Clinic Growth, Service Expansion, & CEO Lessons with Dr. Michael McDuffie, Agape

Speaker A: Thank you so much everybody for joining us on the next episode of the Community Health Center Podcast. The CHC podcast, the nation's leading podcast for community health centers. Uh, we are so blessed today to be joined by one of our good friends, Dr. McDuffie. Dr. McDuffie, thank you so much for joining us today.

Speaker B: You're so welcome. Glad to be here as well.

Speaker A: I am joined by my co host.

Speaker B: Good morning.

Speaker A: My name is Dawson Nimmo.

Speaker B: Absolutely happy to have all of you on here this morning. Greatly appreciate you tuning in for another wonderful episode.

Speaker A: Thank you, Dawson. So Dr. McDuffie is the CEO of Agape Community Health Center. And Dr. McDuffie, we are really excited to discuss all the growth, expansion that you've been experiencing and just maybe some really great best practices that you can share with other leaders in community health centers across the country today. Um, and talk just a little bit about Medicaid and other. All the fun changes, uh, legislatively there. But before we do that, um, we would love to hear about your background, Dr. McDuffie, about how you got into this fun world of community health centers and FQHCs and would love to start there.

Speaker B: My name is Dr. Michael McDuffie. Uh, I am the CEO of Metropolitan, uh, Community Health Services. We do business as Agape Health Services. I've been with the organization roughly um, around 11 years. I started out as the Director of operations, um then moved to the executive Director and then in 2019 I was um, um after uh. After the death of our um, our founder and CEO, um. In a search, um. In search for a new CEO, I was um, um awarded the job, um by the board of directors, uh, of uh, Metropolitan. I've been here, I've worked. Um. This is around the second uh, FQHC that I've worked. I worked for one previously in uh, North Carolina for around 10 years and I've been here about 11 years. So um.

Speaker A: Um.

Speaker B: FQHC is very dear to my heart. Um, I did stop for a while, went um, into teaching uh, at a um, career college and I was teaching medical um, mas and medical billing and coding and. And things like that. And I um, really missed being in the FQH FQHC world and decided to return back. So um. Again I've been back in the uh. I was gone for about a couple years and. And. And turned returned back and this is where I'm, I've landed and this is where I will uh. I hope to. I retire.

Speaker A: Well, Dr. McDuffie, just the incredible work you do at Agape and then your journey to come back to community health center serving your community, serving the population around you I think is just so admirable and I really want to dive into agape. Um you guys have been expanding and growing so quickly and really serving the needs of your community. Um and I think it's a lot of what you're doing that other health centers can learn from. So you know, tell me more about that and how you're doing that in this uncertainty environment and what that looks like.

Speaker B: Okay. So you know one of the things that that um that we like to talk about that this environment. There is a lot of uncertainty in this environment and where a lot of health centers are are maybe uh kind um of dialing back and and you know looking at other, other funds of revenue which we. We always want to look at that. But um. We're in a period of growth and so we do have currently we have three health centers where we provide medical, dental, behavioral health. Uh we have on site pharmacies uh at those three health centers. And then we have. We did venture off into some specialty services and we have an orthopedic clinic. Uh but we also do um uh school based health services uh and jail based uh health services where we provide all of the health services in the Beaufort county jail. Uh and that's our county, um that we have the largest uh um um market um or largest market penetration in um again we also provide um uh mobile health services. Um as we talk about growth we in a period of growth whereas we ah are currently in the Beaufort county area. We adding a new site um where we really were really just trying to. We've grown out of our main site here and um. So we added a new site where we. Where we will be providing um primary um care. We also will be providing. Adding pediatric care to that site. Um and then um we'll have a pharmacy there. We won't have dental there. But then we will expand our behavioral health services. And so we are a um we credentialed uh on the SAPSA as a certified community behavioral health clinic. So the acronym for that is ccbhc and there are only about three in the state of North Carolina and we're. There's one in the. The closer to the coastal side. And um of course in eastern North Carolina we are the only CCBHC as well. Um so um, we're also um expanding in um a small town, a small community that the. The large health health system closed down their rural health care in this town. Um and so in Partnership with our, with the um, with the Beaufort County Commissioners where we are opening that site that was closed in 2022. And in that town they don't have any. The bank recently closed. They don't have a grocery store there. Uh, and then they left. Uh, what was left was uh, no healthcare. And so um, we are happy to actually start services back in that community. Uh and currently we use our mobile unit and we're in that community one to two days a week providing health service where these folks face difficulty, um, face barriers of transportation to get health care. So uh, we had a point now where we're expanding where a lot of other health centers are uh, kind of just holding on to what they have and financially we see um, that we're not having any problems so we can do this. And um, we're also working um, with the association. We have another neighboring health services that had health FQAC that has about three health centers and they are currently having some managerial issues, uh they're having some financial issues. And we've been asked to come in and provide some TA to um, um help them to produce a turnaround plan for them to see if we can get them back uh, on track. So uh, again there's a lot of stuff that we're doing and uh, we're just glad to be in that space to be able to provide these services.

Speaker A: Yeah. Dr. McDuffie, that's incredible. And I think something that I really admire about your leadership in your health center is the ability to diversify into all of those different services from pharmacy to occupational to correctional to school based. And then like you mentioned, in this time of uncertainty where a lot of health centers may be staying where they're at or working and really looking at how do we maximize um, kind of what's going on in the federal or state Medicaid arenas, um, you guys are seeing the opportunities in your neighboring cities, in the communities you serve, seeing opportunities to go deploy resources to go help other people. And you're taking advantage of that and growing into new cities or growing into your new main facility. Just congrats on the growth. But I think it's very admirable to see that even in this time of uncertainty, you guys are taking the need of providing healthcare and removing the barriers to healthcare very seriously and continuing that access in your communities.

Speaker B: Yes. And that's important for us. Um, um is to provide access. And then we are um, um as well. We've planned to. We've uh, purchased the land. Um, we actually beginning to look at the um, um, um building design, we're actually in the same town. We're going to um, build a new uh, health center. Um and not close any of the health centers that we currently have. Um, we're hoping to build maybe um, some about a 40,000 square foot uh, uh, uh health center. Um and uh, it's kind of near the um, it's in the healthcare district, uh near the hospital. Uh, our land, um, um, uh butts up to the health department. So um, but we're looking at that. You know we're about three years down the road now before we um, before we start on that project. Um because we got two projects going and we want to get these projects up and running, uh, um, and making sure they are viable and then we're open, um, we'll start on the new project and that's because of the need that we have in this, in our service area.

Speaker A: Absolutely. And as the leader of the organization, Dr. McDuffie and leading these you know, multi year strategies of growth and leading the new clinics and opportunities to serve others, um, you know, for the other leaders that are listening in what is maybe one or two takeaways that you would have over your last few years of leading this growth and as you continue to lead the growth that maybe here's some best in class recommendations on what do we do with our team or communication or community partners. Um, but yeah, what's kind of some takeaways that maybe you can share with some CEOs that may be in your shoes today. Wanting to expand, uh, but just wanting to know what did you learn from that and what maybe you would do again or do differently.

Speaker B: I think you know one of the things that um we have directly aligned with um, the national association for community health center, Dr. Reed and uh, his vision for health centers as to being the um employee of choice, um being the partner uh, of choice and being the uh, provider of choice and that's those are our desires and it's always been my desire for our health center to become a premier health center. And that's what we've been working towards and it hadn't always been easy for us. Uh, um. When I came um, um in 2014 um this health center um was really on the verge of closing and we had 16 employees between two health centers. Um and today we have almost 200 employees within three health centers plus Ortho. And so some of the takeaways is to one of the things that I had to do to make sure because I wasn't from this area. But, uh, what I found that the health center and our previous administration is that for me we had to reconnect with the community and that was important. And that's been the driver behind, I think our success is that the previous administration was somewhat working in a silo. And so, uh, although we still have folks in our area that still don't know what we do, but we have made it. Um, uh, our mission is to get out and to reconnect with the community. Um, um, I am a collaborator. Uh, I love to partner. And so I think that's a lot of our success. We're at this time, we're having folks come and want to partner with us. Okay. And because they see the great work that we're doing and providing the quality care is our utmost important. And we just have a really good. We put together a really good team, uh, uh, our leadership team, um, and just our managerial team in general. I think I have a little. A really good team. Although we have, you know, and we, we daily we're having to define, uh, our workflows and things like that and say, okay, well maybe we should do it. We could do it better this way. So it's always. We always look for those opportunities, uh, uh, for improvement. And that's important. And I tell all of my, even to my staff, I said we always have opportunities to improve. And that's important to me.

Speaker A: Absolutely. And so just to summarize that. Creating the community partnerships, getting the community involved, they know what you're doing, they know the service and the just incredible, uh, care. You're taking care of the population inside that community and just having those community partnerships, surrounding yourself with a great team and then always looking to improve workflows, processes, anything within the organization just to be better and just strive for that excellence.

Speaker B: Yes. And also what uh, I would say to other CEOs is that it's really. Get from behind your desk, work alongside your team. Um, um, be actively involved with what your team is doing. Um, just like last night, um, I had my HR department, um, and my Director of Opera, Director of Operations. Um, um, they was attending a career fair and you know, um, in the area, um, in the healthcare. Well, in Greenville, which is a, uh, um, um, you got East Carolina University, um, so you got a medical school there. And so it was important that I joined them, you know, so you have to be able to. I think it's important that as a CEO you have to be able to work beside your team. So, uh, where I could have just decided to go home that evening I decided, no, I'm going to go with you guys. And so it was important to me to be able to just talk to um, some possible candidates and to, you know, I was probably the only CEO out there. Um, we're the only uh, FQHC, um, organization that career fair. But it's important to, you know, if you want to attract the right talent, then you have to be out there and you have to attend these things and again, be a part of that community. Be a part of the community. That's very important.

Speaker A: Yeah, absolutely. I think the message that, that shows to your employees when the CEO, uh, is rolling their sleeves up and getting into the day to day operations, from recruiting to provider help to organizational help, I think that's a very loud top down message that we are here to be involved, we are here to help and we are here to assist in all aspects of growing our organization. So that's. Well, Dr. McDuffie, I know we're uh, running close on time, but I did want to get one comment in real quick on Medicaid. You know, we're seeing a lot of uncertainty right now, uh, around different Medicaid and maybe even some uncertainty on the federal level. Uh, but what are you seeing in your state and, and how are you guys handling that uncertainty right now? Uh, on the Medicaid?

Speaker B: You know, in a conversation with my executive director even last night, um, um, right now with, with, um, beginning in uh, 10-1-M, we're going to see, uh, Medicaid is their fee schedule. Um, they're adjusting their fee schedule. And so, uh, right now that North Carolina has $318 million shortfall for their Medicaid budget, so they are cutting services, um, reducing services. And we see that. And so, but what we do see, you know, on the other end, even the F3, see we're going to, you know, we're going to be reduced, our fee for service is going to be reduced as well. Um, but what we will see, and we're going to see an increase in quite naturally uninsured, but we're also going to see an increase in the number of Medicaid patients. So we'll, you know, we may not make what we normally would make collect in revenue, but we will probably collect that in volume. And so our volume will be increased, which means a lot. Uh, um, um, because we know that there's going to be a lot of private practices that will no longer accept Medicaid. So we already have that. Um, they don't usually get the enhanced billing rate, um, as FQHC does. And so we already know that we're going to see an increase in our Medicaid population. Uh, we're also going to see an increase in our uninsured population population. Of course, we lean on our federal subsidy, um, to take cover, to cover those who are uninsured, um, um, but pure volume, we think we will see an increase for our Medicaid patients. Now, that's also going to mean that it's going to be some increased expenses because we have to add providers because we, again, uh, um, you know, we don't want to be, uh, three months out for establishing new patient appointments and things like that. So, you know, this is one of those things. We're just going to, again, roll our sleeves up. Um, I've got a good team. Uh, uh, we are looking at going to some type of wave schedule, so we know we're going to have to extend the hours. So those are the things we're looking at. Um, extend an hour so that we can see these patients. Um, um, providers are. We've got a lot of them that will like to go to a wave schedule and not just an 8 to 5 or, um, we do have some extended hours. So, uh, we are preparing for it and we've got to do our best and, uh, we're here to stay and we're going to make it work.

Speaker A: I have no doubt about that, Dr. McDuffie. You guys will roll up your sleeves, make this work, and triumph, uh, in this uncertainty. And it's really interesting what you mentioned. With Medicaid, uh, rates falling, you're going to see probably an influx of volume due to that private practice, uh, discontinuing accepting Medicaid. So really interesting how that balance works out. Uh, and I really hope to see you guys, I know you guys will triumph through that uncertainty in that environment. So, going to be an interesting, uh, next 12 months, and we're excited to catch up with you along the way, so.

Speaker B: Yes, yes, yes.

Speaker A: Awesome. Well, Dr. McDuffie, uh, we can't say much. We appreciate you giving advice on leadership, getting advice on the executive leadership as you grow and expand your health center, looking at opportunities in your community, servicing your patients, and then looking at the, uh, environment for Medicaid and just how you're planning, uh, those opportunities as well. It's been truly a pleasure. And I know the leaders of health centers listening into this today are going to be taking a lot away from, from your advice and guidance.

Speaker B: So thank you, thank you for having me. And again, Like I said, we enjoy what we do. Uh, I'm a CEO. That's not stressed. Um, although, you know, in, in years past I've been there. Uh, uh, but it's just, you know, perseverance is, is very important and um, you know, establishing, uh, ah, working with the community, establishing a, you know, a really good, uh, senior leadership team I think has been key for us and uh, all working together and all agreeing that we can disagree. Um, and that's been important. So I've kind of, you know, I'm not one of those leaders that I do like to listen, um, to my other leaders as well. And again, there's a lot of takeaways from that. And I tell folks I don't want you to agree with me, uh, because that's important that you don't agree with me because we need to be able to hear from other folks and I may just get us in trouble, uh, if you disagree with me on everything. So get that. Um, um, that's something that we all have, uh, agreed upon and it works really well for us. So thank you for having us.

Speaker A: Absolutely. Thank you, Dr. McDuffie. Uh, please turn into our next podcast. Uh, going to be covering topics like Medicaid and also looking into 2026 financial planning. Thank you all so much again for joining. This is Chase Marable and our co host,

Speaker B: Dawson Nemo.

Speaker A: Thank you so much again.

Speaker B: Take care.