July 9, 2019

Lindsay Farrell: Prioritizing Access to Care

Lindsay Farrell’s career with Open Door Family Medical Center has truly been a rewarding journey. She’s gone from volunteering to drive patients to their appointments, waiting for them with her newborn baby in the waiting room, to now running the organization and furthering its patient-driven mission.

As a Federally Qualified Health Center (FQHC), Open Door provides primary care and preventative health services to all ages, regardless of their insurance status or ability to pay.

Since moving to Westchester County, NY, Lindsay has served various roles at Open Door, from Director of Operations and Director of Development to President and CEO. During her tenure, Open Door has strengthened its preventative care programs and increased the number of patients it serves five-fold.

We spoke with Lindsay about the rapidly changing healthcare industry, the importance of community health and the difficulty of prioritizing preventative medicine.

Accessible, affordable healthcare for everyone has been a national talking point. How does the Open Door/FQHC model fit into that conversation?
The Affordable Care Act (ACA) was extremely important and expanded insurance coverage for millions of people who previously couldn’t access it. In 2017, 29.3 million people were uninsured, 19.3 million fewer people than in 2010 when the ACA was signed into law. It was also an important accomplishment in that it made resources available to expand primary care delivery in the United States, administered by the Health Resources and Services Administration. The expansion of FQHCs as a result of the ACA was important and the sector has grown considerably since the adoption of the legislation.

But when you give people insurance you also need to make sure people have access to care. Investing in primary care is an important first step. There are nearly 1,400 community health centers with more than 11,000 locations in urban, suburban and rural communities in all 50 states.

What do you wish people understood better about community health centers?
Community health centers receive a great deal of government and taxpayer money, and as a result, we are highly regulated – much more so than our colleagues in private practice. Even though regulations are burdensome, it ensures we are providing top-notch care in our communities.

Also, because we receive government funding, there’s no room for excess spending. The government wants to make sure we’re operating with remarkable cost-effectiveness and efficiency as we work to deliver high-quality, outcome-oriented care. This ensures a high level of accountability that has taught us a lot about how to stay focused on what’s important: patient outcomes.

We have to provide the status of certain population health indicators related to chronic disease. We have to report on sugar control in our diabetics, blood pressure control in our hypertensives. So they’re public health metrics, but also patient outcomes. We have a very low income, often non-English speaking population, so what we do is hard and our patients don’t have a lot of resources. The challenge is great, and the rewards are inspiring.

You started at Open Door as a volunteer. What is it about Open Door that made you want to stay and go on to lead the organization?
When I moved to Ossining, NY, I had a brand new baby and a job as an interior designer. I was thinking maybe I’d go to Parsons School of Design. Suddenly, I was living in the suburbs as a new parent without a strong social network. So my lifeline became volunteering, and I really enjoyed the people I met.

I used to drive people to their medical appointments and I would wait for them in the waiting room with my baby because I didn’t have a babysitter. I just loved what I saw and was so impressed by the work that was done at Open Door. I was able to get to know some of the folks who worked there, and enjoyed them immensely. It was a great way for me to learn about my community. I knew I was going to raise my family here, so I had a vested interest in making sure this was a great place to live, and that’s really what’s sustained me through the years.

How has the healthcare landscape changed in Westchester County during your career?
It used to be all about the hospitals; they were the center of power in terms of the healthcare ecology. That’s really changed – so the large, multispecialty practices have tremendous clout and are very respected. What’s happened in the hospital sector is the acquisition of the systems coming out of the city whether it’s Montefiore or Northwell or New York Presbyterian. So that’s been fun to watch.

Nobody really cared about us, we weren’t even at the table, but as there was greater awareness of the importance of population health and prevention, Open Door was included and involved in conversations beyond the health department.

Why do your employees choose to work at Open Door/a FQHC?
Our staff is very mission-driven. We have a preferential option for the poor, which is laudable, so you’re not going to work here if you’re not comfortable in that setting. We’re patient-centric, and I think that’s very important to a lot of people. In order to have happy patients you have to have a happy staff, so we’re always balancing that. And it’s not all about the money; that’s important but it’s often not at the top of our staff’s list when it comes to priorities at work. There’s a strong sense of purpose in working at a place like Open Door.

Most health systems want to focus on prevention of disease. How do you think they can best make that pivot?
We have residency training programs. That’s been particularly enlightening for me because the training models are old and antiquated. Prevention hasn’t been the focus of clinician training until recently. It’s a big cultural shift for the sector and I know as we started focusing on it here, we had to do a lot of work, a lot of change management. We had to raise awareness, engage in discussion, involve everyone. It took us just a year to talk about it and to focus on it and bring it forward as an organizational priority before we could launch anything for patients.

Physicians get one semester of nutrition training. They don’t have a lot of knowledge or awareness of certain prevention methods. We were trying to get physicians to prescribe a healthy diet as opposed to prescribing medication. Just making that shift took a year of discussion, emphasizing it, providing education. We teamed up with Tulane University, they have a culinary medicine program. We had to bring in the evidence and the experts, and even then, it took a long time.

What we’re trying to do is create peer networks and support groups so that there’s accountability and regularity among the groups. That’s been quite effective, and we want to spread that farther and wider. You’re really giving people skills, it’s a whole new way of living. Behavior change is hard.

The number of patients Open Door sees and treats is only increasing. Why do you think this is?
We speak Spanish. That’s a valuable reality in the New York metropolitan area, where there are a lot of Spanish speakers who aren’t comfortable in a more traditional setting and that’s been a real asset for us.

Healthcare is so darn expensive, so depending on what coverage you have or if you’re uninsured, you’re on our sliding fee scale. We’re very mindful of what it costs to deliver high-quality service, and we’re mindful of what referrals cost. Our patients know we recognize their barriers in the system and word gets out and they tell two friends who tell two friends. I definitely know that patients are aware of the quality of care that we provide as demonstrated by great outcomes. That drives patient growth.

We’re a design firm, so we have to ask: Do you still use your interior design expertise?
After my days driving patients to and from appointments, I actually designed a community room for the elderly at Open Door Medical Center. I’ve designed some windows at Christmastime for the center. I try to engage that creative side of me whenever I can.

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