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.