Health Care is a Right, Not a Privilege: A Commitment for 50+ Years

CHC 50th Part 2

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Marianne O’Hare : Welcome to Conversations on Health Care . This week is part two of
our look back at the last half century of contributions made to the
growth of c ommunity h ealth c enters by our show hosts. Veteran
Journalist Thalia Assuras resumes h er conversation with host Mark
th
Mas s elli and Margaret Flinter , on the 50 anniversary of the founding
of their health center organization . Lori Robertson joins us from
FactCheck.org a nd we end with a bright idea, improving health and
well - being and everyda y lives. Now, Veteran Journalist Thalia Assuras
resumes her conversation with our host Mark Mas s elli and Margaret
Flinter on C onversations on Health Care .

Thalia Assuras : Hello, and welcome to Conversations on Health Care . We a re
continuing our conversatio n with your regular host Mark Ma s selli and
Margaret Flinter o n what is a special edition , special because we are
th
marking the 50 anniversary of Community Health Center
Incorporated and also celebrating the show.

Let's talk about this. Let's talk about thi s very program , your very first
guest. I said I wasn't going to get into politics, but your very first guest
was Speaker of the House Nancy Pelosi, and you have national folks
on your broadcast. Margaret, why did you feel this program was
important to add to your center?

Margaret Flinter : Well, I'll give Mark credit for the original idea on it. But it immediately
made sense to me in part because selfishly it allowed us to call up the
best , the brightest, the most innovative people in the country and
have a conversation with them. I mean, I couldn’t just done that by
myself, I guess, but much better to have it through a radio show.

But in all seriousness, most importantly, it created a forum to talk
about important issues in h ealth c are writ large, right ? We were
talking policy, innovation, technology, sometimes politics, occasionally
clinical and certainly during the time of COVID a big focus on a major
clinical issue but from the policy, public health, politics, economics
communication perspective. I f you go back, as I recently did, through
all the shows which our fabulous communications team lines up for us
because I would not remember all of them. The range is astonishing
from people no longer with us , who I'm so glad we captured Jack
Geiger, Fitzhugh Mulla n, Uwe Reinhardt, people who are legends in
their time, but kind of preserved for posterity with their thoughts to
very recently speaking with a family physician in Ukraine, who
couldn't disclose her location because of the bombings that were
going on and who said we take care of our patients when the sirens
we go off, we run to the shelter and then we come back and we take
care of our patients. T his enormous universe of both intellectual and
policy changing work that's going on, it's been such a pleasure t o
bring that to the forefront of the country. A lso, some of the people

CHC 50th Part 2

we've interviewed over the years, if you go back to 2010 , they are
back in 2014 , 2018 because they continued to increase in their
influence throughout the United States in a positive wa y. It's never
been a got you show. It's always been about bringing people's
thoughts, their ideas and challenging them , b ut bringing that to the
forefront.

Thalia Assuras : Mark , Margaret brought up the point that the pandemic has had a
special place, obvio usly, on the broadcast recently o ver the last, gosh
it’s almost what, three years? What stands out for you there and --
because you've actually, as they say in the news business, committed
news, you've broken news on many fronts.

Mark Ma s selli : Well, let m e just tell a story, because it's just the three of us , right ?

Thalia Assuras : Please.

Mark Ma s selli : Okay. So , I wanted to take us back to that Speaker of the House,
Nancy Pelosi. W e're probably a month before we started the show we
said let's get out a nd I think as Margaret said, we wanted to bring the
lens of c ommunity h ealth c enters to the conversation a nd really get a
focus in on the populations that we care for. W e thought we were
going to do a local show, frankly . We thought this was going to be
Conn ecticut based. A friend called up and said, the Speaker of the
House is coming into the state. I said , by the way, we're doing a radio
show, you think she would be willing to call in and do the show . He
was a good friend, c ongressman back then. H e said, I think I can
arrange it.

W e had her scheduled for 11 o’clock at a radio station W E SU ,
Wesleyan University College Station . A t 10 : 55 the entire station went
out of power for two hours and you can imagine we've lost the
Speaker of the House. We had this all s et up. T he technician said, why
do you care about the Speaker of Connecticut's house? We said no ,
finally the power comes on. We're dispirited , w e're sitting there. The
phone rings. I ' m so sorry I'm late calling in , this is Nancy Pelosi , so.

Margaret Flint er : Calling from the back of a tax .

Mark Ma s selli : Call from the -- -

Thalia Assuras : N obody told her, she -- right, Nobody told her?

Mark Ma s selli : No one told her. It worked perfectly. I think there was sort of good
karma, if you will , on that. T hat's not dissimilar to when we had Dr.
Anthony Fauci on in February of 2020. Before he was a household
name, he came and spen d a half an hour talking with us about this
pandemic that was in Wuhan, China. H e really said some things that
really put the hair on the b ack of my head on edge. He noted that
every day there were 20,000 Chinese who fly into the United States.

CHC 50th Part 2

W e knew once he said that, that was not just that day, it was every
day that this had already reached our shores.

T he other thing that he noted and I think is proven true, he said the
Coronavirus, they mutate, they just do. Th at early on -- and we help
translate I think for a lot of people who listen to the show, they did as
we did after we heard that conversation . We went back and prepared
ourselves. W e've had Ashish Jha who's now the new COVID leader,
interviewing Deborah Birx whose new book just got released. W e've
had the opportunity because of that lucky -- the luck of the Irish or
whatever i n terms of the speaker coming on we've really had the
abil ity to reach out have conversations . B ut also conversations
through the lens of people who live in poverty and organizations like
ours all across America who make a difference in providing them ,
we've been able to bring important critical and credible info rmation
to the m .

Thalia Assuras : Margaret , let me pick up on COVID. Both of you have talked about it.
But CHC Inc, really put together a lot of solutions when people were in
general across the country, health care systems, hospitals, physicians
were flaili ng. What do you think you learned and brought to the table
a nd we'll take forward?

Margaret Flinter : Well, first of all, I think that everything that we learned over the
course of the 47 years that led up to it was put into play. Mark talked
about enduring and adversity overcoming it and moving forward . We
were not strangers to crises . W e weren't strangers to being in a
position where we really didn't have any experience about the best
way forward. We hadn't been part of something like this before. But
we'd had the experience of being in the situation of not knowing.

W hat we did know is that strength comes from pulling together the
team , a nd that team is not necessarily by rank and hierarchy, right .
T hat team is by who can contribute to solving this problem . Mark, I
think, it was this Sunday, probably the Sunday before it really broke
on the national news, Sunday afternoon that we pulled everybody
together. W e made the decision that there'd be no layoffs or
furloughs, which was already becoming the word on th e street, thank
God because we needed every single person that we had and a couple
of hundred more to do what we did.

T hen we'd have to execute on a couple of levels. One was to make
sure we maintained our commitment to our patients . W e had to take
care of them . D idn't matter if there was now this pandemic even
more so we need to take care of them , b ut to do that safely we had to
reorganize everything , and w e did that. C linical chiefs, operational
chiefs, facilities people just did a spectacular job. We als o -- there are
other people like our dentist , or school based health center nurse
practitioners and therapists and hygienist who the schools were about

CHC 50th Part 2

to be shut down, that they couldn't do what they usually did . H onestly
worked for us that they were able to become the nucleus of whole
new categories of jobs that we've never had before , people to do
COVID testing, mass testing , outdoor so it was safe for everybody ,
following up on those results, educating our patients constantly and
really trying to be the crosswalk between primary care and public
health and to take care to the people.

W e've talked about our special populations. The homeless are one of
our special populations. We have a whole program called Wherever
You Are is the name of it. T hat was reall y the philosophy that carried
us through the COVID pandemic, wherever you are we will bring the
testing, we will bring the vaccines into homeless shelters , into tents,
down by the river , into mass eight lane , drive - through clinics, on
abandoned airfields a nd in shopping malls. But it took that initial
group of people coming together and signing up, many of them to
work seven days a week probably for the better part of that year to
make it happen. W hile it was exhausting, it was probably one of the
most exhi larating unifying purpose driven episodes in the history of
the health center.

Mark Ma s selli : You know, I -- -

Thalia Assuras : I can't imagine Mark that you had ever thought you'd be setting up
drive - through vaccine sites, for example. I mean, all of this i s new to
everyone.

Mark Ma s selli : Yeah .

Thalia Assuras : How did you do it ?

Mark Ma s selli : Well, I think, we have a operating phrase here that we want to make
things efficient, effective and elegant , a nd we did that in terms of the
design of the mass testin g sites. As Margaret said, this is an
opportunity for young people who had never been in leadership to
end up doing our mass testing sites. We had them 20 fix them and
dozens and dozens of mobile ones. But that work got the attention of
the g overnor's team here in Connecticut , a nd they reached out to us
and said, we need a mass vaccination site set up. We had never set up
a mass vaccination site .

Meredith Johnson, one of our leaders here in the Health Center was
up at Rentschler F ield and looked out and saw that there was an
abandoned airport, Pratt & Whitney's abandoned airport. T hey said
can you set up here and we said, we will. I n one week, we set up an
entire village that was able to ultimately throughout the state d o 8000
vaccinations per day. I t was re ally a ttribute t o the partnerships that
we had with the National Guard with the state of Connecticut. But the
leaders within the health center that Margaret described earlier, who

CHC 50th Part 2

came from all walks of life were able to set these up. T hat one airfield
was the second a mass vaccination site set up in the United States . I
think Los Angeles had the first one by about 18 hours. But we just had
to use all of the resources that we had built up in the health center.

We also just had to unleash the power of these young people who
wanted to step into leaders hip roles and make a difference, a nd so we
were able to do that . W e ran them from East Hartford to Stanford to
Danbury and to Middletown . T hey ran seven days a week, there was
no le t - up. F or the most part, like t he Pratt & Whitney airport, it had
no power, no running water, we had to bring all of those in.

Thalia Assuras : Wh at other innovations beyond the COVID facilities you set up ,
Margaret, would you say have been primary for CHC Inc ?

Margaret Flinter : I will s ay one of the innovations that is now no longer thought of as an
innovation because it's actually become a central part of health care
in the United States was this idea born out of our experience of caring
for low income, uninsured people, people who didn 't speak the
language, as much as we could do for them in primary care . They
needed specialist care sometime . J ust try and get a specialist
appointment for an uninsured, low income or person who speaks
another languag e or experiences transportation, I woul d I say I could
probably throw a softball if I was a better pitcher and hit two or three
major academic medical centers in Connecticut, but it didn't mean I
could n't get an appointment with a neurologi st or a
gastroenterologist or neurologist of any kind.

W e took a kernel of an idea created by a wonderful fellow Dr. Mitch
Katz when he was Health Director for the ci ty of San Francisco called
the e - R eferral , b ecause he asked the question, does the patient need
to go to the specialist or could the primary care provider consult with
the specialist in an organized and disciplined way and determine the
best course of action including managing the problem in primary care .
We took that kernel of an idea and created a national model of e -
Consults so that today is ope rating around the country. We have an
affiliate for it called ConferMED , proven published results in terms of
the quality, the safety, the efficacy and the cost savings of the model.
T hat's just one of literally thousands of examples that we could give
you of specific innovations that are making a specific difference in
health care today.

Mark Ma s selli : Yeah.

Thalia Assuras : I want to move , Mark , to something a little bit different, because I
understand that you see a connection between your initial passion for
health care service when you were a young person and the challenges
to the environment today. Where was that connection? What do you
mean?

CHC 50th Part 2

Mark Ma s selli : It’s such a great question and that connection is so important.
Margaret and I have the unique op portunity that we've taken on to
interview everybody who's a finalist to work at the h ealth c enter . It's
no small task . There are about 1500 people who work for us , s o every
day, we have new people who are coming. I n part, we want to see
them and hear them . But part of the conversation is animated by their
interest not only in h ealth c are being a right not a privilege, but the
planet that they live in.

I think any organization that doesn't have an environmental focus is
going to lose this intellectual capit al that exists with our young people
who are very worried about the planet. W e are as well, we have set
up our own environmental task force . We've built gardens on our
rooftop, we have mobile gardens in a number of our schools . W e're
trying to think throug h how we can play an important role in it , and
may be planting trees in urban environments, but it's really about
capturing in h ealth c are t he role the environment plays .

I n the last seven years, we've had three of the hottest summers in the
history of the of recorded meteorological data, we see these
enormous wildfires that are happening out in Arizona and California in
the w est . People are breathing bad air. G uess where many of the
environmentally pollutants are housed , they're housed in low - income
neighb orhoods. W e have a responsibility as an organization to speak
truth to power on this and to develop intervention models.

I will tell you, sort of back to the issue of innovations at the health
center . We often say that our real strength is borrowing an ide a and
returning it with interest. The Mitch Katz is one example , b ut so often
because of our context around the globe, we're hearing about great
ideas a nd through our Weitzman Institute we're able to translate that
into a workable, scalable model that can be returned to community
health centers around the country. I think that's our real skill is to
listen to other people carefully , grab that kernel of an idea, which is
so insightful and so brilliant a nd really translated into a program. This
is going to be very important for us on the environmental issues, as
well as we move forward over the next 50 years.

Thalia Assuras : Just very quickly, yes or no. Are these young people passionate about
these environmental issues t hose you speak with Mark, do you see
ho pe ahead ?

Mark Ma s selli : Yes.

Thalia Assuras : F inally, to wrap up and Margaret first, what advances in medical care
do you see ahead? I know just through this COVID period that the way
I have to deal with health care questions has changed. I've not been
on so many Zoom calls in my life and find it kind of strange . Is this
where we're going in h ealth c are and what else?

CHC 50th Part 2

Margaret Flinter: Well, I'm forever optimistic a nd I do believe we have the national
attention at least the policy level focused on transfor ming primary
care as that first rung . T he National Academy of S cience, E ngineering
and M edicine, issued one of their landmark reports, the first one 20
years on primary care last fall , a nd really boils down to saying we
know what great primary care is aste risk. It's just not what most
people in the United States experience today , a nd it's care that moves
away from the fee for service system is team based and
comprehensive. It's about a team of people caring for you . I t delivers
more to the people who need m ore and more than anything else, we
need to get it done a nd we need to address it in a way that, as we've
alluded to earlier , u nderstands that health equity is about life itself,
that we have just huge discrepancies in the very length of life
between group s of people because of their health conditions, many of
which are born out of social determinants of health, adverse
childhood events, but can be ameliorated through really excellent
primary care whether that's in the h ealth c enter or in school based
healt h centers or anyplace else. T hat's sort of the big structural piece ,
a nd we will continue to fight for that.

But then there's this other piece that we finally recognized as a
country , and Francis Collins wa s on our show a couple of times, now
retired D irec tor of the National Institute of Health who created the A ll
of U s P rogram, right . Who recognize that we are massively different
and that we now have the science and the knowledge of genomics to
understand that we need to treat people individually as well a s
members of a group we have to study that . T he A ll of U s P rogram of
which we were one of the first participants as an organization is the
largest research project underway of our times to really look at how
do we look at the impact of genetics on each ind ividual's care , b ut
also the interplay of genetics, with family, neighborhood environment
and personal habits. A lot of exciting things ahead for us, I think.

Thalia Assuras : Mark, what do you see ahead?

Mark Ma s selli : I think it builds off of this of the smartphone . 12 years ago this wasn't
in anyone's hands, it has transformed the delivery system in so many
ways a nd it will only get better . W e need to figure out ways to give
people access to h ealth c are without necessarily saying, you know
what, you work at 7 - Eleven a nd guess what you have to do , y ou have
to get into three buses, going to take an hour and a half to get here .
Y ou're going to have to wait in our room for an hour . Y ou're going to
have 15 minutes with your provider. That is antiquated . W e need to
get rid of that.

R eally, mobile devices are going to be so important . T he price point
has dropped down from -- and we've been measuring the use of
smartphones over the last couple of decades . I think it's going to

CHC 50th Part 2

transform the way we deliver care , so w e have to be on both sides of
the aisle, high touch and high tech . High touch because people need
to be reached out to , we need to go the farm workers where they're
working or the schools where young people are being educated.

But high tech, because we ne ed to drop these barriers that exist that
are so anti poor people in that they are forced to lose income because
we simply haven't figured out a technology solution . Both are going to
be important for us . W e're going to still need to have that
conversation where I can look you in the eye I can say good morning
to you. T he other hand, when it's appropriate, we're going to be able
to use these devices for remote monitoring.

Our friends in the West Coast have developed an ultrasound off of the
iPhone . Y ou're g oing to be able to do EKGs . Y ou're going to be able to
do so muc h on monitoring, a nd we have to have our feet in both of
those worlds to continue to build a world class primary care system
that's focused in on special populations committed to improving
pat ient outcomes, and cultivating healthy communities.

Thalia Assuras : So much more to talk about. But I have to say we've come to the end
of our discussion. I want to thank both of you Mark and Margaret and
congratulate you on 50 years , you and your team . A l so congratulate
you on this program. Thank you again for letting me sit in your chair
flipping the table on you. Thanks also to our audience at home for
listening.

Margaret Flinter: Thank you , Thalia .

Mark Ma s selli : Thank you so much.

[Music]

Mark Masselli : At Conversations on Health Care, we want our audience to be truly in
the know when it comes to the facts about health care reform and
policy. Lori Robertson is an award - winning journalist and Managing
Editor of FactCheck.org, a nonpartisan, nonprofit con sumer advocate
for voters that aim to reduce the level of deception in U . S . politics.
Lori, what have you got for us this week?

Lori Robertson: We've received several questions about whether people who are
vaccinated are more susceptible to COVID - 19 a nd th ose who are
unvaccinated particularly against the Omicron variant. One such
question came from a reader who wondered whether Walgreens had
said vaccinated people were at higher risk. A May Walgreens report
did say that in early 2022 unvaccinated people get ting tested for
COVID - 19 at the company's pharmacies had a lower test positivity
rate than those who had received at least one COVID - 19 vaccine , a
reversal from what was observed prior to the Omicron variant . But
that doesn't mean that the vaccine is makin g people more

CHC 50th Part 2

susceptible.

On the contrary, the Walgreens ’ report specifically says that
unvaccinated people were more likely to report having had COVID - 19
before " unvaccinated patients were significantly more likely to test
positive than vaccinated patien ts. " In the Walgreens case and in
others raw data can be misleading , a phenomenon that has been
exploited by dubious websites that cherry pick data to argue that the
unvaccinated are somehow better off than the vaccinated. A
substantial body of evidence sh ows that's false. Getting vaccinated
increases not lowers your protection against the Coronavirus.

It is true that people who have been vaccinated or boosted are more
susceptible to being infected with the Omicron variant than they were
to past variants. B ut there's no evidence they're more likely to
contract the virus than a similar person who was unvaccinated.
Multiple studies indicate the vaccinated or boosted have at least
some temporary protection against Omicron infection. For instance, a
study of pat ients in Southern California found that two doses of the
M o derna vaccine reduced the risk of Omicron infection by 44 %
compared with 80 % for the Delta variant .

The primary purpose of that vaccination, however, is to prevent
serious illness, and f or that the data are overwhelmingly clear that
vaccination is still quite effective. For instance, CDC analyses show
that two doses of an mRNA vaccine reduce the risk of hospitalization
by 64 % four to six months after the last dose, with protection rising to
84 %. W it h a booster protection is even higher against critical illness
and death.

Johns Hopkins University Epidemiologist Dr. Dav id Dowdy told us , we
shouldn't expect vaccination to garner long lasting protection against
infection with the Coronavirus. But he said the data are very clear that
people who have been vaccinated and boosted are at much lower risk
of hospitalization and death. T hat's my f act c heck for this week . I'm
Lori Robertson, Managing Editor of FactCheck .org .

Margaret Flinter: FactCheck.org is comm itted to factual accuracy from the country’s
major political players and is a project of the Annenberg Public Policy
Center at the University of Pennsylvania. If you have a fact that you’d
like check, e - mail us at ww w.chc.radio.com w e’ll have FactCheck.org’s
Lori Robertson check it out for you here on Conversations on Health Care.

[Music]

Mark Masselli: Each week Conversations highlights a bright idea about how to make
wellness a part of our communities and everyday lives. Asthma is one
of the leading causes of trips to the emergency room for children.

CHC 50th Part 2

T here are often a correlation between high density low income
neighborhoods and more trips to the hospital for treatment and
intervention. When officials at Boston Chil dren's Hospital noticed a
spike in asthma outbreaks in certain neighborhood clusters t hey
decided to do something about it. They launched the Community
Asthma Initiative . They realized that if you could treat the
environments in the patient's home that mig ht reduce the need to
treat the patient in the emergency room.

Dr. Elizabeth W ood : The home visiting efforts work with children and families that have
been identified through their hospitalizations, emergency room visits
as an identification of having poor ly controlled asthma. Also , it's a
teachable moment.

Mark Masselli: Dr. Elizabeth Wood heads the program and says the first step is to
identify the frequent fliers , those kids who make repeated trips to the
emergency room. Then they match with the communit y health
worker who visits their home several times and assesses the home for
asthma triggers .

Dr. Elizabeth W ood : T hey work on three areas , understanding asthma itself, understanding
the medications and the need for control medications , a nd then
working o n environmental issues.

Mark Masselli: Families are given everything from HEPA filter vacuum cleaners to air
purifiers . T hey are told not to clean with certain toxic products , and
the homes are monitored for the presence of pests or rodents. The
result say s Dr. Wood has been pretty dramatic.

Dr. Elizabeth W ood : What's remarkable is that there was a 56 % reduction in patients with
any emergency department visits and 80 % reduction in patients with
any hospitalization.

Mark Masselli: W hile this program is expen sive, there is a return on investment in
reduced hospital costs and healthier children. The program has been
so successful i t's been deployed in other hospital communities around
the country . The Community Asthma Initiative, a simple re - shifting of
resourc es aimed at removing the cause of disease outbreaks in the
community, leading to healthier patient populations. Now that's a
bright idea.

[Music]

Mark Masselli: You've been listening to Conversations on Health Care. I'm Mark
Masselli.

Margaret Flinter: And I'm Margaret Flinter.

Mark Masselli: Peace and h ealth .

[Music]

CHC 50th Part 2

Marianne O’Hare : Conversations on Health Care is recorded at WESU at Wesleyan
University, streaming live at www.chcradio.com , iTunes, or wherever
you l isten to podcasts. If you have comments, please e - mail us at
[email protected] or find us on Facebook or Twitter. We love
hearing from you. Th e show is brought to you by the Community
Health Center .

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