This episode is part of the "Inches Are All Around Us" series looking for all the little pockets—inches, if you will—that comprise the greater than $1 trillion in healthcare waste in this country annually.
For a full transcript of this episode, click here.
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Many of these inches, if we hack them out, will actually improve patient care because these inches are just like the friction that's in the middle.
To this end, I started thinking about FQHCs (Federally Qualified Health Centers), which are (these FQHCs in this context, if you think about it) kind of a great laboratory for scrappy and amazing case studies about finding and cutting out waste with some serious fiscal discipline.
The thing with FQHCs and why they are great places to I spy inches of waste is really because if an FQHC has a budget shortfall, they cannot solve it by cost shifting to commercial patients, commercial members, commercial plans. They have no commercial patients.
Also, they have a patient population that many would consider challenging, and they cannot restrict access. They gotta make do with what they have. They must have actually true fiscal discipline. They either figure out how to be efficient, or their patient population does not get care.
But what tipped me over the edge to revisit this episode from 2021 with Gary Campbell—who is the CEO of an FQHC, by the way—I picked the show to revisit because of my conversation with Nikki King, DHA, that I had earlier this year (EP470).
Nikki and I caught up, and she is now the CEO of an FQHC in Indiana. I had interviewed Nikki, by the way, about rural health a few years ago (EP338). So, go back and listen to that if anything I say today you find intriguing for other reasons.
Tribe, this is interesting to think about what I'm about to tell you. Really. I've been thinking about it for six months.
I wanna start out here recapping my aforementioned catch-up conversation with Nikki King as the lead-in to my conversation with Gary Campbell to follow.
And to be specific here, Gary Campbell is the CEO of an FQHC in Virginia called Johnson Health Center; and Nikki King is CEO at Alliance Health Centers in Indiana.
Let me tell you one thing that Nikki King did. There are many things that she did, but here's one that she told me about. Nikki realized after talking and listening to their patients that one of the biggest barriers to getting care at her FQHC for patients was no transportation.
Also, as most FQHCs, they were short on funds. So, doing things like free Ubers or something like that was not an option. So, you know what Nikki did? She thought about where her patients are. For example, most referrals to their addiction treatment services came from the courthouse—a judge remanding, if that's the right word, someone to treatment.
So, two birds with one stone style, Nikki marched over to the courthouse facilities person and asked if they had any open office space at the courthouse, you know, work from home and all of that. Maybe there were some open offices. Well, the courthouse did. They had some open offices. So, now rent-free or almost rent-free, I don't, I'm not sure, when a judge says to somebody, "Go get addiction treatment," that judge can also point down the hall and the patient can just walk over.
Nikki did the same thing, setting up a clinic in a day care center. She set up a clinic in a homeless shelter and right by a big basketball court.
You compare and contrast this, I don't know, "just get it done" approach to all of the times that you hear about "some cash-strapped entity" who decides the best thing to do immediately is new construction. Pay to build brick and mortar and then in perpetuity, of course, pay all the costs and the snow removal and the security and the utilities and repair for that new construction.
And they could be an FQHC building new buildings—one of the less scrappy ones—but it also could be a big, consolidated health system or anybody in between. It's amazing how many times you hear "razor-thin margins," and then you hear "new construction" in the same sentence.
I'm like, "Yeah … gotcha. Upsize." Call it my Pennsylvania Dutch and Bronx heritage. But yeah … head exploding. That was a tangent.
Bottom line, however, I say all this to say FQHCs (the ones with great leadership, at least) are a wonderful case study to look for insights on how to operate in an environment that cannot rely on, again, raising commercial rates and cost shifting to balance the budget, right?
Let's not forget, there are two very different ways to end up with no profit: One is genuine struggle. The other is simply being very good at spending every dollar that is given to you.
For plan sponsors, this is a vital distinction, regardless of how loud anybody cries poor, any clinical partner who lacks fiscal discipline isn't struggling; they're inefficient. And we do not have a market in healthcare to be able to tell who's struggling versus who is inefficient.
So, yeah … keep that in mind and listen to episode 490 and 492 after this one with Shane Cerone and Sam Flanders, MD, for more on the whole "there's no market" theme, as well as more on the fiscal discipline topic.
But again, this is why FQHCs are such a good case study here, because there's an upper limit to how much money they have. In most circumstances—I mean, barring some big donation or something like that—but under most circumstances, they have a revenue cap that they have to be disciplined enough to work within.
Okay … one last thing before we kick into the show today. I wanna be really clear here. Fiscal discipline isn't something that any individual doctor or nurse or other clinician can tackle in a vacuum. Or even any given administrator. It is a leadership imperative.
Great leadership doesn't just manage the clinical side. It takes accountability for the administrative waste that keeps margins thin and prices high.
So, here's actionable advice for anybody listening, regardless of what you may or may not have to do with FQHCs. If you're a plan sponsor looking for a clinical partner, consider, like, what Nikki King is doing and the thinking that Gary Campbell is gonna talk about as a benchmark.
Real value comes from finding the organizations that treat fiscal discipline as kind of a mission critical strategy, because these days, with all the affordability issues, it is financial toxicity is clinical toxicity. I mean, maybe you can find an organization that actually does unit cost accounting. Listen to the show with Mick Connors, MD (EP495).
Okay … as I said earlier, my guest today is Gary Campbell, who I spoke with in 2021—so this is a deep cut from the archives, but it's also a really great show. Gary, as I said earlier, is CEO of Johnson Health Center, which is an FQHC, in Lynchburg, Virginia. He's also the president of Impact2Lead.
Also mentioned in this episode are Impact2Lead; Johnson Health Center; Nikki King, DHA; Alliance Health Centers; Shane Cerone; Sam Flanders, MD; Kada Health; Mick Connors, MD; Aventria Health Group; John Lee, MD; Beau Raymond, MD; Amy Scanlan, MD; Eric Gallagher; Eve Cunningham, MD, MBA; Joyce Gioia; Robert Pearl, MD; Peter Attia, MD; Jerry Durham; and Tom Nash.
For a list of healthcare industry acronyms and terms that may be unfamiliar to you, click here.
You can learn more at impact2lead.com and follow Gary on LinkedIn.
Gary Campbell is the founder and owner of Impact2Lead, LLC, and the president and CEO of Johnson Health Center (JHC), where he has enjoyed a career centered on leading for/not-for-profit organizations and helping to unleash potential in others along the way.
In 2011, he left Bayer and went to JHC; and in 2013, he launched Impact2Lead to provide transformation-consulting services to other firms across the United States.
Since joining JHC, the center has enjoyed unprecedented success and growth by transforming the culture using his Impact Leadership model and becoming the first Federally Qualified Health Center to be recognized as an Employer of Choice by Employer of Choice International, Inc. The health center has achieved multiple workplace and community awards since that time and has enjoyed exponential growth during his years as the CEO.
Gary currently speaks and consults nationally on leadership, workplace strategies, and motivational topics.
09:03 Why is there no opportunity to cost shift in an FQHC?
09:34 What happens when an FQHC is operating inefficiently?
10:00 "Have you workflowed it out? … You can overstaff yourself in a way that your cost per patient goes way up."
10:23 Why is taking a lean approach not an excuse to cut staff?
11:27 EP490 and EP492 with Shane Cerone and Sam Flanders, MD.
11:35 EP438 with John Lee, MD.
11:38 EP455 with Beau Raymond, MD.
11:40 EP402 with Amy Scanlan, MD.
11:42 EP405 with Eric Gallagher.
12:48 "The nurses are linchpins to everything."
13:44 LinkedIn post from Eve Cunningham, MD, MBA.
15:10 How does standardizing care lead to personalization of care?
16:34 "Our clinical teams see that we care."
16:53 "If you don't have a vision for where you want to be two and three years down the road, you're struggling."
17:09 "I want everybody to understand, What is their why?"
19:45 Lean & Meaningful by Roger E. Herman and Joyce L. Gioia.
24:44 "You have to project plan things out that you want."
25:51 "They don't teach leadership in most medical schools."—Dr. Robert Pearl
26:46 Outlive by Peter Attia, MD.
27:55 "Get to know these clinicians."
29:39 "From a core values perspective, you can make every single decision … on core values."
30:03 "We always start with those values. … They're embedded in everything we do."
30:20 How does an FQHC or private practices that are patient-oriented attract talent?
35:24 EP297 with Jerry Durham.
35:54 "First and foremost, be visible."
Recent past interviews:
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Zack Kanter, Mark Newman, Stacey Richter (INBW45), Stacey Richter (INBW44), Marilyn Bartlett (Encore! EP450), Dr Mick Connors, Sarah Emond (EP494), Sarah Emond (Bonus Episode), Stacey Richter (INBW43)