Preaching the Practice
The head of East Boston's health center took an ailing clinic and helped restore it to health

East Boston Neighborhood Health Center

Author: Allison Connolly

Boston Business Journal March 14-20, 2003

For Jack Cradock, presiding over one of the nation's largest community health centers, is the perfect combination of business and altruism.

"I get to live out my faith every day," said Cradock, president and chief executive officer of the East Boston Neighborhood Health Center and a devout Catholic who says he appreciates being able to care for the underprivileged residents of this isolated section of the city.

But his faith in the system was tested in 1999 when the center filed for bankruptcy — just as it had been expanding with the purchase of Winthrop Hospital, the opening of a clinic at Logan airport and a number of assisted-living homes. He was forced to sell Winthrop Hospital, close the Logan clinic and shelve plans for the assisted-living homes. He laid off 350 of the center's 1,100 employees. And he cut 20 percent of the hospital's $15 million annual budget.

"We built a system with a lot of support early on from our hospital partners on the belief that ... we would reap the financial rewards of that," he said. "But as you know, we all rejected the rigid HMO and we ended up with an expanded system with no support."

The center emerged from bankruptcy almost a year later. Today, the center's bottom line is written in black ink and the hospital itself is growing again.

And he finds himself at the heart of a paradigm shift in the health care industry, as policymakers and health leaders consider forcing patients to undergo procedures in the most cost-effective setting. One idea being bandied about is to direct patients to community health centers for simple procedures. Cradock can envision his center's volume soaring if such a change occurred.

Centers of the system

Already, the Eastie health center's emergency room is staffed by doctors and nurses around the clock, seven days a week. The ER sees 100 patients per day, and only 10 percent of the patients seen there annually are sent to the larger teaching hospitals.

"We've demonstrated that 90 percent of what people call 'emergencies' can be dealt with in the community," Cradock said. "It's a place for Medicaid (the state's health insurance program) to look when they want to cut costs. Hospitals look to us because we can unclog a lot of their emergency rooms."

The new emphasis on community centers is just "talk," Cradock says. But Cradock's longtime friend, Ronald Preston, formerly the regional director of Medicare and Medicaid, is now the secretary of health and human services in the Romney administration, and Preston is considering changes to the system.

In the meantime, Cradock has learned to be entrepreneurial when it comes to finding new sources of revenue: He makes sure patients, as soon as they're in the door, are interviewed for information that might help them get covered by some sort of insurance.

He has set up booths in waiting rooms where staff members help patients sign up for Medicaid, Medicare or free care. But any community health center that relies on state and federal funds is in a precarious position, especially today, when the Medicaid is being cut and the free-care pool is facing a $152 million shortfall.

"We have a huge demand," Cradock said. "Our patients are close to 30 percent uninsured. Another 25 percent are on some form of Medicaid. That's 60-plus percent of our patients and revenue. We're concerned."

Cradock knows the ups and downs of the health care industry. He opened Brookside Community Health Center, the first community health center in Jamaica Plain, just as the community health movement got started in 1970. It was in the same neighborhood where he grew up, on Montebello Road, and the same street on which he now lives. At the time, families were leaving Jamaica Plain for the suburbs. There hadn't been a pediatrician in the community for 15 years, he said.

His wife, Susan, whom he met in college, was an activist on the city's welfare committee and was lobbying city council members to get Brookside built. However, Cradock recalls, she and her peers weren't being taken seriously.

"It's an inside joke we all have," said Cradock, who is tall, soft-spoken and amiable. "She asked me if I would get all dressed up and come in my business suit to one of these meetings, because they felt like they were being treated like housewives. I got more and more interested in what was going on."

He hired doctors and staff on an annual budget of $1 million. Then the Nixon administration said it would no longer fully support community health centers, and clinic administrators had to make up the difference via Medicaid or Medicare and grants.

It was about that time that Cradock took a sabbatical; an internist at Brookside had asked him to go to California and work with Caesar Chavez, the famed labor activist who lobbied on behalf of migrant workers. Cradock spent a year there, helping bring Mexican children across the border for medical treatment.

But Cradock missed Boston, so he brought his wife and three children home. He took the helm of Chinatown's community health center and built it up over two years. Then in 1978 he got the call to East Boston. At that time, the center was bringing in 85,000 medical visits per year. Today, it logs 250,000 visits.

The practice he preaches

The center now employs 150 doctors, and is affiliated with Boston Medical Center and Massachusetts General Hospital.

The bankruptcy — which was caused by an $8 million "readjustment" the state made to the amount it paid the center for free-care patients, Cradock said — made him more business savvy, which helped him to build the Elder Care network of assisted-living homes. The center serves 200 elders at five sites.

Jim Hunt, president of the Boston-based Massachusetts League of Community Health Centers, said Cradock continues to break new ground.

"I get calls from across the country asking how they replicate what he's done there," Hunt said.

Even through the bankruptcy, Hunt said Cradock was a role model. He recalls how Hunt convened a group of "friends" — state officials, city officials and Democratic Sen. Edward Kennedy — to figure out how they could turn the center around. Hunt said he was surprised by what Cradock could do.

"He demands a presence because of the work he does," Hunt said, "not because he demands that presence."

Cradock clearly loves his job, he loves taking care of the people who "clean our office buildings" and "come home from work at the time most of us are leaving our house to go to the office." He takes pains to know each employee's name.

He practices what he preaches: He and his wife have adopted 15 orphans from Costa Rica over the years. And when he's sick, Cradock proudly notes, his own doctor treats him at the center.

As he approaches his 60th birthday, he says it saddens him to think his retirement may be around the corner.

"I would like to say I have another 10 years at least," he said.

To contact Feeley & Driscoll, please click here or call us at 1 (800) 392-6192.