4A (Expenses $ 1868140233 including grants of $ 0) (Revenue $ 1952312192)
THE STATUTE THAT AUTHORIZED THE CREATION OF BOSTON MEDICAL CENTER REQUIRES IT TO SERVE ALL POPULATIONS. BMC IS A PRIVATE, NOT-FOR-PROFIT, 514-LICENSED BED, URBAN ACADEMIC MEDICAL CENTER WHICH EMPHASIZES COMMUNITY-BASED, ACCESSIBLE CARE AND THE MISSION TO PROVIDE CONSISTENTLY ACCESSIBLE HEALTH SERVICES TO ALL IN NEED OF CARE REGARDLESS OF STATUS AND ABILITY TO PAY. BMC IS THE LARGEST SAFETY NET HOSPITAL IN NEW ENGLAND AND PROVIDES A FULL SPECTRUM OF PEDIATRIC AND ADULT CARE SERVICES FROM PRIMARY TO FAMILY MEDICINE TO ADVANCED SPECIALTY CARE. BOSTON MEDICAL CENTER IS DEDICATED TO PROVIDING ACCESSIBLE HEALTH CARE. NEARLY 75 PERCENT OF OUR PATIENTS COME FROM UNDERSERVED POPULATIONS, SUCH AS THE LOW-INCOME AND ELDERLY, WHO RELY ON GOVERNMENT PAYERS SUCH AS MEDICAID, THE HEALTH SAFETY NET, AND MEDICARE FOR THEIR COVERAGE; 27 PERCENT DO NOT SPEAK ENGLISH AS A PRIMARY LANGUAGE. TO ADDRESS THE HEALTH NEEDS OF DIVERSE PATIENT POPULATIONS, BMC PROVIDES A WIDE RANGE OF SERVICES BEYOND THE TRADITIONAL MEDICAL MODEL. THESE PROGRAMS, INCLUDING PATIENT NAVIGATION AND A FOOD PANTRY, HELP TO REDUCE BARRIERS TO ACCESS TO HEALTH SERVICES AND ELIMINATE DISPARITIES IN HEALTH CARE AMONG VARIOUS POPULATIONS THAT BMC SERVES.

4B (Expenses $ 27465409 including grants of $ 27465409) (Revenue $ 0)
BOSTON MEDICAL CENTER PROVIDES RESEARCH SUPPORT TO ORGANIZATIONS WITHIN THE US.

4C (Expenses $ 1387981 including grants of $ 1387981) (Revenue $ 0)
BOSTON MEDICAL CENTER PROVIDES RESEARCH SUPPORT TO FOREIGN ORGANIZATIONS.

PART V, SECTION A:
BOSTON MEDICAL CENTER IS LICENSED BY THE MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH TO OPERATE A HOSPITAL AT ONE BOSTON MEDICAL CENTER PLACE, BOSTON, MA 02118. BOSTON MEDICAL CENTER IS (1) A LICENSED HOSPITAL, (2) PROVIDES GENERAL MEDICAL AND SURGICAL TREATMENT, (3) IS A TEACHING HOSPITAL, AND (4) OPERATES AN ER 24 HOURS PER DAY. THE MAIN CAMPUS OF BOSTON MEDICAL CENTER IS LOCATED AT MENINO PAVILION, 830-840 HARRISON AVENUE, BOSTON, MA 02118. AN INPATIENT SATELLITE HOSPITAL KNOWN AS BMC BROCKTON BEHAVIORAL HEALTH CENTER IS LOCATED AT 34 NORTH PEARL STREET, BROCKTON, MA 02301. A SECOND CAMPUS LOCATION AT 249 RIVER STREET, MATTAPAN, MA 02126 IS LISTED ON BOSTON MEDICAL CENTER'S DEPARTMENT OF PUBLIC HEALTH LICENSE; HOWEVER, THIS LOCATION HAS BEEN OUT OF SERVICE SINCE 1996. THE FOLLOWING OUTPATIENT SATELLITES ARE ALSO LISTED ON BOSTON MEDICAL CENTER'S DEPARTMENT OF PUBLIC HEALTH HOSPITAL LICENSE:1. CODMAN SQUARE HEALTH CENTER2. BRIGHTON HIGH SCHOOL STUDENT HEALTH CENTER3. BOSTON MEDICAL CENTER RADIOLOGY AT RYAN CENTER BOSTON UNIVERSITY4. EAST BOSTON NEIGHBORHOOD HEALTH CENTER SATELLITE EMERGENCY FACILITY (10 GOVE STREET)5. DOTHOUSE HEALTH6. MADISON PARK HIGH SCHOOL STUDENT HEALTH CENTER7. JEREMIAH E. BURKE STUDENT HEALTH CENTER8. GREATER ROSLINDALE MEDICAL & DENTAL9. LATIN ACADEMY STUDENT HEALTH CENTER10. TECHBOSTON ACADEMY SCHOOL HEALTH CENTER11. BOSTON MEDICAL CENTER RADIOLOGY AT UPHAM'S CORNER HEALTH CENTER12. MURIEL SNOWDEN INTERNATIONAL HIGH SCHOOL HEALTH CENTER13. SOUTH BOSTON COMMUNITY HEALTH CENTER - 386 WEST BROADWAY14. BOSTON MEDICAL CENTER SCHOOL-BASED HEALTH CENTER AT BOSTON COMMUNITY LEADERSHIP ACADEMY15. SOUTH BOSTON COMMUNITY HEALTH CENTER - 409 WEST BROADWAY16. EAST BOSTON NEIGHBORHOOD HEALTH CENTER - 20 MAVERICK SQUARE17. EAST BOSTON NEIGHBORHOOD HEALTH CENTER - 79 PARIS STREET18. BOSTON MEDICAL CENTER RADIOLOGY AT WHITTIER STREET HEALTH CENTER19. EBHS SCHOOL BASED HEALTH CENTER20. WINTHROP COMMUNITY HEALTH CENTER21. SOUTH BOSTON COMMUNITY HEALTH CENTER SEAPORT PRIMARY CARE22. BOSTON MEDICAL CENTER - DEPARTMENT OF FAMILY MEDICINE - MELNEA CASS BOULEVARD23. BOSTON MEDICAL CENTER - CROSSTOWN - 801 MASSACHUSETTS AVENUE24. BMC REHABILITATION SERVICES, PHYSICAL AND OCCUPATIONAL THERAPY, HYDE PARK25. SOUTH END COMMUNITY HEALTH CENTER26. SOUTH END COMMUNITY HEALTH CENTER, DR. GERALD HASS CENTER27. CURBSIDE CARE PROGRAM AT BOSTON MEDICAL CENTER (MOBILE UNIT)28. BMC REHABILITATION, ORTHOPEDICS & IMAGING - 39B DISTRICT AVENUE BOSTON MEDICAL CENTER IS LICENSED BY THE DEPARTMENT OF MENTAL HEALTH FOR INPATIENT PSYCHIATRY SERVICES LOCATED AT BMC BROCKTON BEHAVIORAL HEALTH CENTER, AN INPATIENT SATELLITE LOCATED AT 34 NORTH PEARL STREET, BROCKTON, MA 02301.

BOSTON MEDICAL CENTER
PART V, SECTION B, LINE 5: QUALITATIVE DISCUSSIONS AND COMMUNITY ENGAGEMENTTHE COMMUNITY ENGAGEMENT WORK GROUP INCLUDES 24 MEMBERS REPRESENTING A RANGE OF ORGANIZATIONS, INCLUDING HEALTH CENTERS, LOCAL PUBLIC HEALTH, COMMUNITY DEVELOPMENT, COMMUNITY-BASED ORGANIZATIONS, AND HOSPITALS. THE WORK GROUP'S CHARGE IS TO PROVIDE GUIDANCE ON THE APPROACH TO COMMUNITY ENGAGEMENT, INPUT ON PRIMARY DATA COLLECTIONS METHODS, AND SUPPORT WITH LOGISTICS FOR PRIMARY DATA COLLECTION. THE COLLABORATIVE'S COMMUNITY ENGAGEMENT WORK GROUP LED EFFORTS TO GAIN INSIGHT INTO COMMUNITY NEEDS AND STRENGTHS AS WELL AS PRIORITIES FROM COMMUNITY LEADERS AND RESIDENTS, ESPECIALLY AMONG THOSE WHERE THERE HAS BEEN A GAP IN REPRESENTATION IN PREVIOUS PROCESSES. ALTOGETHER, THEY FACILITATED 29 VIRTUAL AND IN-PERSON FOCUS GROUP DISCUSSIONS WITH A TOTAL OF 309 RESIDENTS WHO HAVE BEEN DISPROPORTIONATELY BURDENED BY SOCIAL, ECONOMIC, AND HEALTH CHALLENGES INCLUDING: YOUTH AND ADOLESCENTS, OLDER ADULTS, PERSONS WITH DISABILITIES, LOW-RESOURCED INDIVIDUALS AND FAMILIES, LGBTQIA+ POPULATIONS, RACIALLY/ETHNICALLY DIVERSE POPULATIONS (E.G., AFRICAN AMERICAN, LATINO, HAITIAN, CAPE VERDEAN, VIETNAMESE, CHINESE), LIMITED-ENGLISH SPEAKERS, IMMIGRANT AND ASYLEE COMMUNITIES, FAMILIES AFFECTED BY INCARCERATION AND/OR VIOLENCE, AND VETERANS. SOME FOCUS GROUPS WERE CONDUCTED IN LANGUAGES OTHER THAN ENGLISH, INCLUDING SPANISH, CHINESE, AND VIETNAMESE.COLLABORATIVE MEMBERS CONDUCTED KEY INFORMANT INTERVIEWS WITH 62 INDIVIDUALS. THESE REPRESENTED A CROSS-SECTION OF SECTORS TO IDENTIFY AREAS OF ACTION AND PERSPECTIVES ON THE COMMUNITY. THESE INTERVIEWEES INCLUDED LEADERS AND STAFF FROM PUBLIC HEALTH, HEALTH CARE, BEHAVIORAL HEALTH, THE FAITH COMMUNITY, IMMIGRANT SERVICES, HOUSING ORGANIZATIONS, ECONOMIC DEVELOPMENT, COMMUNITY DEVELOPMENT, RACIAL JUSTICE ORGANIZATIONS, SOCIAL SERVICE ORGANIZATIONS, EDUCATION, COMMUNITY COALITIONS, THE BUSINESS COMMUNITY, CHILDCARE CENTERS, ELECTED GOVERNMENT OFFICES, AND OTHERS.ADDITIONALLY, COLLABORATIVE MEMBERS CONDUCTED FOUR 90-MINUTE VIRTUAL COMMUNITY LISTENING SESSIONS IN JANUARY 2022. A TOTAL OF 122 COMMUNITY MEMBERS PARTICIPATED IN THESE FOUR SESSIONS. THESE SESSIONS OCCURRED MID-WAY INTO THE CHNA PROCESS AND PROVIDED AN OPPORTUNITY TO GATHER FEEDBACK AND INSIGHTS ON PRELIMINARY DATA FINDINGS AND POTENTIAL PRIORITIES AT THIS POINT IN TIME. DURING THESE SESSIONS, COLLABORATIVE MEMBERS SHARED PRELIMINARY THEMES FROM FOCUS GROUPS, INTERVIEWS, AND THE REVIEW OF SECONDARY DATA. THE PARTICIPANTS DISCUSSED THEIR REACTIONS AND FEEDBACK TO THESE PRELIMINARY FINDINGS IN SMALL GROUPS AND IDENTIFIED AREAS THAT WERE THEIR HIGHEST PRIORITY FOR ACTION.TO DEEPEN UNDERSTANDING OF ISSUES THAT WERE SALIENT TO RESPONDENTS, INTERVIEW, FOCUS GROUP, AND COMMUNITY LISTENING SESSION DISCUSSION GUIDES USED OPEN-ENDED QUESTIONS AND DID NOT ASK ABOUT SPECIFIC TOPICS. COMMUNITY ENGAGEMENT WORK GROUP MEMBERS AND THEIR PARTNERS CONDUCTED THE FOCUS GROUPS AND INTERVIEWS, AND THEN SUMMARIZED THE KEY THEMES FROM THE DISCUSSIONS THEY FACILITATED. THESE SUMMARIES WERE THEN ANALYZED TO IDENTIFY COMMON THEMES AND SUB-THEMES ACROSS POPULATION GROUPS AS WELL AS UNIQUE CHALLENGES AND PERSPECTIVES IDENTIFIED BY POPULATIONS AND SECTORS, WITH AN EMPHASIS ON DIVING DEEP INTO THE ROOT CAUSES OF INEQUITIES. FREQUENCY AND INTENSITY OF DISCUSSIONS ON A SPECIFIC TOPIC WERE KEY INDICATORS USED FOR EXTRACTING MAIN THEMES.

BOSTON MEDICAL CENTER
PART V, SECTION B, LINE 6A: BOSTON MEDICAL CENTER (BMC) CONDUCTED THE CHNA WITH THE FOLLOWING HOSPITAL FACILITIES: BETH ISRAEL DEACONESS MEDICAL CENTER, BOSTON CHILDREN'S HOSPITAL, BRIGHAM AND WOMEN'S FAULKNER HOSPITAL, BRIGHAM AND WOMEN'S HOSPITAL, DANA-FARBER CANCER INSTITUTE, MASSACHUSETTS EYE AND EAR INFIRMARY, MASSACHUSETTS GENERAL HOSPITAL, AND TUFTS MEDICAL CENTER.

BOSTON MEDICAL CENTER
PART V, SECTION B, LINE 6B: BOSTON MEDICAL CENTER CONDUCTED THE CHNA WITH THE FOLLOWING ORGANIZATIONS: BOSTON HEALTH CARE FOR THE HOMELESS PROGRAM, BOSTON PUBLIC HEALTH COMMISSION, JAMAICA PLAIN NEIGHBORHOOD DEVELOPMENT CORPORATION, COMMUNITY LABOR UNITED, FENWAY COMMUNITY HEALTH CENTER, HEALTH LEADS, MADISON PARK DEVELOPMENT CORPORATION, MASSACHUSETTS LEAGUE OF COMMUNITY HEALTH CENTERS, UPHAM'S CORNER HEALTH CENTER, AND URBAN EDGE.

BOSTON MEDICAL CENTER
PART V, SECTION B, LINE 11: UNWAVERING IN OUR COMMITMENT TO ADDRESS THE HEALTH NEEDS OF OUR COMMUNITY, BMC PROVIDES A WIDE RANGE OF PROGRAMS BEYOND THE TRADITIONAL MEDICAL MODEL. CORE TO FULFILLING OUR PUBLIC HEALTH MISSION AND CONSISTENT WITH THE CHNA FINDINGS, THE GOALS OF OUR COMMUNITY BENEFITS PROGRAM ARE TO IMPROVE ACCESS TO HEALTH SERVICES AND IMPROVE HEALTH OUTCOMES FOR UNDER-RESOURCED POPULATIONS IN OUR COMMUNITY. KEY FINDINGS THAT EMERGED FROM THE CHNA INCLUDED HEALTH CARE ACCESS AND UTILIZATION, CHRONIC DISEASES AND RISK FACTORS, MENTAL HEALTH AND SUBSTANCE USE DISORDER, VIOLENCE, HOUSING AFFORDABILITY, ENVIRONMENTAL HEALTH. FOR DETAILED INFORMATION ABOUT EACH OF THE PROGRAMS AND INITIATIVES THAT ADDRESSED THESE NEEDS LAST YEAR, PLEASE SEE SCHEDULE H, PART VI, SUPPLEMENTAL INFORMATION, PROMOTION OF COMMUNITY HEALTH BELOW.

BOSTON MEDICAL CENTER
PART V, SECTION B, LINE 13H: SCHEDULE H, PART V, SECTION B, LINE 13AFOR PATIENTS WHO FALL OUTSIDE COMMONWEALTH ASSISTANCE PROGRAMS, PATIENTS ARE CHARGED AT THE SAME LEVELS AS INSURERS ARE CHARGED; HOWEVER, THEY ARE OFFERED A PROMPT-PAY DISCOUNT OF 40% (REGARDLESS OF INCOME LEVEL, ETC.) IF THE PAYMENTS ARE MADE WITHIN THE FIRST 30 DAYS FROM SERVICE.SCHEDULE H, PART V, SECTION B, LINE 13HBY THE DEFINITION OF BMC'S FINANCIAL ASSISTANCE POLICY, PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE HAVE APPLIED FOR ONE OF THE COMMONWEALTH'S FINANCIAL ASSISTANCE PROGRAMS (CONNECTORCARE, MEDICAID, OR HEALTH SAFETY NET) OR HAVE BEEN PROVIDED URGENT/EMERGENT SERVICES. IN THOSE INSTANCES, PATIENTS ARE VIEWED AS UNABLE TO PAY FOR THESE CHARGES AND THE HOSPITAL SUBMITS THE CHARGE FOR REIMBURSEMENT FROM THE HEALTH SAFETY NET.

PART V, SECTION B
THE PREVIOUS CHNA WAS CONDUCTED DURING FISCAL 2018-2019, WITH THE APPROVAL OF THE CHNA IN 2019 AND THE APPROVAL OF THE ASSOCIATED IMPLEMENTATION STRATEGY IN EARLY FISCAL 2020. THE CURRENT CHNA WAS APPROVED IN 2022 AND THE ASSOCIATED IMPLEMENTATION STRATEGY WAS THEN APPROVED IN EARLY FISCAL 2023.

PART I, LINE 3C:
FOR PATIENTS WHO FALL OUTSIDE COMMONWEALTH ASSISTANCE PROGRAMS, PATIENTS ARE CHARGED AT THE SAME LEVELS AS INSURERS ARE CHARGED; HOWEVER, THEY ARE OFFERED A PROMPT-PAY DISCOUNT OF 40% (REGARDLESS OF INCOME LEVEL, ETC.) IF THE PAYMENTS ARE MADE WITHIN THE FIRST 30 DAYS FROM SERVICE.INTRODUCTIONTHE STATUTE THAT CREATED BOSTON MEDICAL CENTER (BMC) REQUIRES IT TO SERVE ALL POPULATIONS. BMC IS A PRIVATE, NOT-FOR-PROFIT, 514-BED, URBAN ACADEMIC MEDICAL CENTER. IT EMPHASIZES COMMUNITY-BASED, ACCESSIBLE CARE AND IS GROUNDED BY ITS MISSION TO PROVIDE CONSISTENTLY ACCESSIBLE HEALTH SERVICES TO ALL IN NEED OF CARE, REGARDLESS OF STATUS AND ABILITY TO PAY. BMC IS THE LARGEST SAFETY-NET HOSPITAL IN NEW ENGLAND AND PROVIDES A FULL SPECTRUM OF PEDIATRIC AND ADULT CARE SERVICES FROM PRIMARY TO FAMILY MEDICINE TO ADVANCED SPECIALTY CARE. DRIVEN BY THE SOCIAL DETERMINANTS OF HEALTH THAT IMPACT HEALTH OUTCOMES AMONG OUR PATIENTS AND COMMUNITY, THE GOAL OF OUR COMMUNITY HEALTH IMPROVEMENT ACTIVITIES, OR COMMUNITY BENEFITS, IS TO IMPROVE COMMUNITY HEALTH. APPROXIMATELY 59% OF OUR PATIENTS ARE FROM GROUPS THAT HAVE BEEN ECONOMICALLY AND SOCIALLY MARGINALIZED AND WHO RELY ON GOVERNMENT PAYERS, SUCH AS MEDICAID, THE HEALTH SAFETY NET, AND MEDICARE, FOR THEIR COVERAGE. 32% OF OUR PATIENTS DO NOT SPEAK ENGLISH AS A PRIMARY LANGUAGE. TO ADDRESS THE HEALTH NEEDS OF ITS DIVERSE PATIENT POPULATION, BMC PROVIDES A WIDE RANGE OF SERVICES BEYOND THE TRADITIONAL MEDICAL MODEL. THESE PROGRAMS, INCLUDING BUT NOT LIMITED TO PATIENT NAVIGATION AND A FOOD PANTRY, HELP REDUCE BARRIERS TO ACCESSING HEALTH SERVICES AND ULTIMATELY ELIMINATE INEQUITIES IN HEALTHCARE AMONG THE PATIENT POPULATIONS BMC SERVES. WITH MORE THAN 25,816 ADMISSIONS AND 1 MILLION PATIENT VISITS PER YEAR, BMC PROVIDES A COMPREHENSIVE RANGE OF INPATIENT, CLINICAL AND DIAGNOSTIC SERVICES IN MORE THAN 70 AREAS OF MEDICAL SPECIALTIES AND SUBSPECIALTIES. THE LARGEST 24-HOUR LEVEL I TRAUMA CENTER IN NEW ENGLAND, BMC'S EMERGENCY DEPARTMENT HAS MORE THAN 139,577 PATIENT VISITS ANNUALLY. BMC SERVES THE URBAN COMMUNITY OF GREATER BOSTON. THE MAJORITY OF THE COMMUNITIES THAT BMC SERVES ARE LOCATED IN BOSTON CENSUS TRACTS THAT ARE FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREAS/POPULATIONS. ALTHOUGH MASSACHUSETTS' UNIVERSAL CARE ENABLES INDIVIDUALS TO SEEK CARE AT ANY HOSPITAL, BMC REMAINS THE LARGEST SAFETY NET PROVIDER IN BOSTON AND NEW ENGLAND. AN ESTIMATED 18% OF BOSTON RESIDENTS LIVE BELOW THE FEDERAL POVERTY LEVEL. THE IMPLEMENTATION OF UNIVERSAL CARE DID NOT REDUCE THE REAL NUMBER OR PERCENT OF UNDERSERVED COMMUNITIES SERVED BY BMCACCORDING TO THE MASSACHUSETTS HEALTH INSURANCE SURVEY'S 2020 RESEARCH BRIEF, AN ESTIMATE OF 2.9% OF RESIDENTS WERE UNINSURED AND 92% OF MASSACHUSETTS RESIDENTS HAD COVERAGE DURING THE SURVEY OF WHICH 55.9% REPORTED EMPLOYER-SPONSORED INSURANCE (ESI) AND 43% REPORTED OTHER NON-ESI. STILL, INSURED RESIDENTS IN FAIR OR POOR HEALTH HAVE HIGH RATES OF AFFORDABILITY ISSUES WITH 25.5% REPORTING CHALLENGES PAYING THEIR MEDICAL BILLS. OF BMC'S PATIENTS IN 2022, MEDICAID MAKES UP 46.46%, MEDICARE IS 22.63%, UNINSURED IS 2.38%, PRIVATE COMMERCIAL IS 27.64%, WITH THE REMAINDER OF 0.89% ACCOUNTED FOR BY OTHER GOVERNMENT AND WORKERS COMP. PART I, LINE 5C:THE ORGANIZATION'S CHARITY CARE DID NOT EXCEED BUDGETED AMOUNTS. THE BUDGETED AMOUNTS ARE PREDICTED CHARITY CARE AMOUNTS. THE ORGANIZATION DID NOT HAVE ANY EXCESS FUNDS.

PART I, LINE 7:
FOR THE CALCULATION OF COSTS OF CHARITY CARE (LINE 7A) & MEDICAID COST (LINE 7B), AN OVERALL COST TO CHARGE RATIO WAS USED. A COST TO CHARGE RATIO IS DETERMINED BY DIVIDING THE TOTAL CHARGES FOR ALL SERVICES INTO THE TOTAL COST OF PROVIDING THE SERVICES. THE RATIO IS MULTIPLIED BY THE CHARGES FOR CHARITY CARE AND MEDICAID TO OBTAIN THEIR RESPECTIVE COSTS.FOR THE CALCULATION OF COMMUNITY HEALTH IMPROVEMENT SERVICES (LINE 7E) DISCRETE COSTING WAS USED. FOR THE CALCULATION OF HEALTH PROFESSIONS EDUCATION COST (LINE 7F) THE CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS) COST ALLOCATION METHODOLOGY (CMS FORM 2552) WAS USED. CMS FORM 2552 IS A REQUIRED ANNUAL FILING TO THE FEDERAL GOVERNMENT.PART I, LINE 7, COLUMN F:THE AMOUNT OF BAD DEBT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE WAS $0.DURING FISCAL YEAR 2022, BMC RECOGNIZED NET FAVORABLE SETTLEMENTS FROM MEDICARE, MEDICAID, WELLSENSE, BLUE CROSS AND OTHER PAYORS RELATED TO PRIOR YEARS OF APPORXIMATELY $6,300,000.

PART II, COMMUNITY BUILDING ACTIVITIES:
BMC CONTRIBUTES TO THE COMMUNITY THROUGH ITS PAYMENT OF LINKAGE FEES TO THE CITY OF BOSTON. THOSE LINKAGE FEES FUND SUPPORT PROGRAMS FOR AFFORDABLE HOUSING AND NEIGHBORHOOD HEALTH CARE. BMC ALSO PROVIDES SUBSIDIES TO BOSTON HEALTHNET, WHICH SUPPORTS COMMUNITY-BASED SERVICES.PHYSICAL IMPROVEMENTS AND HOUSING:ACCORDING TO THE DEVELOPMENT IMPACT PROJECT AGREEMENT FOR THE MOAKLEY CENTER ADDITION AND INPATIENT BUILDING PHASE I TRANSPORT BRIDGE PROJECT BETWEEN BOSTON MEDICAL CENTER AND THE BOSTON REDEVELOPMENT AUTHORITY, DATED MAY 5, 2014, BMC AGREES TO PAY LINKAGE FEES OF $25,746, ENDING IN 2022 TO THE NEIGHBORHOOD JOBS TRUST.SOUTH BOSTON COMMUNITY HEALTH CENTER, A COMMUNITY HEALTH CENTER AFFILIATED WITH BOSTON MEDICAL CENTER, RECEIVED A TOTAL OF $600,000 FROM BOSTON MEDICAL CENTER DURING 2016 IN THE FORM OF A LOAN THAT WAS ORIGINATED EFFECTIVE JANUARY 26, 2016. COMMENCING JANUARY 26, 2017, BOSTON MEDICAL CENTER AGREED TO FORGIVE TEN PERCENT OF THE ORIGINAL PRINCIPAL AMOUNT OF THE NOTE EACH YEAR, WITH THE RESULT THAT THE ENTIRE LOAN OUTSTANDING COULD BE FORGIVEN IN TEN YEARS. IN FISCAL YEAR 2018, BOSTON MEDICAL CENTER INCURRED AN EXPENSE OF $540,000 TO FULLY RESERVE AGAINST THE NOTE RECEIVABLE AS IT WAS DETERMINED THAT NO FUTURE PAYMENTS WERE ANTICIPATED ON THE LOAN. THE LOAN AND RESPECTIVE RESERVE IS ACCOUNTED FOR ON THE BALANCE SHEET, ANNUALLY, EACH IS REDUCED BY THE FORGIVABLE AMOUNT.CAPITAL INVESTMENTS IN BOSTON HEALTHNET:WHILE THE NEED FOR COMMUNITY-BASED SERVICES CONTINUES TO GROW, IT HAS BECOME INCREASINGLY DIFFICULT FOR COMMUNITY HEALTH CENTERS TO MEET THE DEMAND. REIMBURSEMENT OFTEN DOES NOT COVER THE FULL COST OF CARING FOR THE COMPLEX NEEDS OF HEALTH CENTERS' DIVERSE PATIENT POPULATION. COMPOUNDING THIS PROBLEM, IN THE MID-LATE 1990S, MANY HEALTH CENTERS FOUND THEMSELVES OPERATING IN FACILITIES THAT WERE IN DESPERATE NEED OF RESTORATION OR EXPANSION. COSTLY INFORMATION TECHNOLOGY UPGRADES WERE ALSO REQUIRED TO ENHANCE MANAGEMENT EFFICIENCIES AND PATIENT CARE. IN RESPONSE TO THE HEALTH CENTERS' NEEDS, BMC PROVIDED APPROXIMATELY $15.8 MILLION IN OPERATING SUPPORT TO THE BOSTON HEALTHNET HEALTH CENTERS EACH YEAR. OTHER NET SUBSIDIES INCLUDE MOSTLY ECONOMIC DEVELOPMENT, COMMUNITY HEALTH IMPROVEMENT AND WORKFORCE DEVELOPMENT.

PART III, LINE 2:
SCHEDULE H, PART III, LINE 3 REPORTS BAD DEBT EXPENSE AT COST. PATIENT PAYMENTS ON ACCOUNTS THAT ARE WRITTEN OFF TO BAD DEBT ARE RECORDED AS A BAD DEBT RECOVERY, REDUCING THE GROSS BAD DEBT WRITE-OFF.

PART III, LINE 3:
THE ORGANIZATION ESTIMATED $0 OF THE ORGANIZATION'S BAD DEBT EXPENSE (AT COST) AS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY DUE TO THE MANNER IN WHICH THE DETAIL OF THE BAD DEBT EXPENSE IS PROCESSED IN ITS SYSTEM.

PART III, LINE 4:
THE ORGANIZATION'S BAD DEBT EXPENSE IS ADDRESSED IN FOOTNOTES 2(S)(IV) AND 1(U) FOUND ON PAGES 17 AND 18 OF ITS MOST RECENT AUDITED FINANCIAL STATEMENTS.

PART III, LINE 8:
MEDICARE ALLOWABLE COSTS OF $179,836,703 WERE CALCULATED USING THE CMS FORM 2552 METHODOLOGY OF DETERMINING MEDICARE COSTS. THIS USES THE STEP DOWN METHOD OF DETERMINING FULLY-ALLOCATED COSTS BY DISTINCT CLINICAL COST CENTERS AS DEFINED BY CMS. THESE FULLY-ALLOCATED COSTS ARE APPLIED AGAINST TOTAL CHARGES TO CALCULATE A RATIO OF COST TO CHARGES. THE RATIO OF COST TO CHARGES IS APPLIED TO MEDICARE CHARGES BY DISTINCT CLINICAL COST CENTERS TO DETERMINE THE MEDICARE COSTS.

PART III, LINE 9B:
POPULATIONS EXEMPT FROM COLLECTION ACTIVITIESTHE HOSPITAL WILL NOT REQUIRE PRE-ADMISSION OR PRE-TREATMENT DEPOSITS FROM INDIVIDUALS REQUIRING EMERGENCY SERVICES OR DETERMINED TO BE LOW-INCOME. THE FOLLOWING INDIVIDUALS AND PATIENT POPULATIONS ARE EXEMPT FROM ANY COLLECTION OR BILLING PROCEDURES BEYOND THE INITIAL BILL PURSUANT TO STATE REGULATIONS:A. PATIENTS WITH MASSHEALTH, EMERGENCY AID TO THE ELDERLY, DISABLED AND CHILDREN OF THE DISABLED, CHILDREN, AND FULL HEALTH SAFETY NET OR PATIENTS WITH COUNTY MEDICAL SERVICES PROGRAM OR PARTIAL HEPATOSPLENOMEGALY BELOW THE PROGRAM-DEFINED FEDERAL POVERTY LEVEL OR MODIFIED ADJUSTED GROSS INCOME GUIDELINE, OR OTHERS DETERMINED TO BE LOW-INCOME PATIENTS ARE EXEMPT FROM COLLECTION SUBJECT TO:1. THE HOSPITAL MAY SEEK COLLECTION ACTION AGAINST ANY LOW-INCOME PATIENT FOR THEIR REQUIRED CO-PAYMENTS AND DEDUCTIBLES THAT ARE SET FORTH BY EACH SPECIFIC PROGRAM.2. THE HOSPITAL MAY SEEK COLLECTION TO ALLOW A PATIENT TO MEET THE COMMONWEALTH ONE-TIME DEDUCTIBLE.3. THE HOSPITAL MAY ALSO INITIATE BILLING OR COLLECTION FOR A LOW-INCOME PATIENT WHO ALLEGES THAT HE OR SHE IS A PARTICIPANT IN A FINANCIAL ASSISTANCE PROGRAM THAT COVERS THE COSTS OF THE HOSPITAL SERVICES, BUT WHO FAILS TO PROVIDE PROOF OF HIS OR HER PARTICIPATION AND WHOSE INSURANCE CANNOT BE VERIFIED IN THE HOSPITAL ELIGIBILITY SYSTEM. UPON RECEIPT OF SATISFACTORY PROOF THAT A PATIENT IS A PARTICIPANT IN A FINANCIAL ASSISTANCE PROGRAM, INCLUDING RECEIPT OR VERIFICATION FROM THE INSURANCE CARRIER, THE HOSPITAL SHALL CEASE ITS BILLING OR COLLECTION ACTIVITIES.4. THE HOSPITAL MAY CONTINUE COLLECTION ACTION ON ANY LOW-INCOME PATIENT FOR SERVICES RENDERED PRIOR TO THE LOW-INCOME PATIENT DETERMINATION, PROVIDED THAT THE CURRENT LOW-INCOME PATIENT STATUS HAS BEEN TERMINATED OR EXPIRED. HOWEVER, ONCE A PATIENT IS DETERMINED ELIGIBLE AND ENROLLED IN THE HEALTH SAFETY NET, MASSHEALTH, OR CERTAIN FINANCIAL ASSISTANCE PROGRAMS, THE HOSPITAL WILL CEASE COLLECTION ACTIVITY FOR SERVICES PROVIDED PRIOR TO THE BEGINNING OF THE PATIENT'S ELIGIBILITY.5. THE HOSPITAL MAY SEEK COLLECTION ACTION AGAINST ANY OF THE PATIENTS PARTICIPATING IN THE PROGRAMS LISTED ABOVE FOR NON-COVERED SERVICES THAT THE PATIENT HAS AGREED TO BE RESPONSIBLE FOR, PROVIDED THAT THE HOSPITAL OBTAINED THE PATIENT'S PRIOR WRITTEN CONSENT TO BE BILLED FOR THE SERVICE.

PART VI, LINE 3:
THE HOSPITAL POSTS NOTICES OF AVAILABILITY OF FINANCIAL ASSISTANCE IN: I. INPATIENT, CLINIC, AND EMERGENCY DEPARTMENT AND WAITING AREAS; II. PATIENT FINANCIAL COUNSELOR AREAS; III. CENTRAL ADMISSION/REGISTRATION AREAS; IV. BUSINESS OFFICE AREAS THAT ARE OPEN TO PATIENTS. POSTED NOTICES ARE CLEARLY VISIBLE AND LEGIBLE TO PATIENTS VISITING THESE AREAS. THE HOSPITAL ALSO INCLUDES A NOTICE ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE IN ALL INITIAL BILLS. WHEN THE PATIENT CONTACTS THE HOSPITAL, THE PATIENT FINANCIAL SERVICES STAFF NOTIFIES THE PATIENT IF THEY QUALIFY FOR A PAYMENT PLAN. A PATIENT WHO IS ENROLLED IN A PUBLIC FINANCIAL ASSISTANCE PROGRAM (FOR EXAMPLE, MASSHEALTH, HEALTH SAFETY NET, OR FOR MEDICAL HARDSHIP) MAY QUALIFY FOR CERTAIN PLANS. PATIENTS MAY ALSO QUALIFY FOR ADDITIONAL ASSISTANCE BASED ON THE HOSPITAL'S OWN INTERNAL CRITERIA FOR FINANCIAL ASSISTANCE. FOR CASES WHERE THE HOSPITAL IS USING THE VIRTUAL GATEWAY APPLICATION, THE HOSPITAL ASSISTS THE PATIENT IN COMPLETING THE APPLICATION FOR MASSHEALTH CONNECTORCARE, CHILDREN'S MEDICAL SECURITY PLAN, HEALTH START, HEALTH SAFETY NET, OR OTHER FORMS OF FINANCIAL ASSISTANCE PROGRAMS AS THEY BECOME PART OF THE VIRTUAL GATEWAY PROGRAM. ALL SIGNS AND NOTICES ARE TRANSLATED INTO LANGUAGES OTHER THAN ENGLISH IF A LANGUAGE IS SPOKEN BY 5% OR MORE OF THE POPULATION RESIDING IN THE HOSPITAL SERVICE AREA. CURRENTLY, THE HOSPITAL TRANSLATES THE NOTICES INTO ENGLISH, PORTUGUESE, SPANISH, VIETNAMESE, AND HAITIAN CREOLE.

PART VI, LINE 4:
COMMUNITY INFORMATIONPLEASE SEE INTRODUCTION.

SCHEDULE H, PART VI, LINE 5 (CONTINUATION):
PROJECT RECOVERY, EMPOWERMENT, SOCIAL SERVICES, PRENATAL CARE, EDUCATION, COMMUNITY AND TREATMENT (PROJECT RESPECT): PROJECT RESPECT IS A HIGH RISK OBSTETRICAL AND ADDICTION RECOVERY MEDICAL HOME AT BMC AND BOSTON UNIVERSITY SCHOOL OF MEDICINE. PROJECT RESPECT PROVIDES A UNIQUE SERVICE OF COMPREHENSIVE OBSTETRIC AND SUBSTANCE USE DISORDER TREATMENT FOR PREGNANT WOMEN AND THEIR NEWBORNS IN MASSACHUSETTS. THE MAJORITY OF PROJECT RESPECT'S PATIENTS ARE IN RECOVERY FROM OPIOID ADDICTION. IN-PATIENT, MONITORED, ACUTE SUBSTANCE WITHDRAWAL TREATMENT AND INDUCTION OF OPIOID MAINTENANCE THERAPIES FOR PREGNANT WOMAN SEEKING ADDICTION TREATMENT ARE PROVIDED. INTENSIVE, INDIVIDUALIZED OUT-PATIENT TREATMENT PLANS ARE OUTLINED FOR EACH PATIENT TAILORED TO THE SEVERITY OF THEIR DISEASE AND THEIR RECOVERY PROGRESS. THE OUT-PATIENT MEDICAL HOME MODEL PROVIDES ON-SITE, COLLABORATIVE, AND MULTIDISCIPLINARY CARE FOR PREGNANT AND POST-PARTUM WOMEN IN RECOVERY. PROJECT RESPECT TREATS AN AVERAGE OF 120-150 PATIENTS PER MONTH, WITH 6-10 NEW PATIENTS PER MONTH. IN FY22, PROJECT RESPECT SUPPORTED MORE THAN 220 MOTHER/CHILD DYADS.STREETCRED: BMC'S STREETCRED PROGRAM ADDRESSES FINANCIAL AND HEALTH INEQUITIES BY LINKING LOW- TO MODERATE-INCOME (LMI) PEDIATRIC PATIENT FAMILIES TO ANTI-POVERTY SAFE-NET PROGRAMS AND ASSET BUILDING TOOLS. STREETCRED PROVIDES AN ECONOMIC BUNDLE OF SERVICES DURING WELL CHILD VISITS IN THE FIRST YEAR OF LIFE, WHICH INCLUDES FREE TAX-PREPARATION SERVICES THROUGH WELL-TRAINED STAFF AND VOLUNTEERS WHO WORK WITH FAMILIES TO PREPARE THEIR TAXES AND ACCESS THE EITC. THE UNITED STATES FEDERAL EARNED INCOME TAX CREDIT (EITC) IS A REFUNDABLE TAX CREDIT FOR LMI WORKING INDIVIDUALS, PARTICULARLY THOSE WITH CHILDREN. UNDER OUR MEDICAL TAX COLLABORATIVE, STREETCRED HAS PREPARED 6,000 TAX RETURNS, WHICH PROVIDED $14 MILLION IN TAX REFUNDS. THESE TAX REFUNDS CAN HAVE A PROFOUND POSITIVE IMPACT ON A FAMILY'S HOUSEHOLD BUDGET AND, IN CASES OF FINANCIAL STRESS, ALLEVIATE SIGNIFICANT FINANCIAL BURDEN.SUPPORTING PARENTS AND RESILIENT KIDS CENTER (SPARK): THE SPARK CENTER HAS A LONG AND STORIED HISTORY OF PROVIDING INNOVATIVE CARE TO THOSE MOST IN NEED. THROUGH MARCH 2020, THE SPARK CENTER CARRIED OUT THIS MISSION THROUGH AN EDUCATION AND CARE PROGRAM FOR INFANTS AND TODDLERS WHOSE LIVES WERE AFFECTED BY COMPLEX OVERLAPPING HEALTH, EMOTIONAL, BEHAVIORAL, AND DEVELOPMENTAL CHALLENGES. AS A RESULT OF THE COVID-19 PANDEMIC, THE SPARK CENTER PIVOTED FROM CHILDCARE PROGRAMMING TOWARD EXPANDING CHILDHOOD OUTPATIENT BEHAVIORAL HEALTH SERVICES A NEED THAT HAS ONLY BEEN AMPLIFIED THROUGH THE PANDEMIC. AS THESE CRITICAL BEHAVIORAL HEALTH SERVICES PROVIDED A SUPPORTIVE CONNECTION TO CARE FOR MANY FAMILIES THROUGH 2022, THE SPARK CENTER SIMULTANEOUSLY INITIATED A RE-ENVISIONING OF ITSELF AND ITS UNIQUE, COMMUNITY-BASED SETTING. IN AUGUST 2021, SPARK REOPENED AS THE HOME TO A NUMBER OF SPECIALTY PROGRAMS WITHIN BMC'S DEPARTMENT OF PEDIATRICS, ALL WITH THE OVERARCHING MISSION TO PROVIDE HIGH-QUALITY, EVIDENCED-BASED CARE. AT PRESENT, SPARK OFFERS NEURODEVELOPMENTAL ASSESSMENTS AND PSYCHOLOGICAL EVALUATIONS THROUGH THE DIVISION OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS (DBP) TO IDENTIFY CHILDREN'S SPECIFIC EMOTIONAL, BEHAVIORAL, AND COGNITIVE CHALLENGES. MULTIDISCIPLINARY PROVIDERS, INCLUDING PEDIATRICIANS, ADVANCED PRACTICE CLINICIANS, PSYCHOLOGISTS, AND AUTISM RESOURCE SPECIALISTS, WORK COLLABORATIVELY WITH CAREGIVERS TO ACCESS SPECIAL EDUCATION SERVICES AND OTHER VITAL THERAPEUTIC SUPPORTS AS EARLY AS POSSIBLE TO IMPROVE CHILDHOOD OUTCOMES. ADDING TO THE CONTINUUM OF SPECIALIZED CHILDREN'S SERVICES, THE SPARK CENTER IS THE HOME OF THE EARLY CHILDHOOD BEHAVIOR THERAPY PROGRAM AND THE GOOD GRIEF PROGRAM AND IS A CLINICAL SITE FOR THE CHILD WITNESS TO VIOLENCE PROJECT. THESE PROGRAMS OFFER AN ARRAY OF TRAUMA-INFORMED, EVIDENCE-BASED THERAPY INTERVENTIONS FOR CHILDREN AND FAMILIES ROOTED IN TWO-GENERATION APPROACHES THAT UTILIZE THE CAREGIVER-CHILD RELATIONSHIP TO FOSTER HEALTHY CHILD DEVELOPMENT. THE SYNERGISTIC COLOCATION OF THESE SERVICES MAKES THE SPARK CENTER A FACILITY THAT PROVIDES BEST-PRACTICE CARE TO CHILDREN AND FAMILIES IMPACTED BY COMPLEX DEVELOPMENTAL AND BEHAVIORAL CHALLENGES, GRIEF AND LOSS, AND DOMESTIC VIOLENCE AND OTHER FORMS OF INTERPERSONAL VIOLENCE. IN ADDITION, SPARK SERVES AS AN OUTLET FOR PEDIATRIC INFECTIOUS DISEASE CASE MANAGEMENT AND CONCRETE RESOURCE SUPPORT, VIA THEIR INTEGRATED FOOD PANTRY. SPARK IS ALSO THE LOCATION OF A MONTHLY CLINIC, PROJECT POSITIVE HOPE, WHICH PROVIDES COORDINATED SERVICES FROM OBSTETRICS AND GYNECOLOGY, ADULT INFECTIOUS DISEASE AND PEDIATRIC INFECTIOUS DISEASE SPECIALISTS WITH ON-SITE CASE MANAGEMENT, PHARMACIST COUNSELING, AND PEER SUPPORT. WITH THE ABOVE ABUNDANCE OF INNOVATIVE CLINICAL SERVICES, THE SPARK CENTER HAS BECOME AN EXCEPTIONAL TRAINING SITE FOR MENTAL HEALTH CLINICIANS AND DBP TRAINEES. THE CLINICAL TRAINING OFFERED THROUGH THE SPARK CENTER WORKS TO ENHANCE THE SKILLS AND EXPERTISE OF THE FIELD OF PROVIDERS SUPPORTING CHILDREN AND FAMILIES WITH COMPLEX BEHAVIORAL AND DEVELOPMENTAL CHALLENGES AND PSYCHOSOCIAL SITUATIONS. TEAM UP: THE CHILD MENTAL HEALTH INITIATIVE-TEAM UP-IS A PARTNERSHIP BETWEEN BMC AND SEVEN REGIONAL COMMUNITY HEALTH CENTERS THAT SEEKS TO INTEGRATE MENTAL HEALTH CARE WITH PRIMARY CARE FOR CHILDREN SO THAT FAMILIES CAN RECEIVE ALL CARE IN ONE PLACE. ENGAGEMENT WITH THE TEAM UP MODEL OCCURS: WHEN A PARENT BRINGS IN A CHILD WITH BEHAVIORAL HEALTH ISSUES; WHEN A PRIMARY CARE PROVIDER REFERS A CHILD WITH BEHAVIORAL HEALTH ISSUES; WHEN A PRIMARY CARE PROVIDER EXPRESSES CONCERNS ABOUT A FAMILY; WHEN A CHILD OR FAMILY EXPERIENCES A NEW MAJOR STRESSOR (E.G., PARENTAL SEPARATION, DIAGNOSIS OF A SERIOUS ILLNESS); AND AFTER A COMPREHENSIVE PSYCHOSOCIAL AND BEHAVIORAL HEALTH ASSESSMENT DURING A WELL-CHILD VISIT IN THE PRIMARY CARE SETTING. THE GOAL OF TEAM UP IS TO PROMOTE POSITIVE CHILD HEALTH AND WELL-BEING THROUGH INNOVATION AND CONSISTENT DELIVERY OF EVIDENCE-BASED INTEGRATED CARE. BMC SUPPORTS IMPLEMENTATION OF THE TEAM UP MODEL THROUGH A LEARNING COMMUNITY THAT PROVIDES PRACTICE TRANSFORMATION SUPPORT AND CLINICAL TRAINING. BMC IS ALSO UNDERTAKING AN EVALUATION OF THE MODEL; DATA ARE USED TO GUIDE IMPLEMENTATION AND ASSESS THE IMPACT OF THE MODEL.GOOD GRIEF: THE GOOD GRIEF PROGRAM PROVIDES TRAUMA-INFORMED, CULTURALLY RESPONSIVE THERAPEUTIC SERVICES TO CHILDREN (AGE 0-18) IMPACTED BY DEATH AND ACUTE LOSS. AS ONE OF THE ONLY CHILDREN'S GRIEF AND LOSS PROGRAMS WITHIN THE CITY OF BOSTON, GOOD GRIEF WORKS TIRELESSLY TO BEST SERVE URBAN CHILDREN AND YOUTH WHO HAVE SUFFERED MULTIPLE, TRAUMATIC LOSSES. GOOD GRIEF SERVES CHILDREN AND THEIR FAMILIES IN A HOLISTIC WAY, RECOGNIZING THAT SIGNIFICANT LOSS IS ALWAYS ACCOMPANIED BY SECONDARY LOSSES THAT ARE DESTABILIZING, DISORIENTING, AND DAUNTING. OUR SMALL CLINICAL TEAM WORKS WITH FAMILIES TO SUPPORT THEIR MENTAL AND EMOTIONAL HEALTH NEEDS WHILE ALSO MITIGATING OTHER LOSS-RELATED STRESSORS AND STRUCTURAL DETERMINANTS OF HEALTH THEY MAY EXPERIENCE AND WHICH AFFECT OVERALL HEALTH (E.G., CHALLENGES AT SCHOOL, HOUSING/FOOD/FINANCIAL INSECURITY, IMMIGRATION-RELATED NEEDS, ETC.).IN 2017, THE GOOD GRIEF PROGRAM SHIFTED ITS PRIMARY FOCUS FROM TRAINING AND CONSULTATION WITH COMMUNITY-BASED ORGANIZATIONS TO PROVIDING DIRECT CLINICAL SERVICES TO CHILDREN IMPACTED BY SIGNIFICANT LOSS. IN THE FIVE YEARS PROCEEDING, THE NUMBER OF CHILDREN REFERRED TO AND SERVED BY THE PROGRAM HAS GROWN QUICKLY. WHEN CLINICAL SERVICES WERE OPENED IN AUGUST 2017, 26 CHILDREN WERE REFERRED IN A FIVE MONTH PERIOD. IN 2022, OVER 220 CHILDREN WERE REFERRED TO GOOD GRIEF. THE EXPONENTIAL GROWTH OF THE PROGRAM HAS BEEN FUELED BY MANY FACTORS INCLUDING THE DEARTH OF HIGH-QUALITY CHILDREN'S GRIEF SERVICES IN BOSTON AND GOOD GRIEF'S RELIABLE REPUTATION AMONG MEMBERS OF THE COMMUNITY AND OTHER SERVICE ORGANIZATIONS. MOREOVER, THE COVID-19 PANDEMIC HAS RESULTED IN DISPROPORTIONATELY HIGH RATES OF HOSPITALIZATION AND DEATH AMONG BLACK AND AFRICAN AMERICAN AND HISPANIC AND LATINO PERSONS, AND CHILDREN FROM THESE RACIAL AND ETHNIC GROUPS COMPRISED ABOUT 76% OF GOOD GRIEF'S PATIENTS TO DATE.HOUSING IN FISCAL YEAR 2018 BMC LAUNCHED A MULTI-YEAR INVESTMENT IN A SUPPORTIVE HOUSING STRATEGY AS PART OF OUR DETERMINATION OF NEED (DON) COMMUNITY HEALTH INITIATIVE (CHI). THIS PROJECT WAS DESIGNED WITH AS A MULTI-PRONGED APPROACH TO IMPACT AFFORDABLE HOUSING AND AFFORDABLE HOUSING WITH SUPPORTS IN BOSTON. THIS PORTFOLIO INCLUDES NEW FUNDING FOR INTERNAL HOUSING NAVIGATION SUPPORT IN THE PEDIATRIC AND COMPLEX CARE MANAGEMENT, EXPANSION OF THE ELDERS LIVING AT HOME PROGRAM AND AND DEEPER COLLABORATION WITH BOSTON AND CAMBRIDGE HOUSING AUTHORITY ON SUPPORTIVE HOUSING PROGRAMS. THE FOLLOWING ADDRESSES THE SECOND OF THESE MULTI-YEAR COMMITMENTS.

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IN 2022 AND FOR THE SECOND TIME, BMC CONDUCTED A COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN COLLABORATION WITH COMMUNITY ORGANIZATIONS, BOSTON RESIDENTS, HEALTH CENTERS, HOSPITALS AND THE BOSTON PUBLIC HEALTH COMMISSION. THE BOSTON COMMUNITY HEALTH NEEDS ASSESSMENT-COMMUNITY HEALTH IMPROVEMENT PLAN COLLABORATIVE (THE COLLABORATIVE) FORMED IN 2019 TO UNDERTAKE THE FIRST BOSTON-WIDE CHNA AND CHIP. FOCUSING ON THE SOCIAL DETERMINANTS OF HEALTH AND USING A HEALTH EQUITY LENS, THE COLLABORATIVE EMPLOYED A PARTICIPATORY APPROACH THAT ENGAGED THE COMMUNITY IN EVERY STEP OF THE 2019 AND 2022 CHNAS. METHODSTHIS CHNA FOCUSES ON THE SOCIAL DETERMINANTS OF HEALTH AND IS GUIDED BY A HEALTH EQUITY LENS. IN THE U.S., SOCIAL, ECONOMIC, AND POLITICAL PROCESSES WORK TOGETHER TO ASSIGN SOCIAL STATUS BASED ON RACE AND ETHNICITY, WHICH MAY AFFECT ACCESS TO OPPORTUNITIES, SUCH AS EDUCATIONAL AND OCCUPATIONAL MOBILITY AND HOUSING OPTIONS, EACH OF WHICH ARE INTIMATELY LINKED WITH HEALTH. HISTORICAL OPPRESSION, INSTITUTIONAL RACISM, DISCRIMINATORY POLICIES, AND ECONOMIC INEQUALITY ARE SEVERAL ROOT FACTORS THAT SHAPE HEALTH INEQUITIES ACROSS THE U.S.REVIEW OF SECONDARY DATATHE 2022 BOSTON CHNA DATA GATHERING EFFORT INCLUDED A REVIEW OF EXISTING SECONDARY DATA ON SOCIAL, ECONOMIC, AND HEALTH INDICATORS. THESE INDICATORS PROVIDE INSIGHTS INTO PATTERNS ACROSS BOSTON, BY BOSTON NEIGHBORHOOD, AND BY POPULATION GROUPS WITHIN BOSTON. SECONDARY DATA SOURCES INCLUDED U.S. CENSUS/AMERICAN COMMUNITY SURVEY, VITAL STATISTICS (BIRTH/DEATH RECORDS), HOSPITAL CASE MIX DATA, BOSTON BEHAVIORAL RISK FACTOR SURVEILLANCE SURVEY (BBRFSS), BBRFSS COVID-19 HEALTH EQUITY SURVEY, YOUTH RISK BEHAVIOR SURVEY (YRBS), AND THE MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH BUREAU OF SUBSTANCE ADDICTION SERVICES TREATMENT DATA. THE SECONDARY DATA WORK GROUP OF THE COLLABORATIVE INCLUDED 16 MEMBERS REPRESENTING A RANGE OF ORGANIZATIONS, INCLUDING HOSPITALS, HEALTH CENTERS, AND LOCAL PUBLIC HEALTH. THE SECONDARY DATA WORK GROUP'S CHARGE WAS TO PROVIDE GUIDANCE ON SECONDARY DATA APPROACH AND INDICATORS AND FOSTER CONNECTIONS WITH KEY NETWORKS AND GROUPS TO PROVIDE RELEVANT DATA.TO IDENTIFY THE LIST OF SOCIAL, ECONOMIC, AND HEALTH INDICATORS, SECONDARY DATA WORK GROUP MEMBERS REVIEWED THE INDICATOR LIST FROM THE 2019 BOSTON CHNA AND PRIORITIZED WHICH INDICATORS SHOULD BE REVISITED FOR THE 2022 REPORT. THE SECONDARY DATA WORK GROUP ENGAGED IN MULTIPLE DISCUSSIONS AND PRIORITIZED THE SECONDARY DATA THAT ALIGNED WITH THE 2019 PRIORITY AREAS THAT COVID-19 HAD A DISPROPORTIONATE IMPACT ON, AND/OR WHERE THERE WERE THE GREATEST INEQUITIES BY RACE/ETHNICITY, NEIGHBORHOOD, OR OTHER CHARACTERISTICS.SECONDARY DATA IN THE 2022 CHNA REPRESENT THE MOST RECENT DATA AVAILABLE, AND IN SEVERAL CASES OVERLAP WITH DATA INCLUDED IN THE 2019 CHNA DUE TO THE NEED TO COMBINE DATA ACROSS YEARS TO LOOK AT PATTERNS BY NEIGHBORHOOD AND SOCIAL AND DEMOGRAPHIC FACTORS. QUALITATIVE DISCUSSIONS (DESCRIBED IN THE SECTION THAT FOLLOWS) BUILD UPON THE SECONDARY DATA BY SHEDDING LIGHT ON RESIDENTS' RECENT EXPERIENCES WITH AND PERSPECTIVES ON MANY FACTORS, INCLUDING THE SOCIAL DETERMINANTS OF HEALTH AND HOW THESE ISSUES HAVE BEEN AFFECTED BY THE COVID-19 PANDEMIC. QUALITATIVE DISCUSSIONS AND COMMUNITY ENGAGEMENTTHE COMMUNITY ENGAGEMENT WORK GROUP INCLUDES 24 MEMBERS REPRESENTING A RANGE OF ORGANIZATIONS, INCLUDING HEALTH CENTERS, LOCAL PUBLIC HEALTH, COMMUNITY DEVELOPMENT, COMMUNITY-BASED ORGANIZATIONS, AND HOSPITALS. THE WORK GROUP'S CHARGE IS TO PROVIDE GUIDANCE ON THE APPROACH TO COMMUNITY ENGAGEMENT, INPUT ON PRIMARY DATA COLLECTIONS METHODS, AND SUPPORT WITH LOGISTICS FOR PRIMARY DATA COLLECTION. THE COLLABORATIVE'S COMMUNITY ENGAGEMENT WORK GROUP LED EFFORTS TO GAIN INSIGHT INTO COMMUNITY NEEDS AND STRENGTHS AS WELL AS PRIORITIES FROM COMMUNITY LEADERS AND RESIDENTS, ESPECIALLY AMONG THOSE WHERE THERE HAS BEEN A GAP IN REPRESENTATION IN PREVIOUS PROCESSES. ALTOGETHER, THEY FACILITATED 29 VIRTUAL AND IN-PERSON FOCUS GROUP DISCUSSIONS WITH A TOTAL OF 309 RESIDENTS WHO HAVE BEEN DISPROPORTIONATELY BURDENED BY SOCIAL, ECONOMIC, AND HEALTH CHALLENGES INCLUDING: YOUTH AND ADOLESCENTS, OLDER ADULTS, PERSONS WITH DISABILITIES, LOW-RESOURCED INDIVIDUALS AND FAMILIES, LGBTQIA+ POPULATIONS, RACIALLY/ETHNICALLY DIVERSE POPULATIONS (E.G., AFRICAN AMERICAN, LATINO, HAITIAN, CAPE VERDEAN, VIETNAMESE, CHINESE), LIMITED-ENGLISH SPEAKERS, IMMIGRANT AND ASYLEE COMMUNITIES, FAMILIES AFFECTED BY INCARCERATION AND/OR VIOLENCE, AND VETERANS. SOME FOCUS GROUPS WERE CONDUCTED IN LANGUAGES OTHER THAN ENGLISH, INCLUDING SPANISH, CHINESE, AND VIETNAMESE.COLLABORATIVE MEMBERS CONDUCTED KEY INFORMANT INTERVIEWS WITH 62 INDIVIDUALS. THESE REPRESENTED A CROSS-SECTION OF SECTORS TO IDENTIFY AREAS OF ACTION AND PERSPECTIVES ON THE COMMUNITY. THESE INTERVIEWEES INCLUDED LEADERS AND STAFF FROM PUBLIC HEALTH, HEALTH CARE, BEHAVIORAL HEALTH, THE FAITH COMMUNITY, IMMIGRANT SERVICES, HOUSING ORGANIZATIONS, ECONOMIC DEVELOPMENT, COMMUNITY DEVELOPMENT, RACIAL JUSTICE ORGANIZATIONS, SOCIAL SERVICE ORGANIZATIONS, EDUCATION, COMMUNITY COALITIONS, THE BUSINESS COMMUNITY, CHILDCARE CENTERS, ELECTED GOVERNMENT OFFICES, AND OTHERS. ADDITIONALLY, COLLABORATIVE MEMBERS CONDUCTED FOUR 90-MINUTE VIRTUAL COMMUNITY LISTENING SESSIONS IN JANUARY 2022. A TOTAL OF 122 COMMUNITY MEMBERS PARTICIPATED IN THESE FOUR SESSIONS. THESE SESSIONS OCCURRED MID-WAY INTO THE CHNA PROCESS AND PROVIDED AN OPPORTUNITY TO GATHER FEEDBACK AND INSIGHTS ON PRELIMINARY DATA FINDINGS AND POTENTIAL PRIORITIES AT THIS POINT IN TIME. DURING THESE SESSIONS, COLLABORATIVE MEMBERS SHARED PRELIMINARY THEMES FROM FOCUS GROUPS, INTERVIEWS, AND THE REVIEW OF SECONDARY DATA. THE PARTICIPANTS DISCUSSED THEIR REACTIONS AND FEEDBACK TO THESE PRELIMINARY FINDINGS IN SMALL GROUPS AND IDENTIFIED AREAS THAT WERE THEIR HIGHEST PRIORITY FOR ACTION.TO DEEPEN UNDERSTANDING OF ISSUES THAT WERE SALIENT TO RESPONDENTS, INTERVIEW, FOCUS GROUP, AND COMMUNITY LISTENING SESSION DISCUSSION GUIDES USED OPEN-ENDED QUESTIONS AND DID NOT ASK ABOUT SPECIFIC TOPICS. COMMUNITY ENGAGEMENT WORK GROUP MEMBERS AND THEIR PARTNERS CONDUCTED THE FOCUS GROUPS AND INTERVIEWS, AND THEN SUMMARIZED THE KEY THEMES FROM THE DISCUSSIONS THEY FACILITATED. THESE SUMMARIES WERE THEN ANALYZED TO IDENTIFY COMMON THEMES AND SUB-THEMES ACROSS POPULATION GROUPS AS WELL AS UNIQUE CHALLENGES AND PERSPECTIVES IDENTIFIED BY POPULATIONS AND SECTORS, WITH AN EMPHASIS ON DIVING DEEP INTO THE ROOT CAUSES OF INEQUITIES. FREQUENCY AND INTENSITY OF DISCUSSIONS ON A SPECIFIC TOPIC WERE KEY INDICATORS USED FOR EXTRACTING MAIN THEMES. KEY FINDINGS THAT EMERGED FROM THE CHNA INCLUDED HEALTH CARE ACCESS AND UTILIZATION, CHRONIC DISEASES AND RISK FACTORS, MENTAL HEALTH AND SUBSTANCE USE DISORDER, VIOLENCE, HOUSING AFFORDABILITY, AND ENVIRONMENTAL HEALTH. UNWAVERING IN OUR COMMITMENT TO ADDRESS THE HEALTH NEEDS OF OUR COMMUNITY, BMC PROVIDES A WIDE RANGE OF PROGRAMS BEYOND THE TRADITIONAL MEDICAL MODEL TO ADDRESS THESE SOCIAL DETERMINANTS OF HEALTH. CORE TO FULFILLING OUR PUBLIC HEALTH MISSION AND CONSISTENT WITH THE CHNA FINDINGS, THE GOALS OF OUR COMMUNITY BENEFITS PROGRAM ARE TO IMPROVE ACCESS TO HEALTH SERVICES AND IMPROVE HEALTH OUTCOMES FOR UNDER-RESOURCED POPULATIONS IN OUR COMMUNITY.

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PROMOTION OF COMMUNITY HEALTHHEALTH CARE ACCESS BIRTH SISTERS: BIRTH SISTERS ARE COMMUNITY MEMBERS TRAINED BY BMC TO PROVIDE SUPPORT TO PREGNANT BMC PATIENTS FROM THEIR OWN COMMUNITIES DURING PREGNANCY, CHILDBIRTH AND EARLY PARENTHOOD. BIRTH SISTERS OFFER CHILDBIRTH AND PARENTING EDUCATION, CONNECT THEIR CLIENTS TO COMMUNITY AND HOSPITAL-BASED RESOURCES, PROVIDE CONTINUOUS LABOR SUPPORT, AND SUPPORT THEIR CLIENTS IN THE EARLY POSTPARTUM PERIOD. THE BIRTH SISTERS PROGRAM HAS BEEN LINKED TO SIGNIFICANTLY HIGHER BODY/BREASTFEEDING RATES AND FEWER CESAREAN BIRTHS. THE PANDEMIC HAS REQUIRED SHIFTS IN SERVICE PROVISION, MOST NOTABLY, THROUGH THE UTILIZATION OF VIRTUAL SUPPORT STRATEGIES TO BUILD CONNECTION BEFORE AND AFTER BIRTH. DURING THE 2022 FISCAL YEAR, BIRTH SISTERS PROVIDED SUPPORT FOR 245 PATIENTS.CATALYST CLINIC: IN MAY 2016, BOSTON MEDICAL CENTER LAUNCHED THE CATALYST CLINIC (CENTER FOR ADDICTION TREATMENT FOR ADOLESCENT/YOUNG ADULTS WHO USE SUBSTANCES), A PROGRAM DESIGNED TO TREAT YOUNG PEOPLE AGED 25 AND UNDER WHO ARE STRUGGLING WITH SUBSTANCE USE, OR WHO HAVE EXPERIMENTED WITH DRUGS AND ALCOHOL AND MAY BE AT RISK FOR DEVELOPING AN ADDICTION. THE CATALYST CLINIC TEAM WORKS TO PROVIDE INTERDISCIPLINARY, TEAM-BASED CARE THAT INCLUDES PHYSICIANS, A NURSE, TWO SOCIAL WORKERS, A RECOVERY SUPPORT NAVIGATOR AND A PROGRAM MANAGER. THE CATALYST CLINIC TEAM WORKS TOGETHER TO OFFER ASSESSMENT, DIAGNOSIS, AND TREATMENT OF VARIOUS SUBSTANCE USE DISORDERS, AS WELL AS FACILITATES THE TRANSITION FROM ADOLESCENT TO ADULT CARE WHEN APPROPRIATE. IN FISCAL YEAR 2022, THE CATALYST CLINIC RECEIVED APPROXIMATELY 107 REFERRALS TO THE CLINIC; 825 REFERRALS HAVE BEEN RECEIVED SINCE THE PROGRAM'S INCEPTION.THE CENTER FOR THE URBAN CHILD AND HEALTHY FAMILY (THE CENTER): THE CENTER, LAUNCHED IN 2016, IS CATALYZING BMC'S VISION OF MAKING BOSTON ONE OF THE HEALTHIEST CITIES IN THE WORLD BY ENSURING EVERY CHILD HAS AN EQUAL OPPORTUNITY TO BE HEALTHY AND ACHIEVE THEIR FULL POTENTIAL. AS SUCH, THE CENTER IS CREATING A SYSTEM OF PEDIATRIC HEALTH CARE THAT ACTIVELY PROMOTES HEALTH EQUITY AND ERADICATES DISPARITIES. AS AN INNOVATION HUB WITHIN THE DEPARTMENT OF PEDIATRICS, THE CENTER CREATES AND TESTS INNOVATIVE HEALTH CARE DELIVERY MODELS, WORKING IN PARTNERSHIP WITH FAMILIES, COMMUNITIES AND OTHER CHILD- AND FAMILY-SERVING SECTORS. THE CENTER HAS SET A GOAL THAT BY 2028, ALL CHILDREN CARED FOR BY BMC PEDIATRICS WILL BE HEALTHY AND READY TO LEARN WITH ADEQUATE SUPPORTS TO THRIVE BY AGE FIVE. TO ACHIEVE THIS GOAL, THE CENTER CO-DEVELOPED A NEW MODEL OF PEDIATRIC PRIMARY CARE, THE PEDIATRIC PRACTICE OF THE FUTURE, WITH FAMILIES AND PEDIATRIC PROVIDERS. THIS MODEL SUPPORTS WHOLE FAMILY DEVELOPMENT WITH ATTENTION TO FACTORS INFLUENCING WELL-BEING AND BRINGING TOGETHER CARE IN A SYSTEMATIC, EQUITABLE WAY TO PROMOTE WELLNESS THROUGHOUT THE LIFE COURSE. THE CENTER IS PILOTING THE NEW MODEL AIMED AT FAMILIES WITH NEWBORNS, AND IS COLLECTING DATA TO UNDERSTAND ITS IMPACT. THE PILOT LAUNCHED IN JANUARY 2020 AND HAS SINCE ENROLLED 100 FAMILIES. ULTIMATELY, A FINANCIALLY SUSTAINABLE MODEL WILL BE SCALED TO THE LARGER PRIMARY CARE PRACTICE. IN ADDITION, THE CENTER IS PARTNERING WITH WELLSENSE, BMC'S HEALTH INSURANCE PROGRAM, TO TEST ALTERNATIVE PAYMENT MODELS TO ULTIMATELY REDEFINE VALUE IN PEDIATRIC CARE. ELDERS LIVING AT HOME PROGRAM (ELAHP): THE GOAL OF ELAHP IS TO HELP OLDER ADULTS WHO ARE HOMELESS OR AT RISK FOR HOMELESSNESS SECURE AND MAINTAIN A PERMANENT RESIDENCE AND LIVE AS INDEPENDENTLY AS POSSIBLE. ELAHP SERVED 613 CLIENTS DURING FISCAL YEAR 2022. OF THESE CLIENTS, 340 RECEIVED HOUSING SEARCH AND PLACEMENT SERVICES; 112 RECEIVED HOUSING STABILIZATION SERVICES; AND 161 RECEIVED HOMELESSNESS PREVENTION ASSISTANCE. OVER THE LAST 12 YEARS, THE SUCCESS RATE OF ELAHP'S STABILIZATION SERVICES IS 98%. AN ADDITIONAL 157 CLIENTS WERE SERVED THROUGH THE LIVING WELL AT HOME PROJECT, A COMMUNITY-BASED COMPLEX CARE MANAGEMENT PILOT DESIGNED TO IMPROVE HEALTH OUTCOMES FOR FRAIL RESIDENTS OF AN ELDERLY/DISABLED HOUSING COMPLEX IN ROXBURY AND ANOTHER IN CAMBRIDGE. SOME CLIENTS RECEIVED MORE THAN ONE TYPE OF SERVICE. ALL CLIENTS SUFFER FROM AT LEAST ONE CHRONIC ILLNESS, AND 96% SUFFER FROM TWO OR MORE DISABLING MEDICAL CONDITIONS.GROW CLINIC: THE GROW CLINIC WAS FOUNDED IN 1984 WITHIN BMC'S DEPARTMENT OF PEDIATRICS. THE PRIMARY GOAL OF THE GROW CLINIC IS TO PROVIDE COMPREHENSIVE MULTIDISCIPLINARY MEDICAL, NUTRITIONAL, SOCIAL SERVICES AND DEVELOPMENTAL SUPPORT TO CHILDREN FROM THE GREATER BOSTON AREA DIAGNOSED WITH FAILURE TO THRIVE (FTT). CHILDREN WITH FTT HAVE SIGNIFICANT DIFFICULTY GROWING BECAUSE OF MALNUTRITION ASSOCIATED WITH ILLNESS, POVERTY, AND OTHER FAMILY STRESSORS. THE EFFECTS OF FTT INCLUDE SHORTENED ATTENTION SPANS, EMOTIONAL PROBLEMS, DELAYED COGNITIVE DEVELOPMENT, LASTING GROWTH FAILURE, AND FREQUENT SERIOUS ILLNESS, WHICH CAN RESULT IN HOSPITALIZATION. THE GROW CLINIC PROVIDES MEDICAL TREATMENT, NUTRITIONAL ASSESSMENT, HOME HEALTH EDUCATION, SOCIAL SERVICE ADVOCACY, DEVELOPMENTAL REFERRALS, AND ACCESS TO BMC'S THERAPEUTIC FOOD PANTRY, NUTRITIONAL SUPPLEMENTS, CHILDREN'S CLOTHES, DIAPERS, BOOKS AND EDUCATIONAL TOYS, AMONG OTHER SERVICES. APPROXIMATELY 200 FAMILIES ARE TREATED ANNUALLY BY THE GROW CLINIC. IN FY2022, THERE WERE 101 NEW PATIENTS. FORTY-FIVE PERCENT (45%) OF CLINIC PATIENTS WERE 12 MONTHS OF AGE OR YOUNGER; THE AVERAGE AGE AT REFERRAL WAS 24 MONTHS; AND THE AVERAGE LENGTH OF TREATMENT WAS 28 MONTHS. THERE WERE 1,054 TOTAL CLINIC VISITS DURING THIS PERIOD. APPROXIMATELY 20% OF PATIENT FAMILIES WERE HOMELESS AND LIVING IN SHELTERS. CLINICIANS MADE 238 HOME VISITS IN FY22. ALL PATIENTS DEMONSTRATED IMPROVED GROWTH, AND 80% DEMONSTRATED SIGNIFICANT WEIGHT IMPROVEMENT.

PART VI, LINE 6:
"BOSTON MEDICAL CENTER HEALTH PLAN, INC., DOING BUSINESS AS WELLSENSE HEALTH PLAN (WELLSENSE)WELLSENSE IS A NON-PROFIT HEALTH PLAN THAT PROVIDES HEALTH INSURANCE COVERAGE TO MASSACHUSETTS RESIDENTS, INCLUDING LOW INCOME, UNDERSERVED, DISABLED AND ELDERLY POPULATIONS. IT WAS ESTABLISHED IN 1997 BY BMC AND HAS MORE THAN 25 YEARS OF EXPERIENCE DELIVERING ACCESSIBLE CARE TO COMPLEX POPULATIONS. WELLSENSE SERVES OVER 344,000 MEMBERS ACROSS MASSACHUSETTS. IT ALSO PROVIDES HEALTH COVERAGE TO MEDICAID MEMBERS IN NEW HAMPSHIRE. BOSTON HEALTHNET (BHN) THE BOSTON HEALTHNET (BHN) HEALTH CENTER NETWORK REPRESENTS A FUNDAMENTAL PARTNERSHIP BETWEEN BOSTON MEDICAL CENTER AND THE COMMUNITY HEALTH CENTERS (CHCS) TO FULFILL A SHARED COMMITMENT TO THE MOST VULNERABLE AND DIVERSE PATIENTS SERVED. ESTABLISHED IN 1995, BHN IS AN INTEGRATED HEALTH CARE DELIVERY SYSTEM COMPRISED OF BMC, THE BOSTON UNIVERSITY SCHOOL OF MEDICINE AND 12 COMMUNITY HEALTH CENTERS. THE PARTNERSHIP HAS BECOME A NATIONAL MODEL FOR COMMUNITY HEALTH CARE NETWORKS, ESPECIALLY THOSE SERVING URBAN, UNDERSERVED AND WORKING CLASS POPULATIONS BHN'S COMMUNITY HEALTH CENTER PARTNERS PROVIDE OUTREACH, PREVENTION, PRIMARY CARE, SPECIALTY CARE AND DENTAL SERVICES AT SITES LOCATED THROUGHOUT BOSTON'S COMMUNITIES AS WELL AS ATTLEBORO, QUINCY, TAUNTON, AND WINTHROP, THEREBY EXTENDING BMC'S PRESENCE INTO THESE NEIGHBORHOODS. PHYSICIANS WORKING IN THE HEALTH CENTERS ARE CREDENTIALED MEMBERS OF BMC'S MEDICAL STAFF. HEALTH CENTER PATIENTS HAVE ACCESS TO HIGHLY TRAINED SPECIALISTS AND CUTTING-EDGE TECHNOLOGY AT BMC WHILE PROVIDING INDIVIDUALIZED AND CULTURALLY SENSITIVE CARE IN THEIR OWN NEIGHBORHOODS. THE ACCOMPLISHMENTS OF THE NETWORK ARE EVIDENCED BY: NOTABLE SHARE OF BMC VOLUME ORIGINATING FROM THE HEALTH CENTERS;COLLABORATIVE DEVELOPMENT OF QUALITY IMPROVEMENT INITIATIVES, CLINICAL PROTOCOLS, AND STANDARDS OF PRACTICE;DEGREE OF FACILITATION AND COORDINATION OF HEALTH INFORMATION TECHNOLOGY TRAINING, COMMUNICATION AND OPTIMIZATION ACROSS THE HEALTH CENTER NETWORK WITH NINE OF THE BHN HEALTH CENTERS ON THE SAME ELECTRONIC HEALTH RECORD.IN ADDITION, THE COMMUNITY HEALTH CENTER PARTNERSHIP EXTENDS INTO CLINICIAN TRAINING AND JOINT HIRING WITH BU SCHOOL OF MEDICINE STUDENTS USING HEALTH CENTER EDUCATION PROGRAMS, RESIDENTS HAVING LONGITUDINAL AMBULATORY EXPERIENCE AT CHCS DURING 2022 AND PROVIDERS JOINTLY HIRED BY HEALTH CENTERS AND BU FAMILY MEDICINE ACROSS SIX HEALTH CENTERS.OTHER AREAS DEMONSTRATING THE LONGSTANDING AND DEEP PARTNERSHIP INCLUDE:GOVERNANCE: COMMUNITY HEALTH CENTERS ARE NOTABLY INVOLVED IN BMC GOVERNANCE WITH REPRESENTATION ON BMC'S BOARD OF TRUSTEES, TWO COMMITTEES OF THE BMC BOARD OF TRUSTEES AND THREE HOSPITAL COMMITTEES.RESEARCH: FOR OVER 15 YEARS, A RESEARCH COLLABORATIVE COMPRISED OF BHN, COMMUNITY HEALTH CENTERS AND BOSTON UNIVERSITY CLINICAL TRANSLATIONAL SCIENCE INSTITUTE HAS EXISTED IN ORDER TO ADVANCE HEALTH RELATED RESEARCH IN THE COMMUNITY, INCLUDE THE COMMUNITY VOICE IN RESEARCH PROJECTS AND FACILITATE CLINICIAN ENGAGEMENT IN THE RESEARCH PROCESS.ACO PARTICIPATION: CURRENTLY, 8 BOSTON HEALTHNET COMMUNITY HEALTH CENTERS PARTICIPATE IN BACO. BACO'S PARTICIPANTS ARE COLLECTIVELY ACCOUNTABLE FOR THE QUALITY AND COST OF THE CARE THEY PROVIDE. BACO'S MOST SIGNIFICANT RISK ARRANGEMENT IS WITH THE MASSHEALTH ACO PROGRAM. WITH ITS PARTICIPATION IN THE MASSHEALTH ACO PROGRAM, BACO BECAME CLINICALLY AND FINANCIALLY INTEGRATED WITH BMC HEALTH SYSTEM, WHICH INCLUDES BMC, BOSTON UNIVERSITY MEDICAL GROUP, AND WELLSENSE.VACCINATION UPTAKEEARLY IN ITS TRAJECTORY, THE COVID-19 PANDEMIC REVEALED GROSS INEQUITIES IN THE UPTAKE OF VACCINATIONS BY BLACK AND LATINX PEOPLE ACROSS THE US, WITH DEADLY CONSEQUENCES. BETWEEN DECEMBER 2020 AND NOVEMBER 2021, BMC LED LOCAL EFFORTS TO CLOSE THESE DISPARITIES IN BOSTON BY IMPLEMENTING COMMUNITY-BASED VACCINATION SITES IN CHURCHES AND COMMUNITY CENTERS, ORGANIZING MOBILE VACCINATION EVENTS AT SCHOOLS, GROCERY STORES AND COMMUNITY EVENTS, AND PROVIDING VACCINE ACCESS AS WELL AS HEALTH EDUCATION TO RESIDENTS OF THE CITY'S MOST IMPOVERISHED NEIGHBORHOODS.BMC ESTABLISHED SEVEN COMMUNITY-BASED VACCINATION CLINICS AND CONDUCTED 99 INDIVIDUAL MOBILE VACCINATION EVENTS IN ADDITION TO VACCINATION OPPORTUNITIES ON THE MEDICAL CAMPUS TO REACH THE HEALTH EQUITY GOALS IN HISTORICALLY DISINVESTED COMMUNITIES. THE VACCINATION PROGRAM ADMINISTERED OVER 100,000 FIRST DOSES. THESE EVENTS WERE CRITICAL IN PROVIDING ACCESS TO VACCINES IN LOCATIONS WITH THE HIGHEST SOCIAL VULNERABILITY INDEX (SVI), IDENTIFIED USING THE US CENSUS DATA INCLUDING SOCIOECONOMIC STATUS, HOUSEHOLD COMPOSITION AND DISABILITY, SOCIAL/ECONOMIC MINORITY STATUS, LANGUAGE, UNEMPLOYMENT, AND OTHER FACTORS AFFECTING COMMUNITY HEALTH. TO BUILD CONFIDENCE IN COVID-19 VACCINES AND IN THE HEALTHCARE SYSTEM, BMC PARTNERED WITH AFFILIATED HEALTH CENTERS, COMMUNITY PARTNERS, STATE AND LOCAL HEALTH DEPARTMENTS, AND THE COMMONWEALTH OF MASSACHUSETTS. BOSTON MEDICAL CENTER (BMC) SUCCESSFULLY IMPLEMENTED A ROBUST MOBILE COVID-19 VACCINATION ACCESS AND OUTREACH PROGRAM FOCUSED ON ENSURING EQUITABLE ACCESS TO THE VACCINE AND THAT COMMUNITIES COULD BE VACCINATED IN PLACES THAT THEY KNOW AND TRUST. IN ORDER TO MAXIMIZE THE IMPACT OF OUR OUTREACH RESOURCES, BMC MAPPED ADDRESSES OF UNVACCINATED BMC PATIENTS TO IDENTIFY ""HOTSPOTS"" OF VACCINE HESITANCY. BMC LEVERAGED RELATIONSHIPS WITH EXISTING COMMUNITY PARTNERS AND FORMED PARTNERSHIPS WITH NEW ONES. THESE COLLABORATIONS ENABLED INCREASED ACCESS TO VACCINES FOR COMMUNITIES IN NEED AND THE SUCCESSFUL IMPLEMENTATION OF HIGH-TOUCH OUTREACH, EDUCATION, AND VACCINATION ""POP UP"" EVENTS. THE BMC MOBILE COVID-19 VACCINATION TEAM BROUGHT VACCINATION APPOINTMENTS DIRECTLY TO PATIENTS' NEIGHBORHOODS THROUGH ""POP UP"" EVENTS, CURBSIDE VACCINATIONS, AND HOME-BASED VACCINATIONS.BMC RAN MORE THAN 175 MOBILE, ""POP-UP"" VACCINATION EVENTS FROM JULY THROUGH DECEMBER 2021 IN BROCKTON AND BOSTON. EVENTS IN BROCKTON INCLUDED PARTNERSHIPS WITH CHURCHES, COMMUNITY HEALTH CENTERS, AND NUMEROUS AMBULANCE CURBSIDE VACCINATIONS. AS THESE EVENTS WERE HELD IN CONVENIENT LOCATIONS WITHIN THE RESPECTIVE COMMUNITIES, INCLUDING COMMUNITY ORGANIZATIONS, CHURCHES, AND SCHOOLS, AND WITH THE SUPPORT OF BMC'S COMMUNITY VACCINE NETWORK WHICH HELPED PATIENTS TO SECURE VACCINE APPOINTMENTS, OUR EFFORTS WERE HIGHLY EFFECTIVE IN REMOVING BARRIERS TO VACCINATION. VACCINE UPTAKE IN COMMUNITIES DISPROPORTIONALLY IMPACTED BY THE PANDEMIC IMPROVED FOLLOWING THE VACCINATION PROGRAM. BETWEEN JULY 15TH AND DECEMBER 4TH, BMC'S MOBILE VACCINATION EFFORTS ADMINISTERED 4,337 DOSES OF THE COVID-19 VACCINE. OF THE 1,844 FIRST DOSE VACCINES ADMINISTERED, 68% WERE GIVEN TO PEOPLE IN THE TOP THREE SOCIAL VULNERABILITY INDEX (SVI) DECILES AND 55% WERE ADMINISTERED TO BLACK (32%) AND LATINX (23%) PATIENTS. BMC'S MOBILE VACCINATION TEAM WAS COMPRISED OF MULTILINGUAL AND MULTICULTURAL REGISTERED NURSES FROM THE LOCAL COMMUNITY WHO WERE ABLE TO COMMUNICATE WITH PATIENTS IN THEIR PREFERRED LANGUAGES AND EFFECTIVELY ADDRESS VACCINE HESITANCY, PROVIDE CULTURALLY COMPETENT EDUCATION, AND NAVIGATE PATIENTS TO THE POP-UP EVENTS AND VACCINATION SITES. THESE NURSES WERE ABLE TO FACILITATE PATIENT-CENTERED CONVERSATIONS AND DEVELOP RAPPORT, CREATING SPACE FOR PATIENTS TO OPEN UP ABOUT THEIR CONCERNS AND PAST HEALTHCARE TRAUMAS. AS FEATURED IN A SCHOLARLY ARTICLE IN MAY OF 2022 IN THE ANNALS OF INTERNAL MEDICINE, THE BMC VACCINATION INITIATIVE HAS SHOWN THE IMPORTANCE OF HAVING LEADERSHIP AND WORKFORCE COMMITMENT TO HEALTH EQUITY AND COMMUNITY ENGAGEMENT. AS A RESULT, BMC IS NOW PART OF THE COMMUNITY ENGAGED ALLIANCE OF THE NATIONAL INSTITUTES OF HEALTH, AIMED AT INCREASING VACCINE CONFIDENCE AND ENGAGEMENT IN RESEARCH."

SCHEDULE H, PART VI, LINE 5 (CONTINUATION):
IMMIGRANT AND REFUGEE HEALTH CENTER (IHRC): THE IHRC CONNECTS ALL OF BMC'S EXISTING PROGRAMS AND EXPERTISE IN IMMIGRANT AND REFUGEE HEALTH CARE INTO ONE CENTRAL POINT OF ENTRY. THROUGH THE IHRC, ANY IMMIGRANT PATIENT CAN BE CONNECTED WITH ALL OF THE MEDICAL, MENTAL HEALTH AND SOCIAL SERVICES THAT THEY NEED TO HEAL, REBUILD, AND THRIVE. THIS INCLUDES SPECIALIZED PRIMARY CARE SERVICES FOR IMMIGRANT AND REFUGEE PATIENTS INCLUDING REGULAR CHECK-UPS, IMMUNIZATIONS AND SCREENINGS; SPECIALIZED, TRAUMA-INFORMED MENTAL HEALTH CARE FOR IMMIGRANT AND REFUGEE AND TAILORED OBSTETRICS AND GYNECOLOGICAL CARE FOR IMMIGRANT AND REFUGEE PATIENTS, INCLUDING PREGNANCY AND POSTPARTUM CARE, ANNUAL CHECK-UPS, GYNECOLOGIC CARE, CONTRACEPTION COUNSELING, SURGICAL CONSULTATION AND CONSULTATIONS REGARDING FEMALE GENITAL CIRCUMCISION. WE ALSO RECOGNIZE THAT NAVIGATING THE US HEALTHCARE SYSTEM CAN BE CHALLENGING. OUR CASE MANAGEMENT TEAM PARTNERS WITH OUR PATIENTS TO CONNECT THEM WITH THE MEDICAL AND SOCIAL SERVICES THEY NEED (FROM IMMIGRATION LEGAL NEEDS, TO CAREER DEVELOPMENT, TO FOOD AND HOUSING SUPPORT) IN A SUPPORTIVE ENVIRONMENT THAT IS SPECIFICALLY TAILORED TO MEET THE UNIQUE NEEDS OF OUR PATIENTS. FOREIGN AND SIGN LANGUAGE INTERPRETERS ARE AVAILABLE TO HELP PATIENTS COMMUNICATE WITH THE STAFF. THE PRACTICE PROVIDES ON-SITE INTERPRETERS AND PHONE-BASED INTERPRETERS FOR MORE THAN 250 LANGUAGES. IN THE PAST YEAR, THE IHRC SERVED FOR OVER 2,000 IMMIGRANT, REFUGEE, AND ASYLUM SEEKING PATIENTS, DELIVERING APPROXIMATELY 6,400 CLINICAL VISITS ANNUALLY. MARGARET M. SHEA RN ADULT DAY HEALTH PROGRAM: THE PROGRAM HOLDS A LICENSE UNDER THE DEPARTMENT OF PUBLIC HEALTH AND OFFERS FAMILIES PEACE OF MIND AND A SUPPORT SYSTEM TO HELP THEM CARE DAILY FOR A FAMILY MEMBER UNABLE TO FUNCTION ALONE DURING THE DAY. THE PROGRAM OFFERS INTERVENTION PROGRAMS THAT PROVIDE SERVICES IN AN AMBULATORY, HOME-LIKE SETTING FOR ADULTS WHO DO NOT REQUIRE 24-HOUR INSTITUTIONAL CARE BUT, BECAUSE OF PHYSICAL AND/OR MENTAL IMPAIRMENT, ARE NOT COMPLETELY ABLE TO LIVE INDEPENDENTLY OR REMAIN AT HOME, ALLOWING FAMILY MEMBERS THE OPPORTUNITY TO CONTINUE TO WORK WHILE THEIR LOVED ONE IS AT A PROGRAM DURING THE DAY. A REFERRED PARTICIPANT CAN LOOK FORWARD TO PROGRAM OFFERINGS SUCH AS NURSING INTERVENTIONS, SOCIAL SERVICES, THERAPEUTIC ACTIVITIES, AND TRANSPORTATION TO AND FROM THE PROGRAM.DUE TO COVID-19, THE PROGRAM CLOSED IN-PERSON PROGRAMING IN MARCH 2020, WITH STAFF MAINTAINING CLOSE CONTACT VIA TELEPHONIC REMOTE SERVICES. CLIENTS BEGAN TO RETURN TO IN-PERSON SERVICES IN OCTOBER 2020, WITH ONLY 4-6 CLIENTS PER DAY THROUGH THE WINTER OF 2020-2021. REMOTE SERVICES CONTINUED THROUGH FALL OF 2021 INCLUDING CLIENTS JOINING US FROM HOME VIA ZOOM FOR BINGO AND OTHER ACTIVITY PROGRAMS. BY THE END OF DECEMBER 2021 ALL CLIENTS RETURNED TO IN-PERSON PROGRAMING AND TO THEIR AUTHORIZED &/OR SCHEDULED PREFERENCE OF 2-5 DAYS PER WEEK. THE PROGRAM SERVED AN AVERAGE ROSTER OF 33 PARTICIPANTS DURING 2022 WITH AN AVERAGE OF 20 CLIENTS PER DAY IN ATTENDANCE. DURING THIS TIME PERIOD THE PROGRAM ALSO WELCOMED NEW STAFF INCLUDING A NEW PROGRAM DIRECTOR, SOCIAL WORKER, NURSES AND PROGRAM AIDES.PROGRAM FOR INTEGRATIVE MEDICINE AND HEALTH CARE DISPARITIES (INTEGRATIVE MEDICINE): STARTED IN 2004, THE PROGRAM FOR INTEGRATIVE MEDICINE AND HEALTH CARE DISPARITIES AT BMC COMBINES CONVENTIONAL MEDICAL TREATMENT, COMPLEMENTARY THERAPIES, AND LIFESTYLE CHANGES. THE CORE PURPOSE OF THIS PROGRAM IS TO PIONEER A WIDELY ACCESSIBLE, MULTICULTURAL, CROSS-DISCIPLINARY, NATIONAL MODEL OF INTEGRATIVE HEALTH FOR ALL THROUGH CLINICAL SERVICES, EDUCATION, RESEARCH AND ADVOCACY. COMPLEMENTARY THERAPIES INCLUDE YOGA, MASSAGE, ACUPUNCTURE, HERBAL THERAPY, DIETARY SUPPLEMENTS, MEDITATION, HYPNOSIS, CHI GUNG, TAI CHI, AND REIKI. THE PROGRAM OFFERS ALL CLINICAL SERVICES AND CLASSES AT LITTLE OR NO COST.CONVENTIONAL TREATMENTS MAY INCLUDE PRESCRIPTION MEDICATION, X-RAYS, SURGICAL PROCEDURES, PHYSICAL, AND OCCUPATIONAL THERAPY. HISTORICALLY, COMPLEMENTARY THERAPIES WERE NOT PART OF CONVENTIONAL MEDICINE; HOWEVER, CERTAIN THERAPIES ARE BECOMING MORE COMMON IN HEALTHCARE TODAY BECAUSE KNOWLEDGE AND RESEARCH ABOUT THEIR EFFECTIVENESS CONTINUES TO GROW.PEDIATRIC ASSESSMENT OF COMMUNICATION CLINIC (AUTISM PROGRAM): THE AUTISM PROGRAM AT BMC IS A MULTIDISCIPLINARY, MULTI-TIERED, COMPREHENSIVE AND CULTURALLY COMPETENT PROGRAM THAT IS UNIQUELY EQUIPPED TO MEET THE COMPLEX NEEDS OF PATIENTS AND FAMILIES. OUR TEAM, COMPRISED OF A PROGRAM DIRECTOR AND ASSOCIATE DIRECTOR, AUTISM RESOURCE SPECIALISTS, TRANSITION SPECIALIST, RESEARCH COORDINATOR AND AUTISM FRIENDLY HOSPITAL PROJECT COORDINATOR, OFFERS SPECIALIZED OUTREACH, TRAINING AND ADVOCACY SERVICES. IN ADDITION, THE TEAM FORMS EFFECTIVE PARTNERSHIPS WITH SCHOOLS, COLLABORATES WITH LOCAL SUPPORT ORGANIZATIONS AND DRAWS UPON A DEEP KNOWLEDGE BASE OF SOCIAL SERVICE AGENCIES TO FACILITATE LINKAGES TO RESOURCES AND SUPPORTS WHILE DEVELOPING AND SCALING UP NOVEL INTERVENTIONS TO MEET GAPS IN SERVICES. OUR AUTISM RESOURCE SPECIALISTS WORK INTENSELY WITH PATIENT FAMILIES TO HELP ENSURE TIMELY AND APPROPRIATE TREATMENT FOR CHILDREN, WHICH OFTEN INCLUDES PROVIDING SUPPORT FOR THOSE FACING FINANCIAL BARRIERS, LINGUISTIC NEEDS AND CULTURAL ISSUES; ENHANCING PATIENT-PROVIDER COMMUNICATION; NAVIGATING HEALTH CARE SYSTEM OBSTACLES; AS WELL AS ACCESSING STATE AND GOVERNMENTAL BENEFITS. ADDITIONALLY, STAFF PROVIDE INDIVIDUALIZED BEHAVIOR CONSULTATION AND PARENT TRAINING TO STRENGTHEN CHILDREN'S COMMUNICATION AND RELATED SKILL-BUILDING AND REDUCE CHALLENGING BEHAVIORS. OUR TRANSITION SPECIALIST PROVIDES TRANSITION-AGED YOUTH (14-22 YEARS OLD) AND THEIR FAMILIES WITH INFORMATION, GUIDANCE, AND RESOURCES REGARDING THE TRANSITION FROM SCHOOL SERVICES TO ADULT LIFE AND DISCUSSES TOPICS SUCH AS GOAL SETTING, SCHOOL IEP PLANNING, ADULT SERVICES, AND LIFE SKILLS DEVELOPMENT. OUR AUTISM FRIENDLY INITIATIVE (AFI) IS RECOGNIZED AS A NATIONAL AND INTERNATIONAL LEADER IN IMPROVING THE HEALTHCARE EXPERIENCE FOR PATIENTS WITH AUTISM SPECTRUM DISORDER (ASD) AND THEIR FAMILIES. OUR AFI HAS SUCCESSFULLY DEVELOPED AND IMPLEMENTED A RANGE OF INTERVENTIONS ACROSS THE DOMAINS OF INDIVIDUALIZING PATIENT CARE, MODIFYING THE SENSORY ENVIRONMENT, STAFF TRAINING, AND PATIENT/FAMILY ACCOMMODATIONS. THE AUTISM PROGRAM ALSO HAS A WELL-ESTABLISHED SOCIAL MEDIA PRESENCE ON FACEBOOK AND INSTAGRAM-BOTH OF WHICH SERVE AS ADDITIONAL AVENUES TO PROVIDE RESOURCES, INFORMATION, AND GUIDANCE TO FAMILIES. THE AUTISM PROGRAM HAS SUPPORTED OVER 11,000 FAMILY REFERRALS SINCE ITS INCEPTION IN 2007 AND APPROXIMATELY 1,500 IN FY22. ADDITIONALLY, THE PROGRAM TRAINS OVER 1,000 INDIVIDUALS ANNUALLY.

SCHEDULE H, PART VI, LINE 5 (CONTINUATION):
"PEDIATRIC PAIN CLINIC: BMC'S PEDIATRIC PAIN CLINIC MANAGES ACUTE, COMPLEX, AND CHRONIC PAIN IN CHILDREN FROM INFANCY TO AGE 22. OUR TEAM OF EXPERTS WORK CLOSELY WITH EACH PATIENT'S PRIMARY CARE PHYSICIAN, STRIVING TO HELP CHILDREN REGAIN NORMAL LIVES AND PARTICIPATE IN TYPICAL AGE-APPROPRIATE ACTIVITIES. THE PEDIATRIC PAIN CLINIC IS ABLE TO TREAT A WIDE VARIETY OF CONDITIONS, AND OFFERS A VARIETY OF SPECIALIZED THERAPIES. EACH PATIENT IS GIVEN A PERSONALIZED PAIN MANAGEMENT PLAN TO BEST FIT THEIR NEEDS. STRATEGIES AND PARENTING SUPPORT ARE ALSO OFFERED FOR FAMILIES WHO MAY TRAVEL A LONG DISTANCE TO RECEIVE THIS SPECIALIZED CARE. THE TEAM COMMUNICATES WITH SCHOOLS AND OUTSIDE PROVIDERS TO ENSURE COMPREHENSIVE AND COLLABORATIVE CARE.PREVENTIVE FOOD PANTRY, TEACHING KITCHEN, AND ROOFTOP FARM: THE PREVENTIVE FOOD PANTRY AND TEACHING KITCHEN ADDRESS HUNGER-RELATED ILLNESS AND MALNUTRITION AMONG A LOW-INCOME, LARGELY UNDERSERVED PATIENT POPULATION WITHIN GREATER BOSTON. INDIVIDUALS AT RISK OF MALNUTRITION ARE REFERRED TO THE PROGRAM BY BMC OR BOSTON HEALTHNET PHYSICIANS OR NUTRITIONISTS WHO PROVIDE ""PRESCRIPTIONS"" FOR SUPPLEMENTAL FOOD THAT BEST PROMOTES PHYSICAL HEALTH, PREVENTS FUTURE ILLNESS, AND FACILITATES RECOVERY. THE PANTRY STAFF MEMBERS ARE FLUENT IN 4 LANGUAGES AND HAVE BEEN ESSENTIAL IN ASSISTING BMC'S MANY REFUGEE AND IMMIGRANT PATIENTS. DUE TO THE COVID-19 PANDEMIC, THERE HAVE BEEN DECREASED NUMBERS OF PEOPLE VISITING BMC. HOWEVER, THE FOOD PANTRY HAS CONTINUED TO PROVIDE NUTRITIONAL FOOD PRESCRIPTIONS TO APPROXIMATELY 5,643 PEOPLE EACH MONTH. IN FY22, WE PROVIDED FOOD TO 67,712 PEOPLE. WE DISPENSED APPROX. 10,500 POUNDS OF FOOD EACH WEEK. THIS EQUATES TO APPROXIMATELY 8 POUNDS OF GROCERIES PER PERSON. THE TEACHING KITCHEN: OFFERS IN PERSON, VIRTUAL, AND HYBRID CLASSES TO PATIENTS, STAFF, STUDENTS, AND PARTNERING COMMUNITY ORGANIZATIONS. RE-CURRING CLASSES IN THE TEACHING KITCHEN INCLUDE HEALTHY HABITS, WELLNESS AND THE TEACHING KITCHEN, WEIGHT LOSS SURGERY PREP, COOKING FOR RECOVERY, FOOD EXPLORERS, CUISINES OF THE WORLD AND MORE. NEW STRATEGIC PARTNERSHIPS HAVE BEEN MADE THROUGHOUT THE HOSPITAL TO FURTHER INTEGRATE INTO CLINICAL CARE. FOR EXAMPLE, AN INNOVATIVE CLASS WITH THE GROW CLINIC OFFERS NUTRITION AND CULINARY EDUCATION FOR PREGNANT AND POSTPARTUM PEOPLE TO SUPPORT PREGNANCY AND BABIES. PARTNERSHIPS WITH THE GRAYKEN CENTER'S START CLINIC AND CATALYST CLINIC SUPPORT FOLKS WITH SUBSTANCE USE DISORDER TO BUILD HEALTHY EATING HABITS AND GAIN CONFIDENCE IN FOOD PREPARATION USING ACCESSIBLE FOODS. THESE CLINICALLY INTEGRATED CLASSES ENHANCE CARE AND PROVIDE ADDITIONAL EDUCATION, SUPPORT, AND COMMUNITY TO ADDRESS THE NUTRITIONAL NEEDS OF OUR PATIENT POPULATION. RECIPES FEATURE STAPLE FOODS PROVIDED BY THE FOOD PANTRY, AND CULTURALLY COMPETENT FOODS FOR OUR DIVERSE COMMUNITY. RESEARCH EFFORTS CONTINUE TO GROW, INCLUDING A QUALITY IMPROVEMENT PROJECT ASSESSING PATIENTS' FOOD PREFERENCES AND ENVIRONMENT, THE FEASIBILITY OF TEACHING KITCHEN CLASSES IN CLINICAL CARE, AND RESEARCH ON HEALTH OUTCOMES. IN APRIL 2017, BMC OPENED ITS ROOFTOP FARM, TO MEET OUR PATIENTS' GROWING NEED FOR FRESH PRODUCE. THE ROOFTOP FARM HAS 2,400 SQUARE FEET OF GROWING SPACE, AND IS LOCATED ON TOP OF BMC'S ALBANY STREET POWER PLANT. THE FARM PRODUCES CROPS SUCH AS SPINACH, COLLARDS, BOK CHOY, RADISHES, SWISS CHARD, KALE, TOMATOES, AND MUCH MORE. IN ADDITION TO PRODUCE, THE FARM ALSO HAS 4 BEEHIVES WHICH PROVIDE 20-100 POUNDS OF HONEY TO THE HOSPITAL EACH SEASON. AS OF 2022 THE FARM HAS BEEN FULLY OPEN TO THE PUBLIC, HOSTING OVER 1000 VISITORS TO THE FARM LAST SEASON FOR TOURS, GARDENING CLASSES, YOGA, AND COOKING CLASSES. THE FARM CONTINUED TO HOST AN INTERNSHIP PROGRAM FOR PEOPLE LOOKING TO LEARN THE INS AND OUTS OF ROOFTOP FARMING AND GROWING FOOD FOR A HOSPITAL. IN FY 2022, THE FARM GREW OVER 4,000 LBS OF FOOD VALUED AT $18,000 FOR THE HOSPITAL. MORE THAN HALF OF THE FOOD WENT TO THE FOOD PANTRY, WITH THE REST GOING TO THE HOSPITAL CAFETERIA AND WEEKLY FARMERS' MARKET. THE FARMERS MARKET, HOSTED EVERY TUESDAY IN THE SHAPIRO BUILDING, SERVES PATIENTS AND STAFF FRESH FARM PRODUCE AT A SUBSIDIZED RATE. PROJECT REACH: AN INITIATIVE CREATED AS A RESULT OF THE COVID-19 PANDEMIC WAS LAUNCHED TO ASSESS THE WELL-BEING OF ALL BMC PEDIATRIC PATIENTS WHO WERE QUARANTINING IN THEIR HOMES. DURING ASSESSMENTS, THE TEAM LEARNED THAT 15% OF PEDIATRIC FAMILIES WERE NOT ABLE TO LEAVE THEIR HOUSES DUE TO POSITIVE COVID-19 DIAGNOSES, CHILDCARE NEEDS OR RISK TO VULNERABLE FAMILY MEMBERS, LEAVING THEM IN DIRE NEED OF FOOD AND SUPPLIES. IN RESPONSE, PROJECT REACH QUICKLY PARTNERED WITH THE MOBILE TEAM TO EXPAND ON HOME VISITS TO INCLUDE DELIVERIES OF FOOD, HYGIENE ITEMS, CLEANING SUPPLIES AND OTHER SERVICES SUCH AS STRESS MANAGEMENT, FINANCIAL EDUCATION, MUSIC CLASSES AND STORY TIMES FOR CHILDREN. FROM OCTOBER 2020 THROUGH SEPTEMBER 2022, PROJECT REACH STAFF CONNECTED WITH THE FAMILIES OF OVER 1,500 PATIENTS FOR ASSESSMENT OF NEED AND SUPPORTS TO ADDRESS THEM, INCLUDING FOOD INSECURITY."

SCHEDULE H, PART VI, LINE 5 (CONTINUATION):
"BMC INVESTED $1.35M IN A LOAN TO THE COMMUNITY ECONOMIC DEVELOPMENT ASSISTANCE CORPORATION (CEDAC). THE PURPOSE OF THIS LOAN IS TO PARTIALLY CAPITALIZE LOANS UNDER THE ACCELERATING INVESTMENTS IN HEALTH COMMUNITIES (AIHC) INITIATIVE. THROUGH THIS, CEDAC WILL PROVIDE SUBORDINATE LOANS TO THREE AFFORDABLE HOUSING DEVELOPMENTS. THIS INVESTMENT SERVES AS CRITICAL ""GAP"" FINANCING TO ALLOW ALL THE DIFFERENT FINANCING TO BE EXECUTED AT THE SAME TIME AND THEREFORE FOR CONSTRUCTION ON NEW AFFORDABLE HOUSING TO BEGIN BEFORE HOUSING COSTS WENT US FURTHER. THE LOANS ARE LONG TERM, 20+ YEARS COMMITMENTS TO MATCH AND LEVERAGE THE CITY AND STATE INVESTMENTS IN THESE PROJECTS.BMC INVESTED $69,012 IN THE CAMBRIDGE HEALTH ALLIANCE (CHA) TOWARDS A COMMUNITY WELLNESS ADVOCATE AT THE MANNING APARTMENT COMPLEX. THE COMMUNITY WELLNESS ADVOCATE PROVIDED INDIVIDUALIZED CASE MANAGEMENT AND SUPPORT TO RESIDENTS OF MANNING HOUSE TO IMPROVE HEALTH OUTCOMES FOR THESE RESIDENTS. BMC ALSO INVESTED $65,219 IN A COMMUNITY WELLNESS REGISTERED NURSE (RN) AS PART OF THE ELDERS LIVING AT HOME PROGRAM. THE RN WORKED WITH THE CHA AND MANNING HOUSE STAFF TO IMPROVE RESIDENTS' ACCESS TO SERVICES AND SUPPORT, AND SERVED AS THE PRIMARY LIAISON BETWEEN BMC AND OTHER HEALTH CARE PROVIDERS.BMC PROVIDED A THREE-MONTH EXTENSION TO THE COMMUNITY BUILDERS (TCB) TO CONTINUE THE PARTNERSHIP WHICH ALLOWS FOR BMC TO SUPPORT SERVICE PROVISION AT THE NEW FRANKLIN APARTMENTS. TCB IMPLEMENTS A PLACE-BASED MODEL THAT USES STABLE HOUSING AS A PLATFORM FOR RESIDENTS AND NEIGHBORHOODS TO ACHIEVE SUCCESS. THIS ON-SITE HOUSING WORKER DOES ANNUAL ASSESSMENTS OF RESIDENTS' NEEDS IN THE COMMUNITY, AND DEVELOPS PERSONALIZED PLANS TO CONNECTING RESIDENTS TO THOSE RESOURCES. IN ADDITION, WHEN RESOURCES GAPS EXIST, THE ONSITE HOUSING WORKER WILL DEVELOP NEW RESOURCES. EXAMPLES INCLUDE AN ONSITE FOOD PANTRY WHERE RESIDENTS STAFF THE PANTRY TO ASSIST OTHER RESIDENTS, AND USING COMMUNITY ROOMS IN THE HOUSING DEVELOPMENT FOR AFTER SCHOOL PROGRAMMING, EXERCISE CLASSES AND EVEN COVID-TESTING.BMC INVESTED $330,431 IN THE INNOVATIVE STABLE HOUSING INITIATIVE, LED BY HEALTH RESOURCES IN ACTION (HRIA). THROUGH THIS PARTNERSHIP, HRIA HAS SUCCESSFULLY FACILITATED A COMMUNITY ENGAGEMENT PROCESS THAT HAS BROUGHT TOGETHER HOUSING ADVOCATES, HEALTHCARE PROVIDERS, AND COMMUNITY RESIDENTS TO DESIGN AND IMPLEMENT A PARTICIPATORY GRANTMAKING PROCESS FOCUSED ON HOUSING STABILITY AND ECONOMIC MOBILITY. BMC INVESTED IN THE HEALTHY NEIGHBORHOOD EQUITY FUND, A $22.35 MILLION PRIVATE EQUITY FUND LED BY THE CONSERVATION LAW FOUNDATION AND THE MASSACHUSETTS HOUSING INVESTMENT CORPORATION. IT IS BASED ON A SOCIALLY RESPONSIBLE INVESTMENT MODEL THAT CONSIDERS THE COMMUNITY, ENVIRONMENTAL, AND HEALTH BENEFITS AS WELL AS THE FINANCIAL RISKS AND RETURNS. BOSTON PROJECTS INCLUDE TREADMARK, ASHMONT, DORCHESTER AND BARTLETT STATION, DUDLEY SQUARE, ROXBURY. BMC INVESTED IN THE BOSTON HOUSING AUTHORITY (BHA) TO SUPPORT THEIR REASONABLE ACCOMMODATIONS FUND, THOROUGH WHICH BHA INVESTS FUNDS TO IMPROVE THE HEALTH, SAFETY, AND COMFORT OF THEIR RESIDENTS. FURTHER, BMC ALSO PROVIDED SUPPORT TO COVER SOME STAFFING TIME FOR ONE OF BHA'S STAFF MEMBERS. BMC ALSO INVESTED IN THE METROPOLITAN AREA PLANNING COUNCIL (MAPC), THE EVALUATOR FOR BMC'S DON. IN THIS ROLE, MAPC DEVELOPS AND IMPLEMENTS AN EVALUATION PLAN TO ASSESS THE IMPACTS AND EFFECTS OF BMC'S MULTI-YEAR DON FOCUSED ON IMPROVING HOUSING STABILITY. THE EVALUATION WILL SEEK TO ASCERTAIN HOW THE VARIOUS INVESTMENTS IN HOUSING STABILITY INDIVIDUALLY AND COLLECTIVELY ADDRESS CONDITIONS ASSOCIATED WITH HEALTH OUTCOMES AND WITH PERFORMANCE OF THE ORGANIZATIONS INVOLVED IN THE PROCESS.THE HOUSING TO HEALTH PROGRAM IN THE DEPARTMENT OF PEDIATRICS AT BOSTON MEDICAL CENTER HAS SUCCESSFULLY DEPLOYED A MULTIDIMENSIONAL STRATEGY FOR RESPONDING TO A RANGE OF HOUSING AND HOMELESSNESS ISSUES AMONG PATIENT FAMILIES. THIS MODEL INCLUDED TWO FULL-TIME HOUSING NAVIGATORS WITH DEEP EXPERTISE IN SUPPORTING FAMILIES TO ACCESS HOUSING-RELATED PROGRAMS AND SOLUTIONS. THESE NAVIGATORS WORK CLOSELY WITH FAMILIES TO ENTER SHELTER, RESOLVE HOUSING QUALITY ISSUES, APPLY FOR RENTAL ASSISTANCE AND SUBSIDIZING HOUSING, AND CONNECT WITH LEGAL AND COMMUNITY-BASED SERVICES (IN ADDITION TO OTHER WRAPAROUND SUPPORTS). THE WORK OF THE NAVIGATORS WAS BOLSTERED BY KEY EXTERNAL PARTNERSHIPS WITHIN HOUSING TO HEALTH. SPECIFICALLY, FUNDED PARTNERSHIPS WITH METRO HOUSING BOSTON, FAMILYAID BOSTON AND MEDICAL-LEGAL PARTNERSHIP BOSTON (MLPB) SERVED TO ADDRESS A RANGE OF PATIENT FAMILY NEEDS. FOR EXAMPLE, METRO HOUSING CONNECTED BMC FAMILIES WITH RENTAL ASSISTANCE FOR ARREARAGES. FAMILYAID BOSTON WORKED WITH BMC FAMILIES TO ACCESS PRIORITY HOUSING VOUCHERS AND PROVIDE STABILIZATION SERVICES; THEY RECENTLY WORKED WITH BMC AND BOSTON CHILDREN'S HOSPITAL TO ESTABLISH THE HOSPITAL EMERGENCY HOUSING PROGRAM, WHICH OFFERS RAPID RESPONSE SHELTER OPTIONS FOR FAMILIES WITH NO SAFE SHELTERING OPTIONS WHO WOULD OTHERWISE BE FORCED TO STAY OVERNIGHT IN A LOCAL EMERGENCY ROOM. FINALLY, MLPB PROVIDED REGULAR LEGAL PROBLEM-SOLVING TRAININGS TO FRONTLINE STAFF WORKING WITH FAMILIES AS WELL AS CASE-SPECIFIC LEGAL CONSULTATION. CHRONIC DISEASES AND RISK FACTORSCANCER SUPPORT GROUPS: OFFERINGS INCLUDE AN ARRAY OF SIXTEEN (16) MONTHLY SUPPORT GROUPSBY CANCER TYPE (E.G., BREAST, GI, HEAD & NECK); POPULATION TYPE (E.G., MEN, SPANISH-SPEAKING), OTHER DISEASE (E.G., SICKLE CELL, AMYLOIDOSIS); AND RELATED SUPPORT (E.G., OSTOMY, CAREGIVER, BEREAVEMENT). ALSO PROVIDED TO ALL CLIENTS WERE FIVE (5) ONGOING SUPPORT ACTIVITIES FOR MIND/HAND/BODY/NUTRITION THAT MET WEEKLY TO MONTHLY. ADDITIONALLY, EACH QUARTER SAW A VARIETY OF FOUR TO SIX (4-6) FEATURED PROGRAMS IN ART/THEATER/MUSIC. ONE OF THESE FEATURED PROGRAMS SPANNED FIVE MONTHS AND PRODUCED A PROFESSIONALLY-SHOT VIDEO AND A HARDCOVER BOOK SAMPLING PARTICIPANTS' ARTWORK AND CULMINATED WITH A PUBLIC CELEBRATION. THE CANCER & SICKLE CELL SUPPORT PROGRAMS ALSO PROVIDED A FREE WEEKLY ACUPUNCTURE CLINIC FOR PATIENTS CURRENTLY OR RECENTLY IN TREATMENT.ALL PROGRAMS WERE MANAGED AND IMPLEMENTED BY THE PROGRAM MANAGER AND ONE PROGRAM ASSISTANT; TWO IN-HOUSE SOCIAL WORKERS WHO EACH FACILITATED ONE OF THE REGULAR MONTHLY GROUPS; A HIGHLY EXPERIENCED LICENSED ACUPUNCTURIST; BMC REGISTERED DIETITIANS FOR A MONTHLY CLASS; AND SEVERAL OUTSIDE VENDORS CONTRACTED FOR THE FEATURED ART PROGRAMS. BECAUSE OF INCREASED REFERRALS OF PATIENTS TO THE PROGRAM, NUMBERS IN TERMS OF PARTICIPATION LEVEL REMAINED CONSISTENT WITH PREVIOUS YEARS DESPITE SOME EFFECT OF ZOOM FATIGUE AND ZOOM AVERSION. BECAUSE THE PROGRAMS RAN ALMOST ENTIRELY BY ZOOM IN 2021, SECONDARY COSTS SUCH AS FOR FOOD AND SUPPLIES WERE VERY MINIMAL COMPARED TO THE YEARS BEFORE THE COVID PANDEMIC, WHEN MEETINGS WERE ALL HELD IN PERSON. IN 2022, IN PERSON MEETINGS BEGAN AGAIN CREATING A GROWTH IN THIS PROGRAM, INCLUDING SPEND. PATIENT NAVIGATION (PN): BMC'S PN PROGRAM WAS LAUNCHED IN 2005. THE MAIN FOCUS OF THIS PROGRAM IS TO IDENTIFY AND OVERCOME BARRIERS THAT PLAY A KEY ROLE IN A PATIENT'S TREATMENT COMPLIANCE AND COMPLETION. PATIENT NAVIGATORS DO THIS BY PROVIDING ADVOCACY AND CASE MANAGEMENT TO ONCOLOGY PATIENTS WHO HAVE AT LEAST ONE IDENTIFIED BARRIER TO CARE AND ARE UNDERGOING ACTIVE CANCER TREATMENT. PNS WORK TO EMPOWER PATIENTS BY LINKING THEM TO A BROAD RANGE OF SERVICES INCLUDING, BUT NOT LIMITED TO, ONCOLOGY SUPPORT SERVICES, TRANSPORTATION, FINANCIAL ASSISTANCE, AND APPROPRIATE COMMUNITY RESOURCES."

SCHEDULE H, PART VI, LINE 5 (CONTINUATION):
"VIOLENCECHILD WITNESS TO VIOLENCE PROJECT (CWVP): CWVP IS A NATIONALLY-RECOGNIZED AND AWARD-WINNING MENTAL HEALTH COUNSELING, OUTREACH, AND CONSULTATION PROGRAM. CWVP SPECIALIZES IN INTERVENTION WITH VERY YOUNG CHILDREN EXPOSED TO DOMESTIC OR COMMUNITY VIOLENCE. THE PROGRAM OFFERS BOTH SHORT- AND LONG-TERM EVIDENCE-BASED TREATMENTS THAT REPRESENT BEST PRACTICE IN SERVING THE NEEDS OF TRAUMATIZED CHILDREN AND THEIR FAMILIES. THE PROGRAM PROVIDES A FLEXIBLE COMBINATION OF SERVICES, INCLUDING RESOURCE ADVOCACY, AND IT LINKS FAMILIES TO BASIC SERVICES SUCH AS HEALTH CARE, CHILDCARE, HOUSING, AND AFTER-SCHOOL PROGRAMS. THE CWVP PROVIDED REFERRALS, ADVOCACY, ASSESSMENT, SHORT-TERM, AND/OR LONGER-TERM CLINICAL CARE TO APPROXIMATELY 400 FAMILIES IN FY22. IN ADDITION TO ITS CLINICAL SERVICES, CWVP IS ENGAGED IN EXTENSIVE LOCAL, STATEWIDE, AND NATIONAL TRAINING EFFORTS TO RAISE THE STANDARD OF CARE FOR YOUNG CHILDREN EXPERIENCING THE TRAUMATIC EFFECTS OF VIOLENCE. THE STAFF HAVE DELIVERED NUMEROUS TRAININGS ACROSS MULTIPLE STATES AND ABROAD TO MENTAL HEALTH AND OTHER PROVIDERS ACROSS SERVICE SECTORS AND SETTINGS. COMMUNITY VIOLENCE RESPONSE TEAM (CVRT): THE CVRT ADDRESSES THE GREAT NEED FOR SERVICES FOR VICTIMS OF COMMUNITY VIOLENCE AND THEIR FAMILIES, AS WELL AS FAMILY SURVIVORS OF HOMICIDE VICTIMS FROM THE GREATER BOSTON AREA. FREE, CULTURALLY SENSITIVE, FAMILY-FOCUSED CLINICAL SERVICES PROVIDED BY THE CVRT INCLUDE CRISIS INTERVENTION, ADVOCACY, CASE MANAGEMENT, AND TRAUMA-FOCUSED COUNSELING FOR ADULTS, ADOLESCENTS, AND CHILDREN (WITH A FOCUS ON AGE EIGHT AND OVER). CVRT SEEKS TO REDUCE THE EFFECTS OF TRAUMA BY PROVIDING THERAPEUTIC SUPPORT THROUGHOUT THE RECOVERY PROCESS AND ULTIMATELY MINIMIZING MENTAL HEALTH TRAUMA. CVRT STAFF REFLECTS THE DIVERSITY OF BMC'S PATIENT POPULATION. IN FY22 THE CVRT SERVED 491 PEOPLE.DOMESTIC VIOLENCE PROGRAM (DVP): THE DVP PROVIDES DIRECT ADVOCACY SERVICES FOR VICTIMS OF DOMESTIC VIOLENCE, AS WELL AS TRAINING AND EDUCATION FOR STAFF, STUDENTS, AND COMMUNITY GROUPS INTERESTED IN LEARNING MORE ABOUT DOMESTIC VIOLENCE, ITS IMPACT ON HEALTH ACROSS THE LIFESPAN, AND THE ROLE WE ALL CAN PLAY IN ADDRESSING IT. IN FY22 THE MULTI-LINGUAL TEAM OF 4 SAFETY AND SUPPORT ADVOCATES ASSISTED 457 VICTIMS AND SURVIVORS WITH A RANGE OF SERVICES INCLUDING CRISIS INTERVENTION/COUNSELING; RISK ASSESSMENT AND SAFETY PLANNING; ASSISTANCE WITH ACCESSING PROTECTIVE ORDERS AND VICTIM COMPENSATION; ACCOMPANIMENT TO COURT, LEGAL, MEDICAL, HOUSING AND OTHER APPOINTMENTS; REFERRAL TO COMMUNITY-BASED DV ADVOCACY/RAPE CRISIS COUNSELING, MEDICAL/MENTAL HEALTH SERVICES; EMERGENCY FINANCIAL ASSISTANCE; AND OTHER SUPPORT AS NEEDED. OF THOSE SERVED, APPROXIMATELY 75% WERE PATIENTS REFERRED BY BMC PROVIDERS, 2% WERE BMC EMPLOYEES, AND 23% WERE SELF-REFERRALS OR REFERRED BY COMMUNITY AND GOVERNMENT PROGRAMS THAT ASSIST DV SURVIVORS. DURING FY22 THE DV PROGRAM ALSO OFFERED A SERIES OF 6 WEEK SUPPORT GROUPS IN BOTH ENGLISH AND SPANISH FOR WOMEN-IDENTIFIED SURVIVORS. THE PROGRAM MANAGER (WHO IS ALSO THE PROGRAM'S PRIMARY TRAINER/PRESENTER) PROVIDED 59 PRESENTATIONS AND OTHER TYPES OF TRAINING TO OVER 1,000 PARTICIPANTS, MOST OF WHOM WERE BMC STAFF AND PROVIDERS, AS WELL AS A FEW STUDENT AND COMMUNITY GROUPS.VIOLENCE INTERVENTION ADVOCACY PROGRAM (VIAP): CONCEIVED IN 2006 TO HELP STEM THE TIDE OF BOSTON'S GUN AND KNIFE VIOLENCE, VIAP HAS BECOME A VITAL COMPONENT OF VIOLENCE INTERVENTION IN THE CITY AND BEYOND. VIAP'S PURPOSE IS TO HELP VICTIMS HEAL SO THEY CAN AVOID FUTURE VIOLENCE AND BUILD A POSITIVE FUTURE. TO ACCOMPLISH THIS, PATIENT VICTIMS AND THEIR FAMILIES ARE PAIRED WITH A TEAM COMPRISED OF A CASE MANAGER, A MENTAL HEALTH CLINICIAN, AND A FAMILY SUPPORT ADVOCATE TO HELP THEM OVERCOME BARRIERS AND TURN THEIR LIVES AROUND. A POWERFUL VIAP INNOVATION IS THAT THE INTERVENTION WITH THE PATIENT BEGINS IN THE SAFETY OF THE HOSPITAL, WHERE THEY ARE VISITED BY A VIOLENCE INTERVENTION ADVOCATE WITHIN 48 HOURS OF ADMISSION TO INITIATE CASE MANAGEMENT, TAKING ADVANTAGE OF THE ""TEACHABLE MOMENT"" ASSOCIATED WITH VIOLENT INJURY. AS THE VICTIM HEALS, THE VIAP TEAM CONTINUES A COMPREHENSIVE TREATMENT PROGRAM THAT INCLUDES SAFETY PLANNING, COUNSELING, JOB AND EDUCATIONAL TRAINING, MENTAL HEALTH, AND FAMILY SUPPORT SERVICES. DURING FY22, VIAP PROVIDED ESSENTIAL SERVICES TO SURVIVORS OF GUNSHOTS AND STABBINGS, AND THEIR FAMILY MEMBERS. (IT IS SIGNIFICANT TO NOTE THAT BMC RECEIVES 70% OF THE CITY'S GUNSHOT AND STABBING VICTIMS.) DURING THIS PERIOD 407 VICTIMS WERE SERVED, INCLUDING 194 GUNSHOT AND 213 STABBING VICTIMS. THERE WERE 326 FAMILY MEMBERS SERVED THROUGH OUR FAMILY SUPPORT COMPONENT, AS WELL AS 31 FAMILIES OF HOMICIDE VICTIMS. SURVIVORS RECEIVED A SPECTRUM OF SERVICES, INCLUDING EMPLOYMENT HELP (268 SERVICES PROVIDED AND 18 NEW JOBS OBTAINED); BEHAVIORAL AND MENTAL HEALTH CARE (80% IN SHORT-TERM THERAPY AND 40% IN LONG TERM); AND LEGAL ASSISTANCE. VIAP ASSISTED WITH HOUSING APPLICATIONS; EDUCATION (6 OBTAINED THEIR HISET AND 9 COMPLETED JOB TRAINING). MEDICAL ASSISTANCE INCLUDED ACCESSING PRIMARY CARE, PT, REHABILITATION, NURSING SERVICES, SUBSTANCE USE AND MEDICATION MANAGEMENT. ADDITIONAL ASSISTANCE INCLUDED HELP WITH FOOD INSECURITY, TRANSPORTATION, OBTAINING A DRIVER'S LICENSE, SOCIAL SECURITY CARD, AND REGISTERING TO VOTE. VIAP'S STAFF WELLNESS PROGRAM HAS INCLUDED TRAININGS, TEAM BUILDING, AND OTHER ESSENTIAL SUPPORTIVE RESOURCES.MENTAL HEALTH AND SUBSTANCE USE DISORDERMENTAL HEALTH DIVISION INITIATIVE (MHDI) OR CRIMINAL JUSTICE DIVISION PROGRAM (DMH): THROUGHOUT FY22 FISCAL YEAR (OCTOBER 2021-SEPTEMBER 2022), BOSTON MEDICAL CENTER CONTINUED TO STAFF THE THREE BOSTON MUNICIPAL COURT MENTAL HEALTH COURT SESSIONS LOCATED WITHIN BMC CENTRAL DIVISION, WEST ROXBURY DISTRICT COURT AND ROXBURY DISTRICT COURT. SESSIONS CONTINUE TO BE WELL UTILIZED WITH A TOTAL OF TWO HUNDRED AND THIRTY (230) CLIENTS BEING SERVED ACROSS ALL THREE COURTS OVER THE COURSE OF THE FISCAL YEAR.IN TOTAL, ALL THREE SESSIONS COMPLETED INTAKES FOR AND ACCEPTED ONE HUNDRED AND TWENTY THREE (123) NEW CLIENTS. THERE WERE LESS THAN TEN REFERRALS RECEIVED AND NOT COMPLETED, DUE TO VARIOUS REASONS TO INCLUDE THE CLIENT'S INACCESSIBILITY DUE TO INCARCERATION AND THE CLIENT'S DECLINE OF SERVICES. THERE ARE CURRENTLY SIXTEEN (16) REFERRALS PENDING THROUGHOUT ALL THREE SESSIONS, WITH NINE OF THE SIXTEEN ALREADY SCHEDULED FOR INTAKE COMPLETION. STAFF CONTINUE TO OUTREACH THE REMAINING SEVEN IN ORDER TO SCHEDULE THEIR INTAKES AND IT IS ANTICIPATED THAT THE NINE CURRENTLY SCHEDULED WILL BE ACCEPTED INTO SESSION.THE SESSION'S SUCCESS CAN BE DEMONSTRATED THROUGH THE NUMBER OF PROGRAM GRADUATES, OR CLIENTS WHO HAVE MET ALL LEGAL AND PROGRAMMATIC EXPECTATIONS. DURING FY22 THE THREE SESSIONS GRADUATED A TOTAL OF FIFTY-FOUR (54) CLIENTS. BMC-CENTRAL REMAINS THE LARGEST SESSION WITH 2-3 NEW REFERRALS EACH WEEK, AND A TOTAL OF FIFTY-TWO (52) NEW CLIENTS OVER THE YEAR. WEST ROXBURY AND ROXBURY AVERAGE 1-2 NEW REFERRALS A WEEK, AND SINCE FILLING A VACANCY IN BOTH COURTS, THE TOTAL NUMBER OF PARTICIPANTS CONTINUES TO RISE AS PROVEN IN THE INCREASE OF NEW REFERRALS FROM FY21 TO FY22."

SCHEDULE H, PART VI, LINE 5 (CONTINUATION):
FASTER PATHS: FASTER PATHS IS THE LOW-BARRIER SUBSTANCE USE DISORDER BRIDGE CLINIC AT BMC. OPEN SEVEN DAYS PER WEEK, FASTER PATHS OFFERS SAME-DAY, ON-DEMAND CARE BY ADDICTION MEDICINE AND NURSING SPECIALISTS INCLUDING INITIATION AND CONTINUATION OF MEDICATIONS FOR OPIOID USE DISORDER (MOUD), MEDICATIONS FOR OTHER SUBSTANCE USE DISORDERS, OUTPATIENT MEDICALLY MANAGED WITHDRAWAL, REFERRAL TO INPATIENT MEDICALLY MANAGED WITHDRAWAL, INFECTION SCREENING, TREATMENT, AND PREVENTION SERVICES, AND OVERDOSE PREVENTION. AFTER STABILIZATION, FASTER PATHS PATIENTS ARE REFERRED TO A COMPREHENSIVE NETWORK OF BMC AND COMMUNITY SERVICES FOR LONG-TERM CARE, INCLUDING PRIMARY AND BEHAVIORAL HEALTH CARE AND LONG-TERM MOUD. THE FASTER PATHS PROGRAM COLLABORATES CLOSELY WITH LICENSED ALCOHOL AND DRUG COUNSELORS FROM BMC'S PROJECT ASSERT, WHO PROVIDE PSYCHO-SOCIAL ASSESSMENTS AND REFERRALS TO AN ARRAY OF ADDICTION TREATMENT SERVICES AND SHELTERS, OVERDOSE PREVENTION EDUCATION AND NALOXONE, HARM REDUCTION SERVICES, AND TRANSPORTATION. THE RAPID ACCESS PROGRAM, WHICH INCLUDES A TEAM OF RECOVERY COACHES AND ADDICTION COUNSELORS, IS ALSO A CLOSE PARTNER. SPECIFIC MEDICATIONS AVAILABLE IN FASTER PATHS 7 DAYS/WEEK INCLUDING SUBLINGUAL BUPRENORPHINE/NALOXONE, MONTHLY INJECTABLE BUPRENORPHINE, MONTHLY INJECTABLE NALTREXONE, AND METHADONE ADMINISTRATION FOR OPIOID WITHDRAWAL FOR UP TO 72 HOURS WITH LINKAGE TO AN OPIOID TREATMENT PROGRAM. IN ADDITION TO THE INTERNAL COLLABORATIONS, FASTER PATHS PARTNERS CLOSELY WITH COMMUNITY PROGRAMS INCLUDING THE BOSTON PUBLIC HEALTH COMMISSION'S (BPHC'S) PAATHS (PROVIDING ACCESS TO ADDICTION TREATMENT, HOPE, AND SUPPORT) PROGRAM, TO FACILITATE CONNECTIONS TO COMMUNITY SERVICES. IN CY 2022, FASTER PATHS SERVED APPROXIMATELY 1,300 UNIQUE PATIENTS FOR 3,600 VISITS. CARE INCLUDED 950 SUBLINGUAL BUPRENORPHINE/NALOXONE PRESCRIPTIONS PROVIDED FOR 329 UNIQUE PATIENTS, 130 LONG-ACTING INJECTABLE BUPRENORPHINE PRESCRIPTIONS ADMINISTERED TO 81 UNIQUE PATIENTS, 11 LONG-ACTING INJECTABLE NALTREXONE INJECTION, 748 PATIENTS WITH OPIOID WITHDRAWAL TREATED WITH METHADONE AND REFERRED TO AN OPIOID TREATMENT PROGRAM OR OTHER APPROPRIATE ONGOING CARE, 23 PATIENTS WITH BENZODIAZEPINE USE DISORDER WHO RECEIVED OUTPATIENT MEDICALLY MANAGED WITHDRAWAL, 364 NALOXONE KITS PRESCRIBED AND 58 NALOXONE KITS DIRECTLY DISTRIBUTED IN CLINIC. INFECTION SCREENING, TREATMENT, AND PREVENTION SERVICES INCLUDED NEARLY 450 HIV TESTS, 400 HCV TESTS, AND 500 SYPHILIS, CHLAMYDIA, AND GONORRHEA TESTS; 18 PATIENTS WITH HIV WERE TREATED WITH ANTIRETROVIRAL THERAPY AND 79 PATIENTS RECEIVED HIV PRE- OR POST-EXPOSURE PROPHYLAXIS FOR HIV PREVENTION. ADDITIONALLY, FASTER PATHS BEGAN TO OFFER SAFER SMOKING EQUIPMENT ALONGSIDE OTHER HARM REDUCTION SUPPLIES AND BEGAN TO OFFER INTEGRATED LONG-ACTING REVERSIBLE CONTRACEPTION (E.G., CONTRACEPTION IMPLANTS). THE SUCCESS OF THE FASTER PATHS MODEL HAS INSPIRED REPLICATION IN OTHER BRIDGE CLINICS, INCLUDING THE TRANSITIONAL CARE CENTER AT 891 MASSACHUSETTS AVENUE IN CONJUNCTION WITH LOW-THRESHOLD HOUSING. ALCOHOL & SUBSTANCE ABUSE SERVICES, EDUCATION, AND REFERRAL TO TREATMENT (PROJECT ASSERT): PROJECT ASSERT WAS ESTABLISHED IN 1994 TO PROVIDE GREATER ACCESS TO SUBSTANCE USE TREATMENT IN THE EMERGENCY DEPARTMENT (ED) SETTING AND HAS EXPANDED TO INCLUDE A VARIETY OF SOCIAL AND COMMUNITY HEALTHCARE SUPPORT SERVICES. BASED IN THE ED, PROJECT ASSERT COUNSELS PATIENTS WHOSE ALCOHOL AND/OR DRUG USE WAS DIRECTLY AND INDIRECTLY IMPLICATED IN THEIR NEED FOR EMERGENCY SERVICES. LICENSED ALCOHOL AND DRUG COUNSELORS (LADCS) CONSULT AND COLLABORATE WITH HOSPITAL STAFF TO OFFER ED PATIENTS ALCOHOL AND DRUG SCREENING, BRIEF INTERVENTION, COUNSELING ON TREATMENT OPTIONS AND REFERRALS TO HEALTH AND SOCIAL RESOURCES SUCH AS SUD TREATMENT AND PRIMARY CARE SERVICES. DURING THE BMC FY22, PROJECT ASSERT SERVED 1910 WHOM HAD 3153 LADC /RECOVERY SUPPORT NAVIGATORS VISITS. BASED ON SCREENING AND PATIENT PREFERENCE FOR TREATMENT, THE FOLLOWING SERVICES WERE PROVIDED: 795 UNIQUE PATIENTS WERE PLACED IN DETOX/ACUTE TREATMENT SERVICES AND BECAUSE OF MULTIPLE VISITS THERE WERE A TOTAL OF 1204 DETOX / CSS LEVEL OF CARE PLACEMENT AMONG THESE PATIENTS; 785 UNIQUE PATIENTS WERE REFERRED TO NA/AA; 984 PATIENTS WERE PROVIDED WITH TRANSPORTATION SERVICES. SHELTER SERVICES WERE PROVIDED DURING 242 VISITS. PROJECT ASSERT LADCS ALSO EDUCATED PATIENTS AT RISK FOR OPIOID OVERDOSE AND DISTRIBUTED 1107 NALOXONE RESCUE KITS TO PATIENTS AND 586 WERE OFFERED AND REFUSED. A TOTAL OF 2,356 PATIENTS RECEIVED OVERDOSE EDUCATION ON HOW TO RECOGNIZE AND PREVENT AN OPIOID OVERDOSE. IN ADDITION, 105 PATIENTS WERE REFERRED AND SEEN IN OUR MAT MEDICATION FOR ADDICTION TREATMENT CLINIC.SUPPORTING OUR FAMILIES THROUGH ADDICTION AND RECOVERY (SOFAR): THE GOAL OF SOFAR IS TO CREATE A MEDICAL HOME IN THE PEDIATRIC PRIMARY CARE CLINIC FOR MOTHERS IN RECOVERY AND THEIR CHILDREN. SOFAR HOUSES A MULTIDISCIPLINARY TEAM OF PHYSICIANS, SOCIAL WORKERS, PATIENT NAVIGATORS, NURSE PRACTITIONERS, AND COORDINATORS WHO PROVIDE HIGH-QUALITY, COORDINATED MEDICAL AND PSYCHOSOCIAL CARE FOR FAMILIES TO MAXIMIZE THEIR ABILITY TO SUCCESSFULLY NAVIGATE PARENTING AND SUBSTANCE USE RECOVERY. SOFAR EXPANDS ON THE MULTIDISCIPLINARY PRENATAL CARE PROVIDED BY PROJECT RESPECT FOR PREGNANT WOMEN WITH OPIOID USE DISORDER. SOFAR PROVIDES ONGOING SUPPORT FOR FAMILIES TO ENHANCE CHILD DEVELOPMENT AS WELL AS ONGOING SUPPORT FOR RECOVERY, WITH ACCESS TO SPECIALTY CARE AND SOCIAL SERVICES. IN FY22, SOFAR SERVED SERVED 215 FAMILIES, WITH 312 INDIVIDUAL CHILDREN ENROLLED.