to looming federal cuts, both of which will significantly impact rural healthcare providers.
  [02:10]

  "...the state faces a shortfall in their budget to fund a 10% provider based payment rate reduction. And so while this is separate from the federal cuts, it could accelerate projected reductions... So these two policy changes combined will make delivering rural healthcare more difficult..."
  — Andy Zukowski

• Proactive Partnerships & Solutions:
  ECU Health is focused on collaborating with state and federal lawmakers, including opening the state's first rural emergency hospital to maintain care access.
  [02:50]

  "...we're focused on partnering with the state federal lawmakers to find solutions, including opening the first rural emergency hospital in the state of North Carolina to ensure that rural communities have access to quality care..."
  — Andy Zukowski

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3. Access to Rural Transformation Funds

• Equity in Funding Distribution:
  Zukowski highlights the importance of ensuring rural health transformation funds directly benefit rural providers.
  [03:38]

  "It's going to be really critical that the rural health funds get to the rural healthcare providers. And so that's what we're most focused on at this point."
  — Andy Zukowski

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4. Leadership Lessons Learned

• People-Focused Strategy:
  The key takeaway from the previous year is to maintain a steadfast focus on patients, staff, and the organization's long-term strategic agenda.
  [04:10]

  "...the one lesson learned that I'm thinking about carrying from last year to this year is really to maintain focus on continued focus on our people and our patients and more importantly, in support of that, our multi year strategic agenda."
  — Andy Zukowski

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5. Smart Growth at ECU Health (2026-2027)

• Access and Patient Experience:
  Growth starts with improving access and the total patient experience, supporting the system's broader objectives.
  [04:45]

  "...in terms of smart growth, it all starts with, for us, access and the total patient experience—critically important to drive growth."
  — Andy Zukowski

• Capital Investments:
  ECU Health is expanding physical capacity by completing two previously shelved floors, expanding surgical and other services to increase patient access.

• Technology Investments:
  Emphasizing investments in technology to streamline patient intake and registration, enhancing the financial and clinical experience.
  [05:27]

  "...we're investing in technology to improve as relates to that front end experience, to get access, timely access to our physicians as well as as we think about the patient experience, starting with the financial, the front end experience to register from the financial experience to the clinical experience and beyond..."
  — Andy Zukowski

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6. Leadership Mindset for CFOs Amidst Uncertainty

• Growth Mindset & Fundamentals:
  Zukowski stresses the need for a growth mindset, focusing on the organization's fundamentals rather than being distracted by short-term headlines.
  [06:32]

  "Growth mindset is critical, along with continued focus on fundamentals. This is all just to ensure that we can lead through change and not get distracted by the news of the day or the issue at hand. It's critical that we think long term and at the same time focus on those fundamentals."
  — Andy Zukowski

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Memorable Moments & Quotes

• On Collaboration:
  [02:32]

  "We're committed, deeply committed to being the solution to this problem with the focus on, and not limited to collaboration with everybody, all the decision makers."
  — Andy Zukowski

• On Smart Growth:
  [04:45]

  "For us to achieve many of the growth objectives that we have to serve additional patients..."
  — Andy Zukowski

• On Leadership:
  [06:32]

  "...it's critical that we think long term and at the same time focus on those fundamentals."
  — Andy Zukowski

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Key Timestamps

• 01:15 — Andy Zukowski introduces himself and ECU Health’s rural mission
• 01:54 — Top financial threats and policy changes for rural health in 2026
• 03:38 — The importance of equitable distribution of rural transformation funds
• 04:10 — Carrying forward a people-centered focus and long-term strategy
• 04:45 — Defining and investing in 'smart growth' at ECU Health
• 05:27 — Expansion projects and technology upgrades for improved patient experience
• 06:32 — Essential leadership mindsets for navigating volatility

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Conclusion

Andy Zukowski provides a comprehensive look into the financial and strategic considerations facing rural health systems in 2026, highlighting ECU Health’s proactive initiatives in the face of significant policy changes and funding uncertainty. He advocates for a collaborative approach, continued investment in people and technology, and maintaining a forward-thinking, growth-oriented leadership perspective in navigating ongoing industry change.

Transcript

[A]

The most important healthcare decisions don't happen in isolation. They happen when leaders come together. Becker's 16th annual meeting brings together more than 3,500 hospital and health system executives this April in Chicago. With 800 speakers from Ascension, Cleveland Clinic, Common Spirit and more, the conversations get real. Leaders will share how their scenario planning for policy shifts brief breaking through value based care barriers and building clinical teams that translate new ideas into real world care. Join top decision makers in the room April 13th through the 16th. For the agenda and event details, visit BeckersHospitalReview.com and click on the Events tab in the upper right.

[B]

This is Madeline Ashley with the Becker CFO and Revenue Cycle Podcast and I'm excited to have Andy Zukowski, CFO of ECU Health in Greenville, North Carolina on the podcast with me and Andy. It's great to have you back and Happy New Year.

[C]

Happy New Year to you as well, Madeline.

[B]

So excited to chat again with you today. But before we kick things off for maybe some of our listeners who haven't had a chance to catch one of our older episodes, do you mind just sharing a little bit about yourself and more about ECU Health?

[C]

Absolutely, I'd be happy to. So I serve as the Chief Financial Officer for ECU Health in the Brody School of Medicine at East Carolina University. We are a rural academic safety net health system serving well over a million residents in 29 counties across Eastern North Carolina.

[B]

Wonderful. Thank you so much for that little intro there. So Andy, you know I know we've talked about just everything going on in the industry. Every time we talk there's something new happening. But as we enter the new year 2026, what financial trends or shifts are you keeping a watchful eye on and why are you following these so closely?

[C]

Yeah, cost of care is an essential metric to watch as we ensure financial sustainability, especially as we transform models of care within this environment of significant pressure as it relates to reimbursements going down and specifically from a rural health and safety net provider perspective this time of significant uncertainty due we have Medicaid rate challenges within the state of North Carolina along with the federal policy changes. Specifically, the state faces a shortfall in their budget to fund a 10% provider based payment rate reduction. And so while this is separate from the federal cuts, it could accelerate projected reductions from the One Big Beautiful bill starting in October 2027. So these two policy changes combined will make delivering rural health care more difficult and requires us to prepare now by rethinking these traditional models of care as relates to rural health access and the cost of care. At the same time, we're focused on partnering with the state federal lawmakers to find solutions, including opening the first rural emergency hospital in the state of North Carolina to ensure that rural communities have access to quality care they deserve. So it's important to note as we're focused on all this, we're committed, deeply committed to being the solution to this problem with the focus on, and not limited to collaboration with everybody, all the decision makers. As we look at the rural health realities across eastern North Carolina and we're.

[B]

Also seeing a lot of movement just in terms of like the rural transformation Funds and kind of how are you and your team keeping up with all of that there?

[C]

So we're actively engaged and involved in understanding what that will look like. It's going to be really critical that the rural health funds get to the rural health care providers. And so that's what we're most focused on at this point.

[B]

Yeah. Any lessons learned for you? Just over the like since the last time we talked even, you know, again, so much change going on. I'm sure this is helping many system leaders, you know, grow in their roles. How about you? How are you feeling?

[C]

You know, I think the, you know, the one lesson learned that I'm thinking about carrying from last year to this year is really to maintain focus on continued focus on our people and our patients and more importantly, in support of that, our multi year strategic agenda. It's critical for us to successfully lead and navigate through this level of uncertainty and change that's going on.

[B]

Could you kind of switch gears a little bit and talk more about some of the smart growth that you're seeing at ECU this year and maybe in 2027?

[C]

Yeah, I think in terms of smart growth, it all starts with, for us, access and the total patient experience critically important to drive growth. For us to achieve many of the growth objectives that we have to serve additional patients, could you dive a little.

[B]

Deeper into some of those objectives?

[C]

Can you clarify that, Madeline?

[B]

Oh, of course, of course. No, yeah, just in terms of, I know you touched on that. That's type of smart growth. I mean, maybe in your opinion, what, what would be the best thing for ECU health over the next, even two to two to three years, some projects maybe down the line, anything that you could just dive a little deeper into?

[C]

Yeah. So, you know, we're investing in physical capacity. So we have within one of our facilities we'll be finishing off two floors that we had shelved years ago. And so that will allow us to grow key service lines of growth in addition to that inventory, surgery expansion, as well as other investments to create capacity and access for patients. At the same time, we're investing in technology to improve as relates to that front end experience, to get access, timely access to our physicians as well as as we think about the patient experience, starting with the financial, the front end experience to register from the financial experience to the clinical experience and beyond to ensure that we have really met the needs of our patients entirely.

[B]

Yeah. And you know, kind of on the same vein of lessons learned, what are some leadership mindsets that you think will be most important for CFOs as they navigate industry challenges and uncertainties this year?

[C]

Yeah, from my perspective, growth mindset is critical, along with continued focus on fundamentals. This is all just to ensure that we can lead through change and not get distracted by the news of the day or the issue at hand. It's critical that we think long term and at the same time focus on those fundamentals.

[B]

Definitely. Well, Andy, as always, it has been such a pleasure getting to speak with you and I truly look forward to connecting with you again down the line.

[C]

Absolutely. Madeline, thank you so much.

[B]

Thank you.