The Critical Role of Safety Net Health Systems with Boston Medical Center CEO, Kate Walsh

There’s one major difference between Boston Medical Center (BMC)
and the other outstanding health systems in Boston. While being a
major part of a city and region that’s renowned for world-class
healthcare and innovation, BMC is the safety net
institution.

More than half of BMC’s patients live at or below the federal
poverty level, defined as annual income less than $20,000 for a
family of three, and one-third of medical encounters require
translator assistance of some kind. In other words, BMC is a big
and divers place. And it encompasses all the pieces of the health
system, from an academic medical center, to a network of
community health centers, and a Medicaid insurance plan that
services 400,000 people in Massachusetts and New Hampshire.

With this and more in one organization, BMC essentially has one
payer: Medicaid. So, to fulfill its mission of providing
exceptional care without exception, BMC is constantly seeking new
and innovative ways to care for the community and produce
healthcare services at a price the country can afford.

In this episode of Healthcare is Hard, Keith Figlioli talks to
BMC’s president and CEO, Kate Walsh, to learn about how she
approaches these challenges. Their conversation covers a number
of topics including:



Coronavirus magnifying public health necessities. During
a conversation which took place just at the U.S. began to
experience the spread of Covid-19, Kate shares her optimism
about preparedness, especially in Massachusetts, where
government, academic and health leaders have been collaborating
closely. But she also talks about how the pandemic magnifies
questions about where healthcare dollars are spent – more often
on the episode of illness rather than maintaining the public’s
health – and the need to think more comprehensively.


Strength in academics. As the primary teaching affiliate
for Boston University School of Medicine, Kate is extremely
encouraged by hundreds of young residents who, every year,
bring a drive and ambition to change the world. She also talks
about how being a system rooted in academics means that major
decisions are led by evidence, an approach that’s just as
valuable for tackling both clinical and social challenges. She
points to poverty and other social determinants and how they
need the same academic focus, rigor and research. For example,
one of the newest studies from BMC revealed just how difficult
it is to capture the full scope of social determinants through
screening.


Food as medicine. BMC has been ahead of the curve in
addressing the impact of food insecurity. Through a partnership
with the Greater Boston Food Bank, BMC has been writing
prescriptions for food for 15 years and now integrates the
process directly into the clinical workflow. Prescriptions for
food are included in a patient’s electronic medical record to
optimize for dietary needs and, just as importantly, confirm
that a patient has picked up their food. Writing a prescription
for food has also removed some of the stigma of visiting a food
pantry and has developed into a program that now serves 7,000
families per month.


Partnering on housing. Kate jokes that the last person
you want to build housing is a healthcare executive because
they can’t do it for less than $1 million a bed. But with that
awareness, BMC partners with the right organizations that can
direct investments where they help patients most. Kate notes
how this is more than simply providing a key: it’s
understanding where simple rehabs can help patients safely
transition home, to searching for answers about how people fell
into homelessness in order to help them get out.



To hear Kate and Keith talk about these topics and more, listen
to this episode of Healthcare is Hard: A Podcast for Insiders.