1 00:00:02,000 --> 00:00:04,500 This is where health care leadership comes together. 2 00:00:04,639 --> 00:00:07,759 Becker's sixteenth annual meeting brings more than 3,500 3 00:00:07,759 --> 00:00:10,960 hospital and health system executives and nearly 800 4 00:00:10,960 --> 00:00:14,294 speakers to Chicago April. 5 00:00:14,695 --> 00:00:17,414 This year's event includes keynote conversations with Dallas 6 00:00:17,414 --> 00:00:20,295 Cowboys legend Troy Aikman and former president George 7 00:00:20,295 --> 00:00:23,015 w Bush. For the agenda and event details, 8 00:00:23,015 --> 00:00:25,255 visit beckershospitalreview.com 9 00:00:25,255 --> 00:00:26,934 and click on the events tab in the 10 00:00:26,934 --> 00:00:29,620 upper right. We're looking forward to hosting you 11 00:00:29,679 --> 00:00:30,500 in Chicago. 12 00:00:32,000 --> 00:00:34,239 This is Laura Dierda with the Becker's Healthcare 13 00:00:34,239 --> 00:00:36,399 podcast. I'm thrilled today to be joined by 14 00:00:36,399 --> 00:00:38,880 Tiffany Love, associate vice president of nursing at 15 00:00:38,880 --> 00:00:41,219 Greater Lawrence Family Health Center in Lawrence, Massachusetts. 16 00:00:41,600 --> 00:00:43,280 Tiffany is a pleasure to end the podcast 17 00:00:43,280 --> 00:00:46,475 today. Oh, thank you for having me. Absolutely. 18 00:00:46,534 --> 00:00:48,454 Now I'm excited for our conversation because I 19 00:00:48,454 --> 00:00:50,214 know health centers are such an important part 20 00:00:50,214 --> 00:00:52,295 of the broader health care ecosystem. And, you 21 00:00:52,295 --> 00:00:54,394 know, it's really important that, 22 00:00:54,854 --> 00:00:57,335 you are able to, you know, provide a 23 00:00:57,335 --> 00:01:00,190 great service to communities and continue to, grow 24 00:01:00,190 --> 00:01:02,109 and expand. And so I'm looking forward to 25 00:01:02,109 --> 00:01:04,030 our conversation. But before we dig in, can 26 00:01:04,030 --> 00:01:05,569 you tell us a little bit more about 27 00:01:05,629 --> 00:01:08,109 yourself, your background, as well as Greater Lawrence 28 00:01:08,109 --> 00:01:09,090 Family Health Center? 29 00:01:09,790 --> 00:01:12,450 Yes. So I actually have two main roles. 30 00:01:12,510 --> 00:01:15,150 Number one, as the associate vice president for 31 00:01:15,150 --> 00:01:17,614 the, of nursing for the Greater Lawrence Family 32 00:01:17,614 --> 00:01:20,814 Health Center, which is the second largest federally 33 00:01:20,814 --> 00:01:22,594 qualified health center in Massachusetts. 34 00:01:23,134 --> 00:01:25,715 And our catchment area is actually Massachusetts 35 00:01:26,254 --> 00:01:27,234 and New Hampshire. 36 00:01:27,820 --> 00:01:30,540 And what many people probably would not know 37 00:01:30,540 --> 00:01:33,340 is that 80% of the people we serve 38 00:01:33,340 --> 00:01:34,799 are Latinx background. 39 00:01:35,420 --> 00:01:39,040 So we're talking about a a very large, 40 00:01:39,579 --> 00:01:40,719 immigrant population, 41 00:01:42,185 --> 00:01:42,685 predominantly 42 00:01:43,144 --> 00:01:44,045 Spanish speaking. 43 00:01:44,825 --> 00:01:47,224 And then my second role is the founder 44 00:01:47,224 --> 00:01:50,025 and CEO of the Love Leadership Foundation where 45 00:01:50,025 --> 00:01:52,444 I provide career coaching for health care executives 46 00:01:52,984 --> 00:01:53,484 internationally. 47 00:01:53,784 --> 00:01:56,364 So those are my two labors of love, 48 00:01:56,969 --> 00:01:58,569 and I'm just so happy to have the 49 00:01:58,569 --> 00:02:00,269 chance to talk to you about them today. 50 00:02:00,890 --> 00:02:03,129 Well, that's fantastic. You know? What a, 51 00:02:03,689 --> 00:02:05,930 great position to be in, especially being able 52 00:02:05,930 --> 00:02:07,930 to train leaders in the health care space 53 00:02:07,930 --> 00:02:10,844 across the spectrum. I think, you know, having 54 00:02:10,844 --> 00:02:12,925 those connections and being able to shape the 55 00:02:12,925 --> 00:02:13,425 future, 56 00:02:13,805 --> 00:02:17,104 will be really beneficial moving forward. Now, 57 00:02:17,405 --> 00:02:19,664 I'm curious, you know, first and foremost, 58 00:02:20,284 --> 00:02:22,365 when you talk about your role, with the 59 00:02:22,365 --> 00:02:23,729 Greater Lawrence Health Center, 60 00:02:25,169 --> 00:02:27,330 what is the most important initiative you led 61 00:02:27,330 --> 00:02:28,610 last year? What did you do, or what 62 00:02:28,610 --> 00:02:29,349 were the results? 63 00:02:30,530 --> 00:02:33,509 So I can tell you, as someone who 64 00:02:33,729 --> 00:02:34,229 has 65 00:02:35,489 --> 00:02:38,209 received health care in Massachusetts for many years, 66 00:02:38,209 --> 00:02:40,525 because I've worked at all over New England, 67 00:02:40,824 --> 00:02:43,485 and I always have had doctors in Massachusetts. 68 00:02:44,664 --> 00:02:45,724 I will tell you, 69 00:02:46,264 --> 00:02:48,604 now actually physically being in Massachusetts 70 00:02:49,384 --> 00:02:50,604 and serving this population, 71 00:02:50,985 --> 00:02:54,044 there is an emerging primary care crisis. 72 00:02:54,960 --> 00:02:55,699 We literally 73 00:02:56,400 --> 00:02:59,379 do not have enough primary care providers 74 00:03:00,000 --> 00:03:02,879 to care for the patients that need to 75 00:03:02,879 --> 00:03:03,620 be seen. 76 00:03:04,000 --> 00:03:05,780 So according to the Association 77 00:03:06,080 --> 00:03:07,379 of Medical Colleges, 78 00:03:08,159 --> 00:03:10,694 by the year 2034, 79 00:03:10,754 --> 00:03:13,014 there will be a 48,000 80 00:03:13,555 --> 00:03:14,935 primary care physician 81 00:03:15,394 --> 00:03:15,894 shortage. 82 00:03:16,194 --> 00:03:18,614 Now that might sound like a small number, 83 00:03:18,914 --> 00:03:21,314 but I can tell you for my health 84 00:03:21,314 --> 00:03:22,134 care center 85 00:03:22,830 --> 00:03:23,330 specifically, 86 00:03:23,950 --> 00:03:25,569 we have about 2,000 87 00:03:26,030 --> 00:03:26,530 unassigned 88 00:03:26,909 --> 00:03:27,409 patients. 89 00:03:27,870 --> 00:03:30,030 So what does this mean? Now when I 90 00:03:30,030 --> 00:03:31,010 lived in Vermont, 91 00:03:31,710 --> 00:03:34,030 lived in Maine, I could come see doctors 92 00:03:34,030 --> 00:03:36,875 in Massachusetts no problem. But when you are 93 00:03:36,935 --> 00:03:38,314 physically in Massachusetts, 94 00:03:38,615 --> 00:03:40,935 you are required to have a primary care 95 00:03:40,935 --> 00:03:41,435 provider 96 00:03:42,135 --> 00:03:43,675 for any care, 97 00:03:44,055 --> 00:03:45,034 any referrals 98 00:03:45,574 --> 00:03:46,635 that you need. 99 00:03:47,094 --> 00:03:49,495 And so when you have such a large 100 00:03:49,495 --> 00:03:51,990 number of patients that are unassigned to a 101 00:03:51,990 --> 00:03:53,129 primary care provider, 102 00:03:53,670 --> 00:03:54,730 these are people 103 00:03:55,189 --> 00:03:58,010 who are forced to seek their health care 104 00:03:58,469 --> 00:03:58,969 through 105 00:03:59,590 --> 00:04:00,090 emergency 106 00:04:00,390 --> 00:04:03,750 room, urgent care visits, things that should be 107 00:04:03,750 --> 00:04:04,250 going 108 00:04:04,645 --> 00:04:06,824 to a primary care provider. 109 00:04:08,004 --> 00:04:09,544 So with that 110 00:04:10,405 --> 00:04:11,465 being in mind, 111 00:04:11,925 --> 00:04:13,544 for my health care center, 112 00:04:13,844 --> 00:04:15,865 I have been very focused on, 113 00:04:16,485 --> 00:04:17,305 number one, 114 00:04:17,610 --> 00:04:19,790 triaging the people who are trying 115 00:04:20,169 --> 00:04:22,829 their best to get into the health system 116 00:04:23,290 --> 00:04:26,829 coming through acute care, urgent care means, 117 00:04:27,449 --> 00:04:27,949 and 118 00:04:28,329 --> 00:04:31,069 using evidence based triage tools to say, 119 00:04:31,665 --> 00:04:34,884 is this really urgent? Is this nonurgent? 120 00:04:35,264 --> 00:04:37,904 Can this person potentially be seen by a 121 00:04:37,904 --> 00:04:38,404 nurse? 122 00:04:38,865 --> 00:04:41,044 Can this person potentially be seen 123 00:04:41,584 --> 00:04:42,404 in telehealth? 124 00:04:43,024 --> 00:04:44,485 And so really just 125 00:04:45,060 --> 00:04:45,560 focusing 126 00:04:45,860 --> 00:04:46,839 on creating 127 00:04:47,220 --> 00:04:47,720 access 128 00:04:48,339 --> 00:04:49,399 for our patients. 129 00:04:49,699 --> 00:04:52,199 And when it comes to access to primary 130 00:04:52,339 --> 00:04:52,839 care, 131 00:04:53,460 --> 00:04:54,279 there are 132 00:04:54,740 --> 00:04:55,240 approximately 133 00:04:55,860 --> 00:04:57,000 a 100,000,000 134 00:04:57,139 --> 00:04:58,920 Americans who are lacking 135 00:04:59,634 --> 00:05:02,375 a primary care provider, and this is especially 136 00:05:02,595 --> 00:05:05,314 high in rural health care. So you can 137 00:05:05,314 --> 00:05:06,375 imagine Massachusetts 138 00:05:06,675 --> 00:05:07,574 is not rural, 139 00:05:08,115 --> 00:05:09,495 but this is definitely 140 00:05:10,194 --> 00:05:13,329 a problem that we face every day. And 141 00:05:13,329 --> 00:05:16,930 that's on top of workforce shortages, not just 142 00:05:16,930 --> 00:05:19,189 for our primary care providers, 143 00:05:19,889 --> 00:05:21,350 but also for nurses. 144 00:05:22,050 --> 00:05:24,629 And then you have the lack of insurance. 145 00:05:25,675 --> 00:05:27,615 You have the threat 146 00:05:28,074 --> 00:05:29,694 of potentially losing 147 00:05:30,314 --> 00:05:32,735 insurance for the people who are on Medicaid. 148 00:05:33,435 --> 00:05:34,254 So, really, 149 00:05:35,435 --> 00:05:38,414 for a federally qualified health center 150 00:05:38,849 --> 00:05:41,810 that has a mission to focus on health 151 00:05:41,810 --> 00:05:42,310 equity 152 00:05:43,009 --> 00:05:45,909 and serving the underserved people. 153 00:05:46,930 --> 00:05:49,250 It's a really big crisis for us, so 154 00:05:49,250 --> 00:05:51,625 that's where my focus has been. And I'm 155 00:05:51,625 --> 00:05:54,584 proud to say that we have expanded access 156 00:05:54,584 --> 00:05:55,084 to 157 00:05:55,545 --> 00:05:56,365 care by 158 00:05:56,985 --> 00:06:00,425 being more thoughtful about who is getting that 159 00:06:00,425 --> 00:06:03,805 urgent care need versus who can be seen 160 00:06:04,264 --> 00:06:06,230 in a telehealth clinic. That 161 00:06:07,330 --> 00:06:08,689 makes a lot of sense, and it's really 162 00:06:08,689 --> 00:06:10,930 helpful to understand. I think that context you 163 00:06:10,930 --> 00:06:11,910 provided, especially 164 00:06:12,290 --> 00:06:14,290 on primary care and the situation you have 165 00:06:14,290 --> 00:06:14,949 in Massachusetts, 166 00:06:15,410 --> 00:06:18,129 but then looking at, you know, how you're 167 00:06:18,129 --> 00:06:18,949 able to, 168 00:06:19,875 --> 00:06:21,634 see some of the charges going down the 169 00:06:21,634 --> 00:06:24,435 pipe and charges, especially in primary care is 170 00:06:24,435 --> 00:06:25,175 really critical. 171 00:06:25,795 --> 00:06:27,975 So from your perspective, when you talk about, 172 00:06:28,514 --> 00:06:29,795 expanding access and, 173 00:06:30,275 --> 00:06:33,074 providing more digital opportunities, telehealth, and those kinds 174 00:06:33,074 --> 00:06:34,514 of things, what does it take to stand 175 00:06:34,514 --> 00:06:35,610 up a program like that? 176 00:06:36,810 --> 00:06:39,629 Oh my gosh. Well, number one, technology. Right? 177 00:06:40,169 --> 00:06:42,089 Because when you think about it, I just 178 00:06:42,089 --> 00:06:44,909 said that we have a large immigrant population. 179 00:06:46,409 --> 00:06:46,909 So 180 00:06:47,209 --> 00:06:48,189 do they have 181 00:06:48,954 --> 00:06:52,175 a video the opportunity or the ability 182 00:06:53,435 --> 00:06:56,555 to use a video conference calling, or can 183 00:06:56,555 --> 00:06:58,654 they only speak to you over the phone? 184 00:06:58,875 --> 00:07:01,514 Because we know that Medicare no longer will 185 00:07:01,514 --> 00:07:04,495 reimburse for if it's only a telephone visit. 186 00:07:04,610 --> 00:07:06,230 It has to be a video 187 00:07:06,850 --> 00:07:09,889 telephone visit for it to actually count towards 188 00:07:09,889 --> 00:07:10,389 reimbursement. 189 00:07:11,889 --> 00:07:15,350 So just really making sure that our patients 190 00:07:15,490 --> 00:07:16,870 actually have the technology. 191 00:07:17,495 --> 00:07:18,714 Do they have Internet? 192 00:07:19,014 --> 00:07:21,814 And that's especially a problem having worked in 193 00:07:21,814 --> 00:07:22,955 rural health care. 194 00:07:23,495 --> 00:07:26,714 Sometimes you literally don't have the infrastructure 195 00:07:27,654 --> 00:07:30,395 within the state where people get good 196 00:07:30,779 --> 00:07:33,740 Internet access. So imagine trying to have a 197 00:07:33,740 --> 00:07:35,120 call with your provider, 198 00:07:35,420 --> 00:07:37,600 but you actually don't have a good Internet 199 00:07:37,660 --> 00:07:38,160 connection. 200 00:07:39,259 --> 00:07:42,139 So and and I have worked with the 201 00:07:42,139 --> 00:07:44,460 Department of Veterans Affairs for more than eight 202 00:07:44,460 --> 00:07:47,285 years where we would actually put the technology 203 00:07:47,665 --> 00:07:49,285 in the patient's home. 204 00:07:49,665 --> 00:07:50,805 For patients that 205 00:07:51,264 --> 00:07:53,285 need chronic disease management, 206 00:07:53,824 --> 00:07:54,805 we would actually 207 00:07:55,824 --> 00:07:58,404 give them equipment to keep in their home 208 00:07:58,589 --> 00:08:01,550 so that when they needed to have an 209 00:08:01,550 --> 00:08:03,089 interaction with a provider, 210 00:08:03,949 --> 00:08:06,189 we would be able to connect with them 211 00:08:06,189 --> 00:08:08,829 directly with the equipment that we provided for 212 00:08:08,829 --> 00:08:09,329 them. 213 00:08:09,629 --> 00:08:11,629 And I think a lot of systems just 214 00:08:11,629 --> 00:08:14,449 really haven't gotten that advanced where 215 00:08:14,805 --> 00:08:17,685 if the patient doesn't have the equipment that's 216 00:08:17,685 --> 00:08:18,185 required, 217 00:08:18,644 --> 00:08:20,884 that we supply it for them. And so, 218 00:08:20,884 --> 00:08:21,384 hopefully, 219 00:08:21,845 --> 00:08:22,665 in the future, 220 00:08:23,365 --> 00:08:25,925 we will think about that as we're trying 221 00:08:25,925 --> 00:08:29,305 to expand telehealth and expand access to care, 222 00:08:29,689 --> 00:08:32,750 especially for people in rural rural America. 223 00:08:34,009 --> 00:08:35,450 That makes a lot of sense. You know, 224 00:08:35,450 --> 00:08:38,190 it it sounds like a, important solution especially 225 00:08:38,250 --> 00:08:39,769 to make sure they have access to that 226 00:08:39,769 --> 00:08:42,375 type of technology. Now looking ahead, what are 227 00:08:42,375 --> 00:08:43,815 some of the big priorities and kind of 228 00:08:43,815 --> 00:08:45,754 ones you're focused on for 2026? 229 00:08:47,014 --> 00:08:50,535 So for me, working in a federally qualified 230 00:08:50,535 --> 00:08:52,855 health center, and I know a lot of 231 00:08:52,855 --> 00:08:55,735 safety net hospitals are probably focused on this 232 00:08:55,735 --> 00:08:59,129 as well, There are two major threats for 233 00:08:59,129 --> 00:09:02,490 us. So the first is the threat of 234 00:09:02,490 --> 00:09:03,870 the cut to Medicaid. 235 00:09:04,889 --> 00:09:08,089 With the recent legislation with the one big 236 00:09:08,089 --> 00:09:09,070 beautiful bill, 237 00:09:09,504 --> 00:09:11,764 we are expecting that there are gonna be 238 00:09:11,824 --> 00:09:14,884 about a trillion dollars in Medicaid cuts. 239 00:09:15,985 --> 00:09:17,444 And so for 240 00:09:18,304 --> 00:09:21,284 a federally qualified health center that relies heavily 241 00:09:21,345 --> 00:09:22,084 on Medicaid, 242 00:09:22,759 --> 00:09:25,179 that relies heavily on grant funding, 243 00:09:25,799 --> 00:09:27,980 if these cuts come to fruition, 244 00:09:28,759 --> 00:09:30,620 there are a lot of patients 245 00:09:31,000 --> 00:09:33,259 who are suddenly gonna be uninsured. 246 00:09:35,000 --> 00:09:35,500 And 247 00:09:36,044 --> 00:09:38,284 suddenly, we will be in a position where 248 00:09:38,284 --> 00:09:40,625 we're trying to provide care for people who 249 00:09:40,924 --> 00:09:43,725 absolutely cannot pay for it. This is the 250 00:09:43,725 --> 00:09:45,424 same position with most 251 00:09:45,964 --> 00:09:49,330 safety net hospitals as well who heavily depend 252 00:09:49,330 --> 00:09:52,450 on Medicaid, rural health care as well. And 253 00:09:52,450 --> 00:09:54,790 so you have to think about how destabilizing 254 00:09:55,170 --> 00:09:57,910 this can be to these health care systems. 255 00:09:58,690 --> 00:10:01,110 Not only that, but think about the impact 256 00:10:01,170 --> 00:10:03,575 that it's gonna have on private 257 00:10:03,915 --> 00:10:04,415 insurance 258 00:10:04,754 --> 00:10:06,134 and our our 259 00:10:06,915 --> 00:10:07,815 as a organization, 260 00:10:08,595 --> 00:10:11,014 trying to get that highest level reimbursement 261 00:10:12,115 --> 00:10:14,375 from the sources that we can be reimbursed 262 00:10:14,514 --> 00:10:15,014 for, 263 00:10:15,600 --> 00:10:17,620 but also thinking about the people 264 00:10:18,159 --> 00:10:21,279 who may simply give up and not seek 265 00:10:21,279 --> 00:10:21,779 care. 266 00:10:22,559 --> 00:10:26,339 So Medicare Medicaid cuts are one threat. 267 00:10:26,879 --> 00:10:29,404 And then the second threat that a lot 268 00:10:29,404 --> 00:10:31,664 of people might not be thinking of 269 00:10:32,204 --> 00:10:34,524 is the threat of the loss of the 270 00:10:34,524 --> 00:10:36,544 current three forty b program. 271 00:10:37,004 --> 00:10:38,704 The three forty b program 272 00:10:39,084 --> 00:10:41,985 is a program where a lot of organizations 273 00:10:42,600 --> 00:10:44,779 are receive they're able to buy 274 00:10:45,159 --> 00:10:47,819 their medications at a discounted rate. 275 00:10:48,120 --> 00:10:50,759 And so for a community health center like 276 00:10:50,759 --> 00:10:52,620 ours, that is hugely 277 00:10:53,079 --> 00:10:55,639 important because a lot of our patients meet 278 00:10:55,639 --> 00:10:57,959 the criteria to get those three forty b 279 00:10:57,959 --> 00:10:58,459 meds. 280 00:10:59,075 --> 00:11:00,455 And here's the thing. 281 00:11:01,394 --> 00:11:02,695 Being the second largest 282 00:11:03,075 --> 00:11:06,195 health center in federally qualified health center in 283 00:11:06,195 --> 00:11:06,695 Massachusetts, 284 00:11:07,475 --> 00:11:08,295 for us, 285 00:11:09,075 --> 00:11:11,095 if we were to lose this program, 286 00:11:12,120 --> 00:11:14,700 it would equate to millions, 287 00:11:15,160 --> 00:11:18,139 many millions of dollars. So just imagine 288 00:11:18,919 --> 00:11:20,700 larger safety net hospitals, 289 00:11:21,080 --> 00:11:22,379 larger health systems, 290 00:11:22,919 --> 00:11:23,899 and it really 291 00:11:24,279 --> 00:11:26,379 creates a situation where 292 00:11:26,915 --> 00:11:28,215 the vulnerable populations 293 00:11:28,835 --> 00:11:30,535 might not be able to get services. 294 00:11:30,915 --> 00:11:32,695 Those services might be cut. 295 00:11:34,274 --> 00:11:35,014 And so 296 00:11:35,394 --> 00:11:36,615 the proposal, 297 00:11:36,995 --> 00:11:40,514 as I understand it, is that they might 298 00:11:40,514 --> 00:11:41,575 change their program 299 00:11:42,240 --> 00:11:45,220 where we pay for the medications upfront, 300 00:11:46,159 --> 00:11:48,340 and then they reimburse us the discount. 301 00:11:49,519 --> 00:11:52,659 Again, that would be millions of dollars 302 00:11:53,200 --> 00:11:54,820 that we would be paying upfront 303 00:11:55,384 --> 00:11:56,845 that we haven't historically 304 00:11:57,225 --> 00:11:58,684 had to pay for. 305 00:11:59,144 --> 00:12:02,345 So think about the higher cost drugs that 306 00:12:02,345 --> 00:12:04,684 we might not be able to provide anymore 307 00:12:05,464 --> 00:12:07,865 and just the financial strain that it's gonna 308 00:12:07,865 --> 00:12:08,845 put on organizations. 309 00:12:09,144 --> 00:12:10,205 And for some 310 00:12:10,700 --> 00:12:11,200 organizations, 311 00:12:11,660 --> 00:12:12,720 this might be 312 00:12:13,419 --> 00:12:15,360 enough of a financial impact 313 00:12:15,740 --> 00:12:17,740 that at least them to close their doors. 314 00:12:17,740 --> 00:12:19,120 Between these two threats, 315 00:12:19,740 --> 00:12:22,320 it literally could lead to 316 00:12:23,100 --> 00:12:25,039 health core health care organizations 317 00:12:26,174 --> 00:12:28,995 closing because they simply cannot overcome 318 00:12:29,615 --> 00:12:30,914 the financial strain 319 00:12:31,534 --> 00:12:32,595 of these two 320 00:12:32,894 --> 00:12:34,115 new changes. 321 00:12:35,615 --> 00:12:38,514 Absolutely. That, you know, is huge and definitely, 322 00:12:39,134 --> 00:12:41,519 a sobering future when you think about those 323 00:12:41,600 --> 00:12:44,240 programs, those cuts to Medicaid and, three forty 324 00:12:44,240 --> 00:12:46,639 b and other funding programs that are really 325 00:12:46,639 --> 00:12:48,179 critical to FUHCs 326 00:12:48,559 --> 00:12:51,040 and other hospitals and systems and safety net 327 00:12:51,040 --> 00:12:51,540 hospitals, 328 00:12:52,320 --> 00:12:53,955 across the country. And so, 329 00:12:54,514 --> 00:12:56,674 you know, that is definitely a a huge, 330 00:12:57,235 --> 00:12:59,955 challenge. And, you know, when you think about 331 00:12:59,955 --> 00:13:02,035 all of these things that are potentially coming 332 00:13:02,035 --> 00:13:03,634 down the pipe, how do you prepare for 333 00:13:03,634 --> 00:13:06,754 them, while also, you know, keeping yourself and 334 00:13:06,754 --> 00:13:09,394 your teams focused on continuing to deliver care 335 00:13:09,394 --> 00:13:09,929 to patients 336 00:13:11,129 --> 00:13:12,110 today? Well, 337 00:13:12,490 --> 00:13:15,230 so I will tell you that, number one, 338 00:13:15,289 --> 00:13:16,509 because our organization 339 00:13:17,129 --> 00:13:20,009 heavily relies on grant funding, we're trying to 340 00:13:20,009 --> 00:13:20,750 take advantage 341 00:13:21,529 --> 00:13:23,625 of the grant funding that is there. There 342 00:13:23,865 --> 00:13:26,524 have already been cuts that we have seen, 343 00:13:26,985 --> 00:13:29,065 but we're trying to do our best to 344 00:13:29,065 --> 00:13:31,804 take advantage of what is still currently there. 345 00:13:32,585 --> 00:13:34,445 And it's almost impossible 346 00:13:35,065 --> 00:13:35,965 to prepare 347 00:13:36,985 --> 00:13:37,485 for 348 00:13:38,539 --> 00:13:41,100 if there's gonna be Medicaid cuts? Like, how 349 00:13:41,100 --> 00:13:43,199 do you prepare for that? It's really 350 00:13:43,579 --> 00:13:45,519 challenging because there really aren't 351 00:13:45,899 --> 00:13:48,779 any other funding sources unless you look to 352 00:13:48,779 --> 00:13:49,279 philanthropy 353 00:13:50,475 --> 00:13:53,294 and, you know, big donors that are willing 354 00:13:53,355 --> 00:13:57,774 to provide that support for our underserved communities, 355 00:13:58,154 --> 00:14:00,334 which is usually not the case. I mean, 356 00:14:00,475 --> 00:14:02,815 usually, philanthropy, you think about 357 00:14:03,250 --> 00:14:05,410 big donors wanting their name on a new 358 00:14:05,410 --> 00:14:08,610 building or something glamorous. And, really, the work 359 00:14:08,610 --> 00:14:10,629 that we do isn't glamorous. We're just 360 00:14:10,930 --> 00:14:12,870 serving the underserved people. 361 00:14:13,649 --> 00:14:15,269 And so for us, 362 00:14:15,809 --> 00:14:18,129 I would say the biggest challenge is going 363 00:14:18,129 --> 00:14:18,710 to be 364 00:14:19,345 --> 00:14:21,205 if those cuts come to fruition, 365 00:14:22,625 --> 00:14:24,945 do we need to cut services? How are 366 00:14:24,945 --> 00:14:26,884 we going to remain financially 367 00:14:27,264 --> 00:14:27,764 stable? 368 00:14:28,304 --> 00:14:30,785 How are we going to manage the wait 369 00:14:30,785 --> 00:14:32,164 list that are increasing, 370 00:14:32,465 --> 00:14:33,924 especially for people 371 00:14:34,240 --> 00:14:36,259 who cannot afford to pay for the services. 372 00:14:37,040 --> 00:14:38,799 Because we still have to pay for the 373 00:14:38,799 --> 00:14:40,740 doctors. We have to pay for the nurses. 374 00:14:42,399 --> 00:14:44,340 And so that's when organizations 375 00:14:45,200 --> 00:14:46,879 start to think about, do we need to 376 00:14:46,879 --> 00:14:47,700 cut services? 377 00:14:48,639 --> 00:14:49,700 Do we need to 378 00:14:50,375 --> 00:14:51,595 just try and 379 00:14:52,054 --> 00:14:53,815 provide the care for the people that we 380 00:14:53,815 --> 00:14:54,315 can? 381 00:14:55,495 --> 00:14:57,335 Got it. That makes a lot of sense, 382 00:14:57,575 --> 00:14:59,674 you know, and and is a helpful context 383 00:14:59,735 --> 00:15:01,654 to dig a little bit deeper there. Thank 384 00:15:01,654 --> 00:15:02,134 you. 385 00:15:02,615 --> 00:15:04,134 What do you think the hardest thing you'll 386 00:15:04,134 --> 00:15:05,414 have to do in the coming year will 387 00:15:05,414 --> 00:15:05,850 be? 388 00:15:06,809 --> 00:15:07,709 I would say, 389 00:15:08,809 --> 00:15:11,610 number one, caring for the people who are 390 00:15:11,610 --> 00:15:13,769 just not coming into the health care system 391 00:15:13,769 --> 00:15:15,610 because they know they can't they can't pay 392 00:15:15,610 --> 00:15:16,269 for it. 393 00:15:16,970 --> 00:15:18,669 And then when they do come in, 394 00:15:19,449 --> 00:15:21,044 they're very, very sick. 395 00:15:21,605 --> 00:15:23,144 And I can tell you, 396 00:15:24,084 --> 00:15:24,904 even though 397 00:15:25,524 --> 00:15:28,024 I work at a federally qualified health center, 398 00:15:28,485 --> 00:15:32,184 people walk in having strokes, having heart attacks 399 00:15:32,485 --> 00:15:33,784 almost every day. 400 00:15:34,720 --> 00:15:35,460 And so 401 00:15:35,920 --> 00:15:38,320 how how can we reach out to this 402 00:15:38,320 --> 00:15:38,820 community? 403 00:15:39,519 --> 00:15:41,059 What are what other 404 00:15:41,440 --> 00:15:44,019 financial resources can we tap into 405 00:15:44,480 --> 00:15:46,500 to make sure that people literally 406 00:15:46,800 --> 00:15:47,300 aren't 407 00:15:47,855 --> 00:15:50,834 dying because they can't afford health care. 408 00:15:51,454 --> 00:15:53,954 And so I would say the coming year, 409 00:15:55,375 --> 00:15:55,875 really 410 00:15:56,254 --> 00:15:59,934 trying to figure out how to recover if 411 00:15:59,934 --> 00:16:01,875 they do cut Medicaid, 412 00:16:03,909 --> 00:16:06,730 trying to figure out how we do provide 413 00:16:07,110 --> 00:16:07,610 medications 414 00:16:07,990 --> 00:16:09,829 for those who might be cut off from 415 00:16:09,829 --> 00:16:12,629 three forty b. I have to say our 416 00:16:12,629 --> 00:16:13,129 organization 417 00:16:14,230 --> 00:16:16,970 is really awesome when it comes to fundraising 418 00:16:18,024 --> 00:16:20,424 so that we can for those people who 419 00:16:20,424 --> 00:16:22,664 cannot cover the cost of their medications or 420 00:16:22,664 --> 00:16:24,205 other medical needs, 421 00:16:24,664 --> 00:16:26,924 we do have a fund that 422 00:16:27,304 --> 00:16:30,845 our employees actually contribute heavily to 423 00:16:31,399 --> 00:16:34,299 where we provide money so that we can 424 00:16:34,600 --> 00:16:35,100 hopefully 425 00:16:35,720 --> 00:16:37,960 help out those people who just don't have 426 00:16:37,960 --> 00:16:38,620 the means. 427 00:16:39,240 --> 00:16:41,660 So I would say, you know, just 428 00:16:42,519 --> 00:16:44,985 trying to reach out and help as many 429 00:16:44,985 --> 00:16:46,985 people as we can is really gonna be 430 00:16:46,985 --> 00:16:48,684 the hardest thing in the coming year. 431 00:16:49,384 --> 00:16:51,544 Got it. Well, that's incredible. And we definitely 432 00:16:51,544 --> 00:16:53,965 have a bad service oriented mindset, 433 00:16:54,345 --> 00:16:56,684 to the team and and, you know, having 434 00:16:56,745 --> 00:16:59,639 so many resources focused on ensuring people have 435 00:16:59,639 --> 00:17:00,600 the care they need is, 436 00:17:01,320 --> 00:17:01,820 incredible. 437 00:17:02,839 --> 00:17:04,839 And and can I add before we move 438 00:17:04,839 --> 00:17:06,599 on, can I add that I didn't even 439 00:17:06,599 --> 00:17:08,539 mention the rising cost 440 00:17:09,319 --> 00:17:11,880 of care of all of the services that 441 00:17:11,880 --> 00:17:14,924 we use every day? All the costs are 442 00:17:14,924 --> 00:17:15,424 increasing. 443 00:17:17,164 --> 00:17:19,424 And we also have that that 444 00:17:20,044 --> 00:17:20,544 staffing 445 00:17:21,085 --> 00:17:24,144 that the shortage of staffing. You know? 446 00:17:24,444 --> 00:17:26,125 Maybe more people to go to school to 447 00:17:26,125 --> 00:17:27,724 be a nurse, maybe more people to go 448 00:17:27,724 --> 00:17:29,345 to school to be a medical assistant. 449 00:17:29,940 --> 00:17:30,339 And, 450 00:17:30,740 --> 00:17:33,940 the shortage that I mentioned earlier about primary 451 00:17:33,940 --> 00:17:34,759 care providers, 452 00:17:35,299 --> 00:17:36,839 especially now that, 453 00:17:37,859 --> 00:17:40,339 we know that if you go to school 454 00:17:40,339 --> 00:17:41,480 to be a nurse practitioner, 455 00:17:42,315 --> 00:17:45,115 you're not necessarily gonna get the financial support 456 00:17:45,115 --> 00:17:46,494 that you have in the past. 457 00:17:47,835 --> 00:17:49,914 Got it. That's helpful to know and, you 458 00:17:49,914 --> 00:17:52,494 know, definitely a huge, huge challenge to overcome 459 00:17:52,875 --> 00:17:54,875 for health care providers and, you know, especially 460 00:17:54,875 --> 00:17:57,134 those trying to get into the profession. So 461 00:17:57,230 --> 00:17:57,630 I know, 462 00:17:58,349 --> 00:18:00,670 you know, you with your background, and leadership 463 00:18:00,670 --> 00:18:01,570 and in coaching, 464 00:18:02,349 --> 00:18:04,029 to you know, what do you say to, 465 00:18:04,349 --> 00:18:06,529 young professionals who are trying to get into 466 00:18:07,070 --> 00:18:09,650 the physicians or nurses or a clinician, 467 00:18:10,095 --> 00:18:11,375 any way, shape, or form, 468 00:18:11,775 --> 00:18:13,535 within the health care space today trying to 469 00:18:13,535 --> 00:18:15,615 build a career and and be a leader 470 00:18:15,615 --> 00:18:17,294 within those space. What is your advice for 471 00:18:17,294 --> 00:18:18,434 them, and how do you, 472 00:18:19,214 --> 00:18:21,375 position them to be a leader and champion 473 00:18:21,375 --> 00:18:22,035 of change? 474 00:18:22,559 --> 00:18:23,059 Mhmm. 475 00:18:23,359 --> 00:18:26,079 So a lot of people who get into 476 00:18:26,079 --> 00:18:28,799 health care leadership start out as clinicians. We 477 00:18:28,799 --> 00:18:31,119 have our nonclinical folks that have the MHA 478 00:18:31,119 --> 00:18:33,200 and the MBA, but we also have a 479 00:18:33,200 --> 00:18:35,679 large number of people who go from being 480 00:18:35,679 --> 00:18:36,339 a clinician 481 00:18:36,934 --> 00:18:37,835 to being an administrator. 482 00:18:38,775 --> 00:18:40,554 And so for both, 483 00:18:40,855 --> 00:18:44,294 my advice is diversify your skill set. Make 484 00:18:44,294 --> 00:18:45,595 sure that you have 485 00:18:45,894 --> 00:18:47,434 advanced degrees, especially 486 00:18:47,734 --> 00:18:49,974 when you're living in large cities because it's 487 00:18:49,974 --> 00:18:50,794 very competitive. 488 00:18:51,440 --> 00:18:53,380 Make sure that you get those certifications 489 00:18:54,400 --> 00:18:55,859 in lean management, 490 00:18:56,400 --> 00:18:58,019 as a health care executive, 491 00:18:59,440 --> 00:19:00,579 project management, 492 00:19:01,039 --> 00:19:03,974 things that will help you stand out, things 493 00:19:03,974 --> 00:19:06,055 that will make you an asset to an 494 00:19:06,055 --> 00:19:06,555 organization, 495 00:19:07,015 --> 00:19:07,515 especially 496 00:19:08,535 --> 00:19:09,035 now 497 00:19:09,494 --> 00:19:12,075 with leaders having to constantly 498 00:19:12,375 --> 00:19:14,555 be dealing with change management. 499 00:19:15,335 --> 00:19:16,875 You have to be very agile. 500 00:19:17,460 --> 00:19:21,460 So making sure that every single year, you 501 00:19:21,460 --> 00:19:23,319 are investing in your education 502 00:19:23,859 --> 00:19:24,919 and your skills 503 00:19:25,539 --> 00:19:26,039 to 504 00:19:27,220 --> 00:19:27,720 be, 505 00:19:28,179 --> 00:19:31,000 that leader can that can deal with adaptive 506 00:19:31,220 --> 00:19:32,839 leadership changes. Because 507 00:19:33,355 --> 00:19:35,355 we would like to think that problems have 508 00:19:35,355 --> 00:19:36,734 a straightforward answer, 509 00:19:37,194 --> 00:19:38,414 but a lot of times, 510 00:19:39,355 --> 00:19:39,855 especially 511 00:19:40,315 --> 00:19:42,974 in today's health care organizations, 512 00:19:43,914 --> 00:19:45,855 there's not always a straightforward 513 00:19:46,394 --> 00:19:46,894 solution 514 00:19:47,440 --> 00:19:49,119 to the problem. So you have to be 515 00:19:49,119 --> 00:19:49,940 very creative. 516 00:19:50,320 --> 00:19:52,480 You have to make sure you're using evidence 517 00:19:52,480 --> 00:19:54,019 based leadership skills. 518 00:19:54,400 --> 00:19:57,700 And so I would say at every opportunity, 519 00:19:58,320 --> 00:19:58,820 please 520 00:19:59,440 --> 00:19:59,924 invest 521 00:20:00,244 --> 00:20:03,125 in your skill set and making sure that 522 00:20:03,125 --> 00:20:06,025 every year you're learning something new. 523 00:20:06,325 --> 00:20:07,465 And I will say, 524 00:20:08,565 --> 00:20:12,105 I'm on the Harvard Business Review Advisory Council, 525 00:20:12,869 --> 00:20:13,369 and, 526 00:20:14,069 --> 00:20:15,450 we just had 527 00:20:15,750 --> 00:20:17,930 our voting on the top four 528 00:20:18,309 --> 00:20:20,490 HBR articles of the year. 529 00:20:21,269 --> 00:20:22,970 And every single article 530 00:20:23,750 --> 00:20:25,849 had something to do with artificial 531 00:20:26,150 --> 00:20:26,650 intelligence. 532 00:20:27,815 --> 00:20:29,595 So as health care leaders, 533 00:20:29,894 --> 00:20:32,454 you cannot avoid it. You cannot run from 534 00:20:32,454 --> 00:20:35,494 it. Embrace it. Learn it. Learn how to 535 00:20:35,494 --> 00:20:36,234 use it. 536 00:20:36,535 --> 00:20:37,755 AI is everywhere, 537 00:20:38,375 --> 00:20:39,734 and we need to use it to our 538 00:20:39,734 --> 00:20:40,234 benefit. 539 00:20:41,420 --> 00:20:43,819 I love that. Thank you so much, Tiffany, 540 00:20:43,819 --> 00:20:45,339 for joining us on the podcast today. I 541 00:20:45,339 --> 00:20:47,339 think just before we wrap up here, we've 542 00:20:47,339 --> 00:20:48,779 talked a lot about some of the different 543 00:20:48,779 --> 00:20:49,279 challenges, 544 00:20:49,740 --> 00:20:52,619 upcoming and, you know, ways that you're navigating 545 00:20:52,619 --> 00:20:54,140 around it. But, you know, where do you 546 00:20:54,140 --> 00:20:57,005 see some of the actual opportunities for organizational 547 00:20:57,065 --> 00:20:58,525 growth in the future as well? 548 00:20:59,144 --> 00:21:00,204 Yeah. So, 549 00:21:00,505 --> 00:21:02,765 you know, I will say that 550 00:21:03,305 --> 00:21:05,785 I have been in the private sector since 551 00:21:05,785 --> 00:21:06,845 2018, 552 00:21:07,625 --> 00:21:09,305 and one of the things that I think 553 00:21:09,305 --> 00:21:11,404 we don't do well enough is telehealth. 554 00:21:12,519 --> 00:21:14,279 I think that now that we know that 555 00:21:14,279 --> 00:21:15,820 it can be fully reimbursed, 556 00:21:16,200 --> 00:21:17,660 we really need to 557 00:21:18,200 --> 00:21:18,700 expand 558 00:21:19,079 --> 00:21:20,779 our growth in telehealth. 559 00:21:21,320 --> 00:21:22,140 And, honestly, 560 00:21:23,160 --> 00:21:25,660 I would I would challenge our country 561 00:21:26,200 --> 00:21:26,859 to not 562 00:21:27,525 --> 00:21:29,865 restrict telehealth to state lines. 563 00:21:30,884 --> 00:21:33,445 I would encourage because health care is health 564 00:21:33,445 --> 00:21:35,465 care. Health care in Massachusetts 565 00:21:36,325 --> 00:21:38,644 should not be different from Vermont, should not 566 00:21:38,644 --> 00:21:39,945 be different from Maine. 567 00:21:40,325 --> 00:21:41,545 So why cannot 568 00:21:41,845 --> 00:21:42,345 we, 569 00:21:43,070 --> 00:21:43,970 have telehealth 570 00:21:44,430 --> 00:21:45,809 a telehealth provider 571 00:21:46,269 --> 00:21:47,009 in Maine 572 00:21:47,309 --> 00:21:49,009 taking care of someone in Massachusetts 573 00:21:49,309 --> 00:21:50,289 or vice versa? 574 00:21:50,910 --> 00:21:54,450 Thinking about the shortage in primary care providers 575 00:21:54,589 --> 00:21:56,450 and behavioral health providers, 576 00:21:57,115 --> 00:21:58,255 couldn't we potentially 577 00:21:58,954 --> 00:21:59,454 expand 578 00:22:00,474 --> 00:22:01,694 access to care 579 00:22:02,315 --> 00:22:05,755 if we allow telehealth across state lines? So 580 00:22:05,755 --> 00:22:07,934 I see that as a huge opportunity, 581 00:22:09,470 --> 00:22:12,029 and I would I would love to have 582 00:22:12,029 --> 00:22:14,210 the discussion further at the federal level. 583 00:22:15,230 --> 00:22:17,309 Absolutely. I think you and many others, 584 00:22:17,710 --> 00:22:19,710 that that is absolutely makes a lot of 585 00:22:19,710 --> 00:22:21,470 sense and, you know, would be great to 586 00:22:21,470 --> 00:22:24,349 hopefully see some more movement, on policy in 587 00:22:24,349 --> 00:22:26,595 that in that direction. So, 588 00:22:26,894 --> 00:22:28,974 Tiffany, thank you again for your time today. 589 00:22:28,974 --> 00:22:30,255 It's been a lot of fun speaking with 590 00:22:30,255 --> 00:22:31,154 you and learning, 591 00:22:31,615 --> 00:22:33,714 from you and your perspective at the FQHC, 592 00:22:33,855 --> 00:22:35,214 and I look forward to connecting with you 593 00:22:35,214 --> 00:22:37,054 again soon. And I I know you'll be 594 00:22:37,054 --> 00:22:39,134 speaking at our annual meeting upcoming in April, 595 00:22:39,134 --> 00:22:41,230 so it'll be great to connect there in 596 00:22:41,230 --> 00:22:43,069 person and catch up and and just continue 597 00:22:43,069 --> 00:22:43,809 this conversation. 598 00:22:44,429 --> 00:22:46,589 I'm looking forward to it, Laura. Thank you 599 00:22:46,589 --> 00:22:48,289 so much. I'll see you in April.