Latest / Becker’s Healthcare - Clinical Leadership Podcast / Tiffany Love, Associate Vice President of Nursing at Greater Lawrence Family Health Center

Transcript

Tiffany Love, Associate Vice President of Nursing at Greater Lawrence Family Health Center · Becker’s Healthcare - Clinical Leadership Podcast

0:02
This is where health care leadership comes together.
0:04
Becker's sixteenth annual meeting brings more than 3,500
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hospital and health system executives and nearly 800
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speakers to Chicago April.
0:14
This year's event includes keynote conversations with Dallas
0:17
Cowboys legend Troy Aikman and former president George
0:20
w Bush. For the agenda and event details,
0:23
visit beckershospitalreview.com
0:25
and click on the events tab in the
0:26
upper right. We're looking forward to hosting you
0:29
in Chicago.
0:32
This is Laura Dierda with the Becker's Healthcare
0:34
podcast. I'm thrilled today to be joined by
0:36
Tiffany Love, associate vice president of nursing at
0:38
Greater Lawrence Family Health Center in Lawrence, Massachusetts.
0:41
Tiffany is a pleasure to end the podcast
0:43
today. Oh, thank you for having me. Absolutely.
0:46
Now I'm excited for our conversation because I
0:48
know health centers are such an important part
0:50
of the broader health care ecosystem. And, you
0:52
know, it's really important that,
0:54
you are able to, you know, provide a
0:57
great service to communities and continue to, grow
1:00
and expand. And so I'm looking forward to
1:02
our conversation. But before we dig in, can
1:04
you tell us a little bit more about
1:05
yourself, your background, as well as Greater Lawrence
1:08
Family Health Center?
1:09
Yes. So I actually have two main roles.
1:12
Number one, as the associate vice president for
1:15
the, of nursing for the Greater Lawrence Family
1:17
Health Center, which is the second largest federally
1:20
qualified health center in Massachusetts.
1:23
And our catchment area is actually Massachusetts
1:26
and New Hampshire.
1:27
And what many people probably would not know
1:30
is that 80% of the people we serve
1:33
are Latinx background.
1:35
So we're talking about a a very large,
1:39
immigrant population,
1:42
predominantly
1:43
Spanish speaking.
1:44
And then my second role is the founder
1:47
and CEO of the Love Leadership Foundation where
1:50
I provide career coaching for health care executives
1:52
internationally.
1:53
So those are my two labors of love,
1:56
and I'm just so happy to have the
1:58
chance to talk to you about them today.
2:00
Well, that's fantastic. You know? What a,
2:03
great position to be in, especially being able
2:05
to train leaders in the health care space
2:07
across the spectrum. I think, you know, having
2:10
those connections and being able to shape the
2:12
future,
2:13
will be really beneficial moving forward. Now,
2:17
I'm curious, you know, first and foremost,
2:20
when you talk about your role, with the
2:22
Greater Lawrence Health Center,
2:25
what is the most important initiative you led
2:27
last year? What did you do, or what
2:28
were the results?
2:30
So I can tell you, as someone who
2:33
has
2:35
received health care in Massachusetts for many years,
2:38
because I've worked at all over New England,
2:40
and I always have had doctors in Massachusetts.
2:44
I will tell you,
2:46
now actually physically being in Massachusetts
2:49
and serving this population,
2:50
there is an emerging primary care crisis.
2:54
We literally
2:56
do not have enough primary care providers
3:00
to care for the patients that need to
3:02
be seen.
3:04
So according to the Association
3:06
of Medical Colleges,
3:08
by the year 2034,
3:10
there will be a 48,000
3:13
primary care physician
3:15
shortage.
3:16
Now that might sound like a small number,
3:18
but I can tell you for my health
3:21
care center
3:22
specifically,
3:23
we have about 2,000
3:26
unassigned
3:26
patients.
3:27
So what does this mean? Now when I
3:30
lived in Vermont,
3:31
lived in Maine, I could come see doctors
3:34
in Massachusetts no problem. But when you are
3:36
physically in Massachusetts,
3:38
you are required to have a primary care
3:40
provider
3:42
for any care,
3:44
any referrals
3:45
that you need.
3:47
And so when you have such a large
3:49
number of patients that are unassigned to a
3:51
primary care provider,
3:53
these are people
3:55
who are forced to seek their health care
3:58
through
3:59
emergency
4:00
room, urgent care visits, things that should be
4:03
going
4:04
to a primary care provider.
4:08
So with that
4:10
being in mind,
4:11
for my health care center,
4:13
I have been very focused on,
4:16
number one,
4:17
triaging the people who are trying
4:20
their best to get into the health system
4:23
coming through acute care, urgent care means,
4:27
and
4:28
using evidence based triage tools to say,
4:31
is this really urgent? Is this nonurgent?
4:35
Can this person potentially be seen by a
4:37
nurse?
4:38
Can this person potentially be seen
4:41
in telehealth?
4:43
And so really just
4:45
focusing
4:45
on creating
4:47
access
4:48
for our patients.
4:49
And when it comes to access to primary
4:52
care,
4:53
there are
4:54
approximately
4:55
a 100,000,000
4:57
Americans who are lacking
4:59
a primary care provider, and this is especially
5:02
high in rural health care. So you can
5:05
imagine Massachusetts
5:06
is not rural,
5:08
but this is definitely
5:10
a problem that we face every day. And
5:13
that's on top of workforce shortages, not just
5:16
for our primary care providers,
5:19
but also for nurses.
5:22
And then you have the lack of insurance.
5:25
You have the threat
5:28
of potentially losing
5:30
insurance for the people who are on Medicaid.
5:33
So, really,
5:35
for a federally qualified health center
5:38
that has a mission to focus on health
5:41
equity
5:43
and serving the underserved people.
5:46
It's a really big crisis for us, so
5:49
that's where my focus has been. And I'm
5:51
proud to say that we have expanded access
5:54
to
5:55
care by
5:56
being more thoughtful about who is getting that
6:00
urgent care need versus who can be seen
6:04
in a telehealth clinic. That
6:07
makes a lot of sense, and it's really
6:08
helpful to understand. I think that context you
6:10
provided, especially
6:12
on primary care and the situation you have
6:14
in Massachusetts,
6:15
but then looking at, you know, how you're
6:18
able to,
6:19
see some of the charges going down the
6:21
pipe and charges, especially in primary care is
6:24
really critical.
6:25
So from your perspective, when you talk about,
6:28
expanding access and,
6:30
providing more digital opportunities, telehealth, and those kinds
6:33
of things, what does it take to stand
6:34
up a program like that?
6:36
Oh my gosh. Well, number one, technology. Right?
6:40
Because when you think about it, I just
6:42
said that we have a large immigrant population.
6:46
So
6:47
do they have
6:48
a video the opportunity or the ability
6:53
to use a video conference calling, or can
6:56
they only speak to you over the phone?
6:58
Because we know that Medicare no longer will
7:01
reimburse for if it's only a telephone visit.
7:04
It has to be a video
7:06
telephone visit for it to actually count towards
7:09
reimbursement.
7:11
So just really making sure that our patients
7:15
actually have the technology.
7:17
Do they have Internet?
7:19
And that's especially a problem having worked in
7:21
rural health care.
7:23
Sometimes you literally don't have the infrastructure
7:27
within the state where people get good
7:30
Internet access. So imagine trying to have a
7:33
call with your provider,
7:35
but you actually don't have a good Internet
7:37
connection.
7:39
So and and I have worked with the
7:42
Department of Veterans Affairs for more than eight
7:44
years where we would actually put the technology
7:47
in the patient's home.
7:49
For patients that
7:51
need chronic disease management,
7:53
we would actually
7:55
give them equipment to keep in their home
7:58
so that when they needed to have an
8:01
interaction with a provider,
8:03
we would be able to connect with them
8:06
directly with the equipment that we provided for
8:08
them.
8:09
And I think a lot of systems just
8:11
really haven't gotten that advanced where
8:14
if the patient doesn't have the equipment that's
8:17
required,
8:18
that we supply it for them. And so,
8:20
hopefully,
8:21
in the future,
8:23
we will think about that as we're trying
8:25
to expand telehealth and expand access to care,
8:29
especially for people in rural rural America.
8:34
That makes a lot of sense. You know,
8:35
it it sounds like a, important solution especially
8:38
to make sure they have access to that
8:39
type of technology. Now looking ahead, what are
8:42
some of the big priorities and kind of
8:43
ones you're focused on for 2026?
8:47
So for me, working in a federally qualified
8:50
health center, and I know a lot of
8:52
safety net hospitals are probably focused on this
8:55
as well, There are two major threats for
8:59
us. So the first is the threat of
9:02
the cut to Medicaid.
9:04
With the recent legislation with the one big
9:08
beautiful bill,
9:09
we are expecting that there are gonna be
9:11
about a trillion dollars in Medicaid cuts.
9:15
And so for
9:18
a federally qualified health center that relies heavily
9:21
on Medicaid,
9:22
that relies heavily on grant funding,
9:25
if these cuts come to fruition,
9:28
there are a lot of patients
9:31
who are suddenly gonna be uninsured.
9:35
And
9:36
suddenly, we will be in a position where
9:38
we're trying to provide care for people who
9:40
absolutely cannot pay for it. This is the
9:43
same position with most
9:45
safety net hospitals as well who heavily depend
9:49
on Medicaid, rural health care as well. And
9:52
so you have to think about how destabilizing
9:55
this can be to these health care systems.
9:58
Not only that, but think about the impact
10:01
that it's gonna have on private
10:03
insurance
10:04
and our our
10:06
as a organization,
10:08
trying to get that highest level reimbursement
10:12
from the sources that we can be reimbursed
10:14
for,
10:15
but also thinking about the people
10:18
who may simply give up and not seek
10:21
care.
10:22
So Medicare Medicaid cuts are one threat.
10:26
And then the second threat that a lot
10:29
of people might not be thinking of
10:32
is the threat of the loss of the
10:34
current three forty b program.
10:37
The three forty b program
10:39
is a program where a lot of organizations
10:42
are receive they're able to buy
10:45
their medications at a discounted rate.
10:48
And so for a community health center like
10:50
ours, that is hugely
10:53
important because a lot of our patients meet
10:55
the criteria to get those three forty b
10:57
meds.
10:59
And here's the thing.
11:01
Being the second largest
11:03
health center in federally qualified health center in
11:06
Massachusetts,
11:07
for us,
11:09
if we were to lose this program,
11:12
it would equate to millions,
11:15
many millions of dollars. So just imagine
11:18
larger safety net hospitals,
11:21
larger health systems,
11:22
and it really
11:24
creates a situation where
11:26
the vulnerable populations
11:28
might not be able to get services.
11:30
Those services might be cut.
11:34
And so
11:35
the proposal,
11:36
as I understand it, is that they might
11:40
change their program
11:42
where we pay for the medications upfront,
11:46
and then they reimburse us the discount.
11:49
Again, that would be millions of dollars
11:53
that we would be paying upfront
11:55
that we haven't historically
11:57
had to pay for.
11:59
So think about the higher cost drugs that
12:02
we might not be able to provide anymore
12:05
and just the financial strain that it's gonna
12:07
put on organizations.
12:09
And for some
12:10
organizations,
12:11
this might be
12:13
enough of a financial impact
12:15
that at least them to close their doors.
12:17
Between these two threats,
12:19
it literally could lead to
12:23
health core health care organizations
12:26
closing because they simply cannot overcome
12:29
the financial strain
12:31
of these two
12:32
new changes.
12:35
Absolutely. That, you know, is huge and definitely,
12:39
a sobering future when you think about those
12:41
programs, those cuts to Medicaid and, three forty
12:44
b and other funding programs that are really
12:46
critical to FUHCs
12:48
and other hospitals and systems and safety net
12:51
hospitals,
12:52
across the country. And so,
12:54
you know, that is definitely a a huge,
12:57
challenge. And, you know, when you think about
12:59
all of these things that are potentially coming
13:02
down the pipe, how do you prepare for
13:03
them, while also, you know, keeping yourself and
13:06
your teams focused on continuing to deliver care
13:09
to patients
13:11
today? Well,
13:12
so I will tell you that, number one,
13:15
because our organization
13:17
heavily relies on grant funding, we're trying to
13:20
take advantage
13:21
of the grant funding that is there. There
13:23
have already been cuts that we have seen,
13:26
but we're trying to do our best to
13:29
take advantage of what is still currently there.
13:32
And it's almost impossible
13:35
to prepare
13:36
for
13:38
if there's gonna be Medicaid cuts? Like, how
13:41
do you prepare for that? It's really
13:43
challenging because there really aren't
13:45
any other funding sources unless you look to
13:48
philanthropy
13:50
and, you know, big donors that are willing
13:53
to provide that support for our underserved communities,
13:58
which is usually not the case. I mean,
14:00
usually, philanthropy, you think about
14:03
big donors wanting their name on a new
14:05
building or something glamorous. And, really, the work
14:08
that we do isn't glamorous. We're just
14:10
serving the underserved people.
14:13
And so for us,
14:15
I would say the biggest challenge is going
14:18
to be
14:19
if those cuts come to fruition,
14:22
do we need to cut services? How are
14:24
we going to remain financially
14:27
stable?
14:28
How are we going to manage the wait
14:30
list that are increasing,
14:32
especially for people
14:34
who cannot afford to pay for the services.
14:37
Because we still have to pay for the
14:38
doctors. We have to pay for the nurses.
14:42
And so that's when organizations
14:45
start to think about, do we need to
14:46
cut services?
14:48
Do we need to
14:50
just try and
14:52
provide the care for the people that we
14:53
can?
14:55
Got it. That makes a lot of sense,
14:57
you know, and and is a helpful context
14:59
to dig a little bit deeper there. Thank
15:01
you.
15:02
What do you think the hardest thing you'll
15:04
have to do in the coming year will
15:05
be?
15:06
I would say,
15:08
number one, caring for the people who are
15:11
just not coming into the health care system
15:13
because they know they can't they can't pay
15:15
for it.
15:16
And then when they do come in,
15:19
they're very, very sick.
15:21
And I can tell you,
15:24
even though
15:25
I work at a federally qualified health center,
15:28
people walk in having strokes, having heart attacks
15:32
almost every day.
15:34
And so
15:35
how how can we reach out to this
15:38
community?
15:39
What are what other
15:41
financial resources can we tap into
15:44
to make sure that people literally
15:46
aren't
15:47
dying because they can't afford health care.
15:51
And so I would say the coming year,
15:55
really
15:56
trying to figure out how to recover if
15:59
they do cut Medicaid,
16:03
trying to figure out how we do provide
16:07
medications
16:07
for those who might be cut off from
16:09
three forty b. I have to say our
16:12
organization
16:14
is really awesome when it comes to fundraising
16:18
so that we can for those people who
16:20
cannot cover the cost of their medications or
16:22
other medical needs,
16:24
we do have a fund that
16:27
our employees actually contribute heavily to
16:31
where we provide money so that we can
16:34
hopefully
16:35
help out those people who just don't have
16:37
the means.
16:39
So I would say, you know, just
16:42
trying to reach out and help as many
16:44
people as we can is really gonna be
16:46
the hardest thing in the coming year.
16:49
Got it. Well, that's incredible. And we definitely
16:51
have a bad service oriented mindset,
16:54
to the team and and, you know, having
16:56
so many resources focused on ensuring people have
16:59
the care they need is,
17:01
incredible.
17:02
And and can I add before we move
17:04
on, can I add that I didn't even
17:06
mention the rising cost
17:09
of care of all of the services that
17:11
we use every day? All the costs are
17:14
increasing.
17:17
And we also have that that
17:20
staffing
17:21
that the shortage of staffing. You know?
17:24
Maybe more people to go to school to
17:26
be a nurse, maybe more people to go
17:27
to school to be a medical assistant.
17:29
And,
17:30
the shortage that I mentioned earlier about primary
17:33
care providers,
17:35
especially now that,
17:37
we know that if you go to school
17:40
to be a nurse practitioner,
17:42
you're not necessarily gonna get the financial support
17:45
that you have in the past.
17:47
Got it. That's helpful to know and, you
17:49
know, definitely a huge, huge challenge to overcome
17:52
for health care providers and, you know, especially
17:54
those trying to get into the profession. So
17:57
I know,
17:58
you know, you with your background, and leadership
18:00
and in coaching,
18:02
to you know, what do you say to,
18:04
young professionals who are trying to get into
18:07
the physicians or nurses or a clinician,
18:10
any way, shape, or form,
18:11
within the health care space today trying to
18:13
build a career and and be a leader
18:15
within those space. What is your advice for
18:17
them, and how do you,
18:19
position them to be a leader and champion
18:21
of change?
18:22
Mhmm.
18:23
So a lot of people who get into
18:26
health care leadership start out as clinicians. We
18:28
have our nonclinical folks that have the MHA
18:31
and the MBA, but we also have a
18:33
large number of people who go from being
18:35
a clinician
18:36
to being an administrator.
18:38
And so for both,
18:40
my advice is diversify your skill set. Make
18:44
sure that you have
18:45
advanced degrees, especially
18:47
when you're living in large cities because it's
18:49
very competitive.
18:51
Make sure that you get those certifications
18:54
in lean management,
18:56
as a health care executive,
18:59
project management,
19:01
things that will help you stand out, things
19:03
that will make you an asset to an
19:06
organization,
19:07
especially
19:08
now
19:09
with leaders having to constantly
19:12
be dealing with change management.
19:15
You have to be very agile.
19:17
So making sure that every single year, you
19:21
are investing in your education
19:23
and your skills
19:25
to
19:27
be,
19:28
that leader can that can deal with adaptive
19:31
leadership changes. Because
19:33
we would like to think that problems have
19:35
a straightforward answer,
19:37
but a lot of times,
19:39
especially
19:40
in today's health care organizations,
19:43
there's not always a straightforward
19:46
solution
19:47
to the problem. So you have to be
19:49
very creative.
19:50
You have to make sure you're using evidence
19:52
based leadership skills.
19:54
And so I would say at every opportunity,
19:58
please
19:59
invest
20:00
in your skill set and making sure that
20:03
every year you're learning something new.
20:06
And I will say,
20:08
I'm on the Harvard Business Review Advisory Council,
20:12
and,
20:14
we just had
20:15
our voting on the top four
20:18
HBR articles of the year.
20:21
And every single article
20:23
had something to do with artificial
20:26
intelligence.
20:27
So as health care leaders,
20:29
you cannot avoid it. You cannot run from
20:32
it. Embrace it. Learn it. Learn how to
20:35
use it.
20:36
AI is everywhere,
20:38
and we need to use it to our
20:39
benefit.
20:41
I love that. Thank you so much, Tiffany,
20:43
for joining us on the podcast today. I
20:45
think just before we wrap up here, we've
20:47
talked a lot about some of the different
20:48
challenges,
20:49
upcoming and, you know, ways that you're navigating
20:52
around it. But, you know, where do you
20:54
see some of the actual opportunities for organizational
20:57
growth in the future as well?
20:59
Yeah. So,
21:00
you know, I will say that
21:03
I have been in the private sector since
21:05
2018,
21:07
and one of the things that I think
21:09
we don't do well enough is telehealth.
21:12
I think that now that we know that
21:14
it can be fully reimbursed,
21:16
we really need to
21:18
expand
21:19
our growth in telehealth.
21:21
And, honestly,
21:23
I would I would challenge our country
21:26
to not
21:27
restrict telehealth to state lines.
21:30
I would encourage because health care is health
21:33
care. Health care in Massachusetts
21:36
should not be different from Vermont, should not
21:38
be different from Maine.
21:40
So why cannot
21:41
we,
21:43
have telehealth
21:44
a telehealth provider
21:46
in Maine
21:47
taking care of someone in Massachusetts
21:49
or vice versa?
21:50
Thinking about the shortage in primary care providers
21:54
and behavioral health providers,
21:57
couldn't we potentially
21:58
expand
22:00
access to care
22:02
if we allow telehealth across state lines? So
22:05
I see that as a huge opportunity,
22:09
and I would I would love to have
22:12
the discussion further at the federal level.
22:15
Absolutely. I think you and many others,
22:17
that that is absolutely makes a lot of
22:19
sense and, you know, would be great to
22:21
hopefully see some more movement, on policy in
22:24
that in that direction. So,
22:26
Tiffany, thank you again for your time today.
22:28
It's been a lot of fun speaking with
22:30
you and learning,
22:31
from you and your perspective at the FQHC,
22:33
and I look forward to connecting with you
22:35
again soon. And I I know you'll be
22:37
speaking at our annual meeting upcoming in April,
22:39
so it'll be great to connect there in
22:41
person and catch up and and just continue
22:43
this conversation.
22:44
I'm looking forward to it, Laura. Thank you
22:46
so much. I'll see you in April.