Boston Medical Center: A New Era of Exceptional Care without Exception

1. Boston Medical Center: A New Era of Exceptional Care without Exception

2. Boston Medical Center is a private hospital with a public mission • Boston Medical Center was formed in 1996 by a merger between 2 City of Boston public hospitals (Boston City and Boston Specialty and Rehabilitation) and a private, non-profit hospital affiliated with Boston university(University Hospital) • Created a private non-profit corporation designed to carry on both Boston City Hospital’s public and University Hospital’s academic missions BMC is to be the “centerpiece of the city’s public health network”. . .

3. We have maintained both our public and academic mission since our merger • OUR MISSION • To consistently provide accessible health care services to all in need of care, regardless of status or ability to pay • To preserve its commitment to vulnerable and underserved populations • To ensure the availability of a full-range of primary through tertiary medical programs • To enhance its role as a “major academic medical center, including support for bio-medical, public health, health medical education and basic science research”

4. We have extended the reach of our mission through our health plan and affiliated community health centers • Mission to provide Exceptional Care. Without Exception • Largest safety net organization in the Northeast USA • 496 beds with 26K inpatient admissions and 860K outpatient visits per year • Over $300M of research funding 18551 Faculty Practice Foundation • Multi-specialty academic group practice affiliated with BMC and BUSM • Over 700 physicians, 100 non-physician clinicians educators and researchers • Comprised of 18 clinical departments • 61 residency programs across all major sub-specialties & ~ 800 trainees 1994 • Coordinated integrated health care delivery network • Includes 13 community health centers, BMC, BU School of Medicine • Over 160K outpatients clinic visits in 2014 1995 • Mission to support BMC in providing care to vulnerable populations • Covers over 300K Medicaid and government subsidized lives (QHP) • Largest Medicaid Managed Care Organization (MMCO) in Massachusetts 1997 1 Boston University Medical Center Hospital (BUMCH) was founded in 1855, Boston City Hospital (BCH) in 1864.BMC was formed by a merger of the two in 1996.

5. Boston Medical Center and HealthNet’s community health centers interact on many levels • BMC provides more than $4mm in operating support to CHC’s each year • 13 BMC specialty depts. practice on-site • Hiring partnership with BMC’s Department of Family Medicine • Access to BMC’s clinical systems today – Epic EHR to be extended in 2016 • Shuttle busses transport patients and their families between BMC and CHC’s

6. BMC by the Numbers

7. The patients we serve at BMC are disproportionately minority and low income • ~70% are underserved minorities • ~60% black, ~10% Hispanic • > 50% have an annual household income below $20,400 (close to the federal poverty line for a family of 3)1 • ~30% do not speak English as their primary language

8. BMC has thriving research and teaching missions. • Our researchers received ~$120 million in grants in FY15…for a wide range of projects from care innovation to basic science research: • Brian Jack, MD to study and improve transitional care practices • Center for Regenerative Medicine to create 1st open access lung stem cell repository • Jack Maypole, MD to improve care for pediatric patients w/ complex health issues • Jerrold Ellner, MD to investigate and improve Tuberculosis treatment • Suzanne Mitchell, MD to study impact of diabetes self-management education • Traci Green, MD to help reduce opioid addiction and overdose in MA and RI • Our residents exceeded national averages in receiving patient safety education, reporting adverse events, and being involved in hospital quality goals

9. BMC Has Built Expertise in Addiction Medicine • OBOT (Office Based Opioid Treatment) - Developed by BMC staff, OBOT treats patients who are suffering from an opioid addiction in a primary care setting rather than a separate center, thereby making the care more attainable for significantly greater numbers of patients, and, in particular, underserved populations. • Project RESPECT - BMC is Boston's leader in addiction treatment during pregnancy. BMC offers an interdisciplinary treatment program involving high-risk obstetrical care, psychiatric evaluation and treatment, group counseling services, and individual support for addiction recovery and labor coaching. Project RESPECT team includes two obstetricians, a clinical nurse specialist, a psychiatrist and a nurse case manager and collaborates with pediatrics to coordinate care following delivery. • Project ASSERT - Developed by BMC and a national model, Project ASSERT (Alcohol & Substance Abuse Services, Education, and Referral to Treatment) is a team of health promotion advocates (HPAs) that offer substance abuse screening, brief intervention, information, and health resources to patients in the hospital’s emergency department. • Among first medical institutions to have accredited residency program in addiction medicine. • Chief Resident Immersion Training (CRIT) in Addiction Medicine - The CRIT Program is a four-day intensive training program for incoming chief residents and their faculty mentors on state-of-the-art methods in diagnosing, managing, and teaching about substance use disorders. • First Adolescent Medicine Addictions Fellowship Program • Over $70 Million in Federal Funding to BMC for Addiction Research Since 2003

10. In 2010, healthcare reform and the economic downturn took BMC to the brink of defaulting on our debt • Historically BMC received appropriate state funding to deliver on its mission of exceptional care without exception • MA health care reform and the economic downturn put significant pressure on BMC’s revenue • The dramatic reduction in revenue took BMC to the brink of defaulting on our debt in 2010 • BMC cut $100m out of our cost structure and maximized revenue: • Hiring freeze, very tight position control and revamping hiring process • Clinical and non-clinical supply expense reductions • Revenue Cycle improvements to maximize charge capture • Renegotiation of commercial payer rates

11. BMC completes one of biggest hospital turnarounds in the nation • Finished FY12 – FY15 with small but symbolically enormous surpluses ---and we were able to do this without cutting back on care. • Significant improvement in quality and patient satisfaction scores. • We know that access to high quality health care for our patients and our future depends our ability to get people healthy and keep them well. • Ongoing uncertainty in health care market and downward pressure on reimbursement rates will be mitigated by ongoing performance improvement efforts and clinical campus redesign plan.

12. 11 • Fully integrated, safety net health system • Strong primary care focus through Boston HealthNet • Demonstrated commitment to quality • Historic and ongoing investment in HIT • Strong financial & operational MD relationships • Critical mass of low income patients • Operates at-risk Medicaid health plan committed to system delivery reform which provides access and piece of mind for 315,000 people across the region

13. BMC uses simple, practical innovations to have an impact on tough medical and health care delivery issues… Substance Abuse Treatment and Prevention: Project ASSERT; Project RESPECT; OBOT Hunger: Therapeutic Food Pantry and Demonstration Kitchen Homelessness:Elders Living at Home, HUES to Home Children’s Health: Child Witness to Violence; Pieces of Home

14. …and we partner with our patient to improve their health Readmissions: Project RED Obesity: Prescribe a Bike; Outdoors Rx Premature Births and Maternal Health: Birth Sisters; Centering Pregnancy

15. …to move the needle on broader societal and community issues Urban Violence: Violence Intervention Advocacy Program (VIAP)

16. Thank You