Chuck Jones: There’s not a light right now at the end of this tunnel that I can see.

Dan Gorenstein: That was Chuck Jones, CEO of Harbor Health, on March 20, 2020.

Here’s Chuck Jones on March 11, 2021.

CJ: What we’re doing right now I just have to say it’s one of the most exciting times that I’ve had in community health in my professional life, period.

DG: What a difference a year makes.

Today, the view from one community health center, back from the brink and adjusting to a new normal.

From the studio at the Leonard Davis Institute at the University of Pennsylvania, I’m Dan Gorenstein and this is Tradeoffs. 

We invited Chuck back on the show today to tell us how he and Harbor Health are doing one year since our first interview. 

Last March, Chuck and his board had just furloughed more than 100 staff and closed one of the five community health centers Harbor runs in Boston and Cape Cod. As COVID hit, Harbor was providing medical, behavioral health and dental care to more than 30,000 patients, many who are low-income.

DG: So Chuck, when we first talked to you almost a year ago exactly, you were only seeing about a third of your usual patient volume and you were on track to lose a million and a half dollars a month. If this were a check up, how is Harbor Health doing now?

CJ: Well, I’d say we’re I think we’re out of the hospital, I think  we’re graduated from rehab and we are seeing some improvements in our health.

DG: And specifically, let’s take stock of this. Chuck, are all the centers back open again?

CJ: Yes.

DG: How many of those 100 people have you brought back?

CJ: Almost all of them.

DG: And what’s your monthly income like now, are you guys in the black? Are you still in the red?

CJ: Yeah, we are slightly in the black on a month-to-month basis. We’re relatively stable. Like I’m not looking at falling off a cliff any time in the near future, which is a low bar for comfort, but it feels nice to be there as opposed to where we were a while ago.

DG: Harbor Health is one of 1,400 health centers, often called federally qualified health centers and are core to the nation’s medical safety net.  

The centers provide services to 30 million patients, nearly half who live in poverty.

Thanks to a mix of government aid, getting reimbursed for telehealth visits and even philanthropy, many clinics are breathing easier this spring, said a spokesperson from the National Association of Community Health Centers.

And while clinics are on firmer financial footing, many patients continue to avoid coming into the office in person. Chuck tells me, that’s true for Harbor Health, too.  

CJ: The total number of visits that we have face to face are about half of where we  were before we started the slowdown in March of last year. But total volume of visits is about where it was last year due to telehealth.

DG: You said this to me last year — and I’m suspecting it’s probably still true — these are actually really telehealth. It’s not a video call. It’s a phone call. Are you happy with that?

CJ: In an ideal world, all of our telehealth visits would be video. In the world we live in, many of our patients have bandwidth issues. Many patients have technology issues. Sometimes our own staff have been with the technology challenges…So I think we’re going to pursue doing as much bringing folks back into the health center and getting out into the community as much as possible and then finding those areas of telehealth where it makes sense.

DG: Chuck says thanks to telehealth, appointments for mental health or substance use are up 30% from pre-COVID days. Part of that is likely due to the pandemic and just how hard 2020 has been, but Chuck also thinks telehealth may be easing access issues and the stigma that have historically left a lot of these health needs untreated.

CJ: So in that area, I think it goes beyond convenience and it could actually get to a better way to provide care.

DG: To put this in a larger context, a 2019 federal survey found more than 3 in 4 people with a substance use disorder and half of those with a mental illness do not get the care that they need.

When we come back, Chuck on the highs and lows of Harbor’s vaccine push.

MIDROLL 

DG: Chuck, I remember you talked last year about finding it hard to find a light at the end of the tunnel. In all kinds of ways, not just the financial hardships, but this tidal wave that seemed to be crashing on all of us. Now we have a vaccine. What role is Harbor playing in this new phase of the pandemic?

CJ: So we’ve we collaborated with the firefighters union in Dorchester, in Boston, and they gave us their union hall. We worked with Quincy College in Plymouth and they gave us their student center. We worked with Zion Church, which is primarily Portuguese, that many of our patients go to and they gave us a huge sort of part of their church. And those waiting areas are some of the happiest places I’ve ever experienced in health care.

I love stopping by these sites and and just talking. For one, everybody is happy, you know, everybody is it feels like they just had a birthday party because they got vaccinated and they’ve been waiting so long for this. Staff feel great because they’re able to do something that’s actually solving the problem and not just not just sort of surviving the problem. It’s just happiness…mostly. There’s a lot of stress on our side for my team because…

DG: Well, hold on before you get to that I’m going to ask you, you know, walk us through what it really means to be to host a vaccination site. Like what kind of operations [and] logistics are you dealing with?

CJ: Three months ago, four months ago, if you would have asked me, “How do you pull together a vaccine clinic?” I would have talked about it like a flu clinic, where folks come in, you have them sign a consent, they get the shot, they’re out. It’s not that heavy of a lift. With the COVID vaccine, we have, there are a number of factors that make it more complicated. 

DG: First, says Chuck, there’s the unsexy stuff: recruiting and vetting volunteers, dealing with liability insurance, rolling out a new electronic health record system. And juggling all of that while also running COVID testing clinics and telehealth visits. Then, you’ve got all the people out there looking for vaccine. 

CJ: One of the toughest things is setting up a program that can be responsive to our local communities and provide the vaccine to our own patients and members of the community and not get completely overridden by the pressing sort of crush of demand for the vaccine.

News clip montage: The Massachusetts COVID19 command center said the state’s website traffic crashed Thursday because it couldn’t handle the traffic. // Thousands of others sat frustrated unable to snag one of the 12,000 appointments that went up for grabs Thursday morning. // It’s just been a phenomenal mess in a state that’s supposed to be really smart.

DG: Harbor’s solution for fending off vaccine hunters…go old school. No online portals. Instead, Harbor created a special 800 number and only published it locally. 

It’s worked…most of the time.

CJ: Our phone system is going down half a dozen times since this whole thing started, because every time there’s a public announcement that there’s a vaccine available. So we hired and outsourced a call center who can staff up and down depending on demand and much more predictably, answer the phone when folks call.

DG: Chuck says all Harbor needs now is more vaccines. They’ve got the space and staff capacity to do nearly double the 400 shots per day they’ve been averaging. But even with the logistical challenges, about 90 percent of the doses have gone to people from the communities that Harbor serves, thanks to working with pastors and other neighborhood leaders.

Last March, Chuck, you were choking back tears, really daunted by the heavy decisions coming at you a mile a minute, not knowing what was happening next. If there’s one story or moment that encapsulates how you’re feeling now, what would it be? 

CJ: So, really hopeful. I’ll go back to last weekend when I was at the Geiger Gibson Community Health Center on Saturday morning…

DG: That’s, that’s the one that you closed?

CJ: Yeah. It’s the first health center of the country. So I went I volunteered to go out and help that weekend. And I signed up to be a monitor. And then I got fired from that job because you need to have some clinical skills. So that’s fine. I got to be a greeter…

Music

CJ: …and one of my favorite patients who I helped was a tiny older Vietnamese woman. And she didn’t speak English. She had a very hard time walking. So I grabbed her by the elbow. I think she was about 4 feet tall and I’m 6-foot-5. And I’m helping her along. And she was so ecstatic to be getting that vaccine and she reached up and went to touch my mask. And my initial reaction was, “What are you doing? Don’t touch my mask.” But what I really wanted to do was just give the old lady a hug.

So just holding her by the elbow, helping her into the room, seeing the great smile on her face, and she got vaccinated and sort of did her thing to put this all behind her. That’s, that’s like the exact opposite of where I was about a year ago.

DG: Chuck, thanks a lot for taking the time to talk to us on Tradeoffs. 

CJ: Dan, it’s been great talking to you. Thanks for having me.

DG: Last week, the Biden administration brought even more good news to Chuck.

First, the American Rescue Plan Act included $7.6 billion in flexible COVID funding for community health centers.

The next day, Biden’s team also announced 700 more community health centers would start getting vaccines directly from the federal government.

Harbor Health was on the list.

I’m Dan Gorenstein and this is Tradeoffs.