Sharing Best Practices: Lessons from Community Health Centers Coast to Coast

240423_Conversations_BestPractices_01.mp3

Speaker 1 [00:00:04] From Boston to Hawaii Community Health Center served over 31
million patients last year. How are they keeping pace with their success while always
working to improve the quality of the care? Do you want to have a portfolio that has, you
know, innovations and improvement on your core business, but you also want to be
thinking about what are some game changers or transformative things that you could do?
And so when you think about a 3 to 5 year plan, you want to have a lot of things that are
going to make you better, stronger, healthier. But you also want to have a couple items
that are kind of swinging for the fences, types of stuff.

Speaker 2 [00:00:42] Community Health Best Practices is a network of 17 of the nation's
leading community health centers. Their ideas and optimism are bringing innovation to the
entire sector. This is conversations on health care.

Speaker 1 [00:01:04] Well, welcome to Conversations on Health Care. Margaret and I
recently have the opportunity to moderate a discussion at the Community Health Best
Practices Forum, which is a terrific conference for learning how community health centers
effectively provide comprehensive primary care and behavioral health services to all
patients, regardless of their ability to pay.

Speaker 2 [00:01:26] The panel members all serve as CEOs of their organizations. Let's
list them. They are Gloria Amador from Salud Integrar en la Montana and Puerto Rico.
Eddie Chan with Northeast Medical Services in San Francisco. Nieves Gomez with
Columbia Basin Health Association. And Connell, Washington and Kauffman. Noland with
sun River Health in New York City, Long Island, and the Hudson Valley. And Greg Wilmot
with East Boston Neighborhood Health Center.

Speaker 1 [00:01:56] We started by asking them how Covid had changed their non-profits.

Speaker 3 [00:02:01] My ha moment, was that we have so many heroes amongst us.
When nobody knew what was happening with Covid, we had our providers at the frontline.
Yeah. You know, you didn't know how transmitted even at the time, you know, doing the
testing and, you know, making patient, making sure patients were okay. We have I have
so many pictures that I keep going back to look at, just to see our providers standing there.
And, you know, we didn't have all the, you know, with garbage bags. We had, you know,
we didn't have all the stuff yet because, you know, your masks, we're doing these weird
things with masks, right. And trying to trying to clean them somehow and send them to the
state and state would clean them and give them back to you. But that lipstick got it. So,
you know, it wasn't yours. And, you know, so it was it was really it was really hard. Right.
But but to have our providers and our EMS and our clinical staff going out there day after
day, not knowing. Right. Like you're going to. Right. Yeah, right. So that was my moment.

Speaker 1 [00:03:06] I was leading parts of the directly the vaccine, effort leading that,
charge. And so I have all my text messages of all the stuff I was doing. I still on my phone,
I'll scroll through it every once in a while just to relive some of the, trauma of all those, all
that work. But, one of the things that was really interesting to me. So on the back end of all
of the the work on the vaccine, and this was a team effort, community effort, but in
Massachusetts, the communities that had the highest rates of vaccination amongst the
Latinx community were East Boston, Revere and Chelsea. Now, those are just, you know,
neighborhoods. I think that some of you may not be familiar with. Those were the
communities in Massachusetts that we stood up vaccine centers. Yeah. And partnered

with great intention to bring vaccine to the Latinx community. And that one, those were the
vaccine centers. But we did a focused, strategic, intentional effort with the goal of how do
we reach a, you know, close that, close the gap on on vaccine rates. So the moment in
that, when we saw the data and saw the relationship between the work that we set out to
do, the strategy that we set in motion, and the intentionality of it was if we bring
intentionality, data, and strategy to an issue, we can actually close the gap and address
the issue. And I think the for me in that is, the same level of urgency and intentionality to
which we approached, vaccine rates for Covid 19. I'm bringing that same, focus in
partnership with, my fellow colleagues and leaders at the health center to each issue that
we see that we know to be problems in our communities. And I think that's what is
possible. And that's the, you know, so for me that we got that in us, we can actually close
these gaps and deliver, on some of these outcomes. It just requires that, focus,
intentionality and strategic intention, sort of maybe sort of walk under the process of how
you think about your role run as a strategic leader for your staffs and for your board, and
as you apply that over the next couple of years.

Speaker 4 [00:05:35] Being ready to to to face any other emergency is very important for
us. Well, everybody shut down. We stay open. We never close a minute. Our operations in
our seven centers, we never shut down our emergency room. Even I was receiving 12
patients per day because that's the the engagement you have. That's a message you sent
to your community that you're here on the barrier into. Good. And that's that's takes us to
establish new infrastructure to face new, challenges on environment or or or curate
games. There are things like new warehouses. Now we're thinking on buying a gas station
because we spend like $300,000 in diesel. In the last emergency, we are looking into
establishing other, other businesses that can support what we do. And the most important
thing is trying to make our employees understand that we are always behind them, that
when they have a necessity, we going to be there, stand for them. I don't know if it
happens to you, but we lose a lot of employees during covet. Now, generations have
changed. Payment types have changed. Salaries have grown a lot. So we have to make
changes also to make sure we have the best benefits and salaries for our employees. So
they stay with us and we can grow old together. That's the only way you can tell your
community. When everybody leaves you, we are here, and we stand here for you. We
keep providing our services. And people feel the same way. We increase 7000 patients on
the 2020 like one. Everybody lose lives. As a managed care system, we increase in lives.
So our strategy has been in reinforcing more infrastructure for preparedness. So, for our
employees also knows that we're going to be back in them.

Speaker 5 [00:08:02] It has to belong to our strategic plan right now, whether we like it or
not. And I'll take the perspective of, you know, recruitment, providers right now. You know,
traditional urgent cares. Are our providers right now are being burnt out in primary care
because of being a patient centered medical home and being responsible for the totality of
the patient. Right. That's the feedback that I'm getting from my providers more and more
and more and more. And I always say, and this is to not offend anyone because I include
myself in comparison to you all who have a lot more experience than I do even in an
administration. But I often find myself saying they don't make them the same anymore, and
by that I mean they can't. You can't bear as much, you know, we can endure as much as
new generation right now. And that's what I'm seeing. And new grads and recruits that we
have right now, they come into the primary care system and they're tapping out. They're
saying, I can't do this anymore, especially when there is that unique combination of the
90th percentile in terms of productivity with access and then being responsible for quality
and everything else. And so you look at that and see what's happening right now. And it's
this reset post-COVID-19 of that generation that's coming in where we kind of slow down

as a health system in general universally. And so, you know, we're in that dynamic where
we have to talk strategy about how do we save our system from losing providers, because
that's what's happening right now. They're moving over to urgent care models, where they
don't, you know, really have to follow the patient. They just do what I need today, that they
could do good work, and they do a quick note, and they're that there's no administration or
I heard, say before, there's there's probably not a large inbox, right, for the for the medical
provider. And so there's an attraction there. Being as rural as we are, I didn't feel
challenged by that very much, but it just caught up to us later after everyone else. But it
caught up to us. And so that's, conundrum that we're working with right now is, is really
addressing that. And we've moved in terms of our strategy in recent years to have a co-
located sort of express care.

Speaker 4 [00:10:17] Yeah.

Speaker 5 [00:10:18] We have found that that is necessary to try to separate somewhat,
the acute from the more, chronic, for lack of a better word and more of the preventative
type of appointment as well. And not combined so much to schedule that way to
overburden our providers. So I think from that perspective, you know, we should be having
those conversations about is a strategy called, call, located care with urgent care. Express
care. However, we defined that, with, you know, CMH model and primary care, you know,
is that the first step as we bring them in? Certainly we need to provide the access. And we
do that the best, I believe. But we also need to take care, of the whole self of the patient.
And so that's our responsibility. So, and I know that's where you guys are moving, so
maybe you have a little more on that.

Speaker 1 [00:11:11] Correct. So I'll, I'll, I'll, I'll speak more process than, than kind of
specific strategies. But you know how I think about process, you need a strategic planning
process. And you have to think about the outcome of that process as being, a tool,
dynamic tool, not just, you know, you know, to create a strategic plan like a glorified
paperweight. And so from a process standpoint, what I try to do with the, you know, not
going through the actual process itself, but my goal in going through strategic planning, as
an organization, is to have, a set of, priorities that are generally understood across the
organization. So you have to define that because there's so much that we're wading
through as organizations, there's a lot before us that we're trying to solve. How do you
prioritize that, and how do you think about directing the resources of the organization
toward the issues that need to be addressed? And so you so we we create a strategic
plan. And that strategic plan has some structured priorities. Within the plan, what I try to do
with strategic plans I've done and I mentioned I've, I've kind of worked in strategy for a
long while, professionally as a strategist, in my capacity with the for the state of
Massachusetts specifically. And have continued to kind of lead that way is you want to
have a portfolio that has, you know, innovations and improvement on your core business,
but you also want to be thinking about what are some game changers or transformative
things that you could do. And so when you think about a 3 to 5 year plan, you want to have
a lot of things that are going to make you better, stronger, healthier. But you also want to
have a couple items that are kind of swinging for the fences, types of stuff. And so I try to
have a portfolio that has that mix, because you can have these opportunities where you
have a game changing. Game changing initiative that is going to get you further upstream
or, really affect the very issues that you're trying to that you're there to solve. Right. So
we're we're in the business of health care. So, you have a lot of work on just how do we
become a better health care provider. But also, you know, how do you get to a place
where you are not having to deal with some of these issues? How do you get upstream,
get at some of the social determinants of health? More deeply. So we're doing a lot just in

terms of an example, around food and thinking about, the impact of nutrition equity on, on
the health of our community. But I think that's how I think about just processes. Do I have
and I that's what I think about all the time. Yeah. Do I have the right mix of projects on the,
on on our, in our portfolio that are going to make us healthier and stronger? And do I have
some game changing initiatives mixed in there as well?

Speaker 4 [00:14:10] We set about, achieving a North Star and establish the North Star as
a value based value care of a care system that focused on value, on on the quality of our
patient care, on the, the, lifting, a new model of care where we were supported by a new
model of, of payment. And that lifting has been a challenge for the last couple of years,
because lifting a change when that change has not really occurred universally, and where
you have a large percentage of the population uninsured, the only way you can do it is to
concentrate on those value based care contracts in place, to make enough money to be
able to handle the the rest of the population in a universal, system. And so that has been,
our single, focus on North Star, with the centerpiece being our quintuple aim and wrapped
around it. Important are the access measures. So how are we achieving better access?
How are we, working on sustainability in terms of the hotspots our patients living in, the
hottest places in the, in the flooded communities, in the highest need communities. How
are we serving and initiating a sustainability, program that reaches, enough information to
our clinicians to help in identifying and and educating our patients about water where they
can get hot, where can you get relief from hotspots? So there's this sustainability aspect to
all of this. There's an advocacy aspect that has to envelop. And I thought more and more
as we sat here in this session, these last few, days, that the more advocacy we put
together and raise, with community health centers being at the forefront of all of this work,
it is such a collaborative process. It could be augmented by all of us. And that's another
area that we have strongly taken on in our own organization. In fact, we provide, it would
seem to me of the three New York centers joined together, we would be much better
leaders, more, aggressive leadership than what we currently have in the state. We need
not to compromise and be homogenous by the middle, but to reach for our North Star. All
of our North Star really was to to move it. So I think those are our challenges.

Speaker 2 [00:17:12] But this for anyone. How are you? How are you managing across an
incredibly multi-generational workforce as you move into the future, still growing, still
expanding your services?

Speaker 5 [00:17:24] You know, what we're seeing is a different there are different needs
in our workforce and whether that is being, flexible, with our workforce and providing,
remote opportunities, whether that is getting creative, as we learned yesterday, about
creating different shifts or different schedules, whether that's pay that's accelerated at a
time, you know, over, over, you know, the last several years, it's looking at every, every
opportunity to really keep the workforce. And I think the key word is really engagement.
Yeah. Regardless of how you deliver on that, it's engagement. We've been asked lately.
You know, how do any modern health care best places to work 4 or 5 years in a row? And
we've made a decision to really engage, at that level and introduce technology that
allowed us to feel like we were communicating often. As you guys have seen. And that's
really worked for us. We made a decision to only measure, not just the top box combined,
but just the excellent scores and really decided to be transparent as leaders, and open sort
of this feedback loop, you know, what are what are what is the workforce expectation and
how do we meet that and how do we get creative around that? We dedicated resources for
not just community engagement but employee engagement. And then we decided, to not
be so uptight and serious as an executive team, even though that's maybe natural to us.
But to allow our workforce to see us in a different environment, whether that is, you know,

dance videos to music of the 80s and 90s, and that's nonnegotiable. Everybody has to do
that. You know, on our team. And so just really bringing that that sort of culture and fun
environment, and it is our responsibility as executive leaders, to really foster the culture
that we want to see.

Speaker 3 [00:19:35] 83 I would say we really struggle with that. Yeah. I come from a very
old school, you know, type of mentality. And, you know, for me, you know, back in the day
when you went to work, you just went to work and or people give you hell, you just take it,
right? You can't do that, right? You just can't do that anymore. And and, you know, we've
been struggling and we've been taking all the tidbits that we've been getting for best
practices. We stole some things from you guys. You stole some things from, PMS. And, I
think that's helped. And it's all around engagement. We've also, you know, bumped up
salaries quite a bit. And because of a combination of things, I would say that our overall
staff workforce, has been relatively steady over the, post-pandemic. You know, the whole
thing around California and it's minimum wage for healthcare workers are now at $25 an
hour. We actually went way above that. We're at 30, you know, from the janitors down.
Everyone's above that as well. And so I think the pay helps benefits are one of the best, in
the Bay area. And so I think that piece of it, plus some the communication things that
we've learned from best practices, I think has helped. I know in the past we were all
struggling to get, our positions filled. You know, we have a couple of hundred outstanding
positions in the past that were, you know, double digits. But I don't know what it is about all
but 62. So a lot better. Right. And, so I think overall, we've learned a lot from you guys,
and I thank you all. It's helped us a lot. I don't know what's next. Iterations going to be
right. There's so much, so much we can do as employers to provide, you know, all these
various things from, you know, monthly. Thank you. You've been doing a great job. You
know, put a little star on you this month, and there's only so much you can do, right? And,
yeah. And it seems like the, you know, like the my kids, you know, you got to recognize
them all the time. You did a great job. These guys are 35, right? And, you know, we're still
doing it. And, you know, so I think we're going to have to continue a little bit more. But I
really don't know the answer to this.

Speaker 2 [00:21:59] What about the other end of the, the spectrum? Maybe the people
who are thinking about retiring, but you're hoping to keep them in the workforce for a few
more years. What kind of flexibility are you creating for people?

Speaker 3 [00:22:11] So I know we have some physicians that, have what I wanted to
retire and, you know, Doctor Ty's always coming up with ideas, and, and we have them
working from home now, and, they see their panel of patients. It's all 100%. Tell them it for
them, and they just stay at home. They don't have to come in. So we're testing that out.
But, you know, you're going to have to come in and eventually your patients have to come
in eventually. Right. And so that's kind of what we're running into. Even though they're at
home 100% of the time, it's still, takes other providers to, to help fill in the void anywhere
else.

Speaker 1 [00:22:47] And yeah, I think, I think one thing that we've done a good job of
over the years, and credit to, I think just the organization's commitment to maintaining a
certain culture is, we outlined a set of values, to which we all hold each other accountable
for those values center around respect. Teamwork, diversity, innovation. Essentially. And
so, we communicate those regularly. Everyone that comes into the organization goes
through an orientation where those values are strongly conveyed and communicated. I've,
started a process of coming to every one of our new hire orientations, and I talk about who
we are as an institution, who I am as the leader of the organization. And I think that's kind

of the thread that ties everyone together. Is that, that shared purpose that we have, to, to
serve, members of our community, with distinction alongside those core values. And I think
a lot of the other pieces are challenging, as you know, Eddie was touching on there's just,
so many unique, needs that whether generational or cultural or other kind of just ways that
people present to the workplace. You just want to create a culture that's inclusive and
respectful. Claire.

Speaker 4 [00:24:15] Just just a comment. We are going to be 50 years in October. We
still have employees who started a company. That probably will be retiring afterwards. But
establishing, a way for them to feel saved that they going to be prepared for retirement is
important. The 401 K or any other, help you give to your employees, profit sharing or
whatever. The other thing we have is, we have five generations working together. So in
our leaders retreat, we do talk a lot about this theme, how we can work together without
being, disrespectful to the older generation. How we can join forces with your knowledge
and technology, with my knowledge in how to run these operations. I have to credit our our
executive team and the work that they're doing in clinical. And it really comes down to an
assessment, market assessment of salaries. And we've got a union in part of the
organization. So regionally, we're out the Hudson Valley and Long Island in New York City.
Long Island has the union. And so we have, various compensation, barriers, that that
presents, and in challenge. It's really challenging, but we've done a pretty good job in that.
But that's what we're working with right now in market assessments, trying to pull people
up and making sure we don't have anybody that's dragging at the bottom, that we're not
leaving anybody behind in terms of a living wage. We went early, in New York. We
matched. We were there before New York. There was there with where that was at $15.
And, you know, we're raising to 20. We don't have anybody below 20, but we have our eye
on California. And I think we're we're keeping pace with that. New York will follow
California everywhere. We hope they they put in place virtual care and a lot of other
regulations that are and and and funding of medic of physicians and residency training,
training programs as you do in California. But I think trying to model that really using other
places as our model and learning from all of you has been very helpful. As we look forward
to how to retain, I learned a lot from the discussion around what, what the residents want.

Speaker 1 [00:26:59] As the fun side of this. What would one do with an unanticipated
gift? I'm the incoming chair of the National school based Health Alliance, about a $3 million
operation. We open the mail. We've got a $9.9 million check from Mackenzie Scott. That
got delivered. Requested unsolicited fundraising could possibly shape reshape your future
in some ways. What are you doing in that area? That's, moving that ball forward.

Speaker 5 [00:27:31] Yeah. So it's comprehensive health. Got the same surprise. And so
we got $7.5 million from Mackenzie Scott.

Speaker 2 [00:27:38] No way.

Speaker 5 [00:27:39] Recently. And at first I was skeptical because I didn't know much
about it. And so I asked a lot of questions and I said, what's the criteria? They said, well,
you have to provide access, quality and looks of the CEO. So I know why we got it now or
no, I think it's I think it's important. It's a blessing, you know, to work with organizations to
be recognized based on the work that we do. You know, I remember a time where, you
know, I got grants made up, you know, less than 10% of our revenues. And now, during
Covid, especially post-Covid, you know, we're really reliant on the money, just because of
all the change that has happened. And so we prefer not to obviously, we want to be able to
generate that, but, certainly, every opportunity that comes out, we, we, we explore it a lot

more today than we used to in the past. And we built teams around that too, in order to
manage that, because there's a lot of requirements that come with that. So certainly, the
last thing I'll say is that, you know what? We're looking, for that type of money and support
we're looking for, not restrictive, money. And luckily, that Mackenzie Scott is one of those.
And, we'll be looking to use that, to build new access and health center, in a new
community for us and compete for that.

Speaker 1 [00:28:59] That's correct. Eddie, have you opened your mail?

Speaker 4 [00:29:02] Yes.

Speaker 3 [00:29:04] I open it all the time. Once I heard that, and then nothing yet. So for
us, we've never fundraised at all in my entire career. I don't know how to do it. I have no
knowledge of how you all do it. So that's definitely something we are going to have to
figure out. But that's never been a requirement of my, my job to fundraise. Although it may
change in the future. So I look forward to getting all your input, how to get some money.
And if you know Mackenzie Scott. Good word.

Speaker 1 [00:29:42] It was a great conversation, and we appreciated everyone for
participating.

Speaker 2 [00:29:47] Thank you to our audience for being here. Be sure to subscribe to
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