The following is a transcript of our interview with Greg White. To find links to the audio files and more information about the interview, please click here.
These transcripts are made possible by a gift from the NNEAHE.
These transcripts are made possible by a gift from the NNEAHE.
Interviewer:
Welcome to the Forge, Greg.
Gregory White:
Thank you.
Interviewer:
You went to Babson College in Wellesley, Mass. What brought you there, and what did you study there?
Gregory White:
I was coming out of high school. I certainly was interested in business, though at that time, I wasn't really sure what area. When I got there, we had a chance to try, obviously like most freshman, a number of different avenues. Being somewhat introverted, the numbers seemed to appeal to me so I went down the accounting road.
Interviewer:
What drew you to accounting?
Gregory White:
I hate to put the stereotype of being a little introverted and like to work by yourself a little bit. It certainly clicked and being strong in math, it seemed like a profession that I could pursue, so I had the interest in becoming a CPA.
Interviewer:
You first worked as a staff accountant at Alexander Aronson Finning & Co CPAs in Westborough, Mass. What did you do as a staff accountant?
Gregory White:
At Alexander Aronson, I was a staff accountant, but what I did is function as an auditor, so I would go out. I spent most of my time out of the office. I was out at clients doing financial audits, where you would basically verify their financial statements, make sure they are presented fairly, do a little business consultation, tax return preparation, cost report preparation. As it turned out, most of my clients were not for profit. I was a little surprised, actually. Going into public accounting, I was anticipating going out to State Street in Boston, big manufacturers. All of my clients were inner city nonprofits, a little eye-opening, I would have to say.
Interviewer:
What did you enjoy most about that position?
Gregory White:
I got a chance to learn. I got a lot of opportunity to see different communities, the inner workings of small social service organizations. I think it opens your eyes to perhaps some of the ills of our society in terms of the shortcomings of our healthcare system, housing, poverty, things that you might have thought about but perhaps hadn't impacted you personally, so it was very eye-opening. Actually, I forged some great relationships with people while I was there.
Interviewer:
Can you give me a couple examples of the organizations you worked with?
Gregory White:
As a staff auditor for this firm in particular, I had the opportunity to work with community health centers, such as this organization, community development corporations, which deal more with housing issues, and social service organizations. You lump together, and each one is very specific to each community, so there was some that dealt with gang violence. There was some that dealt with getting people to work. There was some that dealt with pregnant moms and nutrition, so they tended to be very grant or funding-specific. I think I forged some great relationships, particularly in the healthcare, health center community, and that was actually the jumping off point for my career.
Interviewer:
You left Alexander Aronson in 1990 and joined the staff at Greater Lawrence Family Health Center. What was the Greater Lawrence Family Health Center?
Gregory White:
The Greater Lawrence Family Health Center was one of my clients, actually. I was the auditor on that engagement for a couple of years. They are a community health center much like this. At the time when I left being an auditor, they were about to start a new residency training program and were about to embark on the construction of a 50,000 square foot new facility. I had forged a great relationship with the CFO of that organization, and he brought me on because he needed the help. I thought it was pretty exciting to get in at the ground level of a new training program. A facility project is always exciting to participate in, so very different from what I was doing as an auditor, though.
Interviewer:
What prompted you to transition to healthcare?
Gregory White:
Again, I enjoyed working with the clients that I had in the community healthcare field. Dad was a banker, and Mom was a nurse, so healthcare finance seemed like a great fit. At the time, too, I wanted to get out of public accounting. The hours were very demanding at the time. I'm not critical of that. I learned a lot, but I also wanted to have a family, so I wanted a little steadier pace in terms of my hours and demands. That's not to say that I didn't put in a ton of hours when I got there, but it was a shift of speeds, and I would say more focused. As an auditor, you had a very broad purview. "Okay, this week, it's housing. Next week, it's healthcare. Oh, look, I've got a manufacturer I've got to be at. Now, it's March, and it's tax season." I'm less of a generalist, more a specialist.
Interviewer:
Tell us more about the reimbursement model you developed.
Gregory White:
As I said, we were developing a new residency training program, so the CFO put it in my hands to come up with a budget that balanced, that incorporated all the costs of the program, that incorporated the added cost of the facility, so that we could leverage what's called Graduate Medical Education funding from the federal government. The challenge being is that funding had to come through the hospital, which was not the health center, so there was a bit of a negotiation there. I built the model to balance the budget that included as many of our costs as we could reasonably substantiate. That's where it started. I think it's a little different today, but I'm very proud to have built that. I remember vividly not showing up to a company event because I was back at the office putting that model together and feeling thrilled when it finally worked.
A challenge that community health centers face is workforce. When I say workforce, we often times have challenge attracting, recruiting, and retaining family physicians, so family practice doctors, so where we were unable to buy that talent, we set about to make that talent. What we would have is a training program with 24 residents who have graduated from medical school but now have a three-year program of getting field experience working under the supervision of other physicians. Typically, physicians go through a residency based on their specialty, so this specialty was family medicine.
Interviewer:
We see that you held three different positions over your five years. How do you feel you grew in the organization?
Gregory White:
I think I grew with the organization because while we were building this program and while we were building that facility, the organization blossomed and grew. We brought on 24 residents. That's a huge capacity enhancement, so I grew from an analyst accounting role to a manager role to a controller role as the finance staff grew. I was very fortunate to have a CFO that trusted me and treated me like his right-hand person and encouraged me to seek training and developed me. That was, I think, my good fortune.
Interviewer:
Looking back on your first job, what are some words of advice you have for young people about to enter into the workforce?
Gregory White:
I would say don't discount the relationships that you're starting now. When I say that, the people that you're getting to know, so your professors, your colleagues and friends at school, people that you work with. You'll never know when that comes back to help you. The folks at Alexander Aronson Finning, the CPA firm I started with, I am still in contact with. In my career, I have crossed paths with them numerous times. I've had the opportunity to refer them as an audit firm. They've had the opportunity to refer me to career opportunities. Just maintain and build those relationships. Twenty five some odd years later, I'm still in contact with them. I count them as friends, and it's worked well. Let's put it that way.
Interviewer:
You left Greater Lawrence Family Health Center in 1998 to go to Manchester Community Health Center as CFO. Why did you decide to make this move?
Gregory White:
Career opportunity. The CFO at Greater Lawrence, I did not anticipate leaving anytime soon. I had a little bit of ambition and desire for upward mobility, so the folks at Alexander Aronson Finning were their audit firm and made it known to me that they were looking for a CFO. This is a fairly small industry so it's somewhat specialized so that being experienced in a community health center was certainly a leg up. That and it was close to home. I'm from New Hampshire, and Manchester was a fairly new community health center at the time. It was getting off the ground and 20 minutes from my house.
That's probably not my priority, but certainly being close to home with a growing family made a big impact in terms of my availability and seeing my children but very excited to take on that role. I think there were some folks that looked at me kind of funny like, "Is that really the move you want to make," because it was so much smaller than the Greater Lawrence Family Health Center, but in retrospect, I'm very glad I did because it helped me start a new network in a different state. That state is my home state.
Interviewer:
Tell us a bit more about Manchester Community Health Center. What is the nature of the organization? What services did they provide, and what community did you serve?
Gregory White:
Largely, like a community health center in general, it served the underserved population. We had a very diverse population that we served in terms of non-English speaking. We had a lot of immigrants and refugees, so at the time we had a lot of folks arriving from the Baltic regions, Bosnian folks, Croatian, so we had some language and cultural things to learn. It was a primary care medical provider. We had a large OB program. We had some social service type enhancements around interpretation and transportation, nutrition, things like that. Largely primary care.
I would say smaller than this present organization at the time and much smaller than Lawrence when I was there, so it was a great opportunity to come in at a high level at a small organization because the exposure you get to things beyond finance. As I arrived, I got to see things and be heavily involved in human resources, legal, operating, the true operations of the health center in terms of scheduling and compensation and recruitment. It's something I probably wouldn't have seen as readily in a large organization.
Interviewer:
What was this change to an executive position like?
Gregory White:
In that organization, in particular, it was strange because we were small enough where I would find times where I was doing very nitty gritty accounting work, really in the weeds with the budget, doing journal entries, making the closing every month, doing payroll, things like that when somebody was out. Then the next day, I might be out in the public with the CEO entertaining a visiting Congressman or going to the state to advocate for our funding or have some very high profile type of endeavor, so it was quite a diverse opportunity there in terms of the realm of things that you'd be working in. Some days, you're not dressed up. You've got your sleeves rolled up, and you're trying to figure out the budget. The next day, you're out in front of TV cameras. It's a little awkward but that struck me as interesting, I guess.
Interviewer:
How did you learn from that experience?
Gregory White:
I think my experience in Manchester, I developed beyond being I guess the technical expert. I perfected management skills, or I wouldn't say perfected. I built my management skills. I improved them, and the CEO there really took me under his wing to show me how the organization operates and how a board of directors operate and how you interact and how you interact publicly. Here's the courtesy way to do things. We need to be mindful of how we say something and who we say it to, so it was an opportunity to learn, I think.
Interviewer:
During your time at the Center, a new facility was added. How was this a challenge to finance, and what were some challenges of this task?
Gregory White:
In our industry, if you were to take a look at our financial statements and determine where all of our finding comes from, it's either the government, the government, or the government, which puts it at risk for politics and budgetary things, so things change. When you're going to a bank looking to borrow money, they want to understand. "How will you assure me that you'll be able to make the debt payment down the road when you've got all this Medicaid money? You've got this grant money. You've got Medicare money. Let me understand this. Most of your patients are below the federal poverty level, and a majority of them have no resources at all." My response was, "This is a not a model anyone would ever set out to build on purpose, but I would tell you that our track record has grown, and we continue to grow. The program is stronger than it has ever been."
I would say it was fairly unique for me because I was the only finance person in the operation aside from some bookkeeping folks. I have a very vivid memory of going to a place in Concord that does public financing for nonprofits and sitting at the end of a long table wearing my suit in front of all these very stern-faced banking finance folks who were basically going to give me the yay or nay as to whether they're going to lend us money. I just laid it out there and was honest with them. "Look, our audits are strong. Our finances are strong. We've got some money in the bank. We're responsibly managed. While there may be some question about how solid our future funding is, if you look at the track record of growth and continuing to grow," I think I made the case. They agreed to back our loan, so that was the finance side.
Project management-wise on a construction project is fun if maybe you're not the person in charge. I got to certainly be a key component of that but it wasn't my project to manage. When you hold the purse strings, you are certainly a key player in that, so being able to take your organization and one, relocate it, but to design a facility that suits your needs and is state-of-the-art, air quotes, I think that's pretty exciting. To see it come from nothing to the day we moved in, the big ribbon cutting and all of that, I think is very rewarding.
Interviewer:
After working for the Manchester Community Health Center for 12 years, you moved to the Lowell Community Health Center in Lowell, Mass. First off, what is this organization like?
Gregory White:
Similarly, another community health center but much larger than Manchester, and I would say more reflective of the Lowell community, so again, very diverse but more so with the Southeast Asian community, a lot of Cambodian folks, a lot of Spanish folks. There's a growing African community there. Arriving there and getting back to my building networks, the CEO of that organization is someone that I used to work with in Lawrence who needed a CFO, who needed somebody to come in and one, take hold of the financial operation, but two, get them ready for a major capital project where they would be consolidating five sites within the city into one large rehabilitated mill building. A very complicated financing proposal in terms of government grants, government loans, tax credits, which is God-awful complicated, but she needed somebody who could come in and knew the industry already. I took it on as a challenge, as a growth opportunity, as a much bigger organization. I looked at it as very challenging, but the challenges are something that you learn from.
Interviewer:
Yeah. I'm from Lowell.
Gregory White:
Oh, really?
Interviewer:
Yeah. I'm curious, what mill was it?
Gregory White:
One [inaudible 00:16:24] mill building on Jackson Street.
Interviewer:
Oh, yeah.
Gregory White:
Right now there's an artist housing next door, and I think there's housing on the other side, so it's right across from the parking garage.
Interviewer:
Yeah, they've done really cool things with those mills.
Gregory White:
Yes, they are very much.
Interviewer:
Was that the time of rapid expansion that you mentioned?
Gregory White:
Yes, quite a bit, so not only were we moving people from multiple sites into one building but we were growing. I think we added about 100 staff in the four years that I was there, so we went from about 250 staff to 350. Actually, I think there are over 450 now and growing more.
Interviewer:
In 2013, you came into Lamprey Health Care. Can you tell us about Lamprey as an organization?
Gregory White:
We are also a community health center, though I would say very different than Lowell. Where Lowell is an inner city type of operation and very concentrated on the eight surrounding communities and Lowell center, Lamprey is both an urban and a rural operation, so we have three sites, Nashua, Newmarket, and Raymond. As you might imagine, relatively speaking, Nashua is our urban site. It's very diverse. Our sites in Newmarket and Raymond are more rural, but we're very spread out, and we serve 43 communities. We are smaller than the Lowell operation, where we have about 16,000 patients. I think Lowell has 30 to 40,000 patients, so we face some different issues. We do have some interpretation challenges in Nashua in terms of the diversity of the patients we serve, but transportation is a challenge in the more rural communities.
Interviewer:
Can you tell us more about the mission of Lamprey?
Gregory White:
Our mission is to provide high quality primary healthcare with some focus on lifestyle, but primarily it's to provide those services without regard to an individual's ability to pay. Whether you have no insurance, whether you have poor insurance, whether you have Medicaid, that's not our concern. We want to make sure we get you in and get you primary care.
Interviewer:
How many providers are in this organization?
Gregory White:
We have about 25 providers. I would say half of them are physicians. The other half are nurse practitioners, physician assistants. We have two obstetricians. We have two pediatricians. We have some behavioral health clinicians, as well.
Interviewer:
You're now the CEO at Lamprey Health Care. How did you make the transition from CFO to CEO?
Gregory White:
I have to say that's a big transition, very different, so being a CFO and regardless of the size of the organization I was at, I felt you were always very much in the details. You're the rules' person. You have to understand how funding works. You have to understand how reimbursement works, a lot of the legalities, how rates are set, so you're very much in the details. Your definition of what work is changes, so in the finance area you do reports. You run financial statements. You do analysis. You know when your work is done. As the CEO, your role is much more outward-facing, meaning I spend my day in meetings. I go to talk to people. I integrate with the community. I advocate for the organization, and my vision needs to be down the road planning longer term. Now CFOs do that, as well, but it was a big shift for me, I found.
I had to adjust to, "I've got my to-do list today," which is very concrete. I had to do the monthly financial report. I had to do this cost report. I had to review a contract, review a staff person or two. Now it's I've got to think about something, or I've got to read something and make sure that that integrates with our longer term plan. I've got to go meet with the mayor. I've got to go to Concord and testify before a Senate committee as to why continuing to fund us is a good idea. Things like that, so a bit of a shift in gears, for sure, particularly for someone who perhaps is a little introverted. I'm used to that.
Interviewer:
How did your previous roles prepare you to be CEO?
Gregory White:
I think I was fortunate in that I worked with a couple of folks who trusted me and I would say, brought me under their wing to a degree, so I got to see how they worked. I got to see from a very close distance how they thought about things, how they went about things, not just the result but the process that got to that. I was, again, fortunate to have forged some relationships there that folks trusted me and actually looked to me to support their decision-making. That, I think, I benefited from that.
Interviewer:
Who reports to you as your senior leadership team?
Gregory White:
I have a very large team, and I suspect perhaps we might need to think about making that a little less flat but I have a finance officer. I have a chief medical officer. I have an operating officer. I have a clinical director, marketing. I have human resources. I have compliance and IT. I'm sure I've missed one. Oh, and there's a director of our health education programs and public health network, as well.
Interviewer:
In terms of work, what is the workplace culture of Lamprey Health Care like?
Gregory White:
I think historically we've certainly had a culture of learning. We've had a culture of high quality and a culture of fiscal responsibility, which I think all of which we retain today. Though I would point out, each one of our sites is in a different community, and I would say each one of our sites reflects the culture of that community. In Nashua, we are very diverse. I would say three-quarters of our staff are either bi or trilingual, and it's not all English and Spanish. There's Portuguese. There's Arabic. There's Indian dialects. There's a lot of refugee dialects that most folks have not heard of, so very reflective of the folks that work there and reflective of the folks that we serve. I think over here in Raymond and Newmarket, we have a proximity to UNH in Newmarket, so we have some involvement there. I think our culture in Raymond is very unique, too. It's a very working class blue-collar community, and we're very tied into that.
Interviewer:
What metrics do you keep track of to judge the health of the system short and long-term? How do you know you're bringing value to the community?
Gregory White:
We have our operating statistics that we watch every month. Typically, they're financial measures in terms of revenue and expense. We have visit volume that we track every month. Presently in the healthcare world and at least our world, we're reimbursed based on the numbers of patient visits that we provide, so as volume goes up, revenue goes up. We certainly track active users, which is very important to us as we evolve into perhaps a new reimbursement environment. We're also watching things like quality measures, and when I say quality measures, there are clinical measures that we have to keep track of.
One for our federal grant but two, I think that's the way the industry is headed, so we need to take a look at outcomes. We need to make sure that certain age groups have had the appropriate screenings, that kiddos have had their well visits and have had their immunizations, that women have gotten breast exams and PAP smears, that we're doing prostate screenings, that we're doing depression and hypertension screenings, things like that. Those are all foundational towards better outcomes and things like that in the primary care world.
We also work quite a bit in terms of our community benefit reporting, and there's measures that go into that in terms of the amount of free care that we provide, in terms of the people that we serve. We often look at the pay mix. When I say pay mix, meaning how many uninsured patients do we have, how many Anthem Blue Cross patients do we have? How many Medicaid patients do we have? Those are all things that we watch very closely and are actually important to the folks that fund us. We are a charitable organization. We're not for profit, so we have oversight from many folks in terms of the local community, the state community, the federal government, things like that, so there are measures that we're held accountable for there, as well.
Interviewer:
What external issues are you looking at?
Gregory White:
Right now, the big one subsequent to the elections is our funding environment. There's a big question mark on it from a public standpoint. As a community health center right now, we're faced with renewing what's called our Section 330 grant funding, which comes from the national Public Health Service. This organization receives about a three million grant annually from the federal government to help maintain access to healthcare. While it's not all of our budget, it's a substantial piece. We are watching to assure that legislation is enacted to continue that funding beyond September of 2017. There's a large component of that that is set to expire, so that's obviously of concern to us. There are other pieces, but the two big ones are the continuation of expanded Medicaid has a tremendous impact upon our patients and our organization and some workforce endeavors at the federal level that help us recruit new providers.
Interviewer:
Have any economic issues?
Gregory White:
Those are all economic issues for us in terms of the money that comes in. The other side of the equation tends to be, there's a very good job market right now, so that has an upward pressure on inflating salaries and benefits. While we are not for profit, we do have to show a surplus every year to maintain our existence, so there's the struggle of adequate revenue, raising that and keeping costs as low as you can, within reason.
Interviewer:
How sensitive is your organization to fluctuation in those measures?
Gregory White:
Hugely, hugely sensitive. Certainly our payer mix is very important, so where you might get paid for a visit at let's say $100 as a commercial payer, you might get paid as a community health center, $150 for a Medicaid visit, and you might get paid $10 for an uninsured visit, so those are very important to watch. Certainly, the quality measures are important to us. While the results from a funding or economic standpoint is not immediate, long-term, we're often times incentivized by our outcomes. The better the outcomes, an opportunity exists from time to time to enhance your revenue or to share in the savings and the system.
Interviewer:
What do you see as the biggest health policy issues facing healthcare today, and how do those affect Lamprey and the communities you serve?
Gregory White:
Certainly, healthcare as a whole, you're aware of the ACA or Obamacare and moves to change that at the federal level. It's certainly not a perfect legislation, but what it did was set about to make sure everyone had insurance coverage. There are aspects that are challenging, I understand, but changes to that will have a profound impact upon us. Depending on how far back that gets rolled, in terms of either reduction of benefits or reduction of funding, obviously it will land on us fairly hard if it's in any way a reduction. We're also very dependent upon grant and contract funding that come from the state and federal government, as well, so where there's budgetary pressures in those arenas, those numbers tend to get squeezed, too. Again, the revenue side as revenue shrinks, I have to think about expense side.
There's policy things that we think about in terms of laws and such but also, looking at the demographic of our community. New Hampshire is aging, on average. That coupled with what they're calling the silver tsunami of the baby boomers that are starting to retire, we've got to think about, "Am I set up correctly to serve that demographic of folks?" Our patients are aging with us, to some degree, but so are our providers, so I need to be sure that I'm recruiting the right folks to serve the patients that need the services.
Interviewer:
The big buzz in the healthcare community is population health. How does Lamprey work to address population health, more specifically the opioid crisis?
Gregory White:
Population health, overall, we've been doing for our existence, at least in our population. Overall, you're starting to see projects like the Dartmouth-Hitchcock or the Granite five hospitals put what's called Accountable Care Organizations together where they'll be in a position to assume more risk in the healthcare financing realm. Right now, really the risk, financial risk-wise with either the state or the insurance company in terms of who bears the risk of someone getting sick, etc. Right now, our risk is volume related, so where we're not able to see enough patients, the risk is that we won't have enough revenue. The transition under an ACO where population health is, I may be tasked with keeping people healthy, and I won't be reimbursed on a volume basis but based on the numbers of patients that I have under my care.
At the same time, I may be accountable to having to pay bills for their services elsewhere, so that shifts the risk, and our challenge is we're likely not big enough to assume that sort of risk. We are participating in some of these projects. We are participating under what's called an 1115 Waiver with Medicaid program, which is where basically the state sought a waiver of the federal Medicaid rules to try something new, particularly around the Medicaid population, to deliver services in a different way with the hopes of perhaps changing the reimbursement mechanism. We are participating in that and just getting started.
Interviewer:
What is the role of the board for Lamprey Health, and how does someone come to be on the board?
Gregory White:
At Lamprey Health Care, our Board of Directors right now is about 12 people. As a federally qualified health center, more than half of our board members actually have to be consumers of services at our organization. What they are, they are the governing body of this organization, so they are my boss. I am one employee. They task me with the day-to-day operations and putting together plans and whatnot, but it's their job to oversee policy, to set the course, and give my direction. Right now, we are a mix of professionals and folks from the community, so it's a very growing diverse group.
Interviewer:
Great. How do you develop a strategic plan that Lamprey will continue to be successful with all of the uncertainty in the marketplace?
Gregory White:
With all the uncertainty in the marketplace, often times your strategic plan might be short or a little vague in the out years because things are changing, so we're in the midst of a strategic plan right now that purposely kept it vague. We couldn't anticipate what the changes would be, but we knew we had to grow the numbers of patients that we're serving. That, I think, would hold true regardless of where we ended up in the marketplace. We wanted to work at workforce. We wanted to work at raising our profile in the community, strategic relationships, particularly along the ACO conversation we just had, so we're working closely with some hospital organizations. We're working closely with some mental health organizations. The 1115 Waiver projects are tying in the opioid epidemic and with that, too.
That's our current plan. I think setting a course. I think once some of our funding environment settles down, will probably happen about the same time when we're about to start our next plan. In healthcare, it's hard to plan too long-term, but we do sense that obviously there's workforce challenges. There's the shift in demographics in the environment, the patients. Where everybody now has insurance, competition means a little more, where previously when there was a lack of insurance, people weren't necessarily competing for the patients we were serving.
Interviewer:
How do you motivate your employees as a CEO?
Gregory White:
That's a hard one. It's difficult. Different people are motivated different ways. Certainly, engaging folks and letting them participate in the process, to develop plans to be communicative, be heard, I think is important. I certainly don't think people appreciate the suits showing up and, "Here's what you've got to do." I show up and it's like, "Well, I need to hear from you what our needs are. I need to hear from you what are the issues in the community so that we can use that information to build a program that is successful."
Some of the way we used to do things perhaps isn't as effective now but that may be a generational thing. People's lives are very busy so getting together after work isn't as easy as it used to be. I think most folks have both parents working in the household now, so people are very protective of their free time. It's hard to plan things off hours, to have the outings and things. People maybe aren't as interested in that, but people appreciate recognition, too, but often times in different ways.
Interviewer:
What is the most important thing you've learned from the role of CEO?
Gregory White:
I think it's important to understand that your mission comes first. As I've developed a little bit, you need an inspiration behind what you do. It's not a job. As the CEO, you've got to be the cheerleader. You're the chief marketing officer. You're the face when something goes well. You're the face when something doesn't go well. It's a team effort. This organization is not what it is because of me. It's because of the people that I work with. I think they need to be recognized for that. I think it's very important to cultivate folks and let them develop, give them opportunities. Give them opportunities to fail but also give them opportunities to succeed, too. It's not about me.
Interviewer:
What surprised you most about becoming CEO?
Gregory White:
I had the biggest adjustment to getting used to what the definition of work is. I come to work, and I go to meetings. I say that facetiously, but that's my role. I rather vividly remember arriving here three and a half years ago, and within the first two weeks of being here, being asked to show up in Concord to testify before some committee about our funding and absolutely unprepared for that. Again, someone who is perhaps a little more introverted and not my bailiwick but getting forced out into that a little bit, out of your comfort zone. It didn't kill me, so you get used to that. People certainly look to you for your response and cues as to how to respond to things and how to act but again, you surround yourself with professionals and give them a chance. I would say my style is a little less out in front than some leaders, but I certainly surround myself with folks who know what they're doing and help me be that person.
Interviewer:
As a CEO, what keeps you up at night?
Gregory White:
Oh, boy. The funding environment right now is a big one. Staffing and retention is another big one. It's funny, though. As much as my outward role is here very much of the challenges and stresses are making sure that the inward things are working and that the team is adequately supported and that the day-to-day things get addressed. Like any organizations, there are bumps in the road and things you have to deal with, but those are the things that take your focus. If you want a great outcome, you want to put a little time and effort.
Interviewer:
What is the thing that people outside of healthcare least understand about running a federally qualified health center?
Gregory White:
We are a business. We are actually an employer of 160 people. We are not necessarily a small poor, not for profit. We are a sophisticated organization, and it does take some skill. It does take some experience and effort to run an organization like this. This is not something that just anybody can do as, "Oh, I'll downsize my career. I'll go run a health center." It is fairly complicated. It's a niche provider but I think it's very rewarding, but we're sophisticated. We've had an electronic medical record for 18 years now. I would say that's probably 10 years more than most providers, so in many ways we're out in front of it.
Interviewer:
How was the transition going from a larger city like Lowell to a small town like Newmarket?
Gregory White:
The speed is a little different in terms of the volume of people but the concept is the same. It's about relationships, and don't let anybody kid you. The politics in small towns are just as challenging as they are in the big city. Often times, it's about forging relationships and getting to know folks, so that they trust you. Certainly, I grew up in a small town in New Hampshire. I know how that works. I appreciate being able to walk down the street and know this person and know that person and know that they know me and trust me because of the work we've done together. It takes a little time to build that, for sure.
Interviewer:
You touched a bit upon this earlier, but how did the community you served change?
Gregory White:
Certainly, we're getting older. New Hampshire, like I said, is in the throes of an opiate epidemic right now, and that's heartbreaking. We are not without our ills otherwise in terms of mental health system and things like that. Obviously as we've grown and become more heavily populated in the southern tier of the state, some of the urban challenges start to show up. That is not to say that drug abuse isn't a problem in the rural areas, but it's more readily available coming from a small town. People often times kept their business to themselves, and the problems of alcoholism and domestic abuse and mental health were kept inside. I think perhaps now those things are starting to come to the fore. Gosh, if we can help you, the outcomes are they help you with your employment. It's a community challenge, so we're starting to see more of that, people more willing to talk about it. Our community in southern New Hampshire is becoming more diverse, and actually I'm pretty excited about that.
Interviewer:
How as healthcare changed in the time that you've been working in the field?
Gregory White:
Certainly with Medicaid expansion in the last few years, we've been better funded as a community health center. We've enjoyed a lot of growth. Very pleased with the fact that this movement started 50 some odd years ago, and we have continued to enjoy bipartisan support at the federal level, which is hard to do, but we have benefited from that in terms of core funding and program expansion. As an industry, we serve about 24 million patients across the country, so I'm very pleased with our growth and that we are a sustainable model.
Interviewer:
Let's transition to talk a bit about leadership. What is your leadership philosophy?
Gregory White:
I think I talked about it a little bit earlier. I am not necessarily one that seeks that the spotlight. Again, maybe that's more my personality. I tend to like to surround myself with people that are the experts and in the know. If you need me to be out in front, I will do that, but I also want to highlight the folks whose skills and talents are getting us to where we are. I tend to like to relate to folks. I'm a regular person. I'm Greg. If anybody ever called me Mr. White, I look behind me to look for my father because I'm not that.
I am very mindful of the suit and tie when I work in some of our buildings because I don't want to intimidate people. I obviously have to dress the part some days in terms of what you're up to, but Fridays, we wear the dress down. You just blend in and talk with folks and have a relationship, talk about the Red Sox, you name it. I'm work here, too. I'm part of the team. My job just happens to be out in the community. I'm very proud of the folks that deliver care here, very proud of the folks, the community health workers that are out relating to folks and finding folks in need.
Interviewer:
What are the characteristics and behaviors of a good leader, and how do you aspire to be those yourself?
Gregory White:
I think a good leader, you've got to show ... It's half perspiration in terms of demonstrating hard work and commitment, but the other half is inspiration. It's very challenging to be an inspiring person unless this comes naturally to you. Like some of our political leaders are very good speakers and can be very inspiring that way. I've never considered myself to be that, but if you speak from the heart and demonstrate that things are meaningful to you, people get that message. Certainly, showcasing folks that are the success stories here, I'm very proud to do that.
In terms of my leadership style, I think there's very much a distinction between being a manager and a leader. A manager is tasked with getting things done, and it can be very technical sometimes and process-oriented. It's very necessary. I think to get beyond that as a leader, you have to demonstrate. You have to live it. You have to be out there and show people this is where we're headed, and are you ready to follow?
Interviewer:
Who did you learn this leadership philosophy from?
Gregory White:
I think over my career between obviously my folks growing up, but as I said earlier, I had a couple of CEOs that I worked with that had very different styles. One, I think, came from a hospital background, was an excellent manager, showed me the ropes of how things worked from a business-side and helped me develop there. The other was a very community-oriented person, very engaged with community development and engaging this population of folks or this community or these new arrivals from a new country. When I got to Lowell ... This is the leader in Lowell, and she really gave me an opportunity to pause from being the business guy to being this is what's important to the organization. If maybe our financial results aren't quite so good, we're delivering and we're building trust.
She actually showed me the inspiration part, which it's striking when it gets you. Suddenly, the light goes off. "Oh, my gosh. That's why we're doing this," and then it means something to you. Both were very important to me, I think, as mentors and developed me. I was very struck by how different they were and what I was able to pick up from both of them.
Interviewer:
Give an example of a difficult leadership lesson you had to learn the hard way.
Gregory White:
We're living it right now. We have a system upgrade that's going on with our electronic medical record system, and through some staffing transition, the commitment was made for this process that seemed like a good idea at the time. We had a couple of staff transitions happen at the same time, had to pick up the pieces of this project. I don't think we adequately engaged the users of this system, and it has made for some ill feelings and some strife so I have to get out there. I own it. I have to acknowledge that this is not going well and ultimately it will be my decision as to whether we continue with this, but in terms of my own education, I need to do a better job of making sure I engage the stakeholders and engage them adequately.
Are they heard? Have we acted upon what they've shared in terms of concerns, in terms of successes, and what does that mean for the long-term? We've been fortunate and not had to deal with anything say like the folks at United Airlines this week. Those are things in the back of your mind from time to time, that yes, wake you from a sound sleep that that could easily be you. That happens. You just have to be prepared for it, and that's my job. Knock on wood, I've been fortunate, but those things happen.
Interviewer:
What do you look for when hiring leaders?
Gregory White:
As for leadership, I look at communication skills. How do they relate to people? Do they look you in the eye? Can they relate to challenging information, to their staff but do it in a way that is constructive so that you come away with a solution, not a reprimand? Communication is important. How do they relate to me as a team member? How do they relate to the folks working on their own team? Often times, how do they relate to folks on very different teams? How does our finance leadership relate to the medical folks? How does the medical director relate with human resources? Making sure that we're a team and folks that are willing to work that way. You may be very technically proficient and an expert in your field, but I also need you to communicate and represent internally and externally. People have to trust you.
Interviewer:
What is organizational culture, and why is it important?
Gregory White:
I think we had talked a little bit of what our culture is or at least what I feel it is. I think it's important because it establishes who we are, not just what we do. People will know us from their interactions with us. We have some challenges now and again with different cultures within the organization, so that can be challenging, but when people from the outside, whether you be a patient or a whether you be a visitor to the facility, they encounter happy smiling faces and engaging. That's our culture, and how do we sustain that, but that reflects on us.
Interviewer:
What aspects of organizational culture are particularly important to you?
Gregory White:
I put a priority on quality and in the healthcare field, quality is often times equated with outcomes or this is the right delivery of service at the right time and the right price to the right person, but that goes beyond that. Do a good job with getting the human resources' paperwork done, doing the finance reports or that we're compliant with the rules of our grants and funders so that we go about with the mentality as I want to do a good job. We may not be the brightest star in terms of in the media, or we might not be the first to do it, but we're going to do it well. When people look at us, they know there's a solid operation, so that's my culture piece. I think the challenge is making sure I communicate that and that people grasp it.
Interviewer:
How do successful leaders shape organizational culture?
Gregory White:
You got to walk the walk, certainly. You've got to demonstrate that you're committed to it. It's how you go about things. Maybe even something as simple as you're walking down the hall, and you pick up a piece of paper on the floor or the things that you choose to ignore. It sets an example. How you treat people is a huge one. I have worked for people in the past that when they were displeased, there was no question that you knew they were displeased and perhaps a little more than they needed to but you can deliver tough news or constructive news in a way that doesn't necessarily tear people apart but again, be engaging. Listen. That's a big one right there.
Interviewer:
Did you have a mentor or mentors early in your career?
Gregory White:
Yeah, the two CEOS that I spoke to, one of them. The hard part, I think, with the two mentors that I had is they were actually my boss, which is not something I would necessarily recommend. Often times, you might have some conflict or struggle in your career, and if it's with your boss, it's not really going to work to go talk to them. It is going to work to talk to them but they're not one that they can give you advice in the situation, but the first fellow that took me under his wing and purposely, that was part of his one development because he wanted to be a mentor. I was really interested in developing my career, so that worked well. I think this woman that subsequently, maybe a less formally, but she was a very good teacher in a very subtle way that helped me adjust from being the finance guy to having a broader perspective.
I think I've benefited tremendously from having the guidance of both of them. I'm still in contact with them, and I still make it a point to have lunch with them. They're both retired, but I still go back and I bounce things off of them like, "Wow. I hadn't anticipated this challenge. When you were doing this role, how did you do this?" There's always tidbits or things that they suggest to me, and there's a few sayings I always remember.
One of them was like, "I was worried about how do you do everything or how do you get to know this or that, in terms of the community?" The advice was, "Half the battle is just showing up. People will get to know you. You'll start to learn what's going on, and it will evolve." There are a few others I won't share but again, they were very different. That's the part I think I enjoyed the most is that they weren't necessarily coming from the same background, and their styles were very different, very different. Each one of them, you wanted to make sure you did a good job but for different reasons.
Interviewer:
What does a good mentor do?
Gregory White:
Listen, tries to take some of the emotion out of the situation and be objective, so obviously if you're needing some guidance, there's something that you're either unsure about in tackling a problem or a project or, "My gosh. I'm overwhelmed." I find that relaying, "Yeah, I've been there. This is what I did, and this is what didn't work, or this is what did work for me. Now you're a different personality than I am. It might not work for you, but sometimes I think you really do know what the answer is. It's just making sure that the mentee really understands that or has the confidence built in them to go about it.
I always found it wasn't some much coming up with the right answer. It's the, "How to go about effecting that and the impacts that it will have, and have you considered this?" It's often times the right answer might be obvious. "Though it might be painful to have to deal with, you really need to break that relationship with that other organization or that staff problem you've been talking about, I think we both know what the answer is there. Time to get on it," kind of thing. Yeah, it gives you a little boost of confidence, I would say.
Interviewer:
How important is the mentor relationship?
Gregory White:
In retrospect, I think it was hugely important. At the time, you're busy, and you maybe don't realize it as much. It doesn't fit all situations, too. It may be very specific to a project. It may be very specific to your career, but early in my career, I was not in the mindset. I wanted to be promoted. I wanted to make more money. I wanted a little more prestige but it wasn't so much the big picture problems that I face now. It's the how do I get to this job." There was some guidance from your peers and those that are doing it in front of you but I wouldn't really call that mentorship, necessarily.
Interviewer:
How important are professional associations for development?
Gregory White:
Getting back to the networking piece I said early on, yes, I'd say they are fairly important. Though, I wouldn't say they're the be all and end all. I belong to the Healthcare Financial Management Association. I belong to our state trade association and our national. Now there's a lot of networks there that happen because of that, but a lot of these folks I would network with anyway. Though, it does open doors and connects you with people you might not have met, so your state gets a lot smaller when you belong to an association because you're meeting these folks. Suddenly, oh, yeah. You recognize the fellow's name in the paper or I worked with that woman on a project or on a committee. It's suddenly like, "Oh, yeah. I can call them. It's no problem."
Interviewer:
If you had to pick one book, that early careerist who inspired a senior leadership should read, what would it be?
Gregory White:
I don't have a book I would recommend. I tend to read for pleasure and not for work so much, but what I would say is pick a leader that you respect. Now they may or may not have a book but their style might appeal to you. Take a look at it that way. In terms of business books, I've always enjoyed reading Warren Buffet's books but that's more about investing than leadership. He's got a little plain spoken style about him and he's an expert at what he does but he's really simple in some ways. It goes above things for the long-term and not the immediate hit which I think would benefit a lot of us.
I don't really have a recommended book for say somebody coming out of college. Go out and see the world a little bit. Get a job, and watch people. Watch a manager and evaluate how are they treating me? How are they treating people around them? How are they treating their peers? Watch the leader of the organization. "Does that fit me? Is that my personality?" Do you think that worked? Why did they do it that way? Then think about, did they do it on a purpose, or is this just their personality? Yeah, that's how I would go about it.
Interviewer:
For a young person thinking about a career in health, why should they think about working in a federally qualified health center?
Gregory White:
It's a growing industry, despite all the trials and tribulations of our funding in the last 10 years. We've doubled as an industry, so we're serving 24 million with aspirations of more. We are actually quickly becoming the public health infrastructure of the country. There is now a community health center in every Congressional district. While we don't serve the lion's share of the folks in New Hampshire, we are fairly well distributed. It continues to grow and particularly as there's uncertainty in our funding environment nationally as to how sustainable employer sponsored health insurance is. We're here, and there's going to be more of us. We're going to be bigger.
Now in many of the centers, not only are primary care, but they're dental. They're behavioral health. We're looking at vision programs. Often times, there are other ancillary programs that work with that in terms of job training, substance abuse treatment, you name it, so we're quickly becoming a public health infrastructure and I think a social service infrastructure in many ways, too.
Interviewer:
Lastly, what kind of training, education should someone pursue if they're thinking about getting into a federally qualified health center?
Gregory White:
I would say in terms of leaders that are coming out that are in community health now, often times they'll have a social work background. They might have a nursing background. There are few of us with a financial background. Once in a while, you might have a public policy or a legal background. I've seen that, but I'm thinking most of my colleagues are social workers and nurses. Again, as folks' talents require, perhaps that's where the jobs, you may find yourself. Social media is a huge obviously growing area, and even health centers are availing themselves of that. Finance is always a need and then having somebody good in that role is always important. IT is another area that we have a large dependence upon so obviously, those are specialized areas generally speaking to be the CEO, you could come from any one of those areas. I know CEOs with backgrounds in all of them.
Interviewer:
Great. That concludes our interview. Thank you for your time, Greg.
Gregory White:
Thank you. Nice talking with you.
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