The Heart of Healthcare | A Digital Health Podcast Managing Medicaid in Challenging Times | Boston Medical Center CEO Dr. Alastair Bell
Aug 18, 2025
Dr. Alastair Bell, President and CEO of Boston Medical Center, shares insights from his work with underserved populations and managing a large Medicaid plan. He discusses the critical role of essential hospitals in healthcare and the ongoing financial challenges they face. The impact of the 340B drug pricing program on safety-net hospitals is explored, alongside the promise and pitfalls of integrating AI in healthcare, particularly the risks of exacerbating inequities. Bell advocates for strategic investments in Medicaid to improve outcomes and manage budgets effectively.
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Essential Hospital Model
- Boston Medical Center (BMC) reframes 'safety-net' as an "essential" system focused on lower-income populations and academic medicine.
- BMC combines a medical center, FQHC network, physician group, and a large Medicaid health plan covering ~40% of state Medicaid enrollees.
State Dependence And Influence
- Large Medicaid provider status gives BMC policy influence but creates heavy dependence on state finances and budgeting decisions.
- State budget exposure means provider financial health closely tracks state fiscal pressures and policy shifts.
ACO Reform Revealed Risk Gaps
- Massachusetts' Medicaid ACO reforms aligned payers and providers by assigning Medicaid patients into plan-linked ACOs, shifting incentives toward population health.
- That alignment revealed inadequate risk adjustment for complex needs like homelessness, requiring state-provider negotiation and model refinement.