Church Health Center, Antony Sheehan, and Crosstown

The Long View

Antony Sheehan is standing at the top of Sears Crosstown. In the distance, the Memphis city skyline floats like a mirage above a sea of furry green trees. From here, it’s 10 stories to the ground — quite a ways to fall — but Sheehan strides right up to the edge of the roof.

“You know,” he says, in a crisp British accent, “it amazes me when people say that Memphis isn’t a beautiful city. I’m standing here, looking out across the canopy of trees, at the gorgeous old buildings, and it’s stunning.

“But when you look at a vista from this altitude,” he continues, “I think a lot of detail can be lost. I mean things like poverty and families suffering from poor health. Really, that’s what the Church Health Center is all about: the beauty and the long view — but also the detail and the humanity that lives in the city.”

Sheehan is the new president of the Church Health Center (CHC), a Memphis nonprofit that offers low-cost health and wellness care to the working uninsured. The organization started in 1987 with just seven employees and an annual budget of $300,000. From there it has grown into America’s largest privately funded, faith-based nonprofit clinic, as well as a world leader in the growing field of Whole Person Care.

Maureen Bisognano is president and CEO of Boston’s Institute for Healthcare Improvement, one of the country’s leading healthcare think tanks.

“Whole Person Care is not just gallbladder surgery or a cast for a broken foot,” Bisognano says. “It means keeping people healthy enough that they don’t have to come back to the hospital. In the long run, it means becoming accountable for the health outcomes of your community over time. And the Church Health Center has really been at the forefront of that revolution.”

Today, more than 60,000 people in Memphis and Shelby County depend on the Church Health Center for their health and wellness care. With an annual budget of $15 million, the organization employs 250 full-time staff and coordinates volunteer services from more than 1,000 doctors around the city. Over the years, the CHC model has proved itself so effective that it has been duplicated by more than 40 startup clinics around the country.

Now the CHC is on the cusp of a major change. In order to better fulfill its mission of making Memphis healthy, it has lately placed two big bets, and nothing less than the fate of the organization hangs in the balance.

“This is an enormous, audacious undertaking,” says Dr. Scott Morris, the CHC’s founder and CEO. “I’ve put all my chips on the table, because I believe this is the right thing for the Church Health Center, and it’s the right thing for Memphis.”

The first bet is Sears Crosstown. At more than 1.5 million square feet of space, it’s one of the biggest buildings in Memphis, larger than two Clark Towers laid down side by side. The building began its life as a distribution hub for Sears Roebuck, but it’s been empty now for 30 years. Today, its massive, 14-story tower looms over one of the poorest neighborhoods in Memphis, wind whistling through its broken windows.

Lately a group of investors has come forward with a new plan for the building. They want to convert the old Sears into what they’re calling a “vertical urban village” — a local center for the cultivation of health and well-being. And the Church Health Center is at the heart of that plan. The CHC has committed to lease 160,000 square feet of space and move almost their entire operation, spread out over 14 buildings across the city, into the Sears Crosstown.

“If we have an anchor tenant,” says Sears Crosstown developer Todd Richardson, “it is the Church Health Center. Both in terms of the kind of work they’ll be doing and the footprint they will occupy, they will be right at the heart of this project.”

The second bet is Antony Sheehan, the man who will have to move the CHC into Crosstown. With his sensible shoes and his self-effacing smile, Sheehan may not look like a world-beater. But appearances can be deceiving: he is, after all, the man the Guardian newspaper called “the most influential nurse in England.” (Sheehan is a mental health nurse by training.)

Before coming to America, Sheehan was CEO of one of England’s largest community health services, where he managed a staff of 7,000 and was responsible for the health outcomes of 1.2 million people. Before that, from 1999 to 2007, he was second-in-command at the British National Health Service under Prime Minister Tony Blair.

“With his resume,” Bisognano of Boston’s IHI says, “Antony could work anywhere in the world he wanted. The fact that he chose Memphis is really a credit to the city and the work Morris has done there.”

The 2010 U.S. Census identifies Memphis as one of the poorest major cities in the country, with one out of every four Memphians living at or below the federal poverty line. At the same time, the city is experiencing a health crisis, with rates of obesity, diabetes, hypertension, smoking, and infant mortality that are among the highest in the nation.

To cite just one example, Memphis’s 2012 infant mortality rate was 10.6 deaths per thousand births, or about twice the national average. In some zip codes, that number rises as high as 17 or 20; it’s safer to give birth in Syria or the Gaza Strip than in some Memphis neighborhoods.

“Unfortunately, Memphis is a city of haves and have-nots,” says Yvonne Madlock, executive director of the Shelby County Health Department. “The Church Health Center is such a valuable asset to our community because it serves people who otherwise would not have access to healthcare.”

Morris frames the situation even more starkly. He maintains that if the stakes for the Church Health Center are high, then the stakes for Memphis are even higher.

“Nobody’s gonna care about Memphis,” Morris says, “except the people who live in Memphis. Nashville doesn’t care about Memphis. I promise you that Washington doesn’t care about Memphis.

“We’re it,” Morris continues. “We’re the ones who will have to make ourselves better.”


The CHC and Obamacare

In June 2012, the U.S. Supreme Court upheld several key elements of Obamacare, including the individual mandate, which requires most Americans to carry health insurance. The court also ruled that states like Tennessee do not have to expand their Medicaid programs, which carries significant consequences for Memphis’s uninsured.

In March 2013, Tennessee governor Bill Haslam confirmed that he would not expand Medicaid in Tennessee, opting to continue with Tenncare, a private insurance program. Over the next 10 years, that decision means refusing over $2 billion in federal subsidies, a cost that will be passed along to Tennessee taxpayers. It also means that many of Tennessee’s most vulnerable residents will continue to be uninsured.

Before Obamacare, roughly 18 percent of people in Shelby County were uninsured. After the law was fully implemented, experts hoped that number would shrink to 9 percent. But because of Tennessee’s failure to expand Medicaid, according to data from the Kaiser Family Foundation, it only shrank to 15 percent. In Shelby County, that leaves 142,645 people without health insurance.

These Memphians have fallen into what has come to be called the “Medicaid Gap” — and they are exactly the ones the Church Health Center is trying to help. People like Alan, age 51.

“All right, I’m going to go ahead and remove the dressing.”

Alan winces and jerks as Jean Reed, a wound care nurse, unwinds a soiled gauze bandage from his right foot. He’s sitting in a brightly lit exam room at the CHC Clinic on Peabody. Underneath the bandage, on the ball of Alan’s foot, there is an inflamed, L-shaped cut that oozes cloudy yellow pus.

“Yeah,” Alan says, wrinkling his nose, “I noticed it was smelling kind of bad. They said maybe it was getting infected.”

Alan is a trim carpenter who lives in Millington. He says he injured himself while hanging curtains at his home; he fell off the stool he was using and cut his foot on the metal base. Since then, he’s been to the doctor twice: first to the emergency room at a local hospital, then to the CHC’s drop-in clinic. That was two weeks ago, but for some reason, the wound isn’t healing.

While she cleans the cut, Reed explains that there are a number of possible reasons. First, Alan has hypoglycemia, a blood sugar disorder that affects the circulation in his hands and feet. Second, Alan is a smoker, which constricts his blood vessels and further impacts blood flow.

“Yeah, I’m trying to quit,” says Alan, with a sigh. “I just had a bad winter. My truck’s broke and my dog died. But I guess I’m coming around.”

Alan is typical of the 60,000 Memphians who depend on the CHC for their health and wellness care. He is uninsured and lives alone. Lately, because of his foot, he’s had trouble getting to work, and he says he’ll be lucky if he makes $10,000 dollars this year.

For someone like Alan, a serious foot injury is more than just an inconvenience. Without prompt medical care, it could lead to unemployment, bankruptcy, or even amputation.

“Oh, there’s no question,” says Dr. Nia Zalamea, the CHC’s general surgeon, “without an intervention, he could lose the leg. If he could afford a prosthesis, he might be able to walk again. But these are the people you end up seeing in wheelchairs on the street.

“Alan is like the majority of my patients,” Zalamea continues. “If they have to pay full price for the doctor, most of them just won’t go. It’s a scary situation.”

Each year, the CHC raises about $15 million dollars in private money. It also coordinates material donations and volunteer services from 1,000 doctors around the city, including every major Memphis hospital: things like medication samples, operating rooms, anesthesia, x-rays, labs, and support staff.

As a result, the CHC delivers about $8 worth of care for every real dollar it spends, according to a recent economic impact analysis. That’s $120 million of care, delivered on a $15 million budget. For someone like Alan, that means getting medical care for a foot injury — or an appendectomy, or gallbladder surgery — all for the price of a standard copay: $35.

Dr. Hollis Halford is a radiologist who volunteers for the CHC; he’s been reading their x-rays once a week for the last 25 years.

“The Church Health Center has given more to me than I could ever give back,” Halford says. “The Bible says that it’s better to give than to receive, and this organization has really been the embodiment of that.”

Medical interventions are just a part of what the CHC does. Increasingly, the organization is implementing the Whole Person Care model, so it can keep people healthy enough that they don’t have to go to the hospital.

The physical embodiment of that philosophy is Wellness, the CHC’s 80,000-square-foot medical fitness facility on Union Avenue. Here, in addition to family medical care, members can take advantage of a smorgasbord of health and wellness offerings — more than 20 in all — including things like physical therapy, water aerobics, cooking classes, and family counseling.

“In many cases,” says Jenny Prescott-Bartlett, the facility’s director of clinical services, “we found that the biggest barrier to wellness was getting people through the door. So, now, when we see a new patient, we bring them here.”

Back at the clinic, Reed holds a mirror so that Alan can see the bottom of his foot. For the past few minutes, she’s been telling him about the CHC’s family medical care services and encouraging him to become a regular patient. Now she’s showing him how to apply steri-strips, thin adhesive bandages that will help his wound stay closed.

“How are things looking down there?” asks Alan, his voice shaky.

“Well,” says Reed, lightly pressing the cut, “It’s not real pretty, but I think we’re gonna be OK.”


The World Beater

Since coming to Memphis, Sheehan has fielded a lot of questions. And why not? It isn’t every day that a prominent English civil servant packs up and moves to the American South. He says many of the questions hinge on his plummy Staffordshire accent: “Are you Australian?” and “What did you just say?”

“The other day I was in Panera Bread,” Sheehan says. “I ordered a mango smoothie, and they brought me a caramel latte. You go figure that one out.”

But of all the questions Sheehan must answer, the one he likes least is “Why Memphis?”

“I guess I don’t really know what people are getting at,” Sheehan says. “From my perspective, I always thought, why not Memphis? It’s a wonderful city with a rich history and vibrant culture. More importantly, in terms of my work, it’s a city where there is opportunity and need in equal measure.”

Sheehan is sitting in a small, high-ceilinged office at the CHC’s current headquarters on Peabody Avenue. Framed letters from Bill Clinton and Jimmy Carter hang on the walls. Here Sheehan works closely with CEO Scott Morris — literally. Since October, the two men have shared a single office.

“He made me get rid of my desk,” Morris says with a laugh. “That was a little tough. This had been my office for 27 years, and now it’s our office.”

Holding degrees from both Yale Divinity School and Emory Medical School, Morris is that rara avis, a certified family practitioner who is also an ordained Methodist minister. To this day, he still sees patients once a week at the CHC Clinic. He says he got the idea for the Church Health Center at Yale, where he saw a pamphlet entitled “How to Start a Church-based Health Clinic.”

“I read somewhere that Memphis was the poorest major city in America,” Morris recalls. “And I said, ‘That’s where I’m going.’ It’s 1986, I’m 33 years old, and I am too young and too dumb to realize that what I want to do has no chance to succeed.”

The Church Health Center is a faith-based clinic — so what role does faith play in the care they give? To what extent, if any, is it dependent on faith?

“Apart from the cross in our logo,” Morris says, “there are no spiritual undertones to the care we give. There are no requirements. We don’t frontload the care with faith, but we do teach that faith and spirituality can be an important part of health.”

Over the years, Morris has lived by those words. In its very first year, the Church Health Center was funded partly through a grant from the Plough Foundation, a Jewish family fund. Since then, Morris has worked with more than 150 local congregations, including Christians, Jews, and Muslims.

“I don’t have all the answers,” Morris says. “I do believe there is one God, but I also believe there are many paths to that God. The Christian perspective is what works for me, but theology aside, I’ll work with anyone who cares about these issues.”

Morris met Sheehan in 2011 at a conference of the Institute for Healthcare Improvement. He was struck by Sheehan’s keen intelligence and his humility, and Morris says he knew almost immediately that he had found a successor. What followed was an elaborate, three-year courtship that resulted in Sheehan’s coming on as president in October 2013.

“My management style,” Morris says, “has always been to surround myself with the smartest people I could find and then let them do the work. We are a large organization now; I am keenly aware of that. And what Antony has the skill set for — which I truly don’t — is to manage a large organization.”

Today, Sheehan and his wife, Andrea, live in a spacious Craftsman-style home in Memphis’ Central Gardens neighborhood. Their daughters, Ellie and Ava, attend school at St. Mary’s and Perea Preschool, respectively. Meanwhile Antony and Andrea say they have adopted a Midtown lifestyle, biking through Overton Park and taking their coffee at Otherlands.

“We love Corky’s,” Sheehan says, “but I’m afraid there’s been a bit of a barbecue effect. I think I’ve gained about 15 pounds since October.”

As president, Sheehan takes charge of the Church Health Center’s day-to-day operations, chiefly administration and budgeting. Meanwhile, Morris will stay on as CEO, assuming responsibility for the large-scale vision of the organization as well as fundraising and development.

“We just had a meeting about our budget,” Morris says. “As usual, the budget’s too big, so we have to cut it down. In the past, I would have had to spend the time to fix it. But now I just throw in my two cents, and then Antony takes over. It’s an enormous weight off my shoulders.”

As Morris, age 60, nears retirement — “not any time soon,” he hastens to add — Sheehan will take on more of the work. Over the next two years, Sheehan will also be responsible for the move into Crosstown — an enormous logistical and conceptual shift. Is he up to the job?

“Of course, on one level, it’s terrifying,” Sheehan says. “The practical steps of this process are big and complex, and successfully navigating this transition will require an enormous amount of planning and a high level of execution.

“But on another level,” he continues, “I think you could make the case that everything in my life, both personally and professionally, has been leading up to this moment. I’m aware of the challenges we face, and I think we are ready to meet those challenges.”


An Epidemic of Wellness

Just across the street from Sears Crosstown is Cleveland Street Flea Market. It’s a neighborhood hot spot bursting with second-hand treasures: vintage cookie tins, christening gowns, calligraphy sets, and transistor radios — all for a good price, as long as you’re willing to stand around and bargain.

For the last 15 years, Malcom Nolen — known to his friends as Cold Water — has been serving up the latest fashions from his tiny barbershop at the back of the flea market. Today he’s giving a summer buzz cut to one of his customers, Elie Holland.

“Got any big plans this weekend?” asks Holland, age 82.

“My big plans,” answers Nolen, carefully maneuvering his clippers around Holland’s ear, “are to stay out of trouble and live to see next week.”

In addition to his gig at Cleveland Street, Nolen, age 48, also cuts hair at Southland Mall Barbershop, and he’s interested in picking up some part-time work as a forklift operator. He says he’s been to the Church Health Center Clinic on several occasions — most recently for a rotted tooth — and he’s heard about their plans to move in across the street.

“I think it’s a gift from God,” Nolen says. “Because there are not really any doctors or anywhere for us to go around here. And even if there was, people can’t really afford it.”

For much of the last century, the Crosstown neighborhood was a desirable place to live. Back then it was a fresh-faced suburb, where young couples — many employed at the Sears distribution hub — sought to carve out their slice of the American dream. But, beginning in the 1980s, Memphis’s population and its purchasing power began to shift east. Sears closed its Crosstown retail store in 1983 and boarded up the warehouse 10 years later.

Crosstown neighborhood fell into hard times. Along Cleveland, frayed plastic bags flap noisily from chain link fences. Payday loan shops compete for real estate with dialysis centers, and a for-profit blood bank announces, “New Donors Needed; We Pay Higher Rates.”

With any luck, the new Crosstown will change all that. According to an economic impact analysis commissioned by the City of Memphis, the development will create 1,000 construction jobs and inject about $50 million into the local economy. In the long run, the study suggests, the building will create more than 800 full-time jobs, which in turn will generate about $37 million in new wages annually.

Crosstown LLC recently applied for $115 million in building permits from the city, and construction is slated to begin in the fall 2014. For Cold Water Nolen, that day can’t come quickly enough.

“I don’t see enough dust coming from over there,” Nolen says with a laugh. “I want to hear some hammers banging! I want to see some skill saws!”

Inside, the Sears Crosstown is stripped and bare, bathed in a cold white light that seeps in through regularly spaced windows. Fifty years ago, this would have been a busy warehouse piled high with crates, workers coming and going. Now there is little to suggest their presence except the odd scrap of paper, an old invoice or a brittle timesheet, forgotten on the concrete floor.

On a tour, Sheehan walks up to a line of yellow caution tape that marks out a huge square in the empty warehouse.

“Where we’re standing just now,” Sheehan says, “will be one of the 10-story atriums. Just imagine that, a light well that cuts right through the building from roof to floor, and all the sunlight just pouring in.”

Sheehan is excited, and it’s not hard to see why. In just two years, this will be the CHC’s home base, housing, among other things, a clinic, a wellness center, a swimming pool, and administrative offices. It is also where they will begin to create what Sheehan calls “an epidemic of wellness.”

By that he means, of course, treating people’s illnesses. But it’s more than that. For Sheehan, a true prescription for wellness means caring for the whole person — mind, body, and spirit — and helping him or her to lead a long, happy life.

In practical terms, that means embedding in communities and engaging in lifelong relationships with patients through a variety of medical and wellness services — prenatal to palliative care and everything in between. Sheehan says that will also mean partnering with some of the new Crosstown’s other tenants, organizations like St. Jude Children’s Research Hospital and the Memphis Excel Center, an adult charter school run by Goodwill Industries.

“We now know,” Sheehan says, “that education is the single best predictor of whether people will lead a long and healthy life. We can’t know that and not do something about it. So why wouldn’t we partner with an adult charter school?”

At last, the tour has reached the roof. The day is intermittently sunny, with feathery clouds blown across a deep blue sky by a persistent southerly wind. The wind plucks at the sleeves of Sheehan’s short-sleeve, button-up shirt, and he squints out at the Memphis city skyline in the distance.

In the coming months, the Church Health Center will finalize the terms of their lease as well as the physical shape of its 160,000-square-foot space. They hope to open the doors of their Crosstown location in fall 2016. The move promises to be long and involved, but Sheehan maintains that the ‘how’ of it pales in importance when compared to the ‘why.’

“We want to give people a great start in life,” he says. “We want to give them the chance to have wonderful interactions with their parents, to read, to learn, to exercise freely, to eat well, to have fulfilling relationships, to play, to have enormous fun, and to be in a community where people look out for each other, regardless of our apparent differences.

“That’s how I would define epidemic of wellness,” Sheehan continues, “and I want Memphis and the Church Health Center to be at the epicenter.”


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