Embracing an Entrepreneurial Mindset

Alana Muller (00:10):
Welcome to Enterprise.ing, a podcast from Enterprise Bank & Trust that's empowering business leaders one conversation at a time. Each week we'll hear from top business professionals about lessons on leadership and entrepreneurship that they've learned along the way. I'm your host, Alana Muller, an entrepreneurial executive leader whose primary focus is to connect, inspire and empower community. We, at Enterprise Bank & Trust, thank you for tuning in to another episode.

Alana Muller (00:42)
Listeners, welcome back to Enterprise.ing podcast. What do you get when you combine business knowledge, nonprofit passion, community development skills, and a vision for patient-focused healthcare? The answer is Safe Harbor Medical, a nonprofit community health center in Las Vegas, Nevada. Joining me here in the Enterprise.ing studio today is co-founder and CEO of Safe Harbor Medical, Tina Alicea. Tina, welcome to Enterprise.ing podcast.

Tina Alicea (01:06):
Thank you so much. That was an awesome introduction. Wow.

Alana Muller (01:13):
Well, you can use it. Well, to start our conversation, tell us how you came to work in the nonprofit medical sector and how Safe Harbor Medical came to be.

Tina Alicea (01:20):
I have to tell you, about 15 years ago in Nevada, we had a pretty big economic downturn, and the governor at the time put together a group of consultants to help in various industries. At the time, I was in entertainment, I was working with regulated energy companies, and he asked me to be part of his A-team of consultants. It was a great honor, and a group of us got together and he said, “Well, I want somebody who's going to be focused on mining,” and someone raised their hand. And then he is like, “I want somebody who's going to be focused on tourism,” and somebody else raised their hand, and I'm like, “Well, wait a second here. Are we doing this right now?” He's like, “Yeah.” And everybody was like, “I'll do this, I'll do this.” And I raised my hand last and got health care. That's how I went into health care. It was a complete… like, I stumbled. I stumbled into it and I love it.

Alana Muller (02:21):
Wow. It was the stars aligning, it sounds like.

Tina Alicea (02:22):
I mean, it's funny to say that I raised my hand last, but that's the truth of the matter. I ended up going into doctor’s offices. I have extensive business background, and I was going into doctors’ offices and I was really helping them reassess how they did business. You know, before Affordable Care Act, a doctor took your insurance and then the insurance paid the doctor. But after the economic downturn and, simultaneously, the Affordable Care Act being put into place, if you didn't have insurance and you didn't have good credit, you didn't have medical care because doctors didn't really know how to figure out what their cost was because they just billed insurance. They were told what they were going to be paid. So, I started going in and assessing medical offices and actually giving them like, “Here's your breakeven analysis, here's what it costs for you to pull a tooth, or here's what it costs for you to see a patient.”

Tina Alicea (03:17):
And now that you know what your true cost is, let's look at what it's going to take to get these patients in and let's look at cash rates and let's look at time payments, layaway plans for your health, and let's look at all these different things. And it took off. And from there, I stumbled onto a doctor who was an oncologist wanting to start a nonprofit community health center. And I said, “Well, I speak government,” because that was my first job out of school. I was a weapons analyst for the Pentagon and did military preparedness models. So, I speak government, and I said, “What do you want to do?” And she told me, and I never knew what a Federally Qualified Healthcare Center was. I didn't know that designation until she said, this is what she wanted to do. And I looked into it and I was like, “Hey, Nevada doesn't have very many of these, and we really need these, we really need these concierge-type clinics that take care of everybody regardless of ability to pay, regardless of insurance. Health care needs to be something that everybody can afford at some level.” So I looked into it more and within six months we got her designated as a Federally Qualified Healthcare Center. It was really fast and it was exciting, and I loved it.

Alana Muller (04:35):
Well, so I want to stay on that line. I wanted to ask you about FQHCs and FQHC LALs, which that was a new expression to me, but you've already mentioned it. So, a Federally Qualified Health Center, and in the case of Safe Harbor Medical, as a Federally Qualified Health Center Look-Alike.

Tina Alicea (04:53):
Yes.

Alana Muller (04:54):
What is that? So, you talk about that as a designation. I'm not sure that all of our listeners will be familiar with it. Can you talk about what they are? How an organization actually achieves the designation and how they're maintained?

Tina Alicea (05:06):
So, Federally Qualified Healthcares -- the “grantee” they're called -- it's a competitive bid that Congress appropriates funds for and comes out every three to six years. And so, it's a really, highly competitive…Across the nation, they average about 72 new FQHCs every three to six years. So, do the math. That's a highly, highly competitive area. That's one way to become an FQHC grantee. And the other way is to, as I say, “Ginger Rogers it,” do it high heels, backwards, and that's how you become a Look-Alike. So, the whole point of a Look-Alike is we do everything a Federally Qualified Healthcare Center does without the federal government money.

Alana Muller (06:02):
Oh, interesting.

Tina Alicea (06:03):
So, we meet all 21 program requirements. The federal government comes out and assesses it and says, “Yes, you are doing everything.” And then they give you the designation. The only thing, or the only difference between an FQHC grantee and an FQHC Look-Alike, is that the grantee receives federal funds every year, and the Look-Alike makes their money in different ways.

Tina Alicea (06:29):
They both get wrap payments, so they both get enhanced billing, they can enhance bill. So, for the layman, what that means is everybody gets paid on Medicare rates. Well, we get paid on higher rates because we actually wrap the patient. We are expected to be more of a concierge approach. We take care of their medical needs, their social needs, their transportation needs, their translation needs. There's all these additional things that an FQHC is responsible for when taking care of a patient. So, we get paid a higher rate, and that rate is dependent upon the state, and it's dependent upon the individual FQHC. So, it's not like a one-number fits all.

Alana Muller (07:14):
Right.

Tina Alicea (07:15):
And so with that…we also are 340B eligible, which means we can have our own pharmacies as an FQHC Look-Alike or as a grantee. We have pharmacies, so we're able to get the medication to our people for lower costs and we also are allowed to do tuition reimbursement programs. So, in order to be competitive with the hospitals and the larger medical groups, when our employees come to us, our providers come to us, they can apply for tuition reimbursement for their large student loan debt that they have and get that as well.

Alana Muller (07:51):
Wow, that's amazing. So, you get all the nice benefits associated with the designation, but really without any of the…I don't know whether you want to call it shackles or the difficulty associated with the actual funding. You can have other revenue-generating sources, is that correct?

Tina Alicea (08:16):
Yes. And every FQHC grantee also has allowed these additional sources, but a regular for-profit business is not.

Alana Muller (08:23):
Remarkable. So, are you considered a nonprofit?

Tina Alicea (08:25):
We are 100% nonprofit.

Alana Muller (08:28):
Well, I want to shift gears just a little bit. I know not only are you a CEO and a longtime volunteer and philanthropist, you're also a very proud mom of two that you talk about. So, you are multifaceted. Talk a little bit about your relationships, sort of in your personal life and your professional life and how those relationships have played a role in your success.

Tina Alicea (08:50):
Well, I have to say that Robert, who's my partner-in-crime right now, he's the number one man. He is my voice of reason. Sometimes I go out there and I just maybe take too much on or I'm running so fast, nobody can catch up with me. He reels me in. And my boys are, they've been brought up with quote, “CEO Mom.” I've always had my own companies. I've always ran my own businesses, and I run my family kind of the same way. People laugh when they wanted their driver's licenses, they had to sign a contract with me agreeing to keeping their grades up, to only driving in a certain area, otherwise they lose their license privileges. So, they've always had that structure of, I guess, a CEO. They've always had that business [inaudible], and they learned at an early age if I'm on the phone or if I'm talking business, to stay back and to not interrupt, but I have to say I'm ridiculously over-the-top proud of both of them. They're both entrepreneurs. They both run their own businesses. They're fiscally sound, and they've got big hearts and they're just great men. I couldn't be more proud of the two of them.

Alana Muller (10:13):
Oh, that's so great. Is there a piece of business advice that you have conveyed to them that has helped them in their own success as entrepreneurs?

Tina Alicea (10:20):
I'm always about balance, work-life balance. So, for me, I'm like, you can't work too hard and then not appreciate what you have at home, because the people that are working hard are working hard for probably the people they love and they want to give all this back to their family. But if they don't have time to enjoy their family, if they don't have time to just sit around and discuss things, go to their games... You know, I was the loudest cheerleader on the field. I remember one year my son said, “Mom, stop calling me baby.” I was like “Run, baby, run!” He's like, “Come on, mom.” So the next day, I was very quiet, and he's like, “Well, I didn't say you had to be quiet, I just said, stop calling me baby.”

Alana Muller (11:03):
Oh, that's so sweet. It reminds me of when my son was very, very little. My mom, my grandmother and my mother-in-law cared for him. And I remember that when he was old enough to recognize what they were saying to him. My grandmother called him baby one time, and he said, “Mama, nanny called me baby.” And I said, “Well, buddy, you'll always be my baby.” “Okay, mama.” So it is funny how sometimes they want that baby to come out.

Tina Alicea (11:36):
They do, and they want to be special, and they want you cheering for them. They don't want you using their crazy nicknames. Like, my older son, his name's Nick, and I call him “Noodley” because he loves pasta, so he's like, “Mom, now everybody calls me Noodley.”

Alana Muller (11:53):
I love it. I love it.

Tina Alicea (11:55):
Yeah. And my youngest son, Dominic, he's always “Baby” because he was the youngest.

Alana Muller (11:59):
That's the way it goes. Right.

Tina Alicea (12:00):
But now, today, I get to have like a whole different relationship with them now that they're grown up and they're young men and married and like got life going, and they'll come to me and they'll say like, “Okay, mom, I've got this thing at business and what do you think about this and how would I handle that?” I remember my youngest son came to me about a payroll question and I'm like, “Oh, there's an app for that.” I said, “Do you know how long I've been waiting to tell you there's an app for that?”

Alana Muller (12:29):
Exactly. Exactly. It sounds like you've been an amazing mentor for them. Who's a mentor that you have? Is there somebody in your life who's had a meaningful impact on your career and professional journey?

Tina Alicea (12:40):
I've had two people. One is my mom.

Alana Muller (12:43):
Love it.

Tina Alicea (12:44):
My mom is the most… She's brilliant and she's the most self-educated, worldly person I know.

Tina Alicea (12:53):
If I have a question about what's going on in the world, I go to her and she's on Google. I mean, she's 76 years old, and she's out there researching and doing it, and she's still that person. I came home from college one day and I'm like, “Oh, mom, they're doing future valuations and insurance and this and that.” And she goes, “Oh, yeah. Sit down with me, I'll explain it to you.” And she did. She explained, and I was like, yes, it all makes sense now. She's always been that person and has never said to me you can't do something. She'll tell me, and if I fail, she'll be like, “You didn't want it bad enough.”

Alana Muller (13:26):
Oh, I love it.

Tina Alicea (13:27):
And I’m like, well, that's one way to look at it. So she's that person. Probably the person who made the biggest pivot in my life was my counselor in college. I was all set for law school. I was going to law school. I was accepted to law school. And then about a month before I graduated undergraduate on my way to law school, I just decided, I was like, I don't want to be a lawyer. It was like, poof. I don't want to be a lawyer.

Tina Alicea (13:52):
And now what do I do? Because ever since I was five, I was going to be a lawyer. And I went to them and I'm like, my parents are on their way out. They're going to take me back home and we're going to law school. And we sat down and he said to me, he goes, “Well, you know you've won every entrepreneurial award at this college for the last three or four years.” And I'm like, “Yeah, that was a lot of fun. That was like a great game.” And he's like, “No, that could actually be a profession. You could be an entrepreneur.”

Alana Muller (14:23):
You didn't see it. Is that right?

Tina Alicea (14:25):
I did not see it. I'm dating myself too, because back in the eighties when I was graduating college, you were a lawyer, you were a doctor, you were an accountant. There was a title. "Entrepreneur" was not a title.

Alana Muller (14:42):
That was not one. No, that's right.

Tina Alicea (14:44):
No, and if you were going into manufacturing, you were an engineer or you knew a trade, like carpentry or something like that. So, the whole entrepreneurial thing was very new, and it was kind of cool. So, I said to him, I'm like, “Well, how do I go about doing that?” And he goes, “Well, go get your master's in business.” And he goes, but then he said, he goes, “Well, you're not going to be able to do it for three years, because they insist on being at least 25 years old, and you have to have real-life experience and they don't want babies in the master's program.” And I was like, “Oh, well, that's not going to work, because I'll have my law degree by then if it's up to my parents.”

Tina Alicea (15:28):
So he actually talked to me and he called up a friend at Loyola in Chicago and said, well, just go sit for your test. Go sit for the test, and they'll see how you can do, but then you'll at least be able to tell your parents if you can get accepted or not. So I drove down to Chicago. I was at Marquette at the time in Milwaukee, and I drove down to Chicago, and I took the test just cold. I figured, well, it'll give me an idea of what's going on. And the following week, they called me back and they're like, “You can start in September.”

Alana Muller (16:00:)
Oh, my gosh. Well, that is quite a pivot.

Tina Alicea (16:02):
I was so young for that class. I was, but I was like, okay. So, my first year there, they said, well, for your thesis, we're going to have you start a business and it's all going to be virtual and we're going to throw things at you.

Alana Muller (16:18):
Oh, wow.

Tina Alicea (16:19):
We're going to throw environmental change, or we're going to throw tariff claims, or we're going to throw all this stuff at you and it's going to see how it affects your business.

Tina Alicea (16:28):
And me being like… Sometimes I look back and I was so young, I didn't even know to be shy or to not ask a question or not to even feel privileged to be in the room because, you know, I was just too young. And I raised my hand and I said, “So you want us to start a pretend company for three years so you can evaluate our pretend numbers?” And he said, “Yes.” And I'm like, “Well, that just seems like an absolute waste of time.” Oh, he was just like…

Alana Muller (16:59):
Did you start an actual company?

Tina Alicea (17:01):
I did. I started the International Aircraft Support Group and I became a weapons analyst.

Alana Muller (17:07):
That's awesome.

Tina Alicea (17:08):
I just started it right out of the gate and I gave actual financials. When I graduated, I said, here are my financials. And they gave me a C telling me I was too aggressive with my numbers and that it wasn't real. And then I had to explain to them, these are real numbers.

Alana Muller (17:24):
And I hope they amended that grade. That's amazing.

Tina Alicea (17:27):
They did, but I love that story because they really did. They're like, well, this is too aggressive. You're being too ambitious. These numbers aren't real.

Alana Muller (17:38):
What a cool story. I love that. I love just, first of all, your determination, your grit, and that you could see through sort of the ridiculosity, if you will, of the fake company with the fake numbers. You're like, I'll just go do this.

Tina Alicea (17:51):
Yeah, I’ll just start a company. I did. At the time, my fiancé at the time was in logistics for the government, and I said to him, that was right during Desert Shield Desert Storm. And I had said to him, how do we get these thousand dollar screwdrivers and $500 toilet seats that are all over the news and like how does that happen? So when he explained it to me, I was like, oh, well, there's a better way to do that. And I did an unsolicited proposal to the Pentagon and they gave me money to start my company.

Alana Muller (18:26):
What a great story. So fun.

Tina Alicea (18:30):
Sometimes being young and not afraid...

Alana Muller (18:32):
Well, young, not afraid, and a little naive, which is so great. So, it's just like that wide-eyed you could do anything. That's so great. Is there something you're working on now for Safe Harbor Medical that you're especially excited about?

Tina Alicea (18:44):
I am really, really excited. Well, now that we're an FQ and our medical program is pretty solid, I'm really excited about our medical program. We decided to diversify into not just primary care. We have women's health, we have neurology in office, we have wound care in office, and now I'm putting together, we're in the baby stages of our behavioral health program. So we have psychiatry and therapists on staff, and next year, I'm looking to add the dental program. So, we'll add dental next year. I really want to be a campus-style approach to health care, so when our patients come in, they're not being told to go to this doctor or that doctor. They're told, go down the hall, take a left and sign up for this, or we've got that. And they're in the same place, and our patients are just loving having a one-stop shop for all their medical needs.

Alana Muller (19:35):
So smart.

Tina Alicea (19:36):
It's become really positive, and I'm excited about that. Growing the behavioral health is my real true focus right now. We have two psychiatrists and two therapists.

Alana Muller (19:49):
So great.

Tina Alicea (19:50):
We'll keep growing and get it bigger and bigger and bigger.

Alana Muller (19:54):
Wonderful. I admire what you're doing. I think just the heart that you have for this and your community-mindedness, I think is so important. So thank you for the important work you're doing.

Tina Alicea (20:04):
Thank you. And this is the fourth FQHC that I've started.

Alana Muller (20:09):
Wow. Awesome.

Tina Alicea (20:11):
This will be my last one, too. This is my swan song.

Alana Muller (20:14):
The swan song. I like it. I like it. Well, as we're starting to wrap up our conversation, there's a question that I ask of every guest that I have, and I'd like to ask you the same question. And that is, if you could sit down for a cup of coffee with anyone living, not living, fictional or nonfictional, who would it be and why?

Tina Alicea (20:32):
Einstein.

Alana Muller (20:33):
Oh, why is that? Love that.

Tina Alicea (20:35):
Because he didn't look at things…He looked at things three dimensional. He looked at things four dimensional. There was never an end to his thought process, and I just liked the way that he would look at something and just kind of twist it or pivot it and change. He changed so much of how we think about life, quantum physics, you know, just the whole thing. I find that to be fascinating, and I just want to rub off a little on me on looking at the world and not just seeing it as everybody else sees it, but a little different, a little shaded. And being able to take that thought process and grow and grow it and turn it into something beautiful.

Alana Muller (21:23):
I love that. Have you ever seen the Albert Einstein Memorial? The sculpture that's in Washington, D.C.?

Tina Alicea (21:29):
Oh, yes. Oh, yes.

Alana Muller (21:31):
Okay. Love that one, right? I always feel a little smarter sitting there with him.

Tina Alicea (21:35):
Don’t you just hope it rubs off a little bit more on you.

Alana Muller (21:38):
I do. I do. Well, I just love your energy and your positive outlook and disposition, so I'm so grateful to have had you on the program. Tina Alicea, where can our listeners go to learn more about you and about Safe Harbor Medical?

Tina Alicea (21:55):
www.safeharbormedlv.org. And you can Google me. I'm a fun read.

Alana Muller (22:11):
Well, it's just a delight to get to know you. Thank you so much for being on the program.

Tina Alicea (22:14):
Thank you. Thank you for having me.

Alana Muller (22:16):
Thanks for joining us this week on Enterprise.ing. Be sure to visit our website, enterprisebank.com/podcast to subscribe so you'll never miss an episode. If you found value in today's program, please consider leaving a review on Apple Podcasts or telling a friend about us. Enterprise.ing, empowering business leaders one conversation at a time. The views expressed by Enterprise.ing presenters or guests are those of the presenters or guests, and not necessarily of Enterprise Bank & Trust or its affiliates. All content of this podcast and any related materials are for informational purposes only. Enterprise Bank & Trust does not make any warranty, expressed or implied, including warranties of merchantability and fitness for a particular purpose, and specifically disclaims any legal liability or responsibility for the accuracy, completeness, or usefulness of any information presented. Enterprise Bank & Trust is not under any obligation to update or correct any information provided in this podcast. All statements and opinions are subject to change without notice.