Anthony L-T Chen, MD, MPH


California Endowment Scholar in Health Policy

Director of Health, Tacoma-Pierce County Health Department, Tacoma, WA

Dr. Chen has tirelessly advocated for community participation and the needs of minority populations as a family physician for 20 years. With strong interests in cross-cultural medicine, community-oriented primary care, and Asian and immigrant health issues, his projects have included hepatitis B and liver cancer screening and prevention in Asian and Pacific Islander communities, mental health of refugee and immigrant populations, and access to care. He has numerous publications and presentations and has received awards for his community service and work in hepatitis B.

Since completing the Fellowship, he has been Medical Director, Community Health and Director of Minority Health in the Department of Family Medicine of Cambridge Health Alliance. He is the Principal Investigator of the South Asian Community Outreach Project and is involved in developing immigrant, homeless, teen, occupational, and other community health initiatives. As Associate Medical Director of Malden Family Medicine Center, he was involved in planning and opening CHA’s newest and largest ambulatory facility, which integrates the Tufts University Family Medicine Residency Program. He continues to teach Harvard students and Tufts students and residents.

Dr. Chen earned his medical degree from Duke University in 1986 and completed residency training in Family Practice at the University of Cincinnati in 1989, where he was chief resident. After a Family Medicine Faculty Development Fellowship at Duke University in 1990, Dr. Chen served as Associate Director for Research and Faculty Development at Hinsdale Family Practice Residency for three years. After moving to Seattle, he was jointly Medical Director at a health department site and Assistant Director at the Swedish Family Practice Residency. From 1996 to 2005, he established a new office for a community health center primarily serving Asians and Pacific Islanders. He received his MPH from the Harvard School of Public Health (HSPH) as a CFHU Fellow in 2006.
Dr. Chen earned his medical degree from Duke University in 1986, and completed residency training in Family Practice at the University of Cincinnati in 1989, where he was chief resident. He completed the CFHU Fellowship, and received his M.P.H. from the Harvard School of Public Health in 2006.



Anticipating and Planning for Health Care Reform at a Community Health Center


To anticipate changes from health care reform, analyze the impact on financing and operations, and develop contingency plans and a strategic planning framework for a community health center in the Boston area.


Like many other states, Massachusetts has struggled with providing health care for all its residents. Health care reform passed in the late 1980s but was subsequently overturned. Incremental strategies have included Medicaid expansions and the Uncompensated Care Pool (UCP), which pays for services to low-income uninsured and underinsured patients. In 2005-2006, several forces converged to renew pressure for health care reform.

Dorchester House Multiservice Center (DHMSC) is a Federally Qualified Health Center (FQHC) and subgrantee Section 330-funded community health center. With health care reform, it anticipated a loss of over $1 Million in medical UCP payments and a total $2.4 Million loss on an $18 Million budget.


With DHMSC management and staff, the first step involved determining the likely health care legislation to be passed. The Center’s finances were reviewed and the impact on financing and operations projected. Clinic flow and operations were examined and systems and process barriers identified. Key issues to be addressed in contingency planning were identified. Lastly, a framework for strategic planning was proposed.


Both internal and external environments were assessed. The health care reform environment was dynamic but legislation was finally signed in April 2005. An analysis of competitive forces suggested that the largest threats can be expected from New Entrants and Purchasers. Observation and informal interviews of physicians and staff revealed structural, personnel, and workflow challenges. A Balanced Scorecard framework was suggested. Using Vision and Strategy statements drawn from old DHMSC strategic plans, examples of Objectives, Measures, and Initiatives for each of the Customer, Financial, Internal Business Process, and Learning and Growth Perspectives were proposed. Priorities should be guided by the analysis of competitive forces.


A Balanced Scorecard framework combined with an analysis of competitive forces can be helpful for a community health center like Dorchester House Multiservice Center to address anticipated changes from health care reform and internal operational challenges. While DHMSC revisits its strategic planning process, it should be initiating general internal processes to position itself.

Faculty Preceptor:

Joel M Abrams, President and CEO, Dorchester House Multi-Service Center