Becker’s Healthcare Podcast

Guest: Andy Zukowski, Chief Financial Officer at ECU Health

Date: January 21, 2026
Host: Madeline Ashley

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.

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

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

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

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

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

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

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

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

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.