4A (Expenses $ 1602190544 including grants of $ 372387) (Revenue $ 1683298455)
SEE SCHEDULE O-PATIENT CARE

4B (Expenses $ 297504446 including grants of $ 39885754) (Revenue $ 236850027)
SEE SCHEDULE O-RESEARCH

4C (Expenses $ 127374875 including grants of $ 0) (Revenue $ 4553976)
SEE SCHEDULE O-TEACHING

BETH ISRAEL DEACONESS MEDICAL CENTER
PART V, SECTION B, LINE 5: FOR DISCLOSURES RELATED TO FORM 990 SCHEDULE H, PART V, SECTION B PLEASE SEE SCHEDULE H, PART VI SUPPLEMENTAL INFORMATION

BETH ISRAEL DEACONESS MEDICAL CENTER
PART V, SECTION B, LINE 11: FOR DISCLOSURES RELATED TO FORM 990 SCHEDULE H, PART V, SECTION B PLEASE SEE SCHEDULE H, PART VI SUPPLEMENTAL INFORMATION

FORM 990 SCHEDULE H PART V, SECTION C
SUPPLEMENTAL INFORMATION FOR SCHEDULE H PART V, SECTION BFINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITSCOMMUNITY HEALTH IMPROVEMENT SERVICES AND CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPSBETH ISRAEL DEACONESS MEDICAL CENTER AFFILIATIONBETH ISRAEL LAHEY HEALTH (BILH) IS THE SOLE MEMBER OF BETH ISRAEL DEACONESS MEDICAL CENTER (BIDMC). THE BILH NETWORK OF AFFILIATES IS AN INTEGRATED HEALTHCARE SYSTEM COMMITTED TO EXPANDING ACCESS TO EXTRAORDINARY PATIENT CARE ACROSS EASTERN MASSACHUSETTS AND ADVANCING THE SCIENCE AND PRACTICE OF MEDICINE THROUGH GROUNDBREAKING RESEARCH AND EDUCATION. THE BILH SYSTEM IS COMPRISED OF ACADEMIC AND TEACHING HOSPITALS, A PREMIER ORTHOPEDICS HOSPITAL, PRIMARY CARE AND SPECIALTY CARE PROVIDERS, AMBULATORY SURGERY CENTERS, URGENT CARE CENTERS, COMMUNITY HOSPITALS, HOMECARE SERVICES, OUTPATIENT BEHAVIORAL HEALTH CENTERS, ADDICTION TREATMENT PROGRAMS. THE BILH'S COMMUNITY OF CLINICIANS, CAREGIVERS AND STAFF INCLUDES APPROXIMATELY 4,000 PHYSICIANS AND 35,000 EMPLOYEES. AT THE HEART OF BILH IS THE BELIEF THAT EVERYONE DESERVES HIGH-QUALITY, AFFORDABLE HEALTH CARE AND THIS BELIEF IS WHAT DRIVES EACH AFFILIATE TO WORK WITH COMMUNITY PARTNERS ACROSS THE REGION TO PROMOTE HEALTH, EXPAND ACCESS AND DELIVER THE BEST CARE IN THE COMMUNITIES BILH SERVES. BILH'S COMMUNITY BENEFITS STAFF ARE COMMITTED TO WORKING COLLABORATIVELY WITH BILH'S COMMUNITIES TO ADDRESS THE LEADING HEALTH ISSUES AND CREATE A HEALTHY FUTURE FOR INDIVIDUALS, FAMILIES AND COMMUNITIES.BETH ISRAEL DEACONESS MEDICAL CENTER COMMUNITY BENEFITS MISSION STATEMENT THE MISSION OF BETH ISRAEL DEACONESS MEDICAL CENTER (BIDMC) IS TO SERVE OUR PATIENTS COMPASSIONATELY AND EFFECTIVELY, AND TO CREATE A HEALTHY FUTURE FOR THEM AND THEIR FAMILIES. OUR MISSION IS SUPPORTED BY OUR COMMITMENT TO PERSONALIZED, EXCELLENT PATIENT CARE FOR PATIENTS; A WORKFORCE COMMITTED TO INDIVIDUAL ACCOUNTABILITY, MUTUAL RESPECT AND COLLABORATION; AND A COMMITMENT TO MAINTAINING OUR FINANCIAL HEALTH. THE MEDICAL CENTER IS ALSO COMMITTED TO BEING ACTIVE IN THE COMMUNITY AS WELL. SERVICE TO COMMUNITY IS AT THE CORE AND AN IMPORTANT PART OF OUR MISSION. WE HAVE A COVENANT TO CARE FOR THE UNDERSERVED AND TO WORK TO CHANGE DISPARITIES IN ACCESS TO CARE. WE KNOW TO BE SUCCESSFUL WE NEED TO LEARN FROM THOSE WE SERVE.BIDMC'S COMMUNITY BENEFITS MISSION IS FULFILLED BY: INVOLVING BIDMC STAFF, INCLUDING ITS LEADERSHIP AND DOZENS OF COMMUNITY PARTNERS, IN THE CHNA PROCESS AS WELL AS IN THE DEVELOPMENT, IMPLEMENTATION AND OVERSIGHT OF THE HOSPITAL'S THREE-YEAR IMPLEMENTATION STRATEGY; ENGAGING AND LEARNING FROM RESIDENTS THROUGHOUT BIDMC'S COMMUNITY BENEFITS SERVICE AREA (CBSA) IN ALL ASPECTS OF THE COMMUNITY BENEFITS PROCESS, WITH SPECIAL ATTENTION FOCUSED ON ENGAGING DIVERSE PERSPECTIVES, FROM THOSE, PATIENTS AND NON-PATIENTS ALIKE, WHO ARE OFTEN LEFT OUT OF SIMILAR ASSESSMENT, PLANNING AND PROGRAM IMPLEMENTATION PROCESSES; ASSESSING UNMET COMMUNITY NEED BY COLLECTING PRIMARY AND SECONDARY DATA (BOTH QUANTITATIVE AND QUALITATIVE) TO UNDERSTAND UNMET HEALTH-RELATED NEEDS AND IDENTIFY COMMUNITIES AND POPULATION SEGMENTS DISPROPORTIONATELY IMPACTED BY HEALTH ISSUES AND OTHER SOCIAL, ECONOMIC AND SYSTEMIC FACTORS; IMPLEMENTING COMMUNITY HEALTH PROGRAMS AND SERVICES IN BIDMC'S CBSA THAT ADDRESS THE UNDERLYING SOCIAL DETERMINANTS OF HEALTH, BARRIERS TO ACCESSING CARE, AS WELL AS PROMOTE HEALTH EQUITY TO IMPROVE THE HEALTH STATUS OF THOSE WHO ARE OFTEN DISADVANTAGED, FACE DISPARITIES IN HEALTH-RELATED OUTCOMES, EXPERIENCE POVERTY, AND HAVE BEEN HISTORICALLY UNDERSERVED; PROMOTING HEALTH EQUITY BY ADDRESSING SOCIAL AND INSTITUTIONAL INEQUITIES, RACISM AND BIGOTRY AND ENSURING THAT ALL PATIENTS ARE WELCOMED AND RECEIVE CARE THAT IS RESPECTFUL AND CULTURALLY RESPONSIVE; AND FACILITATING COLLABORATION AND PARTNERSHIP WITHIN AND ACROSS SECTORS (E.G., STATE/LOCAL PUBLIC HEALTH AGENCIES, HEALTHCARE PROVIDERS, SOCIAL SERVICE ORGANIZATIONS, BUSINESSES, ACADEMIC INSTITUTIONS, COMMUNITY HEALTH COLLABORATIVES, AND OTHER COMMUNITY HEALTH ORGANIZATIONS) TO ADVOCATE FOR, SUPPORT AND IMPLEMENT EFFECTIVE HEALTH POLICIES, COMMUNITY PROGRAMS AND SERVICES.COMMUNITY BENEFITS FINANCIAL SUMMARY DURING THE FISCAL YEAR COVERED BY THIS FILING, BIDMC PROVIDED COMMUNITY HEALTH IMPROVEMENT SERVICES, COMMUNITY BENEFITS OPERATIONS AND CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS OF $17,546,721 AS REPORTED ON THIS SCHEDULE H, PART I, LINES 7E AND 7I. COMMUNITY BENEFITS LEADERSHIP/TEAMBIDMC'S BOARD OF TRUSTEES ALONG WITH ITS CLINICAL AND ADMINISTRATIVE STAFF IS COMMITTED TO IMPROVING THE HEALTH AND WELL-BEING OF RESIDENTS THROUGHOUT ITS CBSA AND BEYOND. WORLD-CLASS CLINICAL EXPERTISE, EDUCATION AND RESEARCH ALONG WITH AN UNDERLYING COMMITMENT TO HEALTH EQUITY ARE THE PRIMARY TENETS OF ITS MISSION. BIDMC'S COMMUNITY BENEFITS DEPARTMENT, UNDER THE DIRECT OVERSIGHT OF BIDMC'S BOARD OF TRUSTEES, IS DEDICATED TO COLLABORATING WITH COMMUNITY PARTNERS AND RESIDENTS AND WILL CONTINUE TO DO SO IN ORDER TO MEET ITS COMMUNITY BENEFITS OBLIGATIONS. HOSPITAL SENIOR LEADERSHIP IS ACTIVELY ENGAGED IN THE DEVELOPMENT AND IMPLEMENTATION OF BIDMC'S IMPLEMENTATION STRATEGY, ENSURING THAT HOSPITAL POLICIES AND RESOURCES ARE ALLOCATED TO SUPPORT PLANNED ACTIVITIES. THE BIDMC COMMUNITY BENEFITS PROGRAM IS SPEARHEADED BY A TEAM OF COMMUNITY BENEFITS SENIOR LEADERS INCLUDING THE VICE PRESIDENT AND DIRECTOR OF COMMUNITY BENEFITS. THE VICE PRESIDENT OF COMMUNITY BENEFITS HAS DIRECT ACCESS TO AND IS ACCOUNTABLE TO THE BIDMC PRESIDENT AND ALSO REPORTS DIRECTLY TO THE BILH CHIEF DIVERSITY, EQUITY AND INCLUSION OFFICER. IT IS THE RESPONSIBILITY OF THESE LEADERS TO ENSURE THAT COMMUNITY BENEFITS IS ADDRESSED BY THE ENTIRE ORGANIZATION AND THAT THE NEEDS OF COHORTS WHO HAVE BEEN HISTORICALLY UNDERSERVED ARE CONSIDERED EVERY DAY IN DISCUSSIONS ON RESOURCE ALLOCATION, POLICIES, AND PROGRAM DEVELOPMENT. THE BIDMC COMMUNITY BENEFITS ADVISORY COMMITTEE (CBAC) WORKS IN COLLABORATION WITH BIDMC'S HOSPITAL LEADERSHIP, INCLUDING THE HOSPITAL'S GOVERNING BOARD AND SENIOR MANAGEMENT TO SUPPORT BIDMC'S COMMUNITY BENEFITS MISSION TO SERVE ITS PATIENTS COMPASSIONATELY AND EFFECTIVELY, AND TO CREATE A HEALTHY FUTURE FOR THEM, THEIR FAMILIES, AND BIDMC'S COMMUNITY. THE CBAC PROVIDES INPUT INTO THE DEVELOPMENT AND IMPLEMENTATION OF BIDMC'S COMMUNITY BENEFITS PROGRAMS IN FURTHERANCE OF BIDMC'S COMMUNITY BENEFITS MISSION. THE MEMBERSHIP OF BIDMC'S CBAC ASPIRES TO BE REPRESENTATIVE OF THE CONSTITUENCIES AND PRIORITY COHORTS SERVED BY BIDMC'S PROGRAMMATIC ENDEAVORS, INCLUDING THOSE FROM DIVERSE RACIAL AND ETHNIC BACKGROUNDS, AGE, GENDER, SEXUAL ORIENTATION AND GENDER IDENTITY, AS WELL AS THOSE FROM CORPORATE AND NON-PROFIT COMMUNITY ORGANIZATIONS.

THREE:
"JUST HALF OF PATIENTS RECEIVED RECOMMENDED BRAIN-PROTECTIVE VITAMIN SUPPLEMENT IN NATIONWIDE STUDY, BIDMC RESEARCHERS REVEAL ALCOHOL USE IS A WELL-RECOGNIZED RISK FACTOR FOR THIAMINE DEFICIENCY, WHICH IF LEFT UNTREATED CAN LEAD TO COGNITIVE IMPAIRMENT, INCLUDING AN ALCOHOLLINKED NEUROLOGICAL DISORDER KNOWN AS WERNICKEKORSAKOFF SYNDROME. VARIOUS PROFESSIONAL GUIDELINES, INCLUDING THOSE OF THE EUROPEAN FEDERATION OF NEUROLOGICAL SOCIETIES AND THE AMERICAN SOCIETY OF ADDICTION MEDICINE, RECOMMEND THE USE OF THIAMINE (ALSO KNOWN AS VITAMIN B1) SUPPLEMENTATION TO PREVENT BRAIN INJURY IN PATIENTS WITH ALCOHOL USE DISORDER.IN A NATIONWIDE RETROSPECTIVE OBSERVATIONAL STUDY PUBLISHED IN ANNALS OF INTERNAL MEDICINE, RESEARCHERS AT BIDMC DEMONSTRATED THAT APPROXIMATELY HALF OF THE PATIENTS ADMITTED TO ICUS WITH ALCOHOL USE DISORDER DID NOT RECEIVE THIAMINE SUPPLEMENTATION. THE FINDING HIGHLIGHTS A POTENTIAL AREA FOR QUALITY IMPROVEMENT IN THE CARE OF PATIENTS PRESENTING WITH ALCOHOL USE DISORDER.""ALCOHOL USE DISORDER IS THE MOST COMMON RISK FACTOR FOR THIAMINE DEFICIENCY IN NORTH AMERICA, EUROPE AND AUSTRALIA, AND PATIENTS WITH SEPTIC SHOCK, TRAUMATIC BRAIN INJURY AND DIABETIC KETOACIDOSIS HAVE ALSO BEEN SHOWN TO BE AT RISK,"" SAID LEADING AUTHOR RAHUL D. PAWAR, MD, AN INTERNAL MEDICINE PHYSICIAN AT BIDMC. ""THUS, IT IS POSSIBLE THAT CRITICALLY ILL PATIENTS WITH ALCOHOL USE DISORDER ARE ESPECIALLY AT RISK FOR THIAMINE DEFICIENCY AND WOULD BENEFIT FROM THIAMINE SUPPLEMENTATION.""PAWAR AND COLLEAGUES USED DE-IDENTIFIED DATA FROM A LARGE, MULTICENTER AND NATIONALLY REPRESENTATIVE DATA SET IN THE UNITED STATES TO CHARACTERIZE THE INCIDENCE OF THIAMINE SUPPLEMENTATION BETWEEN 2010 AND 2017 ACROSS VARIOUS ILLNESS CATEGORIES, INCLUDING ALCOHOL WITHDRAWAL, SEPTIC SHOCK, TRAUMATIC BRAIN INJURY AND DIABETIC KETOACIDOSIS. THE STUDY INCLUDED DATA FROM 14,998 PATIENTS, 17 YEARS OF AGE OR OLDER, WHO WERE DIRECTLY ADMITTED TO INTENSIVE CARE FROM THE EMERGENCY DEPARTMENT FOR TREATMENT OF ALCOHOL USE DISORDER OR ALCOHOL USE DISORDER-ATTRIBUTABLE CONDITIONS. OVERALL, THE TEAM OBSERVED THAT JUST OVER HALF OF ALL PATIENTS RECEIVED THIAMINE.""OUR STUDY HIGHLIGHTS A POTENTIAL OPPORTUNITY FOR IMPROVING CARE FOR PATIENTS WITH ALCOHOL USE DISORDER WITH CRITICAL ILLNESSES IN THE UNITED STATES,"" SAID SENIOR AUTHOR MICHAEL DONNINO, MD, A CRITICAL CARE AND EMERGENCY MEDICINE PHYSICIAN AT BIDMC.4. RESEARCHERS USE SINGLE-CELL RNA-SEQUENCING ANALYSIS TO MAP THE CELLS OF DIABETIC FOOT ULCERS, PROVIDING DEEP INSIGHT INTO THE WOUND HEALING PROCESSDIABETIC FOOT ULCERATIONS OPEN SORES OR WOUNDS THAT REFUSE TO HEAL ARE A DEVASTATING COMPLICATION AFFECTING MORE THAN 15 PERCENT OF PEOPLE WITH DIABETES AND RESULTING IN MORE THAN 70,000 LOWER EXTREMITY AMPUTATIONS PER YEAR IN THE UNITED STATES ALONE. NOTABLY, MORE THAN HALF OF PATIENTS UNDERGOING AMPUTATIONS DUE TO DIABETIC FOOT ULCERATIONS ARE EXPECTED TO DIE WITHIN FIVE YEARSA MORTALITY RATE HIGHER THAN MOST CANCERS. YET, THE BIOLOGICAL PROCESSES AT WORK IN DIABETIC FOOT ULCERATIONS ARE POORLY UNDERSTOOD.TO GAIN A BETTER UNDERSTANDING OF WHAT CAUSES DIABETIC FOOT ULCERS AND HOW THEY MIGHT BE TREATED, RESEARCHERS AT BIDMC COMPARED CELLS TAKEN FROM PATIENTS WITH ULCERS THAT HEALED TO THOSE TAKEN FROM PATIENTS WHOSE ULCERS FAILED TO HEAL, AS WELL AS TO CELLS TAKEN FROM INTACT FOREARM SKIN IN PATIENTS WITH AND WITHOUT DIABETES. THE SCIENTISTS MAPPED THE CELLULAR LANDSCAPE IN THE DIABETIC FOOT ULCERS OF HEALERS AND NON-HEALERS USING A LEADING-EDGE TECHNOLOGY KNOWN AS SINGLE-CELL RNA-SEQUENCING ANALYSIS, WHICH PROVIDES DEEP INSIGHT INTO CELL FUNCTION AND THE DEVELOPMENT OF DISEASE BY REVEALING GENE EXPRESSION IN INDIVIDUAL CELLS IN TISSUES COMPRISED OF VARIOUS CELL TYPES.""VARIOUS CELL TYPES, INCLUDING ENDOTHELIAL CELLS, FIBROBLASTS, KERATINOCYTES AND IMMUNE CELLS, PLAY AN IMPORTANT ROLE IN THE WOUND HEALING PROCESS BUT LITTLE IS UNDERSTOOD ABOUT THEIR INVOLVEMENT IN IMPAIRED WOUND HEALING IN DIABETIC FOOT ULCERS,"" SAID CO-CORRESPONDING AUTHOR ARISTIDIS VEVES, DSC, MD, DIRECTOR OF THE RONGXIANG XU, MD, CENTER FOR REGENERATIVE THERAPEUTICS AND RESEARCH DIRECTOR OF THE JOSLIN-BETH ISRAEL DEACONESS FOOT CENTER. ""WE HAVE NOW SUBSTANTIALLY EXPANDED THE NUMBER OF CELLS SEQUENCED AND GAINED NOVEL INSIGHTS INTO DIABETIC FOOT ULCERS. OUR DATA SUGGESTS THAT SPECIFIC FIBROBLAST SUBTYPES ARE KEY PLAYERS IN HEALING THESE ULCERS AND TARGETING THESE CELLS COULD BE ONE THERAPEUTIC OPTION. WHILE FURTHER TESTING IS NEEDED, OUR DATA SET WILL BE A VALUABLE RESOURCE FOR DIABETES, DERMATOLOGY AND WOUND HEALING RESEARCH AND CAN SERVE AS THE BASELINE FOR DESIGNING EXPERIMENTS FOR THE ASSESSMENT OF THERAPEUTIC INTERVENTIONS.""5. FAMILY MEMBERS OF PATIENTS WHO RECEIVED OPIOID PRESCRIPTION REFILLS AFTER SURGERY HAD INCREASED RISK OF OPIOID MISUSE AND CHRONIC USEIN 2019, MORE THAN 10 MILLION AMERICANS MISUSED PRESCRIPTION OPIOIDS 1.6 MILLION OF THEM FOR THE FIRST TIME. MORE THAN HALF OF INDIVIDUALS WHO MISUSE OPIOIDS REPORT OBTAINING THE DRUGS FROM FAMILY OR FRIENDS WHO WERE LEGALLY PRESCRIBED THE DRUGS, MANY OF THEM WITHOUT ASKING.IN A PAPER PUBLISHED IN JAMA NETWORK OPEN, PHYSICIAN-SCIENTISTSAT BIDMC INVESTIGATED THE RELATIONSHIP BETWEEN A SURGICAL PATIENT'S NEW OPIOID PRESCRIPTION AFTER HOSPITAL DISCHARGE AND SUBSEQUENT OPIOID MISUSE AND CHRONIC OPIOID USE IN FAMILY MEMBERS IN THE SAME HOUSEHOLD. ""THE RISK OF OPIOID MISUSE APPEARED TO INCREASE ONLY IN HOUSEHOLDS IN WHICH THE PATIENT OBTAINED REFILLS,"" SAID CORRESPONDING AUTHOR GABRIEL A. BRAT, MD, MPH, SURGEON IN TRAUMA AND SURGICAL CRITICAL CARE IN THE DEPARTMENT OF SURGERY AT BIDMC. ""FAMILY MEMBERS IN HOUSEHOLDS WITH ANY REFILL HAD AN INCREASED RISK OF OPIOID MISUSE AND CHRONIC USE. OUR STUDY HIGHLIGHTS THAT SURGEONS SHOULD BE AWARE THAT AMBIENT OPIOID EXPOSURE WITHIN HOUSEHOLDS IS ONE OF THE KNOWN DANGERS OF OVER PRESCRIPTION OF OPIOIDS.""BRAT AND COLLEAGUES ANALYZED ADMINISTRATIVE DATA FROM A U.S. COMMERCIAL INSURANCE PROVIDER WITH MORE THAN 35 MILLION COVERED INDIVIDUALS. PARTICIPANTS INCLUDED 843,531 PATIENTS WHO UNDERWENT SURGERY FROM 2008 TO 2016 PAIRED WITH THEIR FAMILY MEMBERS. MOST PAIRS INCLUDED FEMALE PATIENTS AND MALE FAMILY MEMBERS AND PATIENTS AGED 45-54 YEARS AND FAMILY MEMBERS AGED 15-24. THE TEAM FOUND THAT THE RISK OF OPIOID MISUSE AND CHRONIC USE INCREASED IN HOUSEHOLDS IN WHICH THE PATIENT OBTAINED REFILLS, AND THAT EACH ADDITIONAL PRESCRIPTION REFILL WAS ASSOCIATED WITH NEARLY A 20 PERCENT INCREASE IN HAZARD OF OPIOID MISUSE IN A FAMILY MEMBER IN ADJUSTED MODELS. ""FURTHER RESEARCH INTO THESE HOUSEHOLD ASSOCIATIONS IS NECESSARY TO CLARIFY THEIR CONTRIBUTIONS AND MANY OTHER POSSIBLE MECHANISMS UNDERLYING THE FINDINGS OF THIS STUDY,"" SAID BRAT. ""HOWEVER, HOUSEHOLD OPIOID EXPOSURE COULD BE ONE MARKER TO IDENTIFY PATIENTS AT HIGHER RISK OF OPIOID USE AND MISUSE, AND INTERVENTIONS TO REDUCE OPIOID PRESCRIBING SHOULD CONSIDER THE POSSIBLE OUTCOME FOR BOTH PATIENT WITH A PRESCRIPTION AND THEIR FAMILY MEMBERS."" 6. NATIONWIDE STUDY SHOWS RISE IN PREGNANCY-RELATED COMPLICATIONS DURING COVID-19 PANDEMICIN A PAPER PUBLISHED IN JAMA NETWORK OPEN, PHYSICIAN-SCIENTISTS AT BIDMC ASSESSED HOW PREGNANCY-RELATED COMPLICATIONS AND OBSTETRIC OUTCOMES CHANGED DURING THE COVID-19 PANDEMIC COMPARED TO PRE-PANDEMIC. LOOKING AT THE RELATIVE CHANGES IN MODE OF DELIVERY, RATES OF PREMATURE BIRTHS AND MORTALITY OUTCOMES BEFORE COMPARED TO DURING THE PANDEMIC, THE TEAM FOUND INCREASED ODDS OF MATERNAL DEATH DURING DELIVERY HOSPITALIZATION, CARDIOVASCULAR DISORDERS AND OBSTETRIC HEMORRHAGE DURING THE PANDEMIC.""WHILE HOSPITAL-BASED OBSTETRIC CARE REMAINED AN ESSENTIAL SERVICE DURING THE COVID-19 PANDEMIC, OUTPATIENT PRENATAL CARE EXPERIENCED SUBSTANTIAL DISRUPTIONS, AND MUCH ROUTINE PRENATAL CARE WAS DONE VIRTUALLY,"" SAID FIRST AUTHOR ROSE L. MOLINA, MD, MPH, AN OBSTETRICIAN-GYNECOLOGIST AND DIRECTOR OF THE OBGYN DIVERSITY, INCLUSION, AND ADVOCACY COMMITTEE AT BIDMC. ""IT IS POSSIBLE THAT THESE DISRUPTIONS AND LIMITATIONS IN MONITORING VIA TELEHEALTH MAY HAVE CONTRIBUTED TO THE SLIGHT WORSENING OF PREGNANCY-RELATED HYPERTENSION. ADDITIONALLY, INCREASED RATES OF HYPERTENSIVE DISORDERS MAY BE DUE TO HEIGHTENED STRESS PROVOKED BY THE PANDEMIC."" MOLINA AND COLLEAGUES ANALYZED DATA FROM MORE THAN 1.6 MILLION PREGNANT PATIENTS WHO GAVE BIRTH IN 463 U.S. HOSPITALS IN THE 14 MONTHS PRIOR TO COVID-19 AND DURING THE FIRST 14 MONTHS OF THE PANDEMIC. THEIR ANALYSIS REVEALED MATERNAL DEATH DURING DELIVERY HOSPITALIZATION INCREASED FROM 5.17 DEATHS PER 100,000 PREGNANT PATIENTS PRIOR TO THE PANDEMIC TO 8.69 DEATHS PER 100,000 PREGNANT PATIENTS DURING THE PANDEMIC, A SMALL BUT STATISTICALLY SIGNIFICANT INCREASE. THEY ALSO SAW INCREASES IN THE ODDS OF DEVELOPING HYPERTENSIVE DISORDERS AND HEMORRHAGE. THE RESEARCH TEAM ALSO SAW A DECLINE IN SEPSIS RATES DURING THE PANDEMIC, LIKELY THE RESULT OF ENHANCED HAND HYGIENE AND MASKING DUE TO COVID-19."

FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS
GRADUATE MEDICAL EDUCATION THE MEDICAL CENTER'S DEVOTION TO TEACHING, RESPECT FOR STUDENTS/TRAINEES AND WILLINGNESS TO EMBRACE TECHNOLOGICAL AND CLINICAL PRACTICE INNOVATION MAKE THE MEDICAL CENTER A TOP CHOICE AMONG MEDICAL STUDENTS AND HEALTH CARE PROFESSIONALS. THE MEDICAL CENTER TRAINS HUNDREDS OF MEDICAL STUDENTS, INTERNS, RESIDENTS AND FELLOWS, AS WELL AS PROFESSIONALS IN NURSING, SOCIAL WORK AND THE ALLIED HEALTH SCIENCES. THE MEDICAL CENTER HAS 62 ACCREDITATION COUNCIL FOR GRADUATE MEDICAL EDUCATION (ACGME) APPROVED CLINICAL RESIDENCY AND FELLOWSHIP PROGRAMS WITH 773 RESIDENTS AND CLINICAL FELLOWS. IN ADDITION, THE MEDICAL CENTER HAS 52 NONSTANDARD CLINICAL FELLOWSHIP PROGRAMS WITH 64 TRAINEES PER YEAR. STAFF PHYSICIANS AT THE MEDICAL CENTER WHO HOLD FACULTY APPOINTMENTS AT HARVARD MEDICAL SCHOOL INSTRUCT THE DOCTORS OF TOMORROW THROUGH SUPERVISION OF THEIR DAILY PATIENT CARE AND A RANGE OF INTERACTIVE LEARNING EXPERIENCES. CORE CLINICAL TRAINING PROGRAMSTHE MEDICAL CENTER SPONSORS CORE CLINICAL TRAINING PROGRAMS IN THE FOLLOWING FIELDS: ANESTHESIOLOGY EMERGENCY MEDICINE EAR, NOSE AND THROAT (OTOLARYNGOLOGY) INTERNAL MEDICINE NEUROLOGY NEUROSURGERY OBSTETRICS AND GYNECOLOGY PATHOLOGY PLASTIC SURGERY PSYCHIATRY RADIOLOGY SURGERY TRANSITIONAL YEAR UROLOGYDURING THE FISCAL YEAR COVERED BY THIS FILING, THE MEDICAL CENTER HAD NET EXPENDITURES OF $68,456,175 REPORTED ON THIS SCHEDULE H, PART I, LINE 7F RELATED TO THE MEDICAL CENTER'S TEACHING FUNCTION WHICH REPRESENTED 3.13% OF THE MEDICAL CENTER'S TOTAL EXPENSES.RESIDENCY PROGRAMSTHE MEDICAL CENTER SPONSORS ACCREDITATION COUNCIL FOR GRADUATE MEDICAL EDUCATION (ACGME) APPROVED RESIDENCY PROGRAMS IN EACH OF THE CORE CLINICAL TRAINING PROGRAMS LISTED ABOVE. FELLOWSHIP PROGRAMSIN ADDITION TO THE RESIDENT TRAINING PROGRAMS LISTED ABOVE, THE MEDICAL CENTER SPONSORS A WIDE VARIETY OF FELLOWSHIP TRAINING PROGRAMS FOR ELIGIBLE DOCTORS WHO HAVE COMPLETED THEIR RESIDENCY AND WANT TO ENGAGE IN MORE SPECIALIZED STUDY. APPROXIMATELY HALF OF THESE PROGRAMS (45 OF 97) ARE ACGME APPROVED OR APPROVED BY A COMPARABLE BODY RELATED TO THE PARTICULAR SUBSPECIALTY. THE MEDICAL CENTER SPONSORS THE FOLLOWING FELLOWSHIP PROGRAMS: ANESTHESIA: ADULT CARDIOTHORACIC ANESTHESIOLOGY, ADVANCED CLINICAL ANESTHESIA, ANESTHESIA FOR OUTPATIENT SURGERY, CRITICAL CARE MEDICINE, NEUROANESTHESIA, NEURO CRITICAL CARE, OBSTETRIC ANESTHESIOLOGY, PAIN MEDICINE, REGIONAL ANESTHESIA, VASCULAR ANESTHESIA, PATIENT SAFETY AND QUALITY IMPROVEMENT IN ANESTHESIA, ANESTHESIA MEDICAL EDUCATION DERMATOLOGY: CUTANEOUS ONCOLOGY, DERMATOLOGY RESEARCH FELLOWSHIP IN CLINICAL TRIALS AND OUTCOMES RESEARCH (CLEARS) EMERGENCY MEDICINE: EMERGENCY MEDICAL SERVICES, EMERGENCY ULTRASOUND, DISASTER MEDICINE, ACADEMIC EMERGENCY MEDICINE INTERNAL MEDICINE: ADVANCED CARDIAC NON-INVASIVE IMAGING, ADVANCED ENDOCRINE, DIABETES AND METABOLISM, ADVANCED ENDOSCOPY, ADVANCED INFECTIOUS DISEASE, ADVANCED NEPHROLOGY, CARDIAC MAGNETIC RESONANCE IMAGING, CARDIOVASCULAR DISEASE, CELIAC DISEASE, CLINICAL CARDIAC ELECTROPHYSIOLOGY, CLINICAL INFORMATICS, ENDOCRINOLOGY, DIABETES, AND METABOLISM, GASTROENTEROLOGY, GENERAL MEDICINE, GERIATRIC MEDICINE, GERIATRIC AND DIABETES, GI MOTILITY/FUNCTIONAL BOWEL DISORDERS, GLOBAL HEALTH, HEMATOLOGY AND MEDICAL ONCOLOGY, HEPATOLOGY, HOSPICE AND PALLIATIVE CARE, INFECTIOUS DISEASE, INFLAMMATORY BOWEL DISEASE, INTERVENTIONAL CARDIOLOGY, INTERVENTIONAL PULMONOLOGY, NEPHROLOGY, PULMONARY CRITICAL CARE, RHEUMATOLOGY, SLEEP MEDICINE, SLEEP RESPIRATION, STRUCTURAL HEART DISEASE, TRANSPLANT HEPATOLOGY, TRANSPLANT NEPHROLOGY, LGBTQIA+ HEALTH NEUROLOGY: AUTONOMIC DISORDERS, COGNITIVE BEHAVIORAL NEUROLOGY, CLINICAL NEUROPHYSIOLOGY, EPILEPSY, MOVEMENT DISORDERS, MULTIPLE SCLEROSIS, NEUROLOGY-HIV, NEUROMUSCULAR MEDICINE, NEURO-ONCOLOGY, VASCULAR NEUROLOGY OBSTETRICS AND GYNECOLOGY: FEMALE PELVIC MEDICINE & RECONSTRUCTIVE SURGERY, GYNECOLOGIC ONCOLOGY, MATERNAL FETAL MEDICINE, REPRODUCTIVE ENDOCRINOLOGY PATHOLOGY: BLOOD BANKING/TRANSFUSION MEDICINE, CYTOPATHOLOGY, DERMATOPATHOLOGY, HEMATOPATHOLOGY, MEDICAL MICROBIOLOGY, MEDICAL MICROBIOLOGY CPEP, NEUROPATHOLOGY, SELECTIVE PATHOLOGY PSYCHIATRY: EARLY PSYCHOSIS RADIOLOGY-DIAGNOSTIC: ABDOMINAL RADIOLOGY, BREAST IMAGING RADIOLOGY, INTERVENTIONAL RADIOLOGY-INDEPENDENT, INTERVENTIONAL RADIOLOGY-INTEGRATED, MRI, MUSCULOSKELETAL IMAGING MSK, NEURORADIOLOGY, THORACIC IMAGING RADIOLOGY, RADIATION ONCOLOGY: BRACHYTHERAPY, STEREOTATIC SURGERY: ABDOMINAL TRANSPLANT SURGERY/KIDNEY, ACUTE CARE SURGERY, ANTERIOR SEGMENT OPHTHALMOLOGY, COLON AND RECTAL SURGERY, CORNEA AND REFRACTIVE SURGERY, CEREBROVASCULAR AND ENDOVASCULAR NEUROSURGERY, HEAD & NECK SURGICAL ONCOLOGY & RECONSTRUCTION, INTERDISCIPLINARY BREAST SURGERY, LYMPHATIC SURGERY, MINIMALLY INVASIVE BARIATRIC SURGERY, NEUROSURGERY/ORTHO SPINE, ORTHOPAEDIC HAND SURGERY, ORTHOPAEDIC SPINE SURGERY, OTOLARYNGOLOGY FELLOWSHIP, PLASTIC SURGERY, PLASTIC SURGERY/AESTHETIC RECONSTRUCTION, PLASTIC SURGERY/BREAST RECONSTRUCTION, PODIATRY, SURGICAL CRITICAL CARE, THORACIC SURGERY, UROLOGY, UROLOGY MALE INFERTILITY/SEXUAL DYSFUNCTION, VASCULAR SURGERY, VASCULAR SURGERY-INTEGRATED, JOINTS FELLOWSHIPADDITIONAL INFORMATION ON CLINICAL RESIDENCY AND FELLOWSHIPS -- EXAMPLESBELOW IS MORE DETAIL ON JUST A FEW OF THE SPECIFIC GRADUATE MEDICAL EDUCATION PROGRAMS OFFERED AT THE MEDICAL CENTER:HARVARD AFFILIATED EMERGENCY MEDICINE RESIDENCY AT BIDMCTHE BETH ISRAEL DEACONESS MEDICAL CENTER HARVARD AFFILIATED EMERGENCY MEDICINE RESIDENCY IS A THREE-YEAR PROGRAM (PGY-1 TO PGY-3) AFFILIATED WITH HARVARD MEDICAL SCHOOL AND IS BASED AT BETH ISRAEL DEACONESS MEDICAL CENTER (BIDMC), A 57,000 VISIT PER YEAR LEVEL I TRAUMA CENTER. RESIDENTS ROTATE AT CHILDREN'S HOSPITAL BOSTON, BROCKTON HOSPITAL, CAMBRIDGE HEALTH ALLIANCE, TUFTS MEDICAL CENTER, ST. LUKE'S HOSPITAL, MOUNT AUBURN HOSPITAL, SOUTH SHORE HOSPITAL AND BETH ISRAEL DEACONESS HOSPITAL-NEEDHAM.THE EDUCATIONAL GOALS OF THE RESIDENCY ARE TO PROMOTE EXCELLENCE IN THE CLINICAL, ACADEMIC, AND ADMINISTRATIVE ASPECTS OF EMERGENCY MEDICINE. RESIDENTS ARE TAUGHT HOW TO BE OUTSTANDING CLINICIANS. THIS IS ACCOMPLISHED THROUGH CLINICAL EXPERIENCE IN SEVERAL BUSY EMERGENCY DEPARTMENTS AS WELL AS THROUGH A HIGH QUALITY DIDACTIC PROGRAM. DURING THE CLINICAL EXPERIENCE, THE RESIDENTS ARE CLOSELY SUPERVISED AND GIVEN GRADED RESPONSIBILITY FOR PATIENT CARE AND ULTIMATELY FOR PATIENT FLOW IN THE EMERGENCY DEPARTMENT. ADDITIONALLY, RESIDENTS ARE TAUGHT HOW TO SUPERVISE MEDICAL STUDENTS AND OTHER RESIDENTS AND HOW TO TEACH THE PRACTICE OF EMERGENCY MEDICINE. RESIDENTS TEACH MEDICAL STUDENTS AND PREHOSPITAL PERSONNEL AND CONTRIBUTE TO THE DIDACTIC PROGRAM. SENIOR RESIDENTS TAKE ON THE RESPONSIBILITY OF SUPERVISING JUNIOR RESIDENTS IN THE CLINICAL ARENA. THE FOCUS OF THE RESIDENCY PROGRAM IS ON TEACHING THE LEADERSHIP SKILLS NECESSARY TO DIRECT A BUSY EMERGENCY DEPARTMENT IN ANY SETTING.THE OTHER MAJOR EDUCATIONAL GOAL OF THE RESIDENCY IS TO DEVELOP THE RESEARCH AND ACADEMIC SKILLS REQUIRED FOR A CAREER IN ACADEMIC EMERGENCY MEDICINE. PARTICIPATION IN RESEARCH IS PROMOTED THROUGH A SYSTEM OF MENTORSHIP, JOURNAL CLUB PARTICIPATION, AND A DIDACTIC PROGRAM THAT TEACHES RESEARCH DESIGN AND STATISTICAL METHODS. RESIDENTS ARE REQUIRED TO COMPLETE A RESEARCH OR ACADEMIC PROJECT THAT RESULTS IN A PAPER SUITABLE FOR PUBLICATION. FUNDING IS AVAILABLE WITHIN THE DIVISION OF EMERGENCY MEDICINE AT HARVARD MEDICAL SCHOOL AND THE DEPARTMENT OF EMERGENCY MEDICINE AT BIDMC. PROMOTING THE ADMINISTRATIVE ASPECTS OF EMERGENCY MEDICINE IS ANOTHER GOAL OF THE BIDMC HARVARD AFFILIATED EMERGENCY MEDICINE RESIDENCY. THROUGH AN EMS/ADMINISTRATIVE ROTATION AND A LONGITUDINAL EXPERIENCE IN PREHOSPITAL ADMINISTRATION, RESIDENTS GAIN EXPERIENCE IN RUNNING A LOCAL PREHOSPITAL SYSTEM.THIS PROGRAM TAKES ADVANTAGE OF THE UNIQUE ACADEMIC OPPORTUNITIES AT HARVARD MEDICAL SCHOOL, THE HARVARD TEACHING HOSPITALS, AND THE HARVARD SCHOOL OF PUBLIC HEALTH. THESE OPPORTUNITIES INCLUDE THE OUTSTANDING EXPERIENCE AVAILABLE THROUGH BOSTON CHILDREN'S HOSPITAL AND THE DEPARTMENTS OF MEDICINE, SURGERY, OBSTETRICS AND GYNECOLOGY, AND ANESTHESIA AT BETH ISRAEL DEACONESS MEDICAL CENTER.

HOSPITAL-WIDE GLOBAL HEALTH PROGRAM
"THE BIDMC GLOBAL HEALTH PROGRAM IS A HOSPITAL-WIDE PROGRAM AVAILABLE TO ALL BIDMC RESIDENTS. WHILE REQUIREMENTS AND TIMELINES MAY DIFFER BETWEEN DEPARTMENTS AND SPECIALTIES, THE OVERARCHING GOAL IS TO PROVIDE RESIDENTS WITH FURTHER TRAINING AND EDUCATION IN THE DISCIPLINE OF GLOBAL HEALTH. *****NEUROLOGY EDUCATION AT BIDMCTHE HARVARD MEDICAL SCHOOL NEUROLOGY PROGRAM AT BETH ISRAEL DEACONESS MEDICAL CENTER AND CHILDREN'S HOSPITAL IN BOSTON, MASSACHUSETTS WAS FOUNDED IN 1996 AS THE SUCCESSOR TO THE HARVARD-LONGWOOD NEUROLOGY PROGRAM. THE PROGRAM CONCENTRATES ON THE TRAINING AND RESEARCH OPPORTUNITIES AVAILABLE ON THE HARVARD MEDICAL SCHOOL LONGWOOD CAMPUS, BY COMBINING THE RESOURCES OF TWO MAJOR HARVARD TEACHING HOSPITALS, BETH ISRAEL DEACONESS MEDICAL CENTER AND CHILDREN'S HOSPITAL. THESE COMBINED HOSPITALS, WITH OVER 800 INPATIENT BEDS AND EXTENSIVE OUTPATIENT CLINICS, PROVIDE THE SETTING FOR TRAINING PHYSICIANS IN THE ART AND SCIENCE OF CLINICAL NEUROLOGY.THE COMBINED FACULTY CONSISTS OF MORE THAN 80 NEUROLOGISTS AT THE TWO PARTICIPATING HOSPITALS, AND PROVIDES CORE EXPERIENCES IN INPATIENT AND OUTPATIENT NEUROLOGY, AS WELL AS TRAINING IN ELECTROPHYSIOLOGY (INCLUDING EEG, EMG, AND SLEEP POLYSOMNOGRAPHY) AND NEUROPATHOLOGY. THE KEY DISTINGUISHING FEATURE OF THE PROGRAM IS THE CLOSE RELATIONSHIP BETWEEN THE CLINICAL FACULTY, NEARLY ALL OF WHOM ARE FULL-TIME ACADEMIC NEUROLOGISTS ENGAGED IN SUBSTANTIVE RESEARCH AND TEACHING EFFORTS, AND A SELECT GROUP OF RESIDENTS WHO ARE KEENLY INTERESTED IN FORGING ACADEMIC CAREERS IN NEUROLOGY. VIRTUALLY ALL OF THE CLINICAL TRAINING TAKES PLACE WITHIN A 2 BLOCK RADIUS ON THE HARVARD MEDICAL SCHOOL LONGWOOD CAMPUS. A CRITICAL COMPONENT OF THE PROGRAM IS THE OPPORTUNITY FOR RESIDENTS TO HAVE A MENTORED TEACHING EXPERIENCE AS WELL AS THE OPPORTUNITY TO UNDERTAKE A MENTORED PROJECT, WHICH MAY ENTAIL EITHER CLINICAL OR LABORATORY BASED INVESTIGATION OR PREPARATION OF INNOVATIVE TEACHING MATERIALS OR METHODS. *****PATHOLOGY EDUCATION AT BIDMCTHE DEPARTMENT OF PATHOLOGY AT BETH ISRAEL DEACONESS MEDICAL CENTER IS COMMITTED TO PROVIDING STATE-OF-THE-ART TRAINING TO PREPARE PHYSICIANS FOR LEADERSHIP ROLES IN PATHOLOGY AND ACADEMIC MEDICINE. THE PROGRAM OFFERS THREE RESIDENT TRAINING PATHWAYS: FIRST, A COMBINED ANATOMIC PATHOLOGY/CLINICAL PATHOLOGY (AP/CP) PATHWAY PROVIDES COMPREHENSIVE TRAINING IN ALL AREAS OF TISSUE DIAGNOSTICS AND LABORATORY MEDICINE. SECOND, THE AP ONLY PATHWAY PREPARES RESIDENTS FOR CAREERS AS ACADEMIC SURGICAL PATHOLOGISTS. THIRD, THE CP ONLY PATHWAY PREPARES RESIDENTS FOR CAREERS AS FUTURE LEADERS IN LABORATORY MEDICINE. ALL PATHWAYS INCLUDE EXTENSIVE OPPORTUNITIES TO PARTICIPATE IN RESEARCH PROJECTS WITH WORLD-RENOWNED EXPERTS IN PATHOLOGY OR RELATED DISCIPLINES. KNOWLEDGE COMES THROUGH EXPERIENCE AND EXTENSIVE INTERACTION WITH FACULTY. IN ANATOMIC PATHOLOGY SIGN OUT, RESIDENTS PREPARE THEIR OWN DIAGNOSES AND ARE THEN IN A POSITION TO TAKE FULL ADVANTAGE OF SIGN OUT WITH STAFF MEMBERS. IN CLINICAL PATHOLOGY, RESIDENTS GAIN EXPERIENCE DURING DAILY ROUNDS WITH ATTENDINGS, SOCRATIC TUTORIALS, AND THROUGH POSITIONING OF RESIDENTS AS AN INTERMEDIARY BETWEEN CLINICIAN AND LABORATORY. THERE ARE DAILY TEACHING AND CASE MANAGEMENT CONFERENCES COVERING THE DIFFERENT PATHOLOGY SPECIALTIES. GIVEN THE IMPORTANT ROLE PATHOLOGISTS PLAY IN TEACHING MEDICAL STUDENTS AND COLLEAGUES IN OTHER SPECIALTIES, THE PROGRAM PROVIDES GUIDANCE FOR RESIDENTS AS THEY HONE THEIR TEACHING SKILLS. SUCH ""RESIDENT-AS-TEACHER"" PROGRAMS ARE COMMON IN OTHER SPECIALTIES BUT NOT AS WELL-DEVELOPED IN PATHOLOGY. THE CURRICULUM INCLUDES SESSIONS DESIGNED TO IMPROVE SKILLS RELATED TO GIVING FEEDBACK AND SMALL GROUP TEACHING. THERE IS A SESSION ON DEVELOPING PRESENTATION SKILLS WITH CLOSE MENTORING OF FIRST YEAR RESIDENTS, BY SPECIFIC FACULTY WHO HAVE ALSO BEEN THROUGH THE CURRICULUM, AS THEY PREPARE FOR THEIR FIRST PRESENTATION. THERE ARE ALSO OPPORTUNITIES FOR RESIDENTS TO TEACH MEDICAL STUDENTS BOTH WITHIN OUR DEPARTMENT AND AT HARVARD MEDICAL SCHOOL, AS WELL AS TO RECEIVE FEEDBACK ON THEIR TEACHING SKILLS. RECOGNIZING THE NEED TO INTEGRATE TECHNOLOGY INTO RESIDENCY TRAINING, ALL FIRST YEAR RESIDENTS ARE PROVIDED WITH IPADS. THESE TABLETS ALLOW RESIDENTS TO MORE EASILY PREVIEW THE SLIDES THAT ARE ROUTINELY SCANNED FOR OUR SURGICAL SLIDE CONFERENCE. GENOMIC TECHNOLOGY WILL AFFECT THE PRACTICE OF ALL MEDICAL PRACTITIONERS. AS THE PHYSICIANS WHO MANAGE THE HOSPITAL LABORATORIES, PATHOLOGISTS MUST UNDERSTAND NEXT-GENERATION SEQUENCING TECHNOLOGY AND ITS APPLICATION TO PATIENT CARE. IN 2009, THE PROGRAM CREATED, TO OUR KNOWLEDGE, THE FIRST GENOMIC PATHOLOGY CURRICULUM IN THE COUNTRY. THE CURRICULUM HAS BEEN PUBLISHED AND HAS SERVED AS THE BASIS FOR A COLLABORATIVE EFFORT TO DEVELOP A NATIONAL GENOMICS CURRICULUM (WWW.ASCP.ORG/TRIG).TRAINING IN EVIDENCE-BASED MEDICINE IS CRITICAL. A FIRST-YEAR RESIDENT JOURNAL CLUB ALLOWS AN INTRODUCTION TO CRITICAL REVIEW OF THE MEDICAL LITERATURE. IN LATER YEARS, RESIDENTS LEAD SMALL-GROUP DISCUSSIONS IN MONTHLY JOURNAL CLUBS. THERE IS ALSO AN EVIDENCE-BASED TRANSFUSION MEDICINE CURRICULUM TO HONE THESE SKILLS DURING CP TRAINING. *****RADIOLOGY EDUCATION AT BIDMCTHE RADIOLOGY RESIDENCY PROVIDES FOUR YEARS OF TRAINING IN DIAGNOSTIC IMAGING. APPOINTMENTS ARE HELD JOINTLY AS A RESIDENT AT THE MEDICAL CENTER AND AS A CLINICAL FELLOW AT HARVARD MEDICAL SCHOOL. WITH A CENTRAL ROLE IN CLINICAL SERVICE, TEACHING, AND RESEARCH, THE RADIOLOGY DEPARTMENT PERFORMS OVER 400,000 RADIOLOGIC EXAMINATIONS EACH YEAR. THE DEPARTMENT PROVIDES RADIOGRAPHY, CT, ULTRASOUND, MRI, NUCLEAR MEDICINE, MAMMOGRAPHY, ANGIOGRAPHY, AND INTERVENTIONAL RADIOLOGY SERVICES TO BOTH THE MEDICAL CENTER AS WELL AS OUR AFFILIATED HEALTH CARE FACILITIES. A RADIOLOGY RESEARCH AND ANIMAL LABORATORY IS HOUSED ADJACENT TO THE RADIOLOGY DEPARTMENT. ALL RESIDENTS, FELLOWS, AND FACULTY HAVE APPOINTMENTS AT HARVARD MEDICAL SCHOOL. ALL RADIOLOGIC STUDIES ARE INTERPRETED UNDER THE SUPERVISION OF STAFF RADIOLOGISTS. THE NUCLEAR MEDICINE PROGRAM IS A PART OF THE JOINT PROGRAM IN NUCLEAR MEDICINE AT HARVARD MEDICAL SCHOOL. THE DEPARTMENT PLACES STRONG EMPHASIS ON THE QUALITY OF TEACHING-BOTH IN DIDACTIC LECTURES AND IN INDIVIDUAL CASE-BASED TEACHING.WITH THE ADVENT OF RECENT CHANGES IN RESIDENCY TRAINING, THE CURRICULUM HAS RECENTLY BEEN REVISED SO THAT RESIDENTS UNDERTAKE A COURSE OF STUDY WHICH WILL PERMIT THEM TO OBTAIN EXPERTISE NOT JUST IN CLINICAL SUBSPECIALTIES BUT ALSO IN OTHER KEY AREAS SUCH AS RESEARCH, EDUCATION, GLOBAL HEALTH, QUALITY IMPROVEMENT, AND HEALTH POLICY. RADIOLOGIC PHYSICS HAS BEEN INTEGRATED INTO DAILY DIDACTIC SESSIONS. IN ADDITION, MANY DIDACTIC SESSIONS UTILIZE AUDIENCE RESPONSE TECHNOLOGY, VIDEO-RECORDING, AND IPAD2 TECHNOLOGY.THERE ARE NINE FORMAL SECTIONS IN THE DEPARTMENT: ABDOMINAL IMAGING, BREAST IMAGING, CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY (CVIR), MRI, MUSCULOSKELETAL IMAGING, NEURORADIOLOGY, NUCLEAR MEDICINE, ULTRASOUND, AND THORACIC IMAGING. MOST NON-ANGIOGRAPHIC INTERVENTIONAL PROCEDURES ARE PERFORMED BY THE RESPECTIVE SERVICES. RESIDENTS ROTATING THROUGH THESE SECTIONS ARE PROVIDED WITH READING SUGGESTIONS AND MATERIAL. ACADEMIC ROTATIONS ARE MADE UP OF THIRTEEN 4-WEEK BLOCKS ANNUALLY. AT THE END OF EACH ROTATION RESIDENTS RECEIVE WRITTEN EVALUATIONS AND HAVE THE OPPORTUNITY TO EVALUATE THE STAFF.FIRST YEAR ROTATIONS EMPHASIZE FUNDAMENTALS AND COMMON RADIOLOGIC EXAMINATIONS IN PREPARATION FOR INPATIENT AND EMERGENCY DEPARTMENT RESPONSIBILITIES. PRIOR TO TAKING CALL, ALL FIRST YEAR RESIDENTS ROTATE THROUGH ABDOMINAL IMAGING, BREAST IMAGING, EMERGENCY RADIOLOGY, FLUOROSCOPY, MUSCULOSKELETAL IMAGING, NEURORADIOLOGY, NUCLEAR MEDICINE, THORACIC IMAGING, AND ULTRASOUND.DURING THE SECOND YEAR, RESIDENTS CONTINUE TO GAIN EXPERIENCE IN THESE SECTIONS, PERFORMING AND INTERPRETING MORE ADVANCED EXAMINATIONS AND INTERVENTIONS AS THEIR LEVELS OF EXPERTISE INCREASE. ADDITIONAL ROTATIONS IN MORE SPECIALIZED TOPICS OCCUR THROUGHOUT THE SECOND THROUGH FOURTH YEARS, INCLUDING INTERVENTIONAL RADIOLOGY, MRI, HEAD AND NECK IMAGING, AND PEDIATRIC RADIOLOGY. IN ADDITION, ALL RESIDENTS PARTICIPATE IN A TWO-WEEK ROTATION IN QUALITY ASSURANCE WHICH PROVIDES THEM WITH ESSENTIAL SKILLS FOR EVENTUAL BOARD RE-CERTIFICATION."

BIDMC'S HOSPITAL'S CBAC MEMBERS INCLUDE:
ALBERTE ALTINE-GIBSON, MANAGER OF COMMUNITY HEALTH, BOWDOIN STREET HEALTH CENTER FLOR AMAYA, DIRECTOR OF PUBLIC HEALTH, CITY OF CHELSEA WALTER ARMSTRONG, SENIOR LEADERSHIP DESIGNEE, BIDMC MAIA BETTS, CHIEF BEHAVIORAL HEALTH OFFICER, THE DIMOCK CENTER ELIZABETH BROWNE, CHIEF EXECUTIVE OFFICER, CHARLES RIVER COMMUNITY HEALTH ALEXANDRA CHERY DORRELUS, CO-EXECUTIVE DIRECTOR, LOUIS D. BROWN PEACE INSTITUTE SHONDELL DAVIS, COMMUNITY TRAUMA HEALING SPECIALIST, CORY JOHNSON CENTER FOR POST-TRAUMATIC HEALING LAUREN GABOVITCH, COMMUNITY RESOURCE SPECIALIST, BIDMC RICHARD GIORDANO, DIRECTOR OF POLICY AND COMMUNITY PLANNING, FENWAY COMMUNITY DEVELOPMENT CORPORATION NANCY KASEN, VICE PRESIDENT OF COMMUNITY BENEFITS AND COMMUNITY RELATIONS, BILH BARRY KEPPARD, DIRECTOR OF PUBLIC HEALTH, METROPOLITAN AREA PLANNING COUNCIL KIRA KHAZATSKY, CHIEF OPERATING OFFICER, JEWISH VOCATIONAL SERVICES ANGIE LIOU, EXECUTIVE DIRECTOR, ASIAN COMMUNITY DEVELOPMENT CORPORATION MARSHA MAURER, SENIOR VICE PRESIDENT FOR PATIENT CARE SERVICES AND CHIEF NURSING OFFICER, BIDMC JAMES MORTON, PRESIDENT AND CHIEF EXECUTIVE OFFICER, YMCA OF GREATER BOSTON SANDY NOVACK, SOCIAL WORKER, UNIVERSAL ACCESS COUNCIL ALEX OLIVER-DVILA, EXECUTIVE DIRECTOR, SOCIEDAD LATINA KELINA (KELLY) ORLANDO, EXECUTIVE DIRECTOR, AMBULATORY OPERATIONS, BIDMC JOANNE POKASKI, DIRECTOR OF WORKFORCE DEVELOPMENT AND COMMUNITY RELATIONS, BIDMC TRINIESE POLK, DIRECTOR OF RACIAL EQUITY AND COMMUNITY ENGAGEMENT, BOSTON PUBLIC HEALTH COMMISSION JANE POWERS, CHIEF OF STAFF AND EXECUTIVE VICE PRESIDENT OF STRATEGIC INITIATIVES, FENWAY HEALTH RICHARD ROUSE, ADVISORY BOARD MEMBER, MISSION HILL MAIN STREETS MELODY ROUTE-SATCHELL, PRACTICE MANAGER, BIDMC ROBERT TORRES, DIRECTOR OF COMMUNITY BENEFITS, BIDMC LASHONDA WALKER-ROBINSON, COMMUNITY RESOURCE SPECIALIST, BIDMC FRED WANG, TRUSTEE ADVISOR EMERITUS, BIDMC COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGYMOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENTINTERNAL REVENUE CODE SECTION 501(R)INTERNAL REVENUE CODE SECTION 501(R), ENACTED AS PART OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT, REQUIRES EACH HOSPITAL TO COMPLETE A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND TO FORMALLY ADOPT AN IMPLEMENTATION STRATEGY (IS) PURSUANT TO FEDERAL GUIDELINES, IN ORDER TO MAINTAIN ITS TAX EXEMPT STATUS AS A HOSPITAL UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC) OF 1986, AS AMENDED. BIDMC COMPLETED ITS MOST RECENT NEEDS ASSESSMENT IN SEPTEMBER 2022. THAT CHNA WAS APPROVED BY THE BIDMC BOARD OF TRUSTEES ON SEPTEMBER 21, 2022. THE ACCOMPANYING IMPLEMENTATION STRATEGY FOR THE MOST RECENT CHNA WAS ALSO ADOPTED BY THE BOARD ON SEPTEMBER 21, 2022, WHICH IS WITHIN THE TIMELINE REQUIRED BY THE TREASURY REGULATIONS UNDER 501(R). THE CHNA AND THE ASSOCIATED IMPLEMENTATION STRATEGY (IS) REPRESENT THE CULMINATION OF A YEAR OF WORK AND WERE BORNE LARGELY OF BIDMC'S COMMITMENT TO BETTER UNDERSTAND AND ADDRESS THE HEALTH-RELATED NEEDS OF THOSE LIVING IN ITS COMMUNITY BENEFITS SERVICE AREA WITH AN EMPHASIS ON THOSE WHO ARE MOST DISADVANTAGED. THE PROJECT ALSO FULFILLS THE COMMONWEALTH ATTORNEY GENERAL'S OFFICE AND FEDERAL INTERNAL REVENUE SERVICE (IRS) REGULATIONS THAT REQUIRE THAT BIDMC ASSESS COMMUNITY HEALTH NEEDS, ENGAGE THE COMMUNITY, IDENTIFY PRIORITY HEALTH ISSUES AND CREATE A COMMUNITY HEALTH STRATEGY THAT DESCRIBES HOW BIDMC, IN COLLABORATION WITH THE COMMUNITY AND LOCAL HEALTH DEPARTMENT(S), WILL ADDRESS THE NEEDS AND THE PRIORITIES IDENTIFIED BY THE CHNA.2022 COMMUNITY HEALTH NEEDS ASSESSMENTPRIORITY GEOGRAPHY AND COHORTSAS NOTED ABOVE, BIDMC COMPLETED ITS LAST ASSESSMENT IN SEPTEMBER 2022. THE GEOGRAPHICAL FOCUS OF BIDMC'S MOST RECENTLY COMPLETED COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) ENCOMPASSES THE BOSTON NEIGHBORHOODS OF ALLSTON/BRIGHTON, BOWDOIN/GENEVA, CHINATOWN, FENWAY/KENMORE, MISSION HILL AND ROXBURY, THE CITY OF CHELSEA, AND THE MUNICIPALITIES OF BROOKLINE, BURLINGTON, LEXINGTON, NEEDHAM, NEWTON (CHESTNUT HILL) AND PEABODY. THE CHNA SHOWS THAT LOW-INCOME AND RACIALLY/ETHNICALLY DIVERSE POPULATIONS LIVING IN BOSTON'S NEIGHBORHOODS OF ALLSTON/BRIGHTON, BOWDOIN/GENEVA, CHINATOWN, FENWAY/KENMORE, MISSION HILL AND ROXBURY, AS WELL AS THE ADJACENT CITY OF CHELSEA, FACE THE GREATEST HEALTH DISPARITIES AND ARE MOST AT RISK. AS A RESULT, THESE BOSTON NEIGHBORHOODS AND THE CITY OF CHELSEA HAVE BEEN IDENTIFIED AND PRIORITIZED AS THE FOCUS FOR BIDMC'S COMMUNITY HEALTH EFFORTS.COMMUNITY HEALTH ISSUES AND PRIORITY COHORTS FOR BIDMC'S COMMUNITY BENEFITS INITIATIVES ARE IDENTIFIED THROUGH A COLLABORATIVE COMMUNITY ENGAGEMENT AND PLANNING PROCESS FROM A CHNA THAT IS CONDUCTED EVERY THREE YEARS IN ACCORDANCE WITH THE REQUIREMENTS UNDER IRC SECTION 501(R).BIDMC'S COMMUNITY BENEFITS INVESTMENTS AND RESOURCES WILL FOCUS ON IMPROVING THE HEALTH STATUS OF THOSE WHO ARE MEDICALLY-UNDERSERVED, EXPERIENCE POVERTY OR FACE THE GREATEST HEALTH DISPARITIES IN THE CITY OF CHELSEA AND THE CITY OF BOSTON NEIGHBORHOODS OF ALLSTON/BRIGHTON, BOWDOIN/GENEVA, CHINATOWN, FENWAY/KENMORE, MISSION HILL, AND ROXBURY, AS FOLLOWS: YOUTH LOW-RESOURCED POPULATIONS LGBTQIA+ OLDER ADULTS RACIALLY, ETHNICALLY AND LINGUISTICALLY DIVERSE POPULATIONS FAMILIES AFFECTED BY VIOLENCE AND/OR INCARCERATION

2022 COMMUNITY HEALTH NEEDS ASSESSMENTSUMMARY OF APPROACH AND METHODS
BIDMC'S 2022 CHNA APPROACH INVOLVED EXTENSIVE DATA COLLECTION ACTIVITIES, SUBSTANTIAL EFFORTS TO ENGAGE THE HOSPITAL'S PARTNERS AND COMMUNITY RESIDENTS, AND THOUGHTFUL PRIORITIZATION, PLANNING, AND REPORTING PROCESSES. THROUGHOUT THE CHNA PROCESS, EFFORTS WERE MADE TO UNDERSTAND THE NEEDS OF THE COMMUNITIES ENCOMPASSING BIDMC'S CBSA, ESPECIALLY THE POPULATION SEGMENTS THAT ARE OFTEN DISADVANTAGED, FACE DISPARITIES IN HEALTH-RELATED OUTCOMES, AND WHO HAVE BEEN HISTORICALLY UNDERSERVED. BIDMC'S UNDERSTANDING OF THESE COMMUNITIES' NEEDS IS DERIVED FROM COLLECTING A WIDE RANGE OF QUANTITATIVE DATA TO IDENTIFY DISPARITIES AND CLARIFY THE NEEDS OF SPECIFIC COMMUNITIES AND COMPARING IT AGAINST DATA COLLECTED AT THE REGIONAL, STATE AND NATIONAL LEVELS WHEREVER POSSIBLE TO SUPPORT ANALYSIS AND THE PRIORITIZATION PROCESS, AS WELL AS EMPLOYING A VARIETY OF STRATEGIES TO ENSURE COMMUNITY MEMBERS WERE INFORMED, CONSULTED, INVOLVED, AND EMPOWERED THROUGHOUT THE ASSESSMENT PROCESS. THE CHNA AND IS DEVELOPMENT PROCESS WAS GUIDED BY THE FOLLOWING PRINCIPLES: EQUITY, COLLABORATION, ENGAGEMENT, CAPACITY BUILDING, AND INTENTIONALITY.BETWEEN OCTOBER 2021 AND FEBRUARY 2022, BIDMC CONDUCTED 85 ONE-ON-ONE INTERVIEWS WITH KEY COLLABORATORS IN THE COMMUNITY, FACILITATED 22 FOCUS GROUPS WITH SEGMENTS OF THE POPULATION FACING THE GREATEST HEALTH-RELATED DISPARITIES, AND COMMUNITY LISTENING SESSIONS THAT ENGAGED 226 PARTICIPANTS. IN ADDITION, BIDMC'S BILH PARTNERS, BID NEEDHAM AND LAHEY HOSPITAL & MEDICAL CENTER (LHMC), CONDUCTED A COMMUNITY HEALTH SURVEY, WHICH GATHERED INFORMATION FROM MORE THAN 1,400 COMMUNITY RESIDENTS FROM BID NEEDHAM'S AND LHMC'S CBSAS, INCLUDING 346 RESIDENTS FROM NEEDHAM, 155 RESIDENTS OF BURLINGTON, AND 180 RESIDENTS OF PEABODY. BID NEEDHAM AND LHMC SHARED THIS INFORMATION WITH BIDMC. THE BOSTON PUBLIC HEALTH COMMISSION FIELDED A COVID-19 HEALTH EQUITY SURVEY IN DECEMBER 2020/JANUARY 2021; AS SUCH, BIDMC, BASED ON RECOMMENDATIONS FROM THE BOSTON CHNA- COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) COLLABORATIVE STEERING COMMITTEE, OPTED NOT TO FIELD THE BILH COMMUNITY HEALTH SURVEY IN BOSTON. THE BOSTON PUBLIC HEALTH COMMISSION COVID-19 HEALTH EQUITY SURVEY INCLUDED A RANDOM SAMPLE OF OVER 1,650 RESIDENTS IN MULTIPLE LANGUAGES AND EXAMINED ISSUES RELATED TO JOB LOSS, FOOD INSECURITY, ACCESS TO SERVICES, MENTAL HEALTH, VACCINATION, AND PERCEPTIONS OF RISK AROUND COVID-19. THE NORTH SUFFOLK PUBLIC HEALTH COLLABORATIVE ALSO FIELDED A COMMUNITY HEALTH SURVEY. THE SURVEY COLLECTED DATA FROM 1,401 RESPONDENTS FROM CHELSEA, REVERE, AND WINTHROP. RESULTS WERE STRATIFIED BY COMMUNITY, AGE GROUP, GENDER, RACE, ETHNICITY, AND LANGUAGE. IN ADDITION, BIDMC'S BILH PARTNERS, BID NEEDHAM AND LHMC, CONDUCTED A COMMUNITY HEALTH SURVEY, WHICH GATHERED INFORMATION FROM MORE THAN 1,400 COMMUNITY RESIDENTS FROM BID NEEDHAM'S AND LHMC'S CBSAS, INCLUDING 346 RESIDENTS FROM NEEDHAM, 155 RESIDENTS OF BURLINGTON, AND 180 RESIDENTS OF PEABODY. BID NEEDHAM AND LHMC SHARED THIS INFORMATION WITH BIDMC. 2022 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESSDETAIL OF APPROACH AND METHODSBIDMC RELIED ON NUMEROUS PRIMARY AND SECONDARY DATA SOURCES TO ANALYZE THE HEALTH STATUS AND NEED LEVEL THROUGHOUT THEIR CBSA. BIDMC COLLECTED DATA FROM A NUMBER OF SOURCES INCLUDING PRIMARY QUANTITATIVE AND QUALITATIVE DATA, AS WELL AS SECONDARY DATA. EXAMPLES OF SECONDARY DATA SOURCES THAT BIDMC LEVERAGED INCLUDED: U.S. CENSUS BUREAU, AMERICAN COMMUNITY SURVEY 5-YEAR ESTIMATES (2016-2020) U.S. CENSUS BUREAU, AMERICAN COMMUNITY SURVEY POPULATION CHANGE (2010-2020) U.S. CENSUS BUREAU, COVID-19 HOUSEHOLD PULSE SURVEY (2021) BEHAVIORAL RISK FACTOR SURVEILLANCE SURVEY (2019) MASSACHUSETTS DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION: SCHOOL AND DISTRICT PROFILES (2020-2021) FBI UNIFORM CRIME REPORTS (2019) MASSACHUSETTS DEPARTMENT OF ECONOMIC RESEARCH, LABOR MARKET INFORMATION (2020-2021) MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH, REGISTRY OF VITAL RECORDS AND STATISTICS (2019) MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH, BUREAU OF SUBSTANCE ABUSE SERVICES (2015-2017) MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH, COVID-19 DASHBOARD (2021) MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH, COVID-19 COMMUNITY IMPACT SURVEY (2021) MASSACHUSETTS BUREAU OF INFECTIOUS DISEASE AND LABORATORY SCIENCES (2019) MASSACHUSETTS CENTER FOR HEALTH INFORMATION ANALYSIS (CHIA) HOSPITAL DISCHARGES (2019) MASSACHUSETTS HEALTHY AGING COLLABORATIVE, COMMUNITY PROFILES (2020) MASSACHUSETTS INSTITUTE OF TECHNOLOGY, EVICTION LAB (2018) ROBERT WOOD JOHNSON COUNTRY HEALTH RANKINGS (2019, 2020, 2021)2022 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESSKEY INFORMANT INTERVIEWS WITH INTERNAL AND EXTERNAL STAKEHOLDERS (SCHEDULE H, PART V, SECTION B, LINE 5)BETWEEN OCTOBER 2021 AND FEBRUARY 2022, BIDMC WORKED WITH COLLABORATORS TO CONDUCT 85 KEY INFORMANT INTERVIEWS THAT ENGAGED COMMUNITY-BASED ORGANIZATIONS, CLINICAL AND SOCIAL SERVICE PROVIDERS, PUBLIC HEALTH OFFICIALS, ELECTED/APPOINTED OFFICIALS AND OTHER KEY COLLABORATORS THROUGHOUT BIDMC'S CBSA. DISCUSSIONS EXPLORED INTERVIEWEES' EXPERIENCES OF ADDRESSING COMMUNITY NEEDS AND OPPORTUNITIES FOR FUTURE ALIGNMENT, COORDINATION AND EXPANSION OF SERVICES, INITIATIVES AND POLICIES. A LIST OF KEY INFORMANTS IS INCLUDED IN APPENDIX A OF THE CHNA REPORT THAT IS POSTED ON BIDMC'S WEBSITE. THESE INDIVIDUALS WERE CHOSEN TO AMASS A REPRESENTATIVE GROUP OF PEOPLE WHO HAD THE EXPERIENCE NECESSARY TO PROVIDE INSIGHT ON THE HEALTH OF COMMUNITIES IN BIDMC'S CBSA. INTERVIEWS WERE CONDUCTED VIRTUALLY USING A STANDARD INTERVIEW GUIDE. INTERVIEWS FOCUSED ON IDENTIFYING THE BIGGEST HEALTH-RELATED CONCERNS/ISSUES, AS WELL AS THE BARRIERS AND/OR CHALLENGES FOR ACCESSING RESOURCES AND SERVICES AMONG THOSE THEY SERVE AND/OR THOSE LIVING IN THE COMMUNITY, INCLUDING POSSIBLE STRATEGIES TO ADDRESS THOSE CONCERNS.

2022 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS
FOCUS GROUPS AND COMMUNITY FORUMS (SCHEDULE H, PART V, SECTION B, LINE 5)BIDMC CONDUCTED 22 COMMUNITY FOCUS GROUPS AND HELD COMMUNITY LISTENING SESSIONS THAT ENGAGED 226 RESIDENTS IN BIDMC'S COMMUNITY BENEFITS SERVICE AREA (CBSA) TO GATHER CRITICAL COMMUNITY INPUT FROM COMMUNITY RESIDENTS AND STAKEHOLDERS. THESE FOCUS GROUPS AND LISTENING SESSIONS WERE ORGANIZED IN COLLABORATION WITH THE BOSTON CHNA-CHIP COLLABORATIVE, NORTH SUFFOLK INTEGRATED CHNA AND OTHER BILH HOSPITALS.BIDMC HAS BEEN INTENTIONAL IN ENSURING THAT VARIED EXPERIENCES AND PERSPECTIVES, REFLECTIVE OF BIDMC'S CBSA AND THE COMMUNITY AT LARGE, WERE SHARED THROUGHOUT THE CHNA AND IS PROCESS. TO REACH A BROAD RANGE OF COMMUNITY MEMBERS, ALL COMMUNITY SURVEYS, FOCUS GROUPS AND KEY INFORMANT INTERVIEWS WERE CONDUCTED WITH A FOCUS ON COMMUNITY REPRESENTATIVENESS. FOR EXAMPLE, THE SURVEY WAS ADMINISTERED ONLINE AND VIA HARD COPY IN TWELVE LANGUAGES. FURTHERMORE, EXTENSIVE OUTREACH WAS CONDUCTED VIA SOCIAL MEDIA, INSTITUTIONAL NEWSLETTERS, EMAILS TO LARGE NETWORKS, PUBLIC LIBRARIES, COMMUNITY EVENTS AND LARGE APARTMENT BUILDINGS TO HELP ENSURE DIVERSE REPRESENTATION IN THE CHNA. THE BIDMC COMMUNITY BENEFITS ADVISORY COMMITTEE (CBAC) WAS ALSO INTEGRALLY INVOLVED IN PROVIDING INPUT ON COMMUNITY NEEDS AND PRIORITIZING THE LEADING HEALTH ISSUES. THE CBAC MET FIVE TIMES DURING THE COURSE OF THE ASSESSMENT. THEY PROVIDED INPUT REGARDING THE CHNA OVERALL AND GUIDED THE PRIORITIZATION AND PLANNING PHASE, CONDUCTING OUTREACH TO COMMUNITY VOICES THAT HAVE HISTORICALLY BEEN LEFT OUT OF SIMILAR PROCESSES. 2022 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESSREVIEWING RESULTS AND COMPILING THE COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY DOCUMENTSAS NOTED ABOVE, THE CHNA PROCESS WAS DIVIDED INTO THREE PHASES. THE FINAL PHASE, PHASE III, INCLUDED THE FOLLOWING STEPS: REVIEW OF THE ASSESSMENT'S MAJOR FINDINGS WITH THE BIDMC COMMUNITY BENEFITS ADVISORY COMMITTEE (CBAC) AND HELD A VIRTUAL COMMUNITY FORUM PRESENTING RESULTS. IDENTIFY BIDMC'S COMMUNITY BENEFITS PRIORITY COHORTS, GEOGRAPHIC FOCUS, AND COMMUNITY HEALTH PRIORITIES. ANALYZE BIDMC'S EXISTING COMMUNITY BENEFITS ACTIVITIES WHICH WERE INFORMED BY THE 2019 CHNA AND SUBSEQUENT 2020 2022 IMPLEMENTATION STRATEGY THAT WERE COMPLETED BY BIDMC DURING THE FISCAL PERIOD ENDED SEPTEMBER 30, 2019 (TAX YEAR 2018). DETERMINE IF THE RANGE OF COMMUNITY BENEFITS ACTIVITIES ESTABLISHED DURING THE PREVIOUS CHNA AND IMPLEMENTATION STRATEGY PROCESS NEEDED TO BE AUGMENTED OR CHANGED TO RESPOND TO THE ASSESSMENT COMPLETED DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2022 (TAX YEAR 2021).2022 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESSKEY FINDINGSTHE KEY PRIORITY COHORTS IDENTIFIED THROUGH THE CHNA CONDUCTED DURING THE PERIOD ENDED SEPTEMBER 30, 2022, WERE: YOUTH LOW-RESOURCED POPULATIONS LGBTQIA+ OLDER ADULTS RACIALLY, ETHNICALLY AND LINGUISTICALLY DIVERSE POPULATIONS FAMILIES AFFECTED BY VIOLENCE AND/OR INCARCERATIONBIDMC'S CHNA RESULTED IN KEY FINDINGS IN THE FOLLOWING AREAS: EQUITABLE ACCESS TO CARE: INDIVIDUALS IDENTIFIED A NUMBER OF BARRIERS TO ACCESSING AND NAVIGATING THE HEALTHCARE SYSTEM. MANY OF THESE BARRIERS WERE AT THE SYSTEM LEVEL, MEANING THAT THE ISSUES STEM FROM THE WAY IN WHICH THE SYSTEM DOES OR DOES NOT FUNCTION. SYSTEM LEVEL ISSUES INCLUDED PROVIDERS NOT ACCEPTING NEW PATIENTS, LONG WAIT LISTS, AND AN INHERENTLY COMPLICATED HEALTHCARE SYSTEM THAT IS DIFFICULT FOR MANY TO NAVIGATE. THERE WERE ALSO INDIVIDUAL LEVEL BARRIERS TO ACCESS AND NAVIGATION. INDIVIDUALS MAY BE UNINSURED OR UNDERINSURED, WHICH MAY LEAD THEM TO FOREGO OR DELAY CARE. INDIVIDUALS MAY ALSO EXPERIENCE LANGUAGE OR CULTURAL BARRIERS - RESEARCH SHOWS THAT THESE BARRIERS CONTRIBUTE TO HEALTH DISPARITIES, MISTRUST BETWEEN PROVIDERS AND PATIENTS, INEFFECTIVE COMMUNICATION, AND ISSUES OF PATIENT SAFETY. SOCIAL DETERMINANTS OF HEALTH (E.G., ECONOMIC STABILITY, EDUCATION, AND COMMUNITY/SOCIAL CONTEXT) CONTINUE TO HAVE A MASSIVE IMPACT ON MANY SEGMENTS OF THE POPULATION. THE SOCIAL DETERMINANTS OF HEALTH ARE THE CONDITIONS IN THE ENVIRONMENTS WHERE PEOPLE ARE BORN, LIVE, LEARN, WORK, PLAY, WORSHIP, AND AGE THAT AFFECT A WIDE RANGE OF HEALTH, FUNCTIONING, AND QUALITY-OF-LIFE OUTCOMES AND RISKS. THESE CONDITIONS INFLUENCE AND DEFINE QUALITY OF LIFE FOR MANY SEGMENTS OF THE POPULATION IN THE CBSA. RESEARCH SHOWS THAT SUSTAINED SUCCESS IN COMMUNITY HEALTH IMPROVEMENT AND ADDRESSING HEALTH DISPARITIES RELIES ON ADDRESSING THE SOCIAL DETERMINANTS OF HEALTH THAT LEAD TO POOR HEALTH OUTCOMES AND DRIVE HEALTH INEQUITIES. THE ASSESSMENT GATHERED A RANGE OF INFORMATION RELATED TO ECONOMIC INSECURITY, EDUCATION, FOOD INSECURITY, ACCESS TO CARE/NAVIGATION ISSUES, AND OTHER IMPORTANT SOCIAL FACTORS. THERE IS LIMITED QUANTITATIVE DATA IN THE AREA OF SOCIAL DETERMINANTS OF HEALTH. DESPITE THIS, INFORMATION GATHERED THROUGH INTERVIEWS, FOCUS GROUPS, SURVEY, AND LISTENING SESSIONS SUGGESTED THAT THESE ISSUES HAVE THE GREATEST IMPACT ON HEALTH STATUS AND ACCESS TO CARE IN THE REGION - ESPECIALLY ISSUES RELATED TO HOUSING, FOOD SECURITY/NUTRITION, AND ECONOMIC STABILITY. HIGH RATES OF SUBSTANCE USE (E.G., ALCOHOL, PRESCRIPTION DRUG/OPIOIDS, MARIJUANA) AND MENTAL HEALTH ISSUES (E.G., DEPRESSION, ANXIETY AND STRESS). ANXIETY, CHRONIC STRESS, DEPRESSION, AND SOCIAL ISOLATION WERE LEADING COMMUNITY HEALTH CONCERNS. THE ASSESSMENT IDENTIFIED SPECIFIC CONCERNS ABOUT THE IMPACT OF MENTAL HEALTH ISSUES FOR YOUTH AND YOUNG ADULTS, THE MENTAL HEALTH IMPACTS OF RACISM, DISCRIMINATION, AND TRAUMA, AND SOCIAL ISOLATION AMONG OLDER ADULTS. THESE DIFFICULTIES WERE EXACERBATED BY COVID-19. IN ADDITION TO THE OVERALL BURDEN AND PREVALENCE OF MENTAL HEALTH ISSUES, RESIDENTS IDENTIFIED A NEED FOR MORE PROVIDERS AND TREATMENT OPTIONS, ESPECIALLY INPATIENT AND OUTPATIENT TREATMENT, CHILD PSYCHIATRISTS, PEER SUPPORT GROUPS, AND MENTAL HEALTH SERVICES. SUBSTANCE USE CONTINUED TO HAVE A MAJOR IMPACT ON THE CBSA; THE OPIOID EPIDEMIC CONTINUED TO BE AN AREA OF FOCUS AND CONCERN, AND THERE WAS RECOGNITION OF THE LINKS AND IMPACTS ON OTHER COMMUNITY HEALTH PRIORITIES, INCLUDING MENTAL HEALTH, HOUSING, AND HOMELESSNESS. INDIVIDUALS ENGAGED IN THE ASSESSMENT IDENTIFIED STIGMA AS A BARRIER TO TREATMENT AND REPORTED A NEED FOR PROGRAMS THAT ADDRESS COMMON CO-OCCURRING ISSUES (E.G., MENTAL HEALTH ISSUES, HOMELESSNESS). HIGH RATES OF CHRONIC AND ACUTE PHYSICAL HEALTH CONDITIONS (E.G., HEART DISEASE, HYPERTENSION, CANCER, AND ASTHMA). CHRONIC CONDITIONS SUCH AS CANCER, DIABETES, CHRONIC LOWER RESPIRATORY DISEASE, STROKE, AND CARDIOVASCULAR DISEASE CONTRIBUTE TO 56% OF ALL MORTALITY IN THE COMMONWEALTH AND OVER 53% OF ALL HEALTH CARE EXPENDITURES ($30.9 BILLION A YEAR). PERHAPS MOST SIGNIFICANTLY, CHRONIC DISEASES ARE LARGELY PREVENTABLE DESPITE THEIR HIGH PREVALENCE AND DRAMATIC IMPACT ON INDIVIDUALS AND SOCIETY.THE CHNA THAT WAS COMPLETED DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2022, AND THE ASSOCIATED IMPLEMENTATION STRATEGY ADOPTED FROM THIS PROCESS WERE DESIGNED TO INFORM BIDMC'S COMMUNITY BENEFITS INITIATIVES DURING THE FISCAL YEARS ENDING SEPTEMBER 30, 2023; SEPTEMBER 30, 2024; AND SEPTEMBER 30, 2025.

PRIOR COMMUNITY HEALTH NEEDS ASSESSMENT AND COMMUNITY BENEFITS ACTIVITIES
REPORTED IN THIS FORM 990 SCHEDULE HAS NOTED THROUGHOUT THIS FORM 990 SCHEDULE H, BIDMC MOST RECENTLY COMPLETED CHNA WAS COMPLETED DURING THE FISCAL YEAR ENDED 2022 AND THE FIRST YEAR OF ACCOMPLISHMENTS UNDER THAT CHNA AND IMPLEMENTATION STRATEGY (IS) WILL BE REPORTED IN THE FORM 990 FOR THE FISCAL YEAR ENDING SEPTEMBER 30, 2023. THE PRIOR CHNA AND IMPLEMENTATION STRATEGY PROCESS WHICH WAS COMPLETED BY BIDMC IN 2019 INFORMED THE COMMUNITY BENEFITS OPERATIONS AND ACCOMPLISHMENTS REPORTED IN THIS FORM 990 FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2022 AS DESCRIBED IN DETAIL BELOW. 2019 COMMUNITY HEALTH NEEDS ASSESSMENTTARGETED GEOGRAPHY AND POPULATIONBIDMC COMPLETED ITS 2019 ASSESSMENT IN SEPTEMBER 2019. THE GEOGRAPHIC FOCUS OF BIDMC'S MOST RECENTLY COMPLETED 2019 CHNA ENCOMPASSES THE BOSTON NEIGHBORHOODS OF ALLSTON/BRIGHTON, BOWDOIN/GENEVA, CHINATOWN, FENWAY/KENMORE, MISSION HILL AND ROXBURY, AND THE CITY OF CHELSEA, AND THE MUNICIPALITIES OF BROOKLINE, LEXINGTON, NEEDHAM, AND NEWTON (CHESTNUT HILL). IN AUGUST 2021, BIDMC OPENED TWO NEW LICENSED SITES IN BURLINGTON AND PEABODY; THESE TWO MUNICIPALITIES ARE NOW PART OF BIDMC'S CBSA. THESE MUNICIPALITIES ARE NOT INCLUDED IN THE FY 19 CHNA OR CURRENT FY 20-22 IMPLEMENTATION STRATEGY BUT ARE INCLUDED IN BIDMC'S 2022 CHNA. BIDMC'S FY19 CHNA, ON WHICH THIS REPORT IS BASED, SHOWS THAT LOW-INCOME AND RACIALLY/ETHNICALLY DIVERSE POPULATIONS LIVING IN BOSTON'S NEIGHBORHOODS OF ALLSTON/BRIGHTON, BOWDOIN/GENEVA, CHINATOWN, FENWAY/KENMORE, MISSION HILL AND ROXBURY, AS WELL AS THE ADJACENT CITY OF CHELSEA, FACE THE GREATEST HEALTH DISPARITIES AND ARE MOST AT RISK. AS A RESULT, THESE BOSTON NEIGHBORHOODS AND THE CITY OF CHELSEA HAVE BEEN IDENTIFIED AND PRIORITIZED AS THE FOCUS FOR BIDMC'S COMMUNITY HEALTH EFFORTS. BIDMC'S TARGET POPULATIONS FOCUS ON MEDICALLY-UNDERSERVED AND VULNERABLE GROUPS OF ALL AGES, AS FOLLOWS: YOUTH AND ADOLESCENTS OLDER ADULTS LOW RESOURCE INDIVIDUALS AND FAMILIES LGBTQ POPULATION RACIALLY AND ETHNICALLY DIVERSE POPULATIONS/NON-ENGLISH SPEAKERS TARGET POPULATIONS FOR BIDMC'S COMMUNITY BENEFITS INITIATIVES ARE IDENTIFIED THROUGH A COMMUNITY INPUT AND PLANNING PROCESS, COLLABORATIVE EFFORTS, AND A CHNA THAT IS CONDUCTED EVERY THREE YEARS IN ACCORDANCE WITH THE REQUIREMENTS UNDER IRC SECTION 501(R). 2019 COMMUNITY HEALTH NEEDS ASSESSMENTSUMMARY OF APPROACH AND METHODSTHE CHNA USED A PARTICIPATORY, COLLABORATIVE APPROACH TO LOOK AT HEALTH IN ITS BROADEST CONTEXT. RATHER THAN CONDUCTING A SINGLE ASSESSMENT, BIDMC'S COMMUNITY BENEFITS STAFF CONDUCTED THEIR OWN ASSESSMENT AND CO-LED AND/OR PARTICIPATED IN A SERIES OF ADDITIONAL, CONCURRENT AND COMPREHENSIVE ASSESSMENTS THAT WERE THEN AGGREGATED TO CREATE THE 2019 CHNA REPORT. THESE CONCURRENT ASSESSMENTS WERE CONDUCTED BY ORGANIZATIONS OR COLLECTIVES OF ORGANIZATIONS IN BOSTON AND CHELSEA WITH WHICH BIDMC PARTNERS ON A REGULAR BASIS (BOSTON CHNA-CHIP COLLABORATIVE, NORTH SUFFOLK INTEGRATED CHNA, BILH AND OTHER HOSPITAL CHNAS). BIDMC ALSO INTEGRATED ITS EXTENSIVE COMMUNITY ENGAGEMENT AND PLANNING WORK FROM ITS MASSACHUSETTS DETERMINATION OF NEED NEW INPATIENT BUILDING COMMUNITY-BASED HEALTH INITIATIVE. INVOLVEMENT IN THESE FOUR EFFORTS ALLOWED BIDMC TO LEVERAGE RESOURCES AND CREATE A ROBUST AND INCLUSIVE CHNA AND IMPLEMENTATION STRATEGY. THE COLLABORATIVE PROCESS INCLUDED SYNTHESIZING EXISTING REGIONAL DATA ON SOCIAL, ECONOMIC AND HEALTH INDICATORS AS WELL AS INFORMATION FROM 4,219 SURVEYS, 74 KEY INFORMANT INTERVIEWS, 35 FOCUS GROUPS AND 5 COMMUNITY MEETINGS. COMMUNITY DIALOGUES AND KEY INFORMANT INTERVIEWS WERE CONDUCTED WITH INDIVIDUALS FROM ACROSS THE CITIES OF BOSTON, CHELSEA, REVERE AND WINTHROP THAT COMPRISE THE NORTH SUFFOLK REGION AND WITH A RANGE OF PEOPLE REPRESENTING DIFFERENT AUDIENCES, INCLUDING LEADERS IN EMERGENCY RESPONSE, EDUCATION, HEALTH CARE AND SOCIAL SERVICE ORGANIZATIONS FOCUSING ON VULNERABLE POPULATIONS (E.G., OLDER ADULTS) (SCHEDULE H, PART V, SECTION B, QUESTIONS 3 AND 5). ULTIMATELY, THE QUALITATIVE RESEARCH ENGAGED APPROXIMATELY 1,085 PEOPLE. BIDMC CONDUCTED ITS CHNAS IN THREE PHASES, WHICH ALLOWED BIDMC TO: COMPILE AN EXTENSIVE AMOUNT OF QUANTITATIVE AND QUALITATIVE DATA; ENGAGE AND INVOLVE KEY STAKEHOLDERS, BIDMC CLINICAL AND ADMINISTRATIVE STAFF AND THE COMMUNITY AT-LARGE; DEVELOP A REPORT AND DETAILED STRATEGIC PLAN; AND COMPLY WITH ALL COMMONWEALTH ATTORNEY GENERAL AND FEDERAL IRS COMMUNITY BENEFITS REQUIREMENTS. DATA SOURCES INCLUDED A BROAD ARRAY OF PUBLICLY AVAILABLE SECONDARY DATA, KEY INFORMANT INTERVIEWS, AND FOUR COMMUNITY FORUMS. 2019 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESSDETAIL OF APPROACH AND METHODSBIDMC RELIED ON NUMEROUS PRIMARY AND SECONDARY DATA SOURCES TO ANALYZE THE HEALTH STATUS AND NEED LEVEL THROUGHOUT THEIR CBSA. BIDMC COLLECTED DATA FROM A NUMBER OF SOURCES INCLUDING PRIMARY QUANTITATIVE AND QUALITATIVE DATA, AS WELL AS SECONDARY DATA. EXAMPLES OF SECONDARY DATA SOURCES THAT BIDMC LEVERAGED INCLUDED: U.S. CENSUS BUREAU, AMERICAN COMMUNITY SURVEY 5-YEAR ESTIMATES (2013-2017) BEHAVIORAL RISK FACTOR SURVEILLANCE SURVEY (2017) MASSACHUSETTS DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION: SCHOOL AND DISTRICT PROFILES (2017 AND 2018-2019) FBI UNIFORM CRIME REPORTS (2017) MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH, REGISTRY OF VITAL RECORDS AND STATISTICS (2015) MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH, BUREAU OF SUBSTANCE ABUSE SERVICES (2017) MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH, ANNUAL REPORTS ON BIRTHS (2016) MASSACHUSETTS BUREAU OF INFECTIOUS DISEASE AND LABORATORY SCIENCES (2017) MASSACHUSETTS CENTER FOR HEALTH INFORMATION ANALYSIS (CHIA) HOSPITAL PROFILES (FY13-FY17) MASSACHUSETTS CENTER FOR HEALTH INFORMATION ANALYSIS (CHIA) HOSPITAL DISCHARGES (2017) MASSACHUSETTS HEALTHY AGING COLLABORATIVE, COMMUNITY PROFILES (2018)2019 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESSKEY INFORMANT INTERVIEWS WITH INTERNAL AND EXTERNAL STAKEHOLDERS (SCHEDULE H, PART V, SECTION B, LINE 5)BIDMC CONDUCTED 74 KEY INFORMANT INTERVIEWS THAT ENGAGED INSTITUTIONAL, ORGANIZATIONAL AND COMMUNITY LEADERS AND FRONT-LINE STAFF ACROSS SECTORS. DISCUSSIONS EXPLORED INTERVIEWEES' EXPERIENCES OF ADDRESSING COMMUNITY NEEDS AND OPPORTUNITIES FOR FUTURE ALIGNMENT, COORDINATION AND EXPANSION OF SERVICES, INITIATIVES AND POLICIES. A LIST OF KEY INFORMANTS IS INCLUDED IN APPENDIX H OF THE CHNA REPORT THAT IS POSTED ON BIDMC'S WEBSITE. THESE INDIVIDUALS WERE CHOSEN TO AMASS A REPRESENTATIVE GROUP OF PEOPLE WHO HAD THE EXPERIENCE NECESSARY TO PROVIDE INSIGHT ON THE HEALTH OF COMMUNITIES IN BIDMC'S CBSA. INTERVIEWS WERE CONDUCTED IN PERSON AND ON THE PHONE USING A STANDARD INTERVIEW GUIDE. INTERVIEWS FOCUSED ON IDENTIFYING MAJOR HEALTH ISSUES, INCLUDING POSSIBLE STRATEGIES TO ADDRESS THOSE CONCERNS, AND TARGET POPULATIONS.

2019 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS FOCUS GROUPS
AND COMMUNITY FORUMS (SCHEDULE H, PART V, SECTION B, LINE 5)BIDMC CONDUCTED 35 COMMUNITY FOCUS GROUPS IN BIDMC'S SERVICE AREA TO GATHER CRITICAL COMMUNITY INPUT FROM COMMUNITY RESIDENTS AND STAKEHOLDERS. THESE FOCUS GROUPS WERE ORGANIZED IN COLLABORATION WITH THE BOSTON CHNA-CHIP COLLABORATIVE, NORTH SUFFOLK INTEGRATED CHNA AND OTHER BILH HOSPITALS.BIDMC WAS INTENTIONAL IN ENSURING THAT VARIED EXPERIENCES AND PERSPECTIVES, REFLECTIVE OF BIDMC'S CBSA AND THE COMMUNITY AT LARGE, WERE SHARED THROUGHOUT THE CHNA AND IS PROCESS. TO REACH A BROAD RANGE OF COMMUNITY MEMBERS, ALL COMMUNITY SURVEYS, FOCUS GROUPS AND KEY INFORMANT INTERVIEWS WERE CONDUCTED WITH A FOCUS ON COMMUNITY REPRESENTATIVENESS. FOR EXAMPLE, THE SURVEY SENT OUT AS PART OF THE BOSTON COLLABORATIVE CHNA WAS ADMINISTERED ONLINE AND VIA HARD COPY IN SEVEN LANGUAGES. FURTHERMORE, EXTENSIVE OUTREACH WAS CONDUCTED VIA SOCIAL MEDIA, INSTITUTIONAL NEWSLETTERS, EMAILS TO LARGE NETWORKS, WAITING ROOMS, BOSTON PUBLIC LIBRARY NEIGHBORHOOD BRANCHES, COMMUNITY EVENTS AND LARGE APARTMENT BUILDINGS TO HELP ENSURE DIVERSE REPRESENTATION IN THE CHNA. AS AN EXAMPLE OF BIDMC'S EXTENSIVE AND SUCCESSFUL COMMUNITY OUTREACH, NEARLY HALF (45%) OF FOCUS GROUP PARTICIPANTS IDENTIFIED AS BLACK OR AFRICAN-AMERICAN AND 34% IDENTIFIED AS HISPANIC/LATINO.THE BIDMC COMMUNITY BENEFITS COMMITTEE WAS ALSO INTEGRALLY INVOLVED IN PROVIDING INPUT ON COMMUNITY NEEDS AND PRIORITIZING THE LEADING HEALTH ISSUES. THE COMMUNITY BENEFITS COMMITTEE MET QUARTERLY DURING THE COURSE OF THE ASSESSMENT. THEY PROVIDED INPUT REGARDING THE CHNA OVERALL AND GUIDED THE PRIORITIZATION AND PLANNING PHASE. 2019 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESSREVIEWING RESULTS AND COMPILING THE COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY DOCUMENTSAS NOTED ABOVE, THE CHNA PROCESS WAS DIVIDED INTO THREE PHASES. THE FINAL PHASE, PHASE III, INCLUDED THE FOLLOWING STEPS: REVIEW OF THE ASSESSMENT'S MAJOR FINDINGS. IDENTIFY BIDMC'S COMMUNITY BENEFITS PRIORITY POPULATIONS, GEOGRAPHIC FOCUS, AND COMMUNITY HEALTH PRIORITIES. ANALYZE BIDMC'S EXISTING COMMUNITY BENEFITS ACTIVITIES WHICH WERE INFORMED BY THE 2016 CHNA AND SUBSEQUENT IMPLEMENTATION STRATEGY THAT WERE COMPLETED BY BIDMC DURING THE FISCAL PERIOD ENDED SEPTEMBER 30, 2016 (TAX YEAR 2015). DETERMINE IF THE RANGE OF COMMUNITY BENEFITS ACTIVITIES ESTABLISHED DURING THE PREVIOUS CHNA AND IMPLEMENTATION STRATEGY PROCESS NEEDED TO BE AUGMENTED OR CHANGED TO RESPOND TO THE ASSESSMENT COMPLETED DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2019 (TAX YEAR 2018).2019 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESSKEY FINDINGSTHE KEY PRIORITY POPULATIONS IDENTIFIED THROUGH THE CHNA CONDUCTED DURING THE PERIOD ENDED SEPTEMBER 30, 2019, WERE: YOUTH AND ADOLESCENTS OLDER ADULTS LOW-RESOURCE INDIVIDUALS AND FAMILIES LESBIAN, GAY, BISEXUAL, TRANSGENDER AND QUEER OR QUESTIONING (LGBTQ) INDIVIDUALS RACIALLY AND ETHNICALLY DIVERSE POPULATIONS AND NON-ENGLISH SPEAKERSBETH ISRAEL DEACONESS MEDICAL CENTER'S CHNA RESULTED IN KEY FINDINGS IN THE FOLLOWING AREAS: SOCIAL DETERMINANTS OF HEALTH (E.G., ECONOMIC STABILITY, EDUCATION, AND COMMUNITY/SOCIAL CONTEXT) CONTINUE TO HAVE A MASSIVE IMPACT ON MANY SEGMENTS OF THE POPULATION. THE DOMINANT THEME FROM THE ASSESSMENT'S KEY INFORMANT INTERVIEWS, SURVEY, FOCUS GROUPS AND COMMUNITY FORUMS WAS THE CONTINUED IMPACT THAT THE UNDERLYING SOCIAL DETERMINANTS OF HEALTH ARE HAVING ON THE CBSA'S LOW-INCOME, UNDERSERVED, DIVERSE POPULATION COHORTS. MORE SPECIFICALLY, DETERMINANTS SUCH AS POVERTY, EMPLOYMENT OPPORTUNITIES, HOUSING, VIOLENCE, TRANSPORTATION, RACIAL SEGREGATION, LITERACY, PROVIDER LINGUISTIC/CULTURAL COMPETENCY, SOCIAL SUPPORT, AND COMMUNITY INTEGRATION LIMIT MANY PEOPLE'S ABILITY TO CARE FOR THEIR OWN AND/OR THEIR FAMILIES' HEALTH. HIGH RATES OF SUBSTANCE USE (E.G., ALCOHOL, PRESCRIPTION DRUG/OPIOIDS, MARIJUANA) AND MENTAL HEALTH ISSUES (E.G., DEPRESSION, ANXIETY AND STRESS). THE IMPACT OF SOCIAL DETERMINANTS WAS THE LEAD FINDING, BUT A CLOSE SECOND WAS THE PROFOUND IMPACT OF BEHAVIORAL HEALTH ISSUES (I.E., SUBSTANCE USE AND MENTAL HEALTH) ON INDIVIDUALS, FAMILIES AND COMMUNITIES IN EVERY GEOGRAPHIC REGION AND EVERY POPULATION SEGMENT IN BIDMC'S CBSA. DEPRESSION/ANXIETY, SUICIDE, ALCOHOL USE, OPIOID AND PRESCRIPTION DRUG USE AND MARIJUANA USE ARE MAJOR HEALTH ISSUES AND ARE HAVING A SIGNIFICANT IMPACT ON THE POPULATION AS WELL AS BURDENING THE SERVICE SYSTEM. THE FACT THAT PHYSICAL AND BEHAVIORAL HEALTH ARE SO INTERTWINED COMPOUNDS THE IMPACT OF THESE ISSUES. OF PARTICULAR CONCERN ARE THE INCREASING RATES OF OPIOID USE AND THE IMPACTS OF TRAUMA. HIGH RATES OF CHRONIC AND ACUTE PHYSICAL HEALTH CONDITIONS (E.G., HEART DISEASE, HYPERTENSION, CANCER, AND ASTHMA). THE ASSESSMENT'S QUANTITATIVE DATA CLEARLY SHOWS THAT MANY COMMUNITIES IN BIDMC'S CBSA HAVE HIGH RATES FOR MANY OF THE LEADING PHYSICAL HEALTH CONDITIONS (E.G., HEART DISEASE, HYPERTENSION, CANCER, AND ASTHMA). IN MANY COMMUNITIES, THESE RATES ARE STATISTICALLY HIGHER THAN COMMONWEALTH RATES, INDICATING A PARTICULARLY SIGNIFICANT PROBLEM. HOWEVER, EVEN FOR THOSE COMMUNITIES WHERE THE RATES ARE NOT STATISTICALLY HIGHER, THESE CONDITIONS ARE STILL THE LEADING CAUSES OF PREMATURE DEATH. LIMITED ACCESS TO PRIMARY CARE MEDICAL, MEDICAL SPECIALTY, BEHAVIORAL HEALTH, AND ORAL HEALTH CARE SERVICES FOR LOW-INCOME, FOREIGN BORN, THOSE COVERED BY MEDICAID, UNINSURED, AND OTHER VULNERABLE POPULATIONS FACING HEALTHCARE DISPARITIES AND BARRIERS TO CARE. DESPITE THE FACT THAT MASSACHUSETTS HAS ONE OF HIGHEST RATES OF HEALTH INSURANCE AND THE COMMUNITIES THAT MAKE UP BIDMC'S CBSA HAVE STRONG, ROBUST SAFETY NET SYSTEMS, THERE ARE STILL SUBSTANTIAL NUMBERS OF LOW-INCOME, MEDICAID COVERED, UNINSURED AND OTHERWISE VULNERABLE INDIVIDUALS WHO FACE HEALTH DISPARITIES AND ARE NOT ENGAGED IN ESSENTIAL MEDICAL, BEHAVIORAL AND ORAL HEALTH SERVICES. EFFORTS NEED TO BE MADE TO EXPAND ACCESS, REDUCE BARRIERS TO CARE AND IMPROVE THE QUALITY OF PRIMARY CARE MEDICAL, MEDICAL SPECIALTY, BEHAVIORAL HEALTH AND ORAL HEALTH SERVICES. THE CHNA THAT WAS COMPLETED DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2019, AND THE ASSOCIATED IMPLEMENTATION STRATEGY ADOPTED FROM THIS PROCESS WERE DESIGNED TO INFORM BIDMC'S COMMUNITY BENEFITS INITIATIVES DURING THE FISCAL YEARS ENDED SEPTEMBER 30, 2020; SEPTEMBER 30, 2021; AND SEPTEMBER 30, 2022.

INTERIM CHANGES AND UPDATES
TO 2019 IMPLEMENTATION STRATEGY BASED BASED ON NEWLY IDENTIFIED COMMUNITY NEEDS COVID PANDEMICAS PREVIOUSLY NOTED IN THIS FILING, IRC SECTION 501(R)(3) AND THE PROMULGATED REGULATIONS REQUIRE THAT A TAX-EXEMPT HOSPITAL CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND ADOPT AN IMPLEMENTATION STRATEGY ADDRESSING COMMUNITY HEALTH NEEDS IDENTIFIED THROUGH THE CHNA AT LEAST ONCE EVERY THREE YEARS. THE PREAMBLE TO THE REGULATIONS PROMULGATED UNDER IRC SECTION 501(R)(3) NOTES THAT THE TREASURY AND THE IRS INTENDED FOR THE CHNA AND IMPLEMENTATION STRATEGY REQUIREMENT TO ESTABLISH CONTINUAL FEEDBACK ON CHNA REPORTS AND A HOSPITAL IS REQUIRED TO CONSIDER COMMENTS RECEIVED RELATED TO THE EXISTING CHNA AND IMPLEMENTATION STRATEGY WHEN ENGAGING IN THE NEXT CHNA PROCESS NOT MORE THAN THREE YEARS AFTER ADOPTION. IN ADDITION, FINAL REGULATIONS DO NOT PROHIBIT IMPLEMENTATION STRATEGIES FROM DISCUSSING HEALTH NEEDS IDENTIFIED THROUGH MEANS OTHER THAN A CHNA, PROVIDED THAT THE SIGNIFICANT HEALTH NEEDS IDENTIFIED IN THE CHNA ARE ALSO DISCUSSED. FINALLY, THERE IS NOTHING IN THE REGULATIONS THAT PROHIBITS A HOSPITAL FROM UPDATING ITS IMPLEMENTATION STRATEGY BASED ON AN OFF-CYCLE CHANGE TO THE COMMUNITY HEALTH NEEDS THAT ARISE. DURING THE FISCAL PERIOD, OCTOBER 1, 2019 TO SEPTEMBER 30, 2020, THE HEALTH NEEDS OF THE COMMUNITIES SERVED BY BIDMC WERE IMPACTED BY AN UNEXPECTED GLOBAL PANDEMIC. ON JANUARY 9, 2020, THE WORLD HEALTH ORGANIZATION (WHO) ANNOUNCED THE IDENTIFICATION OF A NEW AND NOVEL CORONAVIRUS-RELATED PNEUMONIA IN WUHAN, CHINA. ON JANUARY 21, 2020 THE UNITED STATES CENTERS FOR DISEASE CONTROL CONFIRMED THE FIRST CASE OF THIS NEW CORONA VIRUS IN THE UNITED STATES. ON JANUARY 31, 2020, THE WHO ISSUED A GLOBAL HEALTH EMERGENCY AND ON FEBRUARY 3 THE UNITED STATES DECLARED A PUBLIC HEALTH EMERGENCY BECAUSE OF THE COVID-19 VIRUS. ON MARCH 11, 2020, THE WHO DECLARED COVID-19 A PANDEMIC AND TWO DAYS LATER, THE PRESIDENT OF THE UNITED STATES DECLARED COVID-19 A NATIONAL EMERGENCY.THE HEALTH OF THE COMMUNITIES SERVED BY BIDMC WERE IMPACTED BY THIS UNFORESEEN HEALTH CRISIS AND IN THE ABSENCE OF REGULATORY GUIDANCE TO THE CONTRARY, BIDMC NEEDED TO QUICKLY REASSESS AND PIVOT TO MEET THE NEW AND PREVIOUSLY UNEXPECTED COMMUNITY NEEDS. AS SUCH, IN RESPONSE TO THE COVID-19 CRISIS BIDMC'S COMMUNITY BENEFITS STAFF ALONG WITH THE HOSPITAL'S COMMUNITY BENEFITS ADVISORY COMMITTEE (CBAC) AND IN RESPONSE TO COVID, EXPANDED GOALS RELATED TO ACCESS TO CARE AND SOCIAL DETERMINANTS OF HEALTH TARGETED PRIMARILY AT LOW INCOME AND MINORITY POPULATIONS WHO HAVE BEEN DISPROPORTIONATELY IMPACTED BY COVID-19.THE ADDITIONAL AND NEWLY URGENT HEALTH NEEDS IN RESPONSE TO COVID-19 WERE:IN FY20, BIDMC DEDICATED SIGNIFICANT TIME AND RESOURCES TO RESPOND TO NEEDS RELATED TO COVID-19. BIDMC WORKED WITH ITS LICENSED AND AFFILIATED COMMUNITY HEALTH CENTERS AND THE HOSPITAL'S CHELSEA LOCATION TO EXPAND COMMUNITY TESTING ACCESS. BOTH BOWDOIN STREET HEALTH CENTER (BSHC), THE HOSPITAL'S LICENSED HEALTH CENTER, AND THE HOSPITAL'S CHELSEA LOCATION REDUCED BARRIERS TO TESTING ACCESS BY OFFERING ON-SITE INTERPRETATION, WELCOMING WALK-INS, AND NOT REQUIRING A PHYSICIAN ORDER. THE HOSPITAL ALSO WORKED WITH BILH TO DEVELOP AND DISTRIBUTE WRITTEN MATERIALS (IN NINE LANGUAGES) TO THE COMMUNITIES MOST IMPACTED BY COVID-19 TO HELP SLOW THE SPREAD OF THE VIRUS AND DELINEATE WHERE RESIDENTS COULD ACCESS SERVICES AND RESOURCES IN THEIR COMMUNITY. BILH AND BIDMC REDEPLOYED STAFF, SUPPLIES, AND OTHER MATERIALS TO BOTH THE COMMUNITY AND WITHIN HOSPITALS, INCLUDING PERSONAL PROTECTIVE EQUIPMENT (PPE), FOOD, HAND SANITIZER, ETC. IN FY21, BIDMC CONTINUED TO OFFER ACCESS TO COVID-19 TESTING AT ITS CHELSEA LOCATION. IN RESPONSE TO FOOD INSECURITY CAUSED AND/OR EXACERBATED BY COVID-19, BIDMC PARTNERED WITH ITS LICENSED AND AFFILIATED HEALTH CENTERS AND OTHER ORGANIZATIONS TO IMPROVE FOOD ACCESS. BOWDOIN STREET HEALTH CENTER DELIVERED BI-WEEKLY FOOD BOXES FOR HEALTH CENTER PATIENTS WHO IDENTIFIED AS FOOD INSECURE. THE DIMOCK CENTER ADDRESSED FOOD INSECURITY AMONG PATIENTS AND COMMUNITY RESIDENTS THROUGH A GIFT-CARD BASED PROGRAM, PROVIDING A FLEXIBLE MECHANISM FOR INDIVIDUALS TO PURCHASE NECESSARY FOOD AND HOUSEHOLD ITEMS. IN FY22, BIDMC CONTINUED TO OFFER ACCESS TO COVID-19 TESTING AT ITS CHELSEA LOCATION, AND THE DIMOCK CENTER CONTINUED TO DISTRIBUTE GIFT CARDS TO PATIENTS AND FAMILIES. IN ADDITION, BOWDOIN STREET HEALTH CENTER CONTINUED TO DISTRIBUTE BAGS OF FRESH FRUITS AND VEGETABLES TO PATIENTS AND COMMUNITY MEMBERS, IN PARTNERSHIP WITH A LOCAL ORGANIZATION.COVID-19 CAUSED SEVERAL OBJECTIVES AND STRATEGIES HIGHLIGHTED IN THIS REPORT TO BE MODIFIED. IN SOME CASES, THEY WERE EXPANDED, AND IN OTHERS THEY WERE REDUCED IN RESPONSE TO THE PANDEMIC AND ITS IMPACT ON OUR COMMUNITY. THE ACTIONS TAKEN TOWARD ADDRESSING THESE NEEDS ARE INCLUDED FURTHER IN THIS NARRATIVE SUPPORT ALONG WITH BIDMC'S DETAILED DESCRIPTION OF ACTIVITIES UNDERTAKEN TO MEET THE COMMUNITY NEEDS.

COMMUNITY HEALTH NEEDS ASSESSMENT MAKING THE CHNA AND IMPLEMENTATION
STRATEGY WIDELY AVAILABLE BIDMC STRIVES TO ADDRESS THE PRIORITY AREAS IN ITS CHNA AND IMPLEMENTATION STRATEGY.AS NOTED ABOVE, BIDMC COMPLETED ITS MOST RECENT CHNA DURING ITS FISCAL YEAR ENDED SEPTEMBER 30, 2022 (TAX YEAR 2021). THAT CHNA AND APPENDIX WITH DETAILED INFORMATION IS AVAILABLE ON THE BIDMC WEBSITE AT: HTTPS://WWW.BIDMC.ORG/-/MEDIA/FILES/BETH-ISRAEL-ORG/ABOUT-BIDMC/HELPING-OUR-COMMUNITY/COMMUNITY-INITIATIVES/COMMUNITY-BENEFITS/BIDMC-2022-COMMUNITY-HEALTH-NEEDS-ASSSESSMENT-093022.PDFIN ADDITION TO THE CHNA, BIDMC COMPLETED ITS MOST RECENT IMPLEMENTATION STRATEGY DURING ITS FISCAL YEAR ENDED SEPTEMBER 30, 2022 (TAX YEAR 2021). THE IMPLEMENTATION STRATEGY IS AVAILABLE ON THE BIDMC WEBSITE AT: HTTPS://WWW.BIDMC.ORG/-/MEDIA/FILES/BETH-ISRAEL-ORG/ABOUT-BIDMC/HELPING-OUR-COMMUNITY/COMMUNITY-INITIATIVES/COMMUNITY-BENEFITS/BIDMC-2022-COMMUNITY-HEALTH-NEEDS-ASSSESSMENT-093022.PDF.IN ADDITION, AS NOTED ABOVE, BIDMC COMPLETED ITS PREVIOUS CHNA DURING ITS FISCAL YEAR ENDED SEPTEMBER 30, 2019 (TAX YEAR 2018). THAT CHNA IS AVAILABLE ON THE BIDMC WEBSITE AT: HTTPS://WWW.BIDMC.ORG/-/MEDIA/FILES/BETH-ISRAEL-ORG/ABOUT-BIDMC/HELPING-OUR-COMMUNITY/COMMUNITY-INITIATIVES/COMMUNITY-BENEFITS/CHNA-REPORT93019FINAL.PDF.FINALLY, THE IMPLEMENTATION STRATEGY ASSOCIATED WITH THE CHNA COMPLETED DURING BIDMC'S FISCAL YEAR ENDED SEPTEMBER 30, 2019 (TAX YEAR 2018) IS AVAILABLE ON THE BIDMC WEBSITE AT: HTTPS://WWW.BIDMC.ORG/-/MEDIA/FILES/BETH-ISRAEL-ORG/ABOUT-BIDMC/HELPING-OUR-COMMUNITY/COMMUNITY-INITIATIVES/COMMUNITY-BENEFITS/IMPLEMENTATION-STRATEGY-2020-2022.PDF.EACH OF THESE DOCUMENTS IS ALSO AVAILABLE ON REQUEST (SCHEDULE H, PART V, SECTION B, LINE 7A).COMMUNITY HEALTH NEEDS ASSESSMENTADDRESSING COMMUNITY HEALTH NEEDS(SCHEDULE H, PART V, SECTION B, LINE 11)AS NOTED ABOVE, BIDMC'S MOST RECENT CHNA AND IMPLEMENTATION STRATEGY WERE CONDUCTED AND APPROVED BY THE BOARD DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2022 BUT IT IS THE PREVIOUS CHNA AND IMPLEMENTATION STRATEGY WHICH INFORMED THE COMMUNITY BENEFITS MISSION AND ACTIVITIES OF BIDMC FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2022 WHICH ARE REPORTED HERE. A SUMMARY OF BIDMC'S COMMUNITY BENEFITS ACTIVITIES THAT ADDRESS THE NEEDS IDENTIFIED IN THE CHNA COMPLETED DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2019 AND PRIORITIZED IN THE RELATED IMPLEMENTATION STRATEGY ARE PROVIDED HERE ALONG WITH THE ENTITIES THAT THE HOSPITAL PARTNERS WITH ON THESE EFFORTS. GIVEN THE COMPLEX HEALTH ISSUES IN THE COMMUNITY, BIDMC HAS BEEN STRATEGIC IN IDENTIFYING ITS COMMUNITY HEALTH PRIORITIES IN ORDER TO MAXIMIZE THE IMPACT OF ITS COMMUNITY BENEFITS PROGRAM AND WORK TO IMPROVE THE OVERALL HEALTH AND WELLNESS OF RESIDENTS IN ITS CBSA. GOALS FOR EACH PRIORITY AREA ARE LISTED BELOW.PRIORITY AREA 1: SOCIAL DETERMINANTS OF HEALTH GOAL 1: PROMOTE HEALTHY NEIGHBORHOODS (HEALTHY EATING, ACTIVE LIVING, OTHER HEALTHY BEHAVIORS, HEALTH-RELATED PROGRAMS/POLICIES) GOAL 2: PROMOTE VIOLENCE PREVENTION (SAFE NEIGHBORHOODS AND COMMUNITY COHESION) GOALS 3 AND 4: PROMOTE AFFORDABLE HOUSING AND PROMOTE HOME OWNERSHIP GOAL 5: SUPPORT WORKFORCE DEVELOPMENT AND CREATION OF EMPLOYMENT OPPORTUNITIES GOAL 6: PROMOTE ENVIRONMENTAL SUSTAINABILITY PRIORITY AREA 2: CHRONIC / COMPLEX CONDITIONS & THEIR RISK FACTORS GOAL 1: IMPROVE CHRONIC DISEASE MANAGEMENT GOAL 2: REDUCE CANCER DISPARITIES (ACCESS TO SCREENING AND TREATMENT) GOAL 3: SUPPORT OLDER ADULTS TO AGE IN PLACE PRIORITY AREA 3: ACCESS TO CARE GOAL 1: INCREASE ACCESS TO QUALITY MEDICAL SERVICES, INCLUDING PRIMARY CARE, OB/GYN, AND SPECIALTY CARE AS WELL AS URGENT, EMERGENT AND TRAUMA CARE GOAL 2: INCREASE ACCESS TO QUALITY ORAL HEALTH SERVICES GOAL 3: PROMOTE EQUITABLE CARE AND SUPPORT FOR THOSE WHO FACE CULTURAL AND LINGUISTIC BARRIERS GOAL 4: PROMOTE GREATER HEALTH EQUITY AND REDUCE DISPARITIES IN ACCESS FOR LGBTQ POPULATIONS PRIORITY AREA 4: MENTAL HEALTH AND SUBSTANCE USE GOAL 1: INCREASE ACCESS TO QUALITY MENTAL HEALTH CARE AND SUBSTANCE USE SERVICES GOAL 2: REDUCE BURDEN OF OPIOID USE GOAL 3: PROMOTE BEHAVIORAL HEALTH WORKFORCE DEVELOPMENT AND INCREASE CAPACITY

THE MEDICAL CENTER ENGAGES IN RESEARCH IN ALL OF THE FOLLOWING DISCIPLINES:
ANESTHESIA, CRITICAL CARE, AND PAIN MEDICINE EMERGENCY MEDICINE MEDICINE O ALLERGY AND INFLAMMATIONO CARDIOVASCULAR MEDICINEO CENTER FOR VASCULAR BIOLOGY RESEARCHO CENTER FOR VIROLOGY AND VACCINE RESEARCHO CLINICAL INFORMATICSO CLINICAL NUTRITIONO ENDOCRINOLOGYO EXPERIMENTAL MEDICINEO GASTROENTEROLOGYO GENERAL MEDICINE AND PRIMARY CAREO GENETICSO GERONTOLOGYO HEMATOLOGY AND ONCOLOGYO HEMOSTASIS AND THROMBOSISO IMMUNOLOGYO INFECTIOUS DISEASEO INTERDISCIPLINARY MEDICINE AND BIOTECHNOLOGYO MOLECULAR AND VASCULAR MEDICINEO NEPHROLOGYO PULMONOLOGYO RHEUMATOLOGYO SIGNAL TRANSDUCTIONO TRANSLATIONAL RESEARCHO TRANSPLANT IMMUNOLOGY NEONATOLOGY NEUROLOGY OBSTETRICS AND GYNECOLOGY ORTHOPAEDIC SURGERY PATHOLOGY PSYCHIATRY RADIOLOGY SURGERY O CARDIAC SURGERYO CENTER FOR MINIMALLY INVASIVE SURGERYO NEUROSURGERYO PLASTIC AND RECONSTRUCTIVE SURGERYO VASCULAR SURGERY TRANSPLANT INSTITUTEDURING THE FISCAL YEAR COVERED BY THIS FILING, THE MEDICAL CENTER REPORTED $71,343,305 OF NET INTERNALLY FUNDED RESEARCH ON THIS SCHEDULE H, PART I, LINE 7H RELATED TO RESEARCH TO FURTHER SCIENCE AND PATIENT CARE, WHICH REPRESENTED 3.02% OF THE MEDICAL CENTER'S TOTAL EXPENSES. ADDITIONALLY, THE MEDICAL CENTER REPORTED $312,605,756 OF RESEARCH EXPENSES FUNDED BY GOVERNMENTS AND OTHER TAX-EXEMPT ENTITIES INCLUDING OTHER HOSPITALS, UNIVERSITIES AND FOUNDATIONS ON SCHEDULE H, PART I LINE 7H COLUMN D, WHICH, IF INCLUDED IN SCHEDULE H, PART I, LINE 7H COLUMN E CALCULATION, WOULD INCREASE THE NET COMMUNITY BENEFIT REPORTED FROM RESEARCH ACTIVITIES ON THIS SCHEDULE H, PART I, LINE 7H TO 1.04%.RESEARCH ENGAGED IN AT THE MEDICAL CENTERTHE REAL CORNERSTONES OF THE MEDICAL CENTER'S SUCCESS CAN BE DESCRIBED IN THREE KEY WORDS: INNOVATION, CULTIVATION, AND TRANSFORMATION. BEGINNING WITH SUPPORT OF BOLD AND INNOVATIVE IDEAS, EXTENDING TO CULTIVATION AND NURTURING OF PROMISING YOUNG SCIENTISTS, AND CULMINATING IN THE TRANSFORMATION OF NOVEL DISCOVERIES INTO THERAPIES AND DIAGNOSTICS, THE MEDICAL CENTER'S RESEARCH PROGRAM HAS EMERGED AS A UNIQUE AND SUCCESSFUL MODEL FOR TODAY'S RAPIDLY CHANGING HEALTH CARE LANDSCAPE.EXAMPLES OF THE RESEARCH ENGAGED IN AT BIDMCBELOW IS INFORMATION RELATED TO JUST A HANDFUL OF THE CUTTING-EDGE RESEARCH STUDIES AND PRINCIPAL INVESTIGATORS AT THE MEDICAL CENTER. THE DETAIL BELOW IS DESIGNED TO PROVIDE THE READER WITH A TASTE OF THE MANY CONTRIBUTIONS THE MEDICAL CENTER IS MAKING TO PATIENT CARE TODAY AND TOMORROW. EXPENSES FROM THE RESEARCH ACTIVITIES NOTED BELOW ARE INCLUDED IN FORM 990 SCHEDULE H, PART I LINE 7H COLUMN C AND MAY OR MAY NOT BE QUANTIFIED IN FORM 990 SCHEDULE H, PART I, LINE 7H COLUMN E, DEPENDING ON FUNDING SOURCE.

COMMUNITY HEALTH NEEDS ASSESSMENT
"APPROACH TO ADDRESSING HEALTH NEEDS (SCHEDULE H, PART V, SECTION B, LINE 11)BIDMC HAS TAKEN A HOLISTIC AND STRATEGIC APPROACH IN ADDRESSING THE HEALTH PRIORITIES IDENTIFIED IN THE CHNA AND ASSOCIATED IMPLEMENTATION STRATEGY BY CREATING, SUPPORTING AND INVESTING IN HEALTH PROGRAMMING AND INITIATIVES THROUGHOUT THEIR CBSA. BELOW IS A SUMMARY OF SOME OF THE COMMUNITY BENEFITS PROGRAMS AND INITIATIVES BIDMC OPERATES AND SUPPORTS TO IMPROVE HEALTH OUTCOMES AMONG THEIR TARGET POPULATIONS THROUGHOUT THEIR PRIORITY NEIGHBORHOODS.BIDMC HAS BEEN A LEADER IN CREATING A MYRIAD OF COMMUNITY BENEFITS PROGRAMS THAT ADDRESS THE SOCIAL DETERMINANTS OF HEALTH. PROGRAMS INCLUDE THE BIDMC CENTER FOR VIOLENCE PREVENTION AND RECOVERY (CVPR), JOB CREATION AND CAREER ADVANCEMENT OPPORTUNITIES THROUGH BIDMC'S OFFICE OF WORKFORCE DEVELOPMENT, DEVELOPMENT OF INSTITUTIONAL METRICS TO MEASURE BIDMC'S SHRINKING CARBON FOOTPRINT, AND TRANSPORTATION RESOURCES TO IMPROVE ACCESS TO HEALTHCARE. THROUGH CVPR, BIDMC HAS LED THE WAY IN DEVELOPING A CONTINUUM OF EDUCATION, OUTREACH, AND TREATMENT INTERVENTIONS TO RESPOND TO VICTIMS OF INTERPERSONAL, SEXUAL, COMMUNITY VIOLENCE, AND HOMICIDE BEREAVEMENT. IT IS ALSO ONE OF THE LEADERS IN DEVELOPING PROGRAMMING TO ADDRESS SECONDARY TRAUMATIC STRESS AMONG DOMESTIC VIOLENCE AND MEDICAL SERVICE PROVIDERS. IN FY22, BIDMC PROVIDED OUTREACH AND/OR COUNSELING SERVICES TO 29 SEXUAL ASSAULT SURVIVORS. TO FURTHER ADDRESS THE SOCIAL DETERMINANTS OF HEALTH, BIDMC IS COMMITTED TO MAKING EMPLOYMENT OPPORTUNITIES AVAILABLE TO COMMUNITY RESIDENTS AND CREATING CAREER ADVANCEMENT OPPORTUNITIES FOR BIDMC EMPLOYEES WHO ARE SEEKING ADDITIONAL SKILLS AND HIGHER INCOMES. IN FY22 BIDMC'S OFFICE OF WORKFORCE DEVELOPMENT OFFERED 8 DIFFERENT CAREER PIPELINE PROGRAMS THAT SERVED 68 PEOPLE. ADDITIONALLY, 27 YOUTH WERE EMPLOYED IN PAID SUMMER JOBS AT BIDMC. OTHER EXAMPLES OF SUCCESS ARE LISTED IN THE SUBSEQUENT SCHEDULE H IMPLEMENTATION STRATEGY UPDATE. BIDMC IS ROOTED IN PROVIDING HEALTHCARE TO POPULATIONS WHO HAVE HISTORICALLY NOT HAD ADEQUATE ACCESS TO CARE. BIDMC CONTINUES TO EXPAND ACCESS THROUGHOUT THEIR CBSA BY SUPPORTING AND LEADING THE COMMUNITY CARE ALLIANCE (CCA), ENSURING THAT RESIDENTS HAVE ACCESS TO QUALITY COMMUNITY HEALTH CENTERS (CHCS) SERVING THE NEEDS OF THE MOST VULNERABLE IN WAYS THAT ARE CULTURALLY RESPONSIVE AND ACCESSIBLE. BIDMC IS COMMITTED TO STRENGTHENING THE CAPACITY OF ITS FIVE AFFILIATED CHCS INCLUDING: BOWDOIN STREET HEALTH CENTER (BSHC), THE DIMOCK HEALTH CENTER, FENWAY HEALTH, CHARLES RIVER COMMUNITY HEALTH, AND SOUTH COVE COMMUNITY HEALTH CENTER. THE PARTNERSHIP TAKES MANY FORMS: RECRUITMENT, RETENTION, FINANCIAL SUPPORT AND CREDENTIALING OF PHYSICIANS AND MID-LEVEL PROVIDERS, BIDMC ADMITTING PRIVILEGES AND ACCESS TO MANAGED CARE CONTRACTS, HARVARD MEDICAL SCHOOL APPOINTMENTS AND TEACHING OPPORTUNITIES, BIDMC-SPONSORED EDUCATIONAL PROGRAMS, AND ACCESS TO UP-TO-DATE (A CLINICAL SUPPORT RESOURCE). WHILE OUTER CAPE HEALTH SERVICES REMAINS A CLINICAL AFFILIATE AND BIDMC COLLABORATOR AND COMMUNITY PARTNER, THE HEALTH CENTER IS LONGER A MEMBER OF CCA. BIDMC HAS FOCUSED ITS EFFORTS ON CREATING TARGETED PROGRAMS THAT ADDRESS CHRONIC DISEASES SUCH AS CANCER, DIABETES, AND HIV. THESE PROGRAMS INCLUDE BUT ARE NOT LIMITED TO BSHC'S FITNESS IN THE CITY AND CANCER PATIENT NAVIGATORS AT BIDMC. TO SUPPORT CANCER PATIENTS WHEN SPECIALTY CARE OR INPATIENT HOSPITALIZATIONS ARE NECESSARY, BIDMC OFFERS THE SERVICES OF BILINGUAL AND BICULTURAL CANCER PATIENT NAVIGATORS WHO BRIDGE THE GULF BETWEEN COMMUNITY PROVIDERS AND THE MEDICAL CENTER. ONE PATIENT NAVIGATOR SPECIALIZES IN SERVING THE LATINO COMMUNITY AND THE OTHER SPECIALIZES IN SERVING THE CHINESE COMMUNITY, THOUGH THEY ALSO SERVE PATIENTS FROM OTHER ETHNIC GROUPS. DETAILS OF OTHER BIDMC PROGRAMS, SUCH AS BOWDOIN STREET HEALTH CENTER'S FITNESS IN THE CITY, ADDRESSING CHRONIC DISEASE MANAGEMENT ARE INCLUDED IN THE IMPLEMENTATION STRATEGY UPDATE BELOW.AMONG THE MANY WAYS BIDMC AND ITS PARTNERS ADDRESS BEHAVIORAL HEALTH NEEDS IS BY EXPANDING BEHAVIORAL HEALTH INTEGRATION AT ITS AFFILIATED HEALTH CENTERS AS WELL AS SCREENING PATIENTS AT BIDMC AND CONNECTING THEM TO APPROPRIATE SERVICES. FOR EXAMPLE, BSHC CONTINUES TO INTEGRATE BEHAVIORAL HEALTH SERVICES INTO THEIR PRIMARY CARE CLINIC. A BEHAVIORAL HEALTH CARE MANAGER IS ON-SITE TO PROVIDE MENTAL HEALTH ASSESSMENT, INTERVENTION, AND CONSULTATION TO PATIENTS AND PROVIDERS DURING PRIMARY CARE VISITS. RESULTS OF THE BEHAVIORAL HEALTH INTEGRATION SHOW THAT MORE HIGH-RISK PATIENTS ARE ACCESSING MENTAL HEALTH SERVICES, AN INCREASE IN APPOINTMENTS KEPT BY PATIENTS WHO RECEIVE A ""WARM HAND-OFF"" BY THEIR PROVIDER TO THERAPISTS, AND REDUCED WAIT TIME FOR MENTAL HEALTH APPOINTMENTS. BIDMC ALSO CONTINUED TO DEDICATE SIGNIFICANT TIME AND RESOURCES TO RESPOND TO NEEDS RELATED TO COVID-19, SUCH AS FOOD INSECURITY, HOUSING INSTABILITY, AND ACCESS TO CARE. FOR EXAMPLE, BIDMC CONTINUED TO OFFER ACCESS TO COVID-19 TESTING AT ITS CHELSEA LOCATION. IN RESPONSE TO FOOD INSECURITY CAUSED AND/OR EXACERBATED BY COVID-19, BIDMC PARTNERED WITH ITS LICENSED AND AFFILIATED HEALTH CENTERS AND OTHER ORGANIZATIONS TO IMPROVE FOOD ACCESS. BOWDOIN STREET HEALTH CENTER DISTRIBUTED BAGS OF FRESH FOOD TO HEALTH CENTER PATIENTS AND COMMUNITY MEMBERS WHO IDENTIFIED AS FOOD INSECURE. THE DIMOCK CENTER ADDRESSED FOOD INSECURITY AMONG PATIENTS AND COMMUNITY RESIDENTS THROUGH A GIFT-CARD BASED PROGRAM, PROVIDING A FLEXIBLE MECHANISM FOR INDIVIDUALS TO PURCHASE NECESSARY FOOD AND HOUSEHOLD ITEMS. A FULL UPDATE ON BIDMC'S HEALTH PRIORITIES AND ASSOCIATED GOALS IS INCLUDED BELOW.FY20 SCHEDULE HIMPLEMENTATION STRATEGY UPDATEKEY: BASELINE-2020, YEAR 1-2021, YEAR 2-2022PRIORITY AREA 1: SOCIAL DETERMINANTS OF HEALTH SOCIAL DETERMINANTS OF HEALTH (E.G., ECONOMIC STABILITY, EDUCATION, AND COMMUNITY/SOCIAL CONTEXT) CONTINUE TO HAVE A MASSIVE IMPACT ON MANY SEGMENTS OF THE POPULATION. THE DOMINANT THEME FROM BIDMC'S KEY INFORMANT INTERVIEWS AND COMMUNITY FORUMS WAS THE CONTINUED IMPACT THAT THE UNDERLYING SOCIAL DETERMINANTS OF HEALTH ARE HAVING ON THE CBSA'S LOW-INCOME, UNDERSERVED, DIVERSE POPULATION COHORTS. MORE SPECIFICALLY, DETERMINANTS SUCH AS POVERTY, EMPLOYMENT OPPORTUNITIES, VIOLENCE, TRANSPORTATION, RACIAL SEGREGATION, LITERACY, PROVIDER LINGUISTIC/CULTURAL COMPETENCY, SOCIAL SUPPORT AND COMMUNITY INTEGRATION LIMIT MANY PEOPLE'S ABILITY TO CARE FOR THEIR OWN AND/OR THEIR FAMILIES' HEALTH. THE IMPACT OF RACISM, BARRIERS TO CARE, AND DISPARITIES IN HEALTH OUTCOMES THAT THESE POPULATIONS FACE ARE WIDELY DOCUMENTED. THERE ARE A MULTITUDE OF INDIVIDUAL, COMMUNITY AND SOCIETAL FACTORS THAT WORK TOGETHER TO CREATE THESE INEQUITIES. THE UNDERLYING ISSUE IS NOT ONLY RACE/ETHNICITY, FOREIGN BORN STATUS, OR LANGUAGE BUT RATHER A BROAD ARRAY OF INTERRELATED ISSUES INCLUDING ECONOMIC OPPORTUNITY, EDUCATION, CRIME, AND COMMUNITY COHESION."

GOAL 1:
PROMOTE HEALTHY NEIGHBORHOODS (HEALTHY EATING, ACTIVE LIVING, OTHER HEALTHY BEHAVIORS, HEALTH-RELATED PROGRAMS/POLICIES) PROGRAMMATIC OBJECTIVES1.1 INCREASE THE NUMBER OF CHILDREN IN CCA CLINICS WHO ARE SCREENED FOR BMI1.2 INCREASE THE NUMBER OF CHILDREN, YOUTH, AND ADULTS WHO ARE PHYSICALLY ACTIVE1.3 DEVELOP AND UPDATE ANNUALLY A STRATEGIC PROGRAM PLAN FOR BOWDOIN STREET WELLNESS CENTER1.4 INCREASE ACCESS TO HEALTHY AND AFFORDABLE FOODS IN THE COMMUNITY1.5 IMPROVE NUTRITIONAL QUALITY OF THE FOOD SUPPLY1.6 DECREASE THE NUMBER OF INDIVIDUALS AND FAMILIES WHO SUFFER FROM FOOD INSECURITY1.7 PROVIDE OPPORTUNITIES FOR NEIGHBORHOODS TO IDENTIFY AND ADDRESS UNIQUE NEIGHBORHOOD NEEDSCOMMUNITY OBJECTIVES / STRATEGIES PROMOTE UNIVERSAL SCREENING FOR BMI ALONG WITH APPROPRIATE COUNSELING FOR PHYSICAL ACTIVITY AND NUTRITION SUPPORT AND PROMOTE THE DEVELOPMENT OF WALKING AND OTHER PHYSICAL ACTIVITY GROUPS IN SCHOOLS, COMMUNITY-BASED AND PRIMARY CARE-BASED SETTINGS (E.G., BOWDOIN STREET WELLNESS CENTER) SUPPORT AND COLLABORATE WITH BPHC AND COMMUNITY-BASED ORGANIZATIONS (E.G., DAILY TABLE, GBFB, ETC.) TO PROMOTE ACCESSIBLE/AFFORDABLE HEALTHY FOOD INCLUDING RX FOOD PRESCRIPTION, AND FARMERS MARKETS SUPPORT HEALTHY CHAMPIONS, A GROUP OF TEENAGERS, IN HEALTHY COOKING AND EDUCATION WORKSHOPS SUPPORT THE FITNESS IN THE CITY PROGRAM AT BSHC SELECT NEIGHBORHOOD COLLECTIVES TO IDENTIFY AND ADDRESS UNIQUE NEIGHBORHOOD NEEDSMETRICS AND STATUS UPDATE: NUMBER OF CHILDREN 3-17 AT AFFILIATED HEALTH CENTERS WHO ARE SCREENED FOR BMI AND COUNSELED FOR PHYSICAL ACTIVITY AND NUTRITION (FY20: 7,137; FY21: 5,694; FY22: 9,173) PERCENTAGE OF CHILDREN SEEN AT AFFILIATED HEALTH CENTERS THAT WERE SCREENED FOR BMI AND COUNSELED FOR NUTRITION AND PHYSICAL ACTIVITY (FY20: 73%; FY21: 62%; FY22: 58%) NUMBER OF SCHOOLS PARTICIPATING IN WALKING PROGRAMS AND OTHER PHYSICAL ACTIVITY GROUPS (FY20: 8 PUBLIC SCHOOLS; FY21: PROGRAM ENDED IN FY20) NUMBER OF PARTICIPANTS IN THE FITNESS IN THE CITY PROGRAM (FY20: 73; FY21: 56; FY22: DATA NOT AVAILABLE) NUMBER OF BOWDOIN GENEVA FARMERS' MARKETS AND OTHER FARMERS MARKETS HELD (FY20: 0 - DID NOT TAKE PLACE DUE TO COVID-19; FY21: PROGRAM ENDED DUE TO FUNDING CHANGES AND REDIRECTION DUE TO COVID-19) POUNDS OF PRODUCE SOLD AT BOWDOIN GENEVA FARMERS' MARKETS (FY20: 0 - DID NOT TAKE PLACE DUE TO COVID-19; FY21: PROGRAM ENDED DUE TO FUNDING CHANGES AND REDIRECTION DUE TO COVID-19) NUMBER OF FOOD BOXES BSHC PROVIDED (FY21: 2,925 BOXES TO 125 UNIQUE FAMILIES; FY22: PROGRAM CHANGED 300 BAGS OF FRESH FOOD WERE DISTRIBUTED FOR FREE TO PATIENTS AND COMMUNITY MEMBERS) NUMBER OF PATIENTS REFERRED TO BSHC COMMUNITY HEALTH WORKERS FOR SUPPORT (FY20: 183; FY21: 438; FY22: 533) NUMBER OF INTERVENTION CALLS BSHC COMMUNITY HEALTH WORKERS RESPONDED TO (FY20: 118; FY21: 85; FY22: 45) NUMBER OF PATIENTS EACH BSHC COMMUNITY HEALTH WORKER PROVIDES SUPPORT/ INTERVENTION TO, ON AVERAGE (FY20: 48; FY21: 74; FY22: 77)GOAL 2: PROMOTE VIOLENCE PREVENTION (SAFE NEIGHBORHOODS AND COMMUNITY COHESION)PROGRAMMATIC OBJECTIVES1.1 INCREASE ACCESS TO MENTAL HEALTH SERVICES AT BSHC FOR AFFECTED VICTIMS1.2 INCREASE PARTICIPATION IN ADVOCATE EDUCATION AND SUPPORT PROJECT1.3 PROVIDE COUNSELING AND OTHER MEDICAL SERVICES TO RAPE VICTIMS1.4 PROVIDE GRIEVING SUPPORT ACTIVITIES1.5 CONDUCT NEIGHBORHOOD CAMPAIGNS TO ENGAGE COMMUNITY AND CREATE GREATER COMMUNITY COHESION1.6 INCREASE ACCESS TO CARE AND SUPPORT TO NEIGHBORHOODS IMPACTED BY TRAUMA THROUGH THE NEIGHBORHOOD TRAUMA TEAMCOMMUNITY ACTIVITIES / STRATEGIES SUPPORT AND ORGANIZE COMMUNITY MEETINGS WHERE RESIDENTS SHARE THEIR CONCERNS AND DISCUSS POSSIBLE ACTION STEPS (VIP/ VILLAGE IN PROGRESS CALL TO ACTION) IDENTIFY AND EMPOWER COMMUNITY LEADERS THROUGH OUTREACH ACTIVITIES TO BUILD COMMUNITY COHESION SUPPORT PROGRAMS IN BSHC THAT INTEGRATE SERVICES PROVIDED BY BEHAVIORAL HEALTH SPECIALISTS AND MONITOR, ASSESS, AND TREAT THOSE EXPERIENCING TRAUMA FROM VIOLENCE HOLD HEALING SERVICES WHEN APPROPRIATE FOR COMMUNITY RESIDENTS PARTICIPATE IN COMMUNITY INTERVENTIONS THAT RAISE AWARENESS ABOUT VIOLENCE, ENGAGE THE COMMUNITY, ADDRESS FACTORS ASSOCIATED WITH VIOLENCE AND PROMOTE A SENSE OF COMMUNITY SUPPORT AND PROMOTE THE IMPLEMENTATION OF TRAINING PROGRAMS, SUPPORT GROUPS FOR ADVOCATES AND AFFECTED COMMUNITY MEMBERS PROVIDE OVERNIGHT STAYS FOR DOMESTIC VIOLENCE AND/OR SEXUAL ASSAULT VICTIMS WITHOUT SAFE SHELTER CONDUCT PUBLIC POLICY ADVOCACY FOR SAFE SHELTERS AND LONG-TERM HOUSING SUPPORT EMPOWER YOUTH TO DEVELOP LEADERSHIP SKILLS, PREVENT VIOLENCE, AND CREATE CHANGE IN THEIR COMMUNITY THROUGH THE YOUTH LEADERSHIP PROGRAM AT BOWDOIN STREET HEALTH CENTER RESPOND TO ALL INCIDENTS OF HOMICIDE OR VIOLENCE WITHIN CATCHMENT AREA THAT MEET CRITERIA AS ESTABLISHED BY THE BPHC (VIP AND NTT)

METRICS AND STATUS UPDATES
"NUMBER OF SEXUAL ASSAULT VICTIMS RECEIVING SERVICES (FY20: PROVIDED SERVICES, INCLUDING COUNSELING TO 56 SEXUAL ASSAULT VICTIMS. PROVIDED POST-HIV EXPOSURE PROPHYLAXIS MEDICATIONS TO 34 SEXUAL ASSAULT VICTIMS; FY21: PROVIDED SERVICES, INCLUDING COUNSELING TO 27 SEXUAL ASSAULT VICTIMS; FY22: PROVIDED SERVICES, INCLUDING COUNSELING TO 29 SEXUAL ASSAULT SURVIVORS) NUMBER OF SAFE BED OVERNIGHT STAYS (FY20: 34; FY21:11; FY22: 9) NUMBER OF HEALTH CENTERS, COLLEGES AND UNIVERSITIES, AND COMMUNITY GROUPS RECEIVING EDUCATIONAL PROGRAMMING AROUND SEXUAL ASSAULT, INTERPERSONAL VIOLENCE, COMMUNITY VIOLENCE AND SECONDARY TRAUMATIC STRESS (FY20:17; FY21: 41; FY22: 7 TRAINING SITES, FOR 33 EMPLOYEES) NUMBER OF HEALING CIRCLES HELD WITH WOMEN, MEN, AND CHILDREN (FY20: 86 HEALING CIRCLES, SERVING OVER 1,130 MEMBERS OF THE COMMUNITY; FY21: 64 HEALING CIRCLES, SERVING OVER 715 MEMBERS OF THE COMMUNITY; FY22: 33 PEACE CIRCLES, SERVING 315 MEMBERS OF THE COMMUNITY) NUMBER OF INCIDENTS OF HOMICIDE OR VIOLENCE RESPONDED TO (FY20: 43; FY21: 36; FY22: 22) NUMBER OF BOWDOIN/GENEVA YOUTH PARTICIPATING IN THE BSHC YOUTH LEADERSHIP PROGRAM (FY20: 30; FY21: 22; FY22: 23)GOAL 3: PROMOTE AFFORDABLE HOUSING AND GOAL 4: PROMOTE HOME OWNERSHIP PROGRAMMATIC OBJECTIVES1.1 INCREASE ACCESS TO AFFORDABLE HOUSING1.2 INCREASE HOME OWNERSHIP1.3 REDUCE RISK OF HOMELESSNESSCOMMUNITY ACTIVITIES / STRATEGIES FUND COMMUNITY-BASED ORGANIZATIONS THAT ARE WORKING ON AFFORDABLE HOUSING AND HOME OWNERSHIP INITIATIVES THROUGH BIDMC'S NEW INPATIENT BUILDING COMMUNITY-BASED HEALTH INITIATIVE (CHI) CONDUCT PUBLIC POLICY AND ADVOCACY THAT AIMS TO INCREASE: ACCESS TO AFFORDABLE HOUSING, HOUSING STABILITY, AND HEALTHY LIVING CONDITIONS (INCLUDING SAFETY) AND IMPROVE HOUSING QUALITY PROVIDE ACCESS TO HOUSING STABILITY SERVICES SUCH AS LEGAL AID PROVIDE RESOURCES TO MITIGATE FINANCIAL ""CLIFF EFFECTS"" PROVIDE HOUSING OPPORTUNITIES FOR LGBTQIA+ YOUTH AND HOMELESS YOUTH AND YOUNG ADULTS BUILD CAPACITY OF RESIDENTS TO ADVOCATE AND ORGANIZE AGAINST UNJUST EVICTIONS AND FORECLOSURES SUPPORT HOME BUYING AND FINANCIAL LITERACY EDUCATION SUPPORT HOMEOWNERSHIP PROGRAMSMETRICS AND STATUS UPDATES RELEASED A REQUEST FOR PROPOSALS IN AUGUST 2020 TO FUND EVIDENCE-BASED AND/OR EVIDENCE-INFORMED STRATEGIES IN THE AREAS OF HOMELESSNESS, RENTAL ASSISTANCE, AND HOME OWNERSHIP TO ADDRESS HOUSING AFFORDABILITY THROUGH BIDMC'S CHI, 7 ORGANIZATIONS WERE FUNDED TO ADDRESS HOUSING AFFORDABILITY EACH CHI GRANTEE CREATED A LOGIC MODEL TO OUTLINE PROJECT ACTIVITIES AND GOALS CHI GRANTEES PARTICIPATED IN 5 EVALUATION LEARNING COLLABORATIVES TO BUILD THEIR EVALUATION CAPACITY THE HOUSING AFFORDABILITY CHI GRANTEES WILL ENROLL PARTICIPANTS IN THEIR PROGRAM, HIRE STAFF, AND TRAIN STAFF/VOLUNTEERS (FY22: 345 PARTICIPANTS ENROLLED, 12 STAFF HIRED, AND 152 STAFF/VOLUNTEERS TRAINED) NUMBER OF CHI HOUSING AFFORDABILITY PARTICIPANTS WHO EXPERIENCE POSITIVE HOUSING OUTCOMES (E.G. GAINED HOUSING, WERE ABLE TO REMAIN IN HOUSING, OR PURCHASED A HOME) (FY22: 32 PARTICIPANTS) RELEASED A REQUEST FOR PROPOSALS IN SEPTEMBER 2022 TO FUND EVIDENCE-BASED AND/OR EVIDENCE-INFORMED STRATEGIES IN THE AREAS OF HOMELESSNESS, RENTAL ASSISTANCE, AND HOME OWNERSHIP TO ADDRESS HOUSING AFFORDABILITY IN THE CITY OF CHELSEA THE BIDMC SOCIAL WORK DEPARTMENT PROVIDED HOUSING SUPPORT TO PATIENTS IN NEED OF SHORT- OR LONG-TERM HOUSING (FY21: 74; FY22: 54)"

GOAL 5:
SUPPORT WORKFORCE DEVELOPMENT AND CREATION OF EMPLOYMENT OPPORTUNITIES PROGRAMMATIC OBJECTIVES1.1 INCREASE MENTORSHIP, TRAINING, AND EMPLOYMENT OPPORTUNITIES FOR YOUTH, YOUNG ADULTS, AND ADULTS RESIDING IN THE BIDMC CBSA AS WELL AS BIDMC EMPLOYEES1.2 PROMOTE WORKFORCE DEVELOPMENT AND CAPACITY BUILDINGCOMMUNITY ACTIVITIES / STRATEGIES ORGANIZE AND SUPPORT PIPELINE PROGRAMS TO ENHANCE SKILLS AND CAREER ADVANCEMENT PROVIDE OPPORTUNITIES THROUGH EMPLOYEE CAREER INITIATIVE (ECI) FOR COLLEGE-LEVEL COURSES AS WELL AS COUNSELING OFFER ESOL CLASSES, GED CLASSES, A BASIC COMPUTER SKILLS COURSE, CITIZENSHIP CLASSES, AND A FINANCIAL LITERACY CLASS PROVIDE JOB AND CAREER INTRODUCTORY OPPORTUNITIES FOR COMMUNITY RESIDENTS PROVIDE JOB AND CAREER INTRODUCTORY OPPORTUNITIES FOR MIDDLE AND HIGH SCHOOL STUDENTS FUND COMMUNITY-BASED ORGANIZATIONS THROUGH THE NEW INPATIENT BUILDING COMMUNITY-BASED HEALTH INITIATIVE TO ADDRESS JOBS AND FINANCIAL SECURITY PROVIDE SUPPORT FOR BI-LINGUAL/BI-CULTURAL PROVIDERS PROVIDE PAID WORKFORCE DEVELOPMENT OPPORTUNITIES FOR LATINX, ENGLISH LANGUAGE LEARNERS, AND IMMIGRANT YOUTHMETRICS AND STATUS UPDATES NUMBER OF PIPELINE PROGRAMS OFFERED (FY20: 6; FY21: 4; FY22: 8) NUMBER OF PARTICIPANTS IN PIPELINE PROGRAM (FY20: 34; FY21: 37; FY22: 68) NUMBER OF PARTICIPANTS WHO GRADUATED FROM PIPELINE PROGRAMS (FY20: 28; FY21: 16; FY22: 32) NUMBER OF EMPLOYEES RECEIVING ECI SERVICES (FY20: 551; FY21: 398; FY22: 315) NUMBER OF EMPLOYEES ENROLLED IN ESOL CLASSES (FY20: 24; FY21: 18; FY22: 20) NUMBER OF ADULT INTERNS PLACED (FY20: 14; FY21: 0 (COVID); FY22: 7) NUMBER OF ADULT INTERNS HIRED AFTER INTERNSHIPS (FY20: 6; FY21: 0; FY22: 2) NUMBER OF REFERRALS/RECOMMENDATIONS BY COMMUNITY PARTNERS FOR BIDMC TO HIRE (FY20: 202; FY21: 310; FY22: 85) NUMBER OF HIRES FROM REFERRALS FROM COMMUNITY PARTNERS (FY21: 40; FY22: 18) NUMBER OF SUMMER JOB OPPORTUNITIES PROVIDED (FY20: 22; FY21: 31; FY22: 27) NUMBER OF SCHOOL INTERNS HOSTED (FY20: 1; FY21: 0; FY22: 0) NUMBER OF BOSTON PUBLIC SCHOOL STUDENTS HOSTED FOR PIC'S ANNUAL JOB SHADOW DAY (FY20: 0 (DID NOT TAKE PLACE DUE TO COVID-19); FY21: PIC HAS DISCONTINUED OFFERING THIS EVENT TO BPS KIDS) NUMBER OF HIGH SCHOOL STUDENTS HOSTED IN SUMMER HEALTH CORPS PROGRAM (FY20: 0 (DID NOT RUN DUE TO COVID-19); FY21: 20; FY22: 20) NUMBER OF EMPLOYEES PARTICIPATING IN COMPUTER SKILLS, CITIZENSHIP, AND FINANCIAL LITERACY CLASSES (FY20: 36 EMPLOYEES PARTICIPATED IN A COMPUTER SKILLS CLASS, 17 ATTENDED CITIZENSHIP CLASSES, AND 155 ATTENDED A FINANCIAL LITERACY CLASS; FY 21: 91 ATTENDED A COMPUTER SKILLS CLASS, 12 ATTENDED CITIZENSHIP CLASSES AND 151 ATTENDED FINANCIAL LITERACY CLASSES; FY22: 53 ATTENDED A COMPUTER SKILLS CLASS, 12 ATTENDED CITIZENSHIP CLASSES, 54 ATTENDED CAREER DEVELOPMENT WORKSHOPS, AND 145 ATTENDED FINANCIAL LITERACY CLASSES) NUMBER OF YOUTH THAT GRADUATED BSHC YOUTH LEADERSHIP PROGRAM (FY20: 12; FY21: 10; FY22: 6) RELEASED A REQUEST FOR PROPOSALS IN AUGUST 2020 TO FUND EVIDENCE-BASED AND/OR EVIDENCE-INFORMED STRATEGIES IN THE AREAS OF EDUCATION/WORKFORCE DEVELOPMENT, EMPLOYMENT OPPORTUNITIES, AND INCOME/FINANCIAL SUPPORTS TO CREATE JOBS AND INCREASE FINANCIAL SECURITY THROUGH BIDMC'S CHI, 8 ORGANIZATIONS WERE FUNDED TO ADDRESS JOBS & FINANCIAL SECURITY EACH CHI GRANTEE CREATED A LOGIC MODEL TO OUTLINE PROJECT ACTIVITIES AND GOALS CHI GRANTEES PARTICIPATED IN 5 EVALUATION LEARNING COLLABORATIVES TO BUILD THEIR EVALUATION CAPACITY THE JOBS & FINANCIAL SECURITY CHI GRANTEES WILL ENROLL PARTICIPANTS IN THEIR PROGRAM, HIRE STAFF, AND TRAIN STAFF/VOLUNTEERS (FY22: 284 PARTICIPANTS ENROLLED, 9 STAFF HIRED, AND 39 STAFF/VOLUNTEERS TRAINED) NUMBER OF JOBS & FINANCIAL SECURITY CHI PARTICIPANTS WHO HAVE GAINED EMPLOYMENT (FY22: 53)GOAL 6: PROMOTE ENVIRONMENTAL SUSTAINABILITY PROGRAMMATIC OBJECTIVES1.1 CREATE A HEALTHY FUTURE FOR OUR PATIENTS, THEIR FAMILIES, AND OURSELVES BY CONSERVING NATURAL RESOURCES, REDUCING OUR CARBON FOOTPRINT, AND FOSTERING CULTURE OF SUSTAINABILITYCOMMUNITY ACTIVITIES / STRATEGIES PROMOTE RECYCLING, COMPOSTING, AND OTHER PROGRAMS TO DIVERT WASTE FROM INCINERATION INCREASE BIDMC'S SPEND ON HEALTHY BEVERAGES AND LOCAL AND SUSTAINABLE FOOD REDUCE CONSUMPTION OF WATER, ENERGY, AND GREENHOUSE GASESMETRICS AND STATUS UPDATES PERCENT OF DOLLARS EXPENDED IN LOCAL & SUSTAINABLE FOOD (FY20: 15%; FY21: 16%; FY22: 17.7%) PERCENT REDUCTION OF GREENHOUSE GAS EMISSIONS (FY20: NOT MEASURED DUE TO COVID-19; FY21: 6%; FY22: REDUCED ORGANIZATIONAL EMISSIONS BY 17.3% FROM 2016 BASELINE) NUMBER OF TAXI OR CHAIR CAR VOUCHERS PROVIDED TO PATIENTS BY BIDMC (FY20: 2,062 RIDE SHARE/TAXI RIDES AND 3 CHAIR CARS; FY21: 3,779 RIDE SHARE/TAXI RIDES AND 5 CHAIR CARS; FY22: 4,397 RIDE SHARE/TAXI RIDES AND 4 CHAIR CARS) PERCENT DECREASE IN GREENHOUSE GAS EMISSIONS RELATED TO EMPLOYEE COMMUTING DUE TO TRANSITIONING TO SUPPORT REMOTE WORK AND DECREASE IN SINGLE-OCCUPANCY VEHICLES DURING COVID-19 (FY20: 29% DECREASE; FY21: 43% INCREASE AS STAFF RETURNS TO WORK; FY22: NO LONGER TRACKING THIS GOAL)

PRIORITY AREA 2:
CHRONIC / COMPLEX CONDITIONS & THEIR RISK FACTORS HIGH RATES OF CHRONIC AND ACUTE PHYSICAL HEALTH CONDITIONS (E.G., HEART DISEASE, HYPERTENSION, CANCER, AND ASTHMA). THE ASSESSMENT'S QUANTITATIVE DATA SHOWS THAT MANY COMMUNITIES IN BIDMC'S CBSA HAVE HIGH RATES FOR MANY OF THE LEADING PHYSICAL HEALTH CONDITIONS (E.G., HEART DISEASE, HYPERTENSION, CANCER, AND ASTHMA). IN MANY COMMUNITIES THESE RATES ARE STATISTICALLY HIGHER THAN COMMONWEALTH RATES, INDICATING A PARTICULARLY SIGNIFICANT PROBLEM. HOWEVER, EVEN FOR THOSE COMMUNITIES WHERE THE RATES ARE NOT STATISTICALLY HIGHER, THESE CONDITIONS ARE STILL THE LEADING CAUSES OF PREMATURE DEATH. LIMITED ACCESS TO CANCER SCREENING FOR RACIAL/ETHNIC DIVERSITY AND OTHER AT-RISK POPULATIONS. MANY OF THE COMMUNITIES THAT ARE PART OF BIDMC'S CBSA HAVE HIGH CANCER MORTALITY RATES. THIS IS PARTICULARLY TRUE FOR CERTAIN CANCERS IN SPECIFIC COMMUNITIES IN BOSTON NEIGHBORHOODS SUCH AS ROXBURY, DORCHESTER, AND CHINATOWN. AT THE ROOT OF ADDRESSING HIGH MORTALITY IS SCREENING, EARLY DETECTION, AND ACCESS TO TIMELY TREATMENT. HIGH RATES OF THE LEADING HEALTH RISK FACTORS (E.G., LACK OF NUTRITIONAL FOOD AND PHYSICAL ACTIVITY, ALCOHOL/ILLICIT DRUG USE, AND TOBACCO USE) ARE ONE OF THE LEADING FINDINGS FROM THE ASSESSMENT IS THAT MANY COMMUNITIES AND/OR POPULATION SEGMENTS IN BIDMC'S CBSA HAVE HIGH RATES OF CHRONIC PHYSICAL AND BEHAVIORAL HEALTH CONDITIONS. IN SOME PEOPLE, THESE CONDITIONS UNDERLYING GENETIC ROOTS THAT ARE HARD TO COUNTER. HOWEVER, FOR MOST PEOPLE THESE CONDITIONS ARE WIDELY CONSIDERED PREVENTABLE OR MANAGEABLE. ADDRESSING THE LEADING RISK FACTORS IS AT THE ROOT OF A SOUND CHRONIC DISEASE PREVENTION AND MANAGEMENT STRATEGY.GOAL 1: IMPROVE CHRONIC DISEASE MANAGEMENT PROGRAMMATIC OBJECTIVES1.1 INCREASE THE NUMBER OF ADULTS WHO RECEIVE EDUCATION AND COUNSELING REGARDING RISK FACTORS, HEALTHY BEHAVIORS TO INCREASE CHRONIC DISEASE HEALTH LITERACY1.2 INCREASE THE NUMBER OF ADULTS SCREENED FOR DIABETES, HYPERTENSION, HIV/AIDS, AND ASTHMA 1.3 INCREASE THE NUMBER OF ADULTS WITH DIABETES, HYPERTENSION, HIV/AIDS, AND PERSISTENT ASTHMA WHO RECEIVE EVIDENCE-BASED COUNSELING/ COACHING AND TREATMENT1.4 INCREASE THE NUMBER OF ADULTS WITH DIABETES, HYPERTENSION, HIV/AIDS, AND PERSISTENT ASTHMA WHOSE CONDITIONS ARE MONITORED AND CONTROLLEDCOMMUNITY ACTIVITIES / STRATEGIES SUPPORT PROGRAMS IN CCA CLINICS INCLUDING LIVE AND LEARN DIABETES AT CRCH THAT EDUCATE AND SCREEN PATIENTS FOR DIABETES, HYPERTENSION, AND PERSISTENT ASTHMA PROVIDE EVIDENCED-BASED COUNSELING/COACHING AND TREATMENT, AS WELL AS APPROPRIATE REFERRALS FOR SPECIALTY CARE SERVICES FOR THOSE WHO SCREEN POSITIVE FOR DIABETES, HYPERTENSION, HIV/AIDS, AND ASTHMA PROVIDE SCREENING, EDUCATION/COUNSELING, AND TREATMENT SERVICES HIV/AIDS AND HIV/HCV CO-INFECTION SUPPORT GROUPS FOR MEN AND WOMEN LIVING WITH HIV/AIDS SUPPORT PRIMARY CARE PROVIDER EDUCATION AT CRCH IN THE AREA OF DIABETES MANAGEMENTMETRICS AND STATUS UPDATES: NUMBER OF CRCH PATIENTS PARTICIPATING IN THE CRCH DISEASE MANAGEMENT PROGRAM LIVE AND LEARN DIABETES (FY20: 24 PATIENTS AND 25 APPOINTMENTS; FY21: 94 PATIENTS AND 71 APPOINTMENTS; FY22: 6 PATIENTS AND 17 APPOINTMENTS (LOWER DUE TO NURSE SHORTAGE)) NUMBER OF BSHC PATIENTS PARTICIPATING IN DISEASE MANAGEMENT PROGRAMS (FY20: 50; FY21: PROGRAM ENDED IN FY20) PERCENTAGE OF CCA FEDERALLY QUALIFIED HEALTH CENTER (FQHC) AND OUTER CAPE HEALTH SERVICES PATIENTS WITH DIABETES WITH HBA1C < 9 (FY20: 80%; FY21: 72%; FY22: 70%) PERCENTAGE OF CCA FQHC AND OUTER CAPE HEALTH SERVICES PATIENTS WITH HYPERTENSION WHO HAD A BLOOD PRESSURE < 140/90 (FY20: 71%; FY21: 60%; FY22: 62%) PERCENTAGE OF CCA FQHC AND OUTER CAPE HEALTH SERVICES PERSISTENT ASTHMATIC PATIENTS WITH PHARMACOLOGICAL THERAPY (FY20: 75%; FY21: METRIC NO LONGER MEASURED BY UNIFORM DATA SYSTEM (UDS))

GOAL 2: REDUCE CANCER DISPARITIES (ACCESS TO SCREENING AND TREATMENT)
"PROGRAMMATIC OBJECTIVES1.1 INCREASE THE NUMBER OF LOW INCOME AND RACIAL/ETHNIC DIVERSE ADULTS EDUCATED AND SCREENED FOR CANCER1.2 INCREASE THE NUMBER OF ADULTS WHO SCREEN POSITIVE FOR CANCER WHO ARE REFERRED FOR EDUCATION, COUNSELING AND TREATMENT1.3 INCREASE THE NUMBER OF ADULTS WHO SCREEN POSITIVE FOR CANCER WHO ARE LINKED TO A CANCER NAVIGATOR1.4 INCREASE THE NUMBER OF ADULTS WHO PARTICIPATE IN CANCER SUPPORT GROUPSCOMMUNITY ACTIVITIES / STRATEGIES SUPPORT ACCESS TO CANCER SCREENING AND TREATMENT FOR LOW INCOME, UNINSURED ADULTS (BREAST, PROSTATE, COLON, AND LUNG, CANCERS), INCLUDING MAMMOGRAMS, COLORECTAL SCREENING, AND CT SCANS LINK PATIENTS SCREENED POSITIVE FOR CANCER TO CANCER PATIENT NAVIGATORS SUPPORT THE IMPLEMENTATION OF CANCER SUPPORT GROUPS SUPPORT SURVIVOR SELF-PORTRAIT AND TESTIMONIES ACTIVITIES TO REDUCE STIGMA IN COMMUNITIES (FACES OF FAITH ANNUAL EXHIBIT)METRICS AND STATUS UPDATES INCREASE ACCESS TO PATIENT NAVIGATORS NUMBER OF UNIQUE PATIENTS SERVED BY THE LATINX AND CHINESE PATIENT NAVIGATORS (FY20: 147; FY21: 421; FY22: 211) NUMBER OF CHINESE PATIENT NAVIGATOR ENCOUNTERS (FY20: 1,640; FY21: 1,790; FY22: DATA NOT AVAILABLE) NUMBER OF LATINX PATIENT NAVIGATOR ENCOUNTERS (FY21: 68; FY22: DATA NOT AVAILABLE) NUMBER OF PEOPLE PARTICIPATING IN CANCER SUPPORT GROUPS AT BIDMC (FY20: 52; FY21: 65; FY22: 56 GROUPS HELD) NUMBER OF MAMMOGRAMS PROVIDED FOR LOW-INCOME PATIENTS AT FENWAY, OUTER CAPE, AND SOUTH COVE COMMUNITY HEALTH CENTERS. (FY20: 1,949; FY21: 1,106, FY22: 5,465) NUMBER OF COLON CANCER SCREENINGS PROVIDED AT BIDMC FOR LOW-INCOME PATIENTS (FY20: 928; FY21: 1,331, FY22: 1,631) NUMBER OF BIDMC PATIENTS SCREENED FOR LUNG CANCER (FY20: 643; FY21:1,616; FY22: 1,126) NUMBER OF MEDICALLY UNDERSERVED PATIENTS WITH BREAST CANCER IDENTIFIED AND ENROLLED IN THE SOCIAL NEEDS ASSESSMENT PROGRAM AT BIDMC (FY20: 68; FY21: 104; FY22: FUNDING FOR RESEARCH ENDED IN FY22 AND DATA IS UNAVAILABLE)GOAL 3: SUPPORT OLDER ADULTS TO AGE IN PLACE PROGRAMMATIC OBJECTIVES1.1 REDUCE INAPPROPRIATE READMISSIONS FOR OLDER ADULTS1.2 REDUCE ELDERLY FALLS1.3 REDUCE SOCIAL ISOLATIONCOMMUNITY ACTIVITIES / STRATEGIES VIP WORK WITH THE ELDER BUILDINGS TO SUPPORT ELDER RESIDENT GROUP PROVIDING THEM RESOURCES, ADDRESS ISSUES (55+)METRICS AND STATUS UPDATES NO METRICS RELATED TO ACTIVITIES TO SUPPORT OLDER ADULTS AGING IN PLACE IN FY20PRIORITY AREA 3: ACCESS TO CARE LIMITED ACCESS TO PRIMARY CARE MEDICAL, MEDICAL SPECIALTY, AND ORAL HEALTH CARE SERVICES FOR LOW-INCOME, MEDICAID INSURED, UNINSURED, AND OTHER VULNERABLE POPULATIONS FACING HEALTH CARE DISPARITIES AND BARRIERS TO CARE. DESPITE THE FACT THAT MASSACHUSETTS HAS ONE OF HIGHEST RATES OF HEALTH INSURANCE AND THE COMMUNITIES THAT MAKE UP BIDMC'S CBSA HAVE STRONG, ROBUST SAFETY NET SYSTEMS, THERE ARE STILL SUBSTANTIAL NUMBERS OF LOW-INCOME, MEDICAID INSURED, UNINSURED, AND OTHERWISE VULNERABLE INDIVIDUALS WHO FACE HEALTH DISPARITIES AND ARE NOT ENGAGED IN ESSENTIAL MEDICAL AND ORAL HEALTH SERVICES. EFFORTS NEED TO BE MADE TO EXPAND ACCESS, REDUCE BARRIERS TO CARE, AND IMPROVE THE QUALITY OF PRIMARY CARE MEDICAL, MEDICAL SPECIALTY, AND ORAL HEALTH SERVICES.BARRIERS TO ACCESS AND DISPARITIES IN HEALTH OUTCOMES CONTINUE TO CHALLENGE THREE SPECIFIC POPULATIONS (INFANTS/MOTHERS/FATHERS, FRAIL OLDER ADULTS, AND LESBIAN, GAY, BI-SEXUAL, AND TRANSGENDER (LGBT) POPULATIONS. BASED ON INFORMATION GATHERED PRIMARILY FROM INTERVIEWS AND COMMUNITY FORUMS, THE ASSESSMENT IDENTIFIED A NUMBER OF SPECIAL POPULATIONS THAT FACE BARRIERS TO CARE AND DISPARITIES IN ACCESS. MORE SPECIFICALLY, INFANTS/MOTHERS/FATHERS, FRAIL OLDER ADULTS, AND THE LESBIAN, GAY, BI-SEXUAL, AND TRANSGENDER (LGBT) POPULATIONS FACE DISPARITIES IN ACCESS AND OUTCOME AND ARE PARTICULARLY AT-RISK. IF THESE DISPARITIES ARE GOING TO BE ADDRESSED, THEN CARE NEEDS TO BE TAKEN TO TAILOR IDENTIFICATION/SCREENING AND PREVENTIVE SERVICES AS WELL AS ACUTE AND CHRONIC DISEASE MANAGEMENT SERVICES FOR THESE SPECIAL POPULATIONS. GOAL 1: INCREASE ACCESS TO QUALITY MEDICAL SERVICES, INCLUDING PRIMARY CARE, OB/GYN, AND SPECIALTY CARE AS WELL AS URGENT, EMERGENT AND TRAUMA CARE PROGRAMMATIC OBJECTIVES1.1 INCREASE ACCESS TO PRIMARY MEDICAL CARE SERVICES, INCLUDING OB/GYN SERVICES, AT BIDMC'S CCA CLINIC SITES AND BIDMC'S CHELSEA SERVICE SITE, AS WELL AS AT ITS APG AND HCA PRACTICES1.2 INCREASE THE NUMBER OF PATIENTS RECEIVING SPECIALTY CARE MEDICAL SERVICES1.3 INCREASE THE NUMBER OF UNINSURED OR UNDERINSURED PATIENTS RECEIVING NEEDED MEDICATIONS1.4 INCREASE ACCESS TO APPROPRIATE, TIMELY, URGENT, EMERGENT, AND TRAUMA CARE SERVICES1.5 INCREASE THE NUMBER OF RESIDENTS WHO ARE SCREENED AND ENROLLED FOR HEALTH INSURANCE1.6 INCREASE PATIENT SATISFACTION1.7 CONTINUE TO SUPPORT HSN TRUST FUND1.8 ADVOCATE FOR POLICIES SUPPORTING PUBLIC HEALTH, MENTAL HEALTH AND SUBSTANCE ABUSE AND ANTI-POVERTY PROGRAMSCOMMUNITY ACTIVITIES / STRATEGIES SUPPORT PRIMARY MEDICAL CARE SERVICES, INCLUDING OB/GYN SERVICES AT BIDMC'S CCA CLINIC SITES AND BIDMC'S CHELSEA SERVICE SITE, AS WELL AS AT BIDMC'S APG AND HCA PRACTICES SUPPORT RESIDENT ROTATIONS INTO CCA CLINIC SITES FACILITATE REFERRALS TO SPECIALTY CARE THROUGH CARE CONNECTION'S INPATIENT DISCHARGE FOLLOW UP PROGRAM PROVIDE FREE PHARMACY MEDICATIONS TO ELIGIBLE, LOW INCOME PATIENTS SUPPORT THE PROVISION OF APPROPRIATE, TIMELY URGENT CARE SERVICES AT BIDMC URGENT CARE LOCATIONS IN CHELSEA, CHESTNUT HILL, AND THE BOWDOIN/GENEVA NEIGHBORHOOD OF BOSTON, AS WELL AS AT SOME OF BIDMC'S APG PRACTICES SUPPORT MEDFLIGHT AND COORDINATED EMS IN BOSTON SUPPORT THE COMMONWEALTH'S HEALTH SAFETY NET (HSN) SUPPORT ACTIVITIES OF THE BOSTON HEALTHY START INITIATIVE (BHSI), ADMINISTERED AT BOWDOIN STREET HEALTH CENTER (BSHC), INCLUDING CASE MANAGEMENT, NUTRITION COUNSELING, PRENATAL EDUCATION, AND PARENTING SUPPORT SUPPORT CLINICAL OPERATIONS AT CCA CLINICS CONDUCT ""MYSTERY SHOPPING"" TO ADDRESS QUALITY IMPROVEMENT SUPPORT CARE INTEGRATION THROUGH INFORMATION SHARING, INCLUDING PARTICIPATION IN MASS HIWAY AND HEALTH INFORMATION EXCHANGE INTEGRATE SOCIAL JUSTICE TOPICS INTO RESIDENT CURRICULUM SUPPORT INSTITUTIONAL AND COMMUNITY EMERGENCY PREPAREDNESS"

METRICS AND STATUS UPDATES
NUMBER OF REFERRALS MADE THROUGH CARE CONNECTION CALL CENTER (FY20: 801; FY21: 1,058; FY22: 1,162) NUMBER OF PREGNANT MOTHERS AND FAMILIES FROM BSHC PROVIDED CASE MANAGEMENT THROUGH THE BHSI PROGRAM (FY20: SERVED 56 PREGNANT CLIENTS AND 62 INTERCONCEPTION/PARENTING CLIENTS; FY21: 140 TOTAL PATIENTS INCLUDING 49 PRENATAL MOTHERS, 41 POSTNATAL MOTHERS, AND 50 CHILDREN; FY22: 251 TOTAL PATIENTS INCLUDING 104 PRENATAL MOTHERS, 48 POSTNATAL MOTHERS, AND 99 CHILDREN) NUMBER OF BIDMC PATIENTS SCREENED FOR ENTITLEMENT ELIGIBILITY (FY20: 9,892; FY21: 161,593; FY22: 315,578) NUMBER OF BIDMC PATIENTS ENROLLED IN ENTITLEMENT PROGRAMS (FY20: 7,463; FY21: 24,221 FY22: 31,251) NUMBER OF UNIQUE PATIENTS SUPPORTED THROUGH HSN (FY20: 1317; FY21: 7,279; FY22: 6,639) NUMBER OF MEDICAL RESIDENTS PLACED AT CCA HEALTH CENTERS (FY20: 28; FY21: 37; FY22: 41) NUMBER OF PRIMARY CARE TRACK RESIDENTS AT CCA HEALTH CENTERS (FY20: 7; FY21: 10; FY22: 3) NUMBER OF BIDMC SPECIALISTS THAT PRACTICE AT CCA HEALTH CENTERS (FY20: 26; FY21: 31; FY22: 33) NUMBER OF PATIENTS SERVED AT CCA HEALTH CENTERS AND OUTER CAPE HEALTH SERVICES (FY20: 115,634; FY21: 135,636; FY22: 125,946) NUMBER OF VISITS PROVIDED AT CCA HEALTH CENTERS AND OUTER CAPE HEALTH SERVICES (FY20: 579,163; FY21: 535,082; FY22: 619,614) NUMBER OF PATIENTS WITHOUT INSURANCE SERVED AT FQHC CCA HEALTH CENTERS (FY20: 9,664; FY21: 8,137; FY22: 7,509) NUMBER OF MYSTERY SHOPPING SURVEYS COMPLETED (FY20: 28; FY21: 48; FY22: 48) NUMBER OF PRESCRIPTIONS FILLED FOR INDIGENT PATIENTS (FY20: 33,431; FY21: 31,095; FY22: 50,567)GOAL 2: INCREASE ACCESS TO QUALITY ORAL HEALTH SERVICES PROGRAMMATIC OBJECTIVES1.1 MAINTAIN AND INCREASE THE NUMBER OF PATIENTS RECEIVING PRIMARY DENTAL CARE SERVICES AT CCA CLINICCOMMUNITY ACTIVITIES / STRATEGIES SUPPORT CLINICAL OPERATIONS AT CCA CLINICS SUPPORT HSNMETRICS AND STATUS UPDATES NUMBER OF DENTAL PATIENTS AT FQHC CCA HEALTH CENTERS (FY20: 25,675; FY21: 16,687; FY22: 17,091) NUMBER OF UNIQUE DENTAL VISITS AT FQHC CCA HEALTH CENTERS (FY20: 76,363; FY21: 39,832; FY22: 45,133)GOAL 3: PROMOTE EQUITABLE CARE AND SUPPORT FOR THOSE WHO FACE CULTURAL AND LINGUISTIC BARRIERS PROGRAMMATIC OBJECTIVES1.1 MAINTAIN OR INCREASE THE NUMBER OF NON-ENGLISH SPEAKING PATIENTS OR RESIDENTS SERVED BY THE INTERPRETER SERVICES PROGRAM1.2 EDUCATE STAFF/CLINICIANS IN HEALTH EQUITY PRINCIPLES1.3 PROMOTE HEALTH EQUITY, HEALTH LITERACY, CULTURAL HUMILITY ACROSS CCA CLINICSCOMMUNITY ACTIVITIES / STRATEGIES INCREASE UNDERSTANDING OF CULTURAL IMPACTS ON HEALTHCARE DELIVERY, HEALTH STATUS AND HEALTH OUTCOMES MAKE AVAILABLE TOOLS AND RESOURCES TO FACILITATE CROSS-CULTURAL COMMUNICATION INCREASE ACCESS TO INTERPRETER SERVICESMETRICS AND STATUS UPDATES NUMBER OF LEP ENCOUNTERS AND LANGUAGES AT BIDMC (FY20: 222,396 ENCOUNTERS (PERSON, TELEPHONE AND VIDEO) IN 76 LANGUAGES; FY21: 271,357 ENCOUNTERS (PERSON, TELEPHONE AND VIDEO) IN 67 LANGUAGES; FY22: 299,428 ENCOUNTERS (PERSON, TELEPHONE, VIDEO, AND ASL)) NUMBER OF HIGH-VOLUME, BIDMC CUSTOM MATERIALS, TRANSLATED INTO SIX LANGUAGES; SPANISH, PORTUGUESE, RUSSIAN, TRADITIONAL CHINESE, HAITIAN CREOLE, AND SIMPLIFIED CHINESE (FY20: 6; FY21: 0; FY22: 0) NUMBER OF PATIENTS BEST SERVED IN A LANGUAGE OTHER THAN ENGLISH AT FQHC CCA HEALTH CENTERS AND OUTER CAPE HEALTH SERVICES (FY20: 48,422; FY21: 45,625; FY22: 49,478) NUMBER OF PATIENTS OF DIVERSE RACE/ETHNICITY SERVED AT FQHC CCA HEALTH CENTERS AND OUTER CAPE HEALTH SERVICES (FY20: 79,788; FY21: 66,522, FY22: 73,354)

GOAL 4:
PROMOTE GREATER HEALTH EQUITY AND REDUCE DISPARITIES IN ACCESS FOR LGBTQ POPULATIONS PROGRAMMATIC OBJECTIVES1.1 REDUCE DISPARITIES1.2 PROMOTE HEALTH EQUITYCOMMUNITY ACTIVITIES / STRATEGIES WORK TO IMPLEMENT SOGI APPROPRIATE POLICIES AND PROCEDURES COLLABORATE WITH FENWAY ON JOINT RESIDENCY PROGRAM SUPPORT PRIDE CELEBRATION SUPPORT EFFORTS ACHIEVE HEALTH CARE QUALITY INDEX RECOGNITION (E.G., SIGNAGE AND PATIENT SELF-IDENTIFICATION OF SEXUAL ORIENTATION)METRICS AND STATUS UPDATES IMPLEMENTED TRAINING FOR BIDMC STAFF ON SEXUAL ORIENTATION AND GENDER IDENTITY (SOGI) IN FY20 NUMBER OF BIDMC STAFF THAT COMPLETED THE SOGI TRAINING (FY20: 7,557; FY21: 2,564; FY22: 2,212) IMPLEMENTED SOGI CAPTURE IN WEBOMR AND PATIENT-SITE IN FY20 NUMBER OF FQHC CCA PATIENTS THAT IDENTIFY AS OTHER THAN STRAIGHT: (FY20: 19,009; FY21: 15,960, FY22: 19,043) NUMBER OF FQHC CCA PATIENTS THAT IDENTIFY AS TRANSGENDER: (FY20: 3,047; FY21: 2,719; FY22: 2,919)PRIORITY AREA 4: MENTAL HEALTH AND SUBSTANCE USE HIGH RATES OF SUBSTANCE USE (E.G., ALCOHOL, PRESCRIPTION DRUG/OPIOIDS, MARIJUANA) AND MENTAL HEALTH ISSUES (E.G., DEPRESSION, ANXIETY, AND STRESS). IF THE IMPACT OF SOCIAL DETERMINANTS WAS THE LEADING FINDING OF THE CHNA, A CLOSE SECOND WAS THE PROFOUND IMPACT THAT BEHAVIORAL HEALTH ISSUES (I.E., SUBSTANCE USE AND MENTAL HEALTH) ARE HAVING ON INDIVIDUALS, FAMILIES AND COMMUNITIES IN EVERY GEOGRAPHIC REGION AND EVERY POPULATION SEGMENT IN BIDMC'S CBSA. DEPRESSION/ANXIETY, SUICIDE, OPIOID AND PRESCRIPTION DRUG DEPENDENCY, AND ALCOHOL AND MARIJUANA USE, PARTICULARLY IN YOUTH, ARE MAJOR HEALTH ISSUES AND ARE HAVING A TREMENDOUS IMPACT ON THE POPULATION AS WELL AS A BURDEN ON THE SERVICE SYSTEM. THE FACT THAT PHYSICAL AND BEHAVIORAL HEALTH ARE SO INTERTWINED COMPOUNDS THE IMPACT OF THESE ISSUES. OF PARTICULAR CONCERN ARE THE INCREASING RATES OF OPIOID ABUSE IN THE COMMONWEALTH.LIMITED ACCESS TO BEHAVIORAL HEALTH SERVICES, PARTICULARLY FOR LOW-INCOME, MEDICAID INSURED, UNINSURED, AND THOSE WITH COMPLEX, MULTI-FACETED ISSUES. DESPITE THE BURDEN OF MENTAL HEALTH AND SUBSTANCE USE ON ALL SEGMENTS OF THE POPULATION, THERE IS AN EXTREMELY LIMITED SERVICE SYSTEM AVAILABLE TO MEET THE NEEDS THAT EXIST FOR THOSE WITH ALL MILD TO MODERATE EPISODIC ISSUES OR THOSE WITH MORE SERIOUS AND COMPLEX, CHRONIC CONDITIONS. EFFORTS NEED TO BE MADE TO EXPAND ACCESS, REDUCE BARRIERS TO CARE (INCLUDING STIGMA), AND IMPROVE THE QUALITY OF PRIMARY CARE AND SPECIALIZED BEHAVIORAL HEALTH SERVICES.GOAL 1: INCREASE ACCESS TO QUALITY MENTAL HEALTH CARE AND SUBSTANCE USE SERVICES PROGRAMMATIC OBJECTIVES1.1 INCREASE PATIENT AWARENESS AND KNOWLEDGE OF BEHAVIORAL HEALTH SERVICES1.2 INCREASE THE NUMBER OF PATIENTS RECEIVING INTEGRATED MENTAL HEALTH AND SUBSTANCE USE SERVICES AT BIDMC'S CCA CLINIC SITES AND BIDMC'S CHELSEA SERVICE SITE, AS WELL AS AT BIDMC'S APG AND HCA PRACTICES 1.3 INCREASE ACCESS TO BEHAVIORAL HEALTH INPATIENT SERVICES AT BIDMC INPATIENT LOCATIONS1.4 ADVOCATE FOR HEALTH POLICY THAT PROMOTES PRIMARY CARE AND BEHAVIORAL HEALTH INTEGRATION1.5 REDUCE STIGMA AROUND BEHAVIORAL HEALTH1.6 INCREASE CAPACITY OF LOCAL ORGANIZATIONS TO PROVIDE CULTURALLY-INFORMED BEHAVIORAL HEALTH CARECOMMUNITY ACTIVITIES / STRATEGIES SUPPORT PRIMARY CARE MEDICAL AND BEHAVIORAL HEALTH INTEGRATION AT BIDMC'S CCA CLINIC SITES AND BIDMC'S CHELSEA SERVICE SITE, AS WELL AS AT BIDMC'S APG AND HCA PRACTICES CONTINUE TO PROVIDE CASE MANAGEMENT SUPPORT SERVICES FOR CCA PATIENTS WITH COMPLEX PHYSICAL AND BEHAVIORAL HEALTH ISSUES ADVOCATE FOR HEALTH POLICY THAT PROMOTES INTEGRATION SUPPORT TELEPHONIC AND ONSITE PSYCHIATRIC CONSULTATION FOR PRIMARY CARE PROVIDERS SERVING THOSE WITH BEHAVIORAL HEALTH (BH) CONDITIONS PROVIDE OB/GYN SERVICES FOR WOMEN WITH CHRONIC SUBSTANCE ABUSE ISSUES PROVIDE CULTURALLY APPROPRIATE MENTAL HEALTH SERVICES FOR THE HISPANIC/LATINO COMMUNITY SUPPORT EDUCATIONAL OPPORTUNITIES ON CULTURAL PSYCHIATRY FOR SPANISH SPEAKING MENTAL HEALTH PROVIDERS CONTINUE SBIRT IN BIDMC'S EMERGENCY DEPARTMENT PROVIDE TRAINING FOR CLINICAL PROVIDERS ON HOW TO BETTER INTEGRATE AND COORDINATE BEHAVIORAL HEALTH SERVICES ACROSS THE SYSTEM FUND COMMUNITY-BASED ORGANIZATIONS THROUGH THE NEW INPATIENT BUILDING COMMUNITY-BASED HEALTH INITIATIVE TO ADDRESS BEHAVIORAL HEALTH SUPPORT EVIDENCE-BASED, COMMUNITY-BASED PROGRAMS AIMED AT REDUCING STIGMA AROUND BEHAVIORAL HEALTH SUPPORT EVIDENCE-BASED BEHAVIORAL HEALTH INTERVENTIONS PROVIDED IN COMMUNITY SETTINGSMETRICS AND STATUS UPDATES PERCENT INCREASE OF MENTAL HEALTH VISITS IN PATIENTS SERVED BY SOCIAL WORK DEPARTMENT (FY20: 16.2%; FY21:11%; FY22: DECREASE OF 17.8% DUE TO STAFFING VACANCIES AND CAPACITY) NUMBER OF PATIENTS SERVED BY BEHAVIORAL HEALTH CARE MANAGER AT BSHC (FY20: 608; FY21: 736; FY22: 669) NUMBER OF PATIENTS ACCESSING BH SERVICES IN FQHC CCA HEALTH CENTERS (FY20: 11,966; FY21: 9,268; FY22: 9,876) NUMBER OF INTEGRATED BEHAVIORAL HEALTH CONSULTATIONS PROVIDED IN BSHC PRIMARY CARE CLINIC (FY20: 184; FY21: 71; FY22: APPROXIMATELY 200) RELEASED A REQUEST FOR PROPOSALS IN AUGUST 2020 TO FUND EVIDENCE-BASED AND/OR EVIDENCE-INFORMED STRATEGIES TO ADDRESS MENTAL HEALTH AND SUBSTANCE USE THROUGH BIDMC'S COMMUNITY-BASED HEALTH (CHI) INITIATIVE, 7 ORGANIZATIONS WERE FUNDED TO ADDRESS BEHAVIORAL HEALTH EACH CHI GRANTEE CREATED A LOGIC MODEL TO OUTLINE PROJECT ACTIVITIES AND GOALS CHI GRANTEES PARTICIPATED IN 5 EVALUATION LEARNING COLLABORATIVES TO BUILD THEIR EVALUATION CAPACITY THE BEHAVIORAL HEALTH CHI GRANTEES WILL ENROLL PARTICIPANTS IN THEIR PROGRAM, HIRE STAFF, AND TRAIN STAFF/VOLUNTEERS (FY22: 386 PARTICIPANTS ENROLLED, 31 STAFF HIRED, AND 172 STAFF/VOLUNTEERS TRAINED)GOAL 2: REDUCE BURDEN OF OPIOID USE PROGRAMMATIC OBJECTIVES1.1 INCREASE THE NUMBER OF ADULTS WITH SUBSTANCE ISSUES WHO ARE APPROPRIATELY MONITORED, ASSESSED, AND TREATED IN CCA CLINICS1.2 INCREASE THE NUMBER OF PATIENTS RECEIVING INPATIENT DETOX SERVICESCOMMUNITY ACTIVITIES / STRATEGIES SUPPORT THE DEVELOPMENT OF A BIDMC EMERGENCY DEPARTMENT BUPRENORPHINE PATHWAY TO PROMOTE ACCESS TO SERVICES FOR THOSE IDENTIFIED WITH SUBSTANCE USE DISORDERS IN THE HOSPITAL SETTING CONTINUE THE SUBOXONE CLINICS IN HEALTHCARE ASSOCIATES AND THE EMERGENCY DEPARTMENT BUPRENORPHINE PATHWAY FOR NON-HCA PATIENTS

METRICS AND STATUS UPDATES
HIRED A SECOND ATTENDING PSYCHIATRIST IN FY20 FOR THE DIVISION OF ADDICTION PSYCHIATRY, ENSURING THAT BIDMC PATIENTS CAN BE SEEN IN THE LINK CLINIC FOR OPIOID USE DISORDER CARE 5 DAYS A WEEK CONTINUED TO CONDUCT BUPRENORPHINE WAIVER TRAININGS IN FY20 AND FY21, ALLOWING MORE PHYSICIANS TO OBTAIN THEIR BUPRENORPHINE X-WAIVERS ADDED INJECTABLE BUPRENORPHINE TO THE FORMULARY AS ANOTHER MEDICATION OPTION FOR BIDMC PATIENTS IN FY20 TRANSLATED PATIENT EDUCATION MATERIALS IN MULTIPLE LANGUAGES PARTICIPATED IN THE OPIOID USE DISORDER INITIATIVE THROUGH THE MASS PERINATAL QUALITY COLLABORATIVE (MPQC) CREATED GUIDELINE FOR TREATING PATIENTS' PAIN WHILE ON BUPRENORPHINE/ NALOXONE (SUBOXONE) UPDATED OPIOID EDUCATION FOR TRAINEES IN FY21 AND DEVELOPED REVIEW PROCESS OF DEPARTMENT-SPECIFIC OPIOID EDUCATION IN FY22 ROLLED OUT OPIOID PRESCRIBING DASHBOARD IN FY21 AND MONITORED AND EVALUATED PRESCRIBERS IN FY22 DEVELOPED PATHWAYS FOR NEW STRATEGIES TO PROVIDE ADDICTION TREATMENT EVALUATED DISCHARGE NEEDSGOAL 3: PROMOTE BEHAVIORAL HEALTH WORKFORCE DEVELOPMENT AND INCREASE CAPACITY PROGRAMMATIC OBJECTIVES1.1 PROMOTE BEHAVIORAL HEALTH WORKFORCE DEVELOPMENT AND INCREASE CAPACITY COMMUNITY ACTIVITIES / STRATEGIES FUND COMMUNITY-BASED ORGANIZATIONS THROUGH THE NEW INPATIENT BUILDING COMMUNITY-BASED HEALTH INITIATIVE TO ADDRESS BEHAVIORAL HEALTHMETRICS AND STATUS UPDATES RELEASED A REQUEST FOR PROPOSALS IN AUGUST 2020 TO FUND EVIDENCE-BASED AND/OR EVIDENCE-INFORMED STRATEGIES IN THE AREAS OF MENTAL HEALTH AND SUBSTANCE USE, INCLUDING BUILDING BEHAVIORAL HEALTH PROVIDER CAPACITY THROUGH BIDMC'S COMMUNITY-BASED HEALTH (CHI) INITIATIVE, 7 ORGANIZATIONS WERE FUNDED TO ADDRESS BEHAVIORAL HEALTHCOMMUNITY PARTNERSBIDMC IS COMMITTED TO IMPROVING THE HEALTH AND WELLBEING OF RESIDENTS WITHIN ITS SERVICE AREA BY COLLABORATING WITH A DIVERSE GROUP OF COMMUNITY PARTNERS. THE HOSPITAL WORKS TOGETHER WITH THESE PARTNERS TO REDUCE BARRIERS TO HEALTH, INCREASE PREVENTION AND/OR SELF-MANAGEMENT OF CHRONIC DISEASE AND INCREASE THE EARLY DETECTION OF ILLNESS. THE HOSPITAL'S COMMUNITY PARTNERS INCLUDE: A BETTER CITY ABOUT FRESH ACEDONE ACTION FOR BOSTON COMMUNITY DEVELOPMENT (ABCD) ADCARE TREATMENT CENTER AFRICAN BRIDGE NETWORK AIDS ACTION COMMITTEE AIDS SUPPORT GROUP OF CAPE COD ALZHEIMER'S ASSOCIATION OF MA (WALTHAM) AMERICAN CHINESE CHRISTIAN EDUCATION & SOCIAL SERVICES, INC. ASIAN AMERICAN CIVIC ASSOCIATION ASIAN COMMUNITY DEVELOPMENT CORPORATION ATRIUS HEALTH AUDUBON CIRCLE NEIGHBORHOOD BAGLY, INC. BAMSI, INC. BEST CORP. BOSTON AREA RAPE CRISIS CENTER (BARCC) BETH ISRAEL LAHEY HEALTH PRIMARY CARE BETH ISRAEL LAHEY HEALTH PRIMARY CARE 1000 BROADWAY BOSTON CENTER FOR INDEPENDENT LIVING BOSTON CHILDREN'S HOSPITAL BOSTON CHINATOWN NEIGHBORHOOD CENTER BOSTON COMPREHENSIVE TREATMENT CENTER BOSTON ELDER SERVICES BOSTON EMERGENCY MEDICAL SERVICES BOSTON FIRE DEPARTMENT BOSTON GREEN ACADEMY BOSTON HEALTH CARE FOR THE HOMELESS PROGRAM BOSTON HOSPITAL COLLABORATION FOR COMMUNITY VIOLENCE BOSTON HOUSING AUTHORITY BOSTON LIVING CENTER BOSTON MEDICAL CENTER BOSTON MEDFLIGHT BOSTON PRIVATE INDUSTRY COUNCIL (PIC) BOSTON POLICE DEPARTMENT BOSTON PUBLIC HEALTH COMMISSION BOSTON UNIVERSITY SCHOOL OF PUBLIC HEALTH BOSTON UNIVERSITY LAW CLINIC BOWDOIN GENEVA MAIN STREETS BOWDOIN STREET HEALTH CENTER BOYS AND GIRLS CLUB OF BOSTON BRIDGE OVER TROUBLED WATERS BRIGHAM AND WOMEN'S HOSPITAL BRIGID'S HOUSE OF HOPE BUNKER HILL COMMUNITY COLLEGE CAMBRIDGE COMMUNITY LEARNING CENTER CAMBRIDGE HEALTH ALLIANCE CAPE VERDEAN ASSOCIATION OF BOSTON CAPIC, INC. CATHOLIC CHARITIES BOSTON CHADD MENTORING COURSE, HMS CASA MYRNA CHARLES RIVER COMMUNITY HEALTH CHELSEA BLACK COMMUNITY CHELSEA COMMUNITY CONNECTIONS CHINATOWN MAIN STREET CHINATOWN RESIDENT ASSOCIATION CHINESE PROGRESSIVE ASSOCIATION CIRCLE OF HOPE CITY OF BOSTON EMERGENCY MANAGEMENT OFFICE CITY OF BOSTON'S GREEN RIBBON COMMISSION CITY LIFE/VIDA URBANA CONFERENCE OF BOSTON TEACHING HOSPITALS (COBTH) COMMUNITY RESEARCH INITIATIVE COMMUNITY SERVINGS CRADLES TO CRAYONS DANA FARBER CANCER INSTITUTE DORCHESTER CATHOLIC PARISHES DORCHESTER FOOD CO-OP DUET INC. ELLIE FUND ENGLISH FOR NEW BOSTONIANS EVERSOURCE FAIR FOODS (BOSTON) FAMILY NURTURING CENTER FATHER BILL'S AND MAINSPRING FATHERS' UPLIFT FENWAY ALLIANCE FENWAY CIVIC ASSOCIATION FENWAY COMMUNITY CENTER FENWAY COMMUNITY DEVELOPMENT CORPORATION FENWAY HEALTH FIRST SOURCE FOUND IN TRANSLATION FRIENDS OF GENEVA CLIFFS FRIENDS OF RONAN PARK GLAAD GREATER BOSTON CHINESE GOLDEN AGE CENTER GREATER BOSTON FOOD BANK GREATER BOWDOIN GENEVA NEIGHBORHOOD ASSOCIATION GREATER FOUR CORNERS ACTION COALITION GREENROOTS HACK DIVERSITY HEALTH CARE FOR ALL HEALTHCARE WITHOUT HARM HEALTH IMPERATIVES HMS DIVERSITY AFFILIATES HOSPITALITY HOMES INTERNATIONAL INSTITUTE OF NEW ENGLAND JANE DOE INC. JASMINE GRACE OUTREACH JEWISH COMMUNITY CENTER (JCC) OF GREATER BOSTON JEWISH FAMILY AND CHILDREN'S SERVICES JEWISH VOCATIONAL SERVICES JOE ANDRUZZI CANCER FUND JOSIAH QUINCY ELEMENTARY SCHOOL JOSLIN DIABETES CENTER JUNIOR ACHIEVEMENT OF NORTHERN NE JUST A START JUSTICE RESOURCE INSTITUTE (JRI) IN BOSTON LA ALIANZA HISPANA LA COLABORATIVA LEUKEMIA & LYMPHOMA SOCIETY LOUIS D. BROWN PEACE INSTITUTE MADISON PARK TECHNICAL HIGH SCHOOL MA PROGRAM MASS COLLEGE OF ART AND DESIGN MASS HIRE MASSACHUSETTS COMMISSION FOR THE BLIND MASSACHUSETTS COMMISSION FOR THE DEAF AND HARD OF HEARING MASSACHUSETTS DEPARTMENT OF CHILDREN AND FAMILIES MASSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION (MASSDEP) MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH COVID-19 PANDEMIC RESPONSE MASSACHUSETTS DEPARTMENT OF TRANSITIONAL ASSISTANCE MASSACHUSETTS DEPARTMENT OF TRANSPORTATION (MASSDOT) MASSACHUSETTS HIV DRUG ASSISTANCE PROGRAM MASSACHUSETTS HEALTH INFORMATION HIGHWAY MASSACHUSETTS IMMIGRANT AND REFUGEE ADVOCACY COALITION (MIRA) MASSACHUSETTS INSTITUTE OF TECHNOLOGY MASSACHUSETTS INSURANCE COMMISSION MASSACHUSETTS GENERAL HOSPITAL MASSACHUSETTS REHABILITATION COMMISSION MASSACHUSETTS STATE POLICE MEDICAL ACADEMIC AND SCIENTIFIC COMMUNITY ORGANIZATION (MASCO) MEDICAL INTELLIGENCE CENTER MEETINGHOUSE HILL CIVIC ASSOCIATION METRO HOUSING:BOSTON MILLENNIUM TRAINING INSTITUTE MOUNT AUBURN HOSPITAL NEW ENGLAND AIDS EDUCATION AND TRAINING CENTER NEWTON NORTH HIGH SCHOOL NORTHEASTERN UNIVERSITY NORTH SHORE COMMUNITY COLLEGE NORTH SUFFOLK MENTAL HEALTH ASSOCIATION OPPORTUNITY COMMUNITIES OPERATION ABLE OF GREATER BOSTON OPERATION P.E.A.C.E. OUTER CAPE HEALTH SERVICES PARTNERS FOR WORLD HEALTH PEER HEALTH EXCHANGE PINE STREET INN POLITICAL ASYLUM AND IMMIGRANT'S RIGHTS (PAIR) PROJECT PRACTICE GREEN HEALTH PRIVATE INDUSTRY COUNCIL PROJECT HOME AGAIN PROJECT PLACE RIA, INC. RIVERSIDE COMMUNITY CARE ROCA ROOM TO GROW ROSE KENNEDY GREENWAY CONSERVANCY ROXBURY COMMUNITY COLLEGE ROXBURY TENANTS OF HARVARD RYAN WHITE DENTAL PROGRAM SCALE (SOMERVILLE PUBLIC SCHOOLS) SEXUAL ASSAULT NURSE EXAMINER (SANE) PROGRAM SEXUAL ASSAULT UNIT OF DISABLED PERSONS PROTECTION COMMISSION SOCIEDAD LATINA SOUTH COVE COMMUNITY HEALTH CENTER SPORTSMEN TENNIS AND ENRICHMENT CENTER STEPS TO SUCCESS ST. MARY'S CENTER FOR WOMEN AND CHILDREN ST. PETER'S TEEN CENTER THE FAMILY VAN THE DIMOCK CENTER THE LATINO MEDICAL STUDENT ASSOCIATION THE NEIGHBORHOOD DEVELOPERS THE NETWORK/LA RED THE PARTNERSHIP, INC. THE STUDENT NATIONAL MEDICAL ASSOCIATION, NATIONAL AND NE CHAPTER TRAINING, INC. TRUSTEES OF RESERVATIONS TUFTS MEDICAL CENTER UP ACADEMY DORCHESTER SCHOOL U.S. ENVIRONMENTAL PROTECTION AGENCY (EPA) UNITED CEREBRAL PALSY OF METROBOSTON VICTIM RIGHTS LAW CENTER VICTORY PROGRAMS VIRIDIAN APARTMENTS WILMERHALE LEGAL SERVICES (ALSO KNOWN AS THE LEGAL SERVICE CENTER) WONDERFUND OF MASSACHUSETTS WORK OPPORTUNITIES UNLIMITED YMCA OF GREATER BOSTON YMCA TRAINING, INC.

AS DESCRIBED IN DETAIL IN THIS SUPPORTING NARRATIVE TO THE FORM 990
AS DESCRIBED IN DETAIL IN THIS SUPPORTING NARRATIVE TO THE FORM 990 SCHEDULE H, BIDMC IS DEEPLY DEDICATED TO ITS COMMUNITY BENEFITS OPERATIONS AND TO IMPROVING THE HEALTH OF ITS COMMUNITY. HOWEVER, IN RESPONSE TO SCHEDULE H, PART V, SECTION B, QUESTION 11, THERE WERE SOME NEEDS IDENTIFIED IN THE CHNA THAT ARE NOT INCLUDED IN THE IS. IN THE FY 2023 - 2025 IS, WHICH WILL GUIDE THE BIDMC'S COMMUNITY BENEFITS ACTIVITIES FOR THE FISCAL PERIODS ENDING SEPTEMBER 30, 2023, SEPTEMBER 30, 2024 AND SEPTEMBER 30, 2025, EXAMPLES OF IDENTIFIED NEEDS THAT WILL NOT BE MET IN THESE YEARS ARE ADDRESSING THE DIGITAL DIVIDE (I.E., PROMOTING EQUITABLE ACCESS TO THE INTERNET) AND SUPPORTING EDUCATION ACROSS THE LIFESPAN. IN ADDITION, THERE WERE SOME NEEDS IDENTIFIED IN THE 2019 CHNA THAT ARE NOT INCLUDED IN THE 2019 IS AND WHICH HAVE GUIDED THE BIDMC'S COMMUNITY BENEFITS ACTIVITIES FOR THE FISCAL PERIOD COVERED BY THIS FILING. WHILE THESE ISSUES ARE IMPORTANT, BIDMC'S CBAC AND SENIOR LEADERSHIP TEAM DECIDED THAT THESE ISSUES WERE OUTSIDE OF THE MEDICAL CENTER'S SPHERE OF INFLUENCE AND INVESTMENTS IN OTHER AREAS WERE BOTH MORE FEASIBLE AND LIKELY TO HAVE GREATER IMPACT. AS A RESULT, BIDMC RECOGNIZED THAT OTHER PUBLIC AND PRIVATE ORGANIZATIONS IN ITS CBSA, BOSTON, AND THE COMMONWEALTH WERE BETTER POSITIONED TO FOCUS ON THESE ISSUES. BIDMC REMAINS OPEN AND WILLING TO WORK WITH COMMUNITY RESIDENTS, OTHER HOSPITALS, AND OTHER PUBLIC AND PRIVATE PARTNERS TO ADDRESS THESE ISSUES, PARTICULARLY AS PART OF A BROAD, STRONG COLLABORATIVE. AS NOTED IN DETAIL ABOVE, THE BIDMC'S PRIMARY TOOL FOR ASSESSING THE HEALTHCARE NEEDS OF THE COMMUNITIES SERVED IS THROUGH THE CHNA AND IS (SCHEDULE H PART VI QUESTION 2).FORM 990 SCHEDULE H PART VI SUPPLEMENTAL INFORMATIONTHE PURPOSE OF THIS FORM 990 SCHEDULE H NARRATIVE DISCLOSURE IS TO HELP THE READER UNDERSTAND IN MORE DETAIL HOW BIDMC CARES FOR ITS COMMUNITY BY PROVIDING FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS. AS DEMONSTRATED IN THIS SCHEDULE H,9.4% OF BIDMC'S TOTAL EXPENSES AS REPORTED ON FORM 990 PART IX, LINE 24, ARE INCURRED IN PROVIDING FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST. COMMUNITY BENEFITSANNUAL COMMUNITY BENEFITS REPORTAS PREVIOUSLY NOTED IN THIS FILING BIDMC'S MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND IMPLEMENTATION STRATEGY WERE COMPLETED AND APPROVED BY THE COMMUNITY BENEFITS ADVISORY COMMITTEE AND BOARD OF DIRECTORS DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2022, AS REQUIRED PURSUANT TO THE REGULATIONS UNDER INTERNAL REVENUE CODE SECTION 501(R). IN ADDITION, AS NOTED IN THIS FORM 990 SCHEDULE H, PART I, LINES 6A AND 6B, THE HOSPITAL PREPARES AN ANNUAL COMMUNITY BENEFITS REPORT THAT IS SUBMITTED TO THE MASSACHUSETTS ATTORNEY GENERAL (SCHEDULE H, PART VI, LINE 7). THAT FILING IS AVAILABLE FOR PUBLIC INSPECTION AT THE ATTORNEY GENERAL'S OFFICE, ON THE ATTORNEY GENERAL'S WEBSITE AND ON THE HOSPITAL WEBSITE AT HTTPS://WWW.BIDMC.ORG/ABOUT-BIDMC/HELPING-OUR-COMMUNITY/COMMUNITY-INITIATIVES/COMMUNITY-BENEFITS.THERE ARE SOME DIFFERENCES BETWEEN THE MASSACHUSETTS ATTORNEY GENERAL DEFINITION OF CHARITY CARE AND COMMUNITY BENEFITS AND THE INTERNAL REVENUE SERVICE DEFINITION OF FINANCIAL ASSISTANCE AND COMMUNITY BENEFITS. AS SUCH, THERE ARE VARIANCES BETWEEN THIS SCHEDULE H DISCLOSURE AND THE REPORT BIDMC FILED WITH THE ATTORNEY GENERAL'S OFFICE. EMERGENCY CARE ACCESSIN ADDITION, AS NOTED IN THIS FORM 990, SCHEDULE H, PART V, SECTION A, BIDMC IS A GENERAL MEDICAL AND SURGICAL HOSPITAL, RESEARCH HOSPITAL AND TEACHING HOSPITAL, PROVIDING 24 HOUR EMERGENCY MEDICAL CARE TO ALL PATIENTS WITHOUT REGARD TO ABILITY TO PAY. FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITSCHARITY CARE AND MEANS TESTED GOVERNMENT PROGRAMSFINANCIAL ASSISTANCEBIDMC'S NET COST OF CHARITY CARE, INCLUDING CARE FOR EMERGENT SERVICES PROVIDED TO NON-PAYING PATIENTS AND INCLUDING PAYMENTS TO THE HEALTH SAFETY NET TRUST, WAS $ 15,241,421 FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2022 AND HAS BEEN REPORTED ON THIS SCHEDULE H, PART I, LINE 7A.AS PREVIOUSLY NOTED IN THIS FORM 990, BIDMC IS ONE OF TEN HOSPITALS WITHIN THE BETH ISRAEL LAHEY HEALTH NETWORK. COMBINED THESE HOSPITALS' NET COST OF CHARITY CARE, INCLUDING CARE FOR EMERGENT SERVICES PROVIDED TO NON-PAYING PATIENTS AND INCLUDING PAYMENTS TO THE HEALTH SAFETY NET TRUST, WAS $55,879,719 FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2022. AS REPORTED IN SCHEDULE H PART I LINE 3 AND AGAIN IN SCHEDULE H PART V SECTION B LINE 13, ELIGIBILITY FOR FREE CARE TO LOW-INCOME INDIVIDUALS IS DETERMINED USING FEDERAL POVERTY GUIDELINES OF 400% FOR FULL FREE CARE AND 400% FOR PARTIAL FREE CARE. ELIGIBILITY FOR DISCOUNTED CARE IS DETERMINED BY REVIEWING THE INDIVIDUAL'S EMPLOYMENT STATUS, FAMILY SIZE AND MONTHLY EXPENSES, INCLUDING MEDICAL HARDSHIP REVIEW.OTHER UNCOMPENSATED CHARITY CAREMEDICAID AND MEDICAREIN ADDITION TO THE CHARITY CARE REPORTED ABOVE, BIDMC ALSO PROVIDES CARE TO PATIENTS WHO PARTICIPATE IN OTHER PROGRAMS DESIGNED TO SUPPORT LOW-INCOME FAMILIES, INCLUDING PARTICULARLY THE MEDICAID PROGRAM, WHICH IS JOINTLY FUNDED BY FEDERAL AND STATE GOVERNMENTS. THE MASSACHUSETTS HEALTH REFORM LAW PROVIDED AN INITIATIVE FOR EXPANSION OF MEDICAID COVERAGE TO GREATER POPULATIONS AND FOR ENROLLMENT OF UNINSURED PATIENTS IN OTHER INSURANCE PROGRAMS. PAYMENTS FROM MEDICAID AND OTHER PROGRAMS THAT INSURE LOW-INCOME POPULATIONS DO NOT COVER THE COST OF SERVICES PROVIDED. DURING THE FISCAL PERIOD COVERED BY THIS FILING, BIDMC GENERATED $90,727,930 RELATED TO TREATING MEDICAID PATIENTS WHICH WAS LESS THAN THE COST OF CARE PROVIDED BY BIDMC FOR SUCH SERVICES BY $9,336,590 AS REPORTED ON THIS SCHEDULE H, PART I LINE 7B. DURING THE FISCAL PERIOD COVERED BY THIS FILING, 18.1% OR 171,547 OF BIDMC'S PATIENT ENCOUNTERS WERE WITH MEDICAID PATIENTS. IN ADDITION, 46.1% OR 437,962 OF THE HOSPITAL'S PATIENT CASES WERE WITH MEDICARE PATIENTS MEDICARE IS THE FEDERALLY SPONSORED HEALTH INSURANCE PROGRAM FOR ELDERLY OR DISABLED PATIENTS, AND BIDMC PROVIDES CARE TO PATIENTS WHO PARTICIPATE IN THE MEDICARE PROGRAM. DURING THE FISCAL PERIOD COVERED BY THIS FILING, BIDMC GENERATED $326,110,471 RELATED TO TREATING MEDICARE PATIENTS. THE COSTS OF PROVIDING CARE TO MEDICARE PATIENTS EXCEEDED REVENUE BY $23,184,973. OF THESE AMOUNTS, REVENUE OF $25,866,380 IS RELATED TO THE PROVISION OF PSYCHIATRY INPATIENT, BOWDOIN STREET HEALTH CENTER, CHESTNUS HILL UC, AND CHELSEA UC AND IS INCLUDED ON THIS SCHEDULE H, PART I, LINE 7G, AS PART OF SUBSIDIZED HEALTH SERVICES BECAUSE THE COST OF THOSE SERVICES EXCEEDED REVENUES BY $39,738,427. IN RESPONSE TO THE FORM 990, SCHEDULE H, PART III, LINE 8, ALTHOUGH BIDMC CONSIDERS THE PROVISION OF CLINICAL CARE TO ALL MEDICARE PATIENTS AS PART OF ITS COMMUNITY BENEFIT, THE REMAINING CARE TO MEDICARE PATIENTS IS NOT QUANTIFIED ON PAGE 1 OF THE SCHEDULE H. INSTEAD, PER THE IRS INSTRUCTIONS TO SCHEDULE H, BIDMC HAS SEPARATELY REPORTED THIS AMOUNT IN SCHEDULE H, PART III, LINE 7, AS REQUIRED. HOWEVER, IF THE MEDICARE SHORTFALL WERE INCLUDED IN THE SCHEDULE H PART I LINE 7 CALCULATION, IT WOULD INCREASE TO 10.38%.

BAD DEBTS
IN ADDITION TO CHARITY CARE AND SHORTFALLS IN PROVIDING SERVICES TO PATIENTS INSURED UNDER STATE AND FEDERAL PROGRAMS, BIDMC ALSO INCURS LOSSES RELATED TO SELF-PAY PATIENTS WHO FAIL TO MAKE PAYMENTS FOR SERVICES OR INSURED PATIENTS WHO FAIL TO PAY COINSURANCE OR DEDUCTIBLES FOR WHICH THEY ARE RESPONSIBLE UNDER INSURANCE CONTRACTS. BAD DEBT EXPENSE IS INCLUDED IN UNCOMPENSATED CARE EXPENSE IN THE CONSOLIDATED FINANCIAL STATEMENTS AND INCLUDES THE PROVISION FOR ACCOUNTS ANTICIPATED TO BE UNCOLLECTIBLE. CHARGES FOR THOSE SERVICES DURING THE FISCAL PERIOD COVERED BY THIS FILING OF $14,605,323 AND ARE REPORTED AS BAD DEBT ON FORM 990, SCHEDULE H, PART III, LINE 2. AS REQUIRED BY THE INSTRUCTIONS TO THIS FORM 990 SCHEDULE H, LOSSES RELATED TO BAD DEBTS HAVE NOT BEEN INCLUDED IN THE CALCULATION OF FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS IN SCHEDULE H PART I LINE 7. RATHER IT HAS BEEN SEPARATELY REPORTED IN SCHEDULE H PART III AS REQUIRED. THE PERCENTAGES CALCULATED IN PART I, LINE 7, COLUMN F WERE BASED ON EACH ITEM OF FINANCIAL ASSISTANCE AND COMMUNITY BENEFIT AS A PERCENTAGE OF TOTAL EXPENSES REPORTED IN PART IX OF THIS FORM 990. THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF THE BETH ISRAEL LAHEY HEALTH, INC. AND AFFILIATES FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2022 INCLUDE THE ACCOUNTS OF: BETH ISRAEL DEACONESS MEDICAL CENTER, INC. (BIDMC), MOUNT AUBURN HOSPITAL (MAH), NEW ENGLAND BAPTIST HOSPITAL (NEBH), BETH ISRAEL DEACONESS HOSPITAL MILTON, INC. (MILTON), BETH ISRAEL DEACONESS HOSPITAL NEEDHAM, INC. (NEEDHAM), BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH, INC. (PLYMOUTH), LAHEY CLINIC FOUNDATION (LCF) , LAHEY CLINIC (LCI), LAHEY CLINIC HOSPITAL D/B/A LAHEY HOSPITAL AND MEDICAL CENTER (LHMC), WINCHESTER HOSPITAL (WINCHESTER), NORTHEAST HOSPITAL CORPORATION (NORTHEAST), ANNA JAQUES HOSPITAL (AJH) AND AFFILIATES. THE FINANCIAL STATEMENTS OF THE SYSTEM ALSO INCLUDE A CONTROLLED AFFILIATE, HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER, INC. (HMFP).FINANCIAL STATEMENT FOOTNOTESREVENUES UNDER THE TRADITIONAL FEE FOR SERVICE MEDICARE AND MEDICAID PROGRAMS ARE BASED PRIMARILY ON PROSPECTIVE PAYMENT SYSTEMS. RETROSPECTIVELY DETERMINED COST-BASED REVENUES UNDER THESE PROGRAMS, WHICH WERE MORE PREVALENT IN EARLIER PERIODS, AND CERTAIN OTHER PAYMENTS, SUCH AS DISPROPORTIONATE SHARE HOSPITAL AND BAD DEBT EXPENSE REIMBURSEMENT, WHICH ARE BASED ON OUR HOSPITALS' COST REPORTS, ARE ESTIMATED USING HISTORICAL TRENDS AND CURRENT FACTORS. COST REPORT SETTLEMENTS UNDER THESE PROGRAMS ARE SUBJECT TO AUDIT BY MEDICARE AND MEDICAID AUDITORS AND ADMINISTRATIVE AND JUDICIAL REVIEW, AND IT CAN TAKE SEVERAL YEARS UNTIL FINAL SETTLEMENT OF SUCH MATTERS IS DETERMINED AND COMPLETELY RESOLVED. THE SYSTEM RECORDS ACCRUALS TO REFLECT THE EXPECTED FINAL SETTLEMENTS ON COST REPORTS. FOR FILED COST REPORTS, THE ACCRUAL IS RECORDED BASED ON THOSE COST REPORTS AND SUBSEQUENT ACTIVITY. THE ACCRUAL FOR PERIODS FOR WHICH A COST REPORT IS YET TO BE FILED IS RECORDED BASED ON ESTIMATES OF WHAT THE SYSTEM EXPECTS TO REPORT ON THE FILED COST REPORTS. AFTER THE COST REPORT IS FILED, THE ACCRUAL MAY NEED TO BE ADJUSTED.EMERGENCY CARE ACCESSBETH ISRAEL DEACONESS MEDICAL CENTER IS A TERTIARY CARE LICENSED ACADEMIC MEDICAL CENTER, PROVIDING MEDICAL AND SURGICAL CARE, TEACHING AND RESEARCH AND AS NOTED ELSEWHERE IN THIS RETURN, PROVIDES 24 HOUR EMERGENCY MEDICAL CARE TO ALL PATIENTS WITHOUT REGARD TO ABILITY TO PAY. THE ED'S MISSION, ALIGNED WITH BIDMC'S MISSION, IS TO DISTINGUISH ITSELF FROM OTHER PROVIDERS THROUGH EXCELLENCE IN PATIENT CARE, EDUCATION, RESEARCH AND THROUGH IMPROVED HEALTH IN THE COMMUNITIES SERVED. BIDMC'S DEPARTMENT OF EMERGENCY MEDICINE, PROVIDES MEDICALLY NECESSARY CARE FOR ALL PEOPLE REGARDLESS OF THEIR ABILITY TO PAY 24 HOURS A DAY, SEVEN DAYS A WEEK, AND 365 DAYS A YEAR (SCHEDULE H, PART V, SECTION A AND SECTION B QUESTION 21).THE BIDMC DEPARTMENT OF EMERGENCY MEDICINE PROVIDES MEDICALLY NECESSARY CARE FOR ALL PEOPLE REGARDLESS OF THEIR ABILITY TO PAY. THE HOSPITAL OFFERS THIS CARE FOR ALL PATIENTS THAT COME TO THIS FACILITY 24 HOURS A DAY, 7 DAYS A WEEK, AND 365 DAYS A YEAR. FINANCIAL ASSISTANCE POLICYINTERNAL REVENUE CODE SECTION 501(R)(4)FINANCIAL ASSISTANCE POLICY PURPOSE BIDMC IS DEDICATED TO PROVIDING FINANCIAL ASSISTANCE TO PATIENTS WHO HAVE HEALTHCARE NEEDS AND ARE UNINSURED, UNDERINSURED, INELIGIBLE FOR A GOVERNMENT PROGRAM OR OTHERWISE UNABLE TO PAY FOR MEDICALLY NECESSARY CARE BASED ON THEIR INDIVIDUAL FINANCIAL SITUATION. THIS FINANCIAL ASSISTANCE POLICY IS INTENDED TO BE IN COMPLIANCE WITH APPLICABLE FEDERAL AND STATE LAWS FOR OUR SERVICE AREA. PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE WILL RECEIVE DISCOUNTED CARE FROM BIDMC AS WELL AS PROVIDERS WHO FOLLOW BIDMC'S FINANCIAL ASSISTANCE POLICY. A LIST OF ALL PROVIDERS WHO PROVIDE CARE WITHIN BIDMC AS WELL AS INFORMATION INDICATING IF THE LISTED PROVIDERS FOLLOW BIDMC'S FINANCIAL ASSISTANCE POLICY IS INCLUDED IN APPENDIX 5 TO THE FINANCIAL ASSISTANCE POLICY. BIDMC DOES NOT DISCRIMINATE BASED ON THE PATIENT'S AGE, GENDER, RACE, CREED, RELIGION, DISABILITY, SEXUAL ORIENTATION, GENDER IDENTITY, NATIONAL ORIGIN OR IMMIGRATION STATUS WHEN DETERMINING ELIGIBILITY.FINANCIAL ASSISTANCE POLICY, CREDIT AND COLLECTION POLICY AND EMERGENCY CARE POLICYAS REQUIRED BY IRC SECTION 501(R)(4) AND THE REGULATIONS PROMULGATED THEREUNDER, THE HOSPITAL MAINTAINS A WRITTEN FINANCIAL ASSISTANCE POLICY (FAP) THAT APPLIES TO ALL EMERGENCY AND OTHER MEDICALLY NECESSARY CARE PROVIDED BY THE HOSPITAL FACILITY. (SCHEDULE H PART I QUESTIONS 1A AND 1B). DETAIL RELATED TO EMERGENCY AND OTHER MEDICALLY NECESSARY CARE COVERED BY THE POLICY IS INCLUDED WITHIN THE POLICY AND THE DEFINITION OF EMERGENCY CARE MEETS THE DEFINITION OF THE EMERGENCY MEDICAL TREATMENT AND LABOR ACT (EMTALA), SECTION 1867 OF THE SOCIAL SECURITY ACT (42 USC 1395DD). (SCHEDULE H PART V SECTION B QUESTION 21). THE FAP INCLUDES A LIST OF PROVIDERS OTHER THAN THE HOSPITAL ITSELF, WHICH ARE COVERED BY THE FAP AND SPECIFIES ELIGIBILITY CRITERIA FOR BOTH FREE AND DISCOUNTED CARE. THE FAP ALSO INCLUDES THE BASIS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS. THE PROVIDER LIST IS UPDATED NOT LESS THAN QUARTERLY. THE HOSPITAL MAINTAINS A SEPARATE CREDIT AND COLLECTION POLICY AS PERMITTED UNDER THE TREASURY REGULATIONS AND THIS CREDIT AND COLLECTION POLICY IS REFERENCED WITHIN THE FAP AS REQUIRED, ALONG WITH INFORMATION ON HOW TO OBTAIN A FREE COPY OF THE CREDIT AND COLLECTION POLICY. (SCHEDULE H PART III SECTION C QUESTIONS 9A AND 9B AND PART V SECTION B QUESTION 17). THE HOSPITAL'S FAP AND CREDIT & COLLECTION POLICY WERE ADOPTED BY THE HOSPITAL'S BOARD PRIOR TO SEPTEMBER 30, 2017 AND THESE DOCUMENTS WERE ALL EFFECTIVE AS OF OCTOBER 1, 2017, THE FIRST DAY OF THE HOSPITAL'S FISCAL YEAR IN WHICH THE HOSPITAL WAS REQUIRED TO BE IN COMPLIANCE WITH THE REGULATIONS PROMULGATED BY THE TREASURY AND RELATED TO IRC SECTION 501(R).

FINANCIAL ASSISTANCE POLICYAPPLYING FOR ASSISTANCE
THE HOSPITAL'S FAP INCLUDES INFORMATION ON THE METHOD FOR APPLYING FOR FINANCIAL ASSISTANCE UNDER THE FAP. IN ADDITION, THE HOSPITAL'S FINANCIAL ASSISTANCE APPLICATION INCLUDES A LIST OF INFORMATION/DOCUMENTATION REQUIRED AS PART OF A PATIENT'S APPLICATION FOR FINANCIAL ASSISTANCE. (SCHEDULE H PART V SECTION B QUESTION 15)FINANCIAL ASSISTANCE POLICYELIGIBILITY GUIDELINES THE HOSPITAL'S FAP USES THE FEDERAL POVERTY GUIDELINES IN DETERMINING ELIGIBILITY FOR FREE AND DISCOUNTED CARE. (SCHEDULE H PART I QUESTION 3A AND 3B AND PART V SECTION B QUESTION 13). IN ADDITION, THE HOSPITAL'S FAP PROVIDES FOR FINANCIAL ASSISTANCE BASED ON MEDICAL HARDSHIP AND ASSET LEVEL (SCHEDULE H PART I QUESTIONS 3C AND 4, PART V SECTION B QUESTION 13 AND PART VI QUESTION 3). FINALLY, THE HOSPITAL UNDERSTANDS THAT NOT ALL PATIENTS ARE ABLE TO COMPLETE A FINANCIAL ASSISTANCE APPLICATION OR COMPLY WITH REQUESTS FOR DOCUMENTATION. THERE MAY BE INSTANCES UNDER WHICH A PATIENT/GUARANTOR'S QUALIFICATION FOR FINANCIAL ASSISTANCE IS ESTABLISHED WITHOUT COMPLETING THE APPLICATION FORM. OTHER INFORMATION MAY BE USED BY THE HOSPITAL TO DETERMINE WHETHER A PATIENT/GUARANTOR'S ACCOUNT IS UNCOLLECTIBLE, AND THIS INFORMATION WILL BE USED TO DETERMINE PRESUMPTIVE ELIGIBILITY AS OUTLINED IN THE HOSPITAL'S FAP. (SCHEDULE H PART I QUESTIONS 3C).FINANCIAL ASSISTANCEPUBLIC ASSISTANCE PROGRAMS (SCHEDULE H PART I QUESTION 3C)IN ADDITION TO FINANCIAL ASSISTANCE ELIGIBILITY UNDER THE HOSPITAL'S FAP, FOR THOSE INDIVIDUALS WHO ARE UNINSURED OR UNDERINSURED, THE HOSPITAL WILL WORK WITH PATIENTS TO ASSIST THEM IN APPLYING FOR PUBLIC ASSISTANCE AND/OR HOSPITAL FINANCIAL ASSISTANCE PROGRAMS THAT MAY COVER SOME OR ALL OF THEIR UNPAID HOSPITAL BILLS. IN ORDER TO HELP UNINSURED AND UNDERINSURED INDIVIDUALS FIND AVAILABLE AND APPROPRIATE OPTIONS, THE HOSPITAL WILL PROVIDE ALL INDIVIDUALS WITH A GENERAL NOTICE OF THE AVAILABILITY OF PUBLIC ASSISTANCE AND FINANCIAL ASSISTANCE PROGRAMS DURING THE PATIENT'S INITIAL IN-PERSON REGISTRATION AT A HOSPITAL LOCATION FOR A SERVICE, IN ALL BILLING INVOICES THAT ARE SENT TO A PATIENT OR GUARANTOR, AND WHEN THE PROVIDER IS NOTIFIED OR THROUGH ITS OWN DUE DILIGENCE BECOMES AWARE OF A CHANGE IN THE PATIENT'S ELIGIBILITY STATUS FOR PUBLIC OR PRIVATE INSURANCE COVERAGE.HOSPITAL PATIENTS MAY BE ELIGIBLE FOR FREE OR REDUCED COST OF HEALTH CARE SERVICES THROUGH VARIOUS STATE PUBLIC ASSISTANCE PROGRAMS AS WELL AS THE HOSPITAL FINANCIAL ASSISTANCE PROGRAMS (INCLUDING BUT NOT LIMITED TO MASSHEALTH, THE PREMIUM ASSISTANCE PAYMENT PROGRAM OPERATED BY THE HEALTH CONNECTOR, THE CHILDREN'S MEDICAL SECURITY PROGRAM, THE HEALTH SAFETY NET, AND MEDICAL HARDSHIP). SUCH PROGRAMS ARE INTENDED TO ASSIST LOW-INCOME PATIENTS TAKING INTO ACCOUNT EACH INDIVIDUAL'S ABILITY TO CONTRIBUTE TO THE COST OF HIS OR HER CARE. FOR THOSE INDIVIDUALS THAT ARE UNINSURED OR UNDERINSURED, THE HOSPITAL WILL, WHEN REQUESTED, HELP THEM WITH APPLYING FOR EITHER COVERAGE THROUGH PUBLIC ASSISTANCE PROGRAMS OR HOSPITAL FINANCIAL ASSISTANCE PROGRAMS THAT MAY COVER ALL OR SOME OF THEIR UNPAID HOSPITAL BILLS.THE HOSPITAL IS AVAILABLE TO ASSIST PATIENTS IN ENROLLING INTO STATE HEALTH COVERAGE PROGRAMS. THESE INCLUDE MASSHEALTH, THE PREMIUM ASSISTANCE PAYMENT PROGRAM OPERATED BY THE STATE'S HEALTH CONNECTOR, AND THE CHILDREN'S MEDICAL SECURITY PLAN. FOR THESE PROGRAMS, APPLICANTS CAN SUBMIT AN APPLICATION THROUGH AN ONLINE WEBSITE (WHICH IS CENTRALLY LOCATED ON THE STATE'S HEALTH CONNECTOR WEBSITE), A PAPER APPLICATION, OR OVER THE PHONE WITH A CUSTOMER SERVICE REPRESENTATIVE LOCATED AT EITHER MASSHEALTH OR THE CONNECTOR. INDIVIDUALS MAY ALSO ASK FOR ASSISTANCE FROM HOSPITAL FINANCIAL COUNSELORS (ALSO CALLED CERTIFIED APPLICATION COUNSELORS) WITH SUBMITTING THE APPLICATION EITHER ON THE WEBSITE OR THROUGH A PAPER APPLICATION.FINANCIAL ASSISTANCE POLICYTRANSLATIONS THE HOSPITAL'S FAP, CREDIT AND COLLECTION POLICY AND PLAIN LANGUAGE SUMMARY OF THE FAP (SEE DETAIL BELOW) HAVE ALL BEEN TRANSLATED INTO THE LANGUAGES SPOKEN BY THOSE IN THE HOSPITAL'S COMMUNITY WHO MAY COMMUNICATE IN A LANGUAGE OTHER THAN ENGLISH. THE HOSPITAL HAS TRANSLATED THESE DOCUMENTS INTO THE LANGUAGES OF LIMITED ENGLISH PROFICIENCY (LEP) OF ITS PATIENTS, 5% OF THE POPULATION OR 1000 PERSONS, WHICHEVER IS LESS, IN ACCORDANCE WITH THE REGULATIONS PROMULGATED UNDER IRC SECTION 501(R). BASED ON THE HOSPITAL'S REVIEW OF THIS SAFE HARBOR, THE HOSPITAL HAS TRANSLATED THESE DOCUMENTS INTO THE FOLLOWING LANGUAGES: SPANISH, SIMPLIFIED CHINESE, TRADITIONAL CHINESE, RUSSIAN, PORTUGUESE, VIETNAMESE, FRENCH, HAITIAN CREOLE, HINDI, ITALIAN, JAPANESE, CAPE VERDEAN, AND ARABIC. (SCHEDULE H PART V SECTION B QUESTION 16I)FINANCIAL ASSISTANCE POLICYWIDELY PUBLICIZING AND AVAILABILITYCOPIES OF THE FAP, CREDIT AND COLLECTION POLICY, FAP SUMMARY AND APPLICATION FOR FINANCIAL ASSISTANCE ARE ALL AVAILABLE IN BOTH ENGLISH AND ALL LEP LANGUAGES AT THE HOSPITAL, BY MAIL FREE OF CHARGE AND/OR ON THE HOSPITAL'S WEBSITE: (SCHEDULE H PART V SECTION B QUESTIONS 16A, 16B, 16C, 16D, 16E, 16H) AT HTTPS://WWW.BIDMC.ORG/PATIENT-AND-VISITOR-INFORMATION/PATIENT-INFORMATION/YOUR-HOSPITAL-BILL/FINANCIAL-ASSISTANCE. IN ADDITION, THE FAP, CREDIT AND COLLECTION POLICY, FAP SUMMARY AND APPLICATION FOR FINANCIAL ASSISTANCE ARE ALL AVAILABLE IN THE HOSPITAL'S EMERGENCY DEPARTMENT AND FINANCIAL COUNSELING OFFICE. (SCHEDULE H PART V SECTION B QUESTION 16F AND SCHEDULE H PART VI QUESTION 3).THE HOSPITAL MAINTAINS SIGNAGE AND CONSPICUOUS PUBLIC DISPLAYS ABOUT FINANCIAL ASSISTANCE AND THE FAP DESIGNED TO ATTRACT THE ATTENTION OF PATIENTS AND VISITORS, INCLUDING BOTH THE EMERGENCY DEPARTMENT AND ADMISSIONS. SUCH SIGNAGE IS POSTED BOTH IN ENGLISH AND THE LEP LANGUAGES NOTED ABOVE. IN ADDITION, FINANCIAL COUNSELING PERSONNEL ROUTINELY VISIT LOCATIONS DESIGNATED FOR SIGNAGE TO ENSURE THAT SUCH SIGNAGE REMAINS VISIBLE TO PATIENTS AND VISITORS AS ATTENDED. THE HOSPITAL PROVIDES INFORMATION ABOUT THE FAP TO PATIENTS BEFORE DISCHARGE AND CONSPICUOUSLY WITHIN BILLING STATEMENTS. INFORMATION PROVIDED TO PATIENTS IN THESE COMMUNICATIONS INCLUDE CONTACT INFORMATION FOR THOSE THAT CAN HELP PROVIDE ADDITIONAL INFORMATION ABOUT THE FAP, INFORMATION ON THE APPLICATION PROCESS AND THE WEBSITE WHERE THE FAP CAN BE OBTAINED. ADDITIONALLY, A PLAIN LANGUAGE SUMMARY OF THE FAP IS PROVIDED TO PATIENTS AS PART OF THE INTAKE PROCESS. (SCHEDULE H PART V SECTION B QUESTION 16G). FINANCIAL ASSISTANCE POLICYPLAIN LANGUAGE SUMMARYAS NOTED IN THIS NARRATIVE SUPPORT TO THE FORM 990 SCHEDULE H, THE HOSPITAL HAS A PLAIN LANGUAGE SUMMARY OF ITS FAP. THIS IS A WRITTEN STATEMENT DESIGNED TO NOTIFY PATIENTS AND VISITORS THAT THE HOSPITAL HAS A WRITTEN FAP AND PROVIDES FINANCIAL ASSISTANCE. THIS PLAIN LANGUAGE SUMMARY INCLUDES INFORMATION ON FREE AND DISCOUNTED CARE, HOW TO OBTAIN A COPY OF THE FAP POLICY AND APPLICATION, INCLUDING THE WEBSITE ADDRESS, THE LOCATION AND PHONE NUMBER OF THE FINANCIAL COUNSELING OFFICE. THE PLAIN LANGUAGE SUMMARY ALSO INCLUDES THE LIST OF LANGUAGES INTO WHICH THE FAP AND SUMMARY HAVE BEEN TRANSLATED AS WELL AS HOW TO ACCESS INFORMATION ON PROVIDERS NOT COVERED BY THE FAP AND TO WHICH OTHER RELATED HOSPITALS APPROVAL UNDER THE FAP WILL APPLY. LINKS TO FINANCIAL ASSISTANCE POLICY AND RELATED DOCUMENTSTHE LINK TO THE BIDMC FINANCIAL ASSISTANCE POLICY (FAP) AND THE FOLLOWING RELATED DOCUMENTS CAN BE FOUND ON THE HOSPITAL'S WEBSITE. CREDIT AND COLLECTION POLICY APPLICATION FOR FINANCIAL ASSISTANCE MEDICAL HARDSHIP APPLICATION FINANCIAL ASSISTANCE POLICY PLAIN LANGUAGE SUMMARY ADDITIONAL INFORMATION ON PATIENT FINANCIAL ASSISTANCE AND BILLING, ALL IN IN ENGLISH, SPANISH, FRENCH, HAITIAN CREOLE, HINDI, ITALIAN, SIMPLIFIED CHINESE, TRADITIONAL CHINESE, RUSSIAN, PORTUGUESE, VIETNAMESE, JAPANESE, ARABIC, CAPE VERDEAN, CAN BE FOUND ON THE BIDMC WEBSITE AT: HTTPS://WWW.BIDMC.ORG/PATIENT-AND-VISITOR-INFORMATION/PATIENT-INFORMATION/YOUR-HOSPITAL-BILL/FINANCIAL-ASSISTANCE

LIMITATION ON CHARGESINTERNAL REVENUE CODE SECTION 501(R)(5)
LIMITATION ON CHARGESAS REQUIRED BY IRC SECTION 501(R)(5) AND THE REGULATIONS PROMULGATED THEREUNDER, THE HOSPITAL LIMITS THE AMOUNTS CHARGED FOR ANY EMERGENCY OR OTHER MEDICALLY NECESSARY CARE IT PROVIDES TO A FINANCIAL ASSISTANCE-ELIGIBLE PATIENT, TO NOT MORE THAN AMOUNTS GENERALLY BILLED (AGB) AND LIMITS THE AMOUNTS CHARGED TO ANY FINANCIAL ASSISTANCE ELIGIBLE PATIENT FOR ALL OTHER MEDICAL CARE TO LESS THAN GROSS CHARGES. AMOUNTS GENERALLY BILLEDLOOK BACK METHODTHE HOSPITAL CALCULATES ITS AGB, USING THE LOOK BACK METHOD, DIVIDING THE TOTAL PAYMENTS RECEIVED FROM ALL COMMERCIAL PLANS AND MEDICARE BY THE TOTAL CHARGES SENT TO THOSE SAME PAYERS FOR THE PREVIOUS FISCAL YEAR. CALCULATED AGB IS INCLUDED IN THE HOSPITAL'S FAP AS REQUIRED UNDER THE REGULATIONS DETAILING THE REQUIREMENTS UNDER IRC SECTION 501(R)(5). (SCHEDULE H PART V SECTION B QUESTION 22). PATIENT REFUNDS FOR CHARGES IN EXCESS OF AMOUNTS GENERALLY BILLEDTHE HOSPITAL REGULARLY MONITORS THE FINANCIAL ACCOUNTS OF FINANCIAL ASSISTANCE ELIGIBLE PATIENTS. WHERE A PATIENT SUBMITS A COMPLETED APPLICATION FOR FINANCIAL ASSISTANCE AND IS DETERMINED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE, THE HOSPITAL REFUNDS ANY AMOUNTS PREVIOUSLY PAID FOR CARE THAN EXCEEDS THE AMOUNT THAT THE PATIENT IS PERSONALLY RESPONSIBLE FOR PAYING WHERE SUCH AMOUNTS ARE EQUAL TO OR EXCEED $5.00. BILLING AND COLLECTIONS501(R)(6)EXTRAORDINARY COLLECTION ACTIVITIESTHE HOSPITAL DOES NOT ENGAGE IN ANY EXTRAORDINARY COLLECTION ACTIVITIES (ECAS) FOR FINANCIAL ASSISTANCE ELIGIBLE PATIENTS. SPECIFICALLY, THE HOSPITAL DOES NOT REPORT TO CREDIT AGENCIES, ENGAGE IN LEGAL OR JUDICIAL PROCESSES OR SELL A PATIENT'S OUTSTANDING AMOUNTS OWED FOR PATIENT CARE. IN ADDITION, THIS EXTENDS TO ANY THIRD PARTY CONTRACTED WITH THE HOSPITAL RELATED TO BILLING AND COLLECTIONS. (SCHEDULE H PART V SECTION B QUESTIONS 18 AND 19).APPLICATION PERIOD PATIENTS MAY APPLY FOR FINANCIAL ASSISTANCE AT ANY TIME UP TO TWO HUNDRED FORTY (240) DAYS AFTER THE FIRST POST-DISCHARGE BILLING STATEMENT IS AVAILABLE. FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS RESEARCHAS PREVIOUSLY NOTED IN THIS FORM 990, PART III, PART OF THE MEDICAL CENTER'S MISSION IS TO BE A WORLD-CLASS RESEARCH INSTITUTION WHERE OUTSTANDING SCIENTISTS WORK TO DEVELOP NEW KNOWLEDGE FOR THE BETTERMENT OF THE HEALTH OF OUR LOCAL AND EXTENDED COMMUNITIES. THE RESEARCH PROGRAM STRIVES TO BE RENOWNED FOR ITS BENCH-TO-BEDSIDE MODEL OF TRANSLATIONAL RESEARCH AND FOR ITS COLLABORATION WITH INDUSTRY AS A PATHWAY FOR TRANSFERRING THE FRUITS OF RESEARCH INTO PRODUCTS AND TREATMENTS THAT IMPROVE THE QUALITY OF LIFE.THE MEDICAL CENTER'S NOTABLE RESEARCH ACCOMPLISHMENTS INCLUDE CONSISTENTLY BEING RANKED IN THE TOP TIER OF INDEPENDENT HOSPITALS IN NATIONAL INSTITUTES OF HEALTH (NIH) FUNDING. THE MEDICAL CENTER SCIENTISTS CONTINUE TO SEARCH FOR IMPROVED UNDERSTANDING OF DISEASES AND BETTER TREATMENTS FOR PATIENTS, WHICH IN TURN DIRECTLY IMPACT THE LIVES OF OUR PATIENTS AND IMPROVE THE MEDICAL CENTER'S PATIENT CARE. DURING THE FISCAL PERIOD COVERED BY THIS FILING, MORE THAN 1,220 ACTIVE FEDERAL, INDUSTRY AND FOUNDATION SPONSORED PROJECTS AND MORE THAN 2,500 ACTIVE EXEMPT, EXPEDITED, AND FULL BOARD-REVIEWED CLINICAL RESEARCH STUDIES. BIDMC RESEARCH IS LED BY MORE THAN 280 PRINCIPAL INVESTIGATORS, THE MAJORITY OF WHOM ARE HARVARD MEDICAL SCHOOL FACULTY. THE KEY AREAS OF RESEARCH INCLUDE VASCULAR BIOLOGY, MOLECULAR IMAGING, TRANSPLANTATION, SIGNAL TRANSDUCTION, CANCER BIOLOGY, METABOLIC DISEASE, NEUROBIOLOGY, AIDS, VACCINE DEVELOPMENT AND VIROLOGY, INFECTION CONTROL AND INFECTIOUS DISEASES AND CARDIOLOGY/CARDIAC SURGERY. AS NOTED IN THIS FILING, THE MEDICAL CENTER IS A TEACHING HOSPITAL OF HARVARD MEDICAL SCHOOL AND IS COMMITTED TO MAINTAINING A COLLABORATIVE CULTURE; TO MAINTAINING MODERN, HIGH-QUALITY FACILITIES, AND TO TAKING FULL ADVANTAGE OF THE UNIQUE RELATIONSHIPS THAT EXIST AMONG THE HARVARD MEDICAL SCHOOL AND THE HARVARD TEACHING HOSPITALS. THE MEDICAL CENTER DESIGNS AND IMPLEMENTS MANY INTERDEPARTMENTAL AND INTERDISCIPLINARY RESEARCH PROGRAMS WITHIN THE INSTITUTION. THE MEDICAL CENTER ALSO COLLABORATES WITH OTHER NATIONALLY RECOGNIZED AND WORLD RENOWNED EXPERTS IN VARIOUS FIELDS IN AN EFFORT TO TRANSLATE NEW KNOWLEDGE INTO NOVEL MEDICAL TREATMENTS AND PATIENT CARE. THE MEDICAL CENTER PARTICIPATES IN HARVARD CATALYST, THE HARVARD CLINICAL AND TRANSLATIONAL SCIENCE CENTER, WHICH BRINGS TOGETHER THE INTELLECTUAL FORCE, TECHNOLOGIES, AND CLINICAL EXPERTISE AT HARVARD UNIVERSITY AND ITS ACADEMIC, HEALTH CARE, AND COMMUNITY PARTNERS TO CREATE CONNECTIONS, ENABLE RESEARCH AT THE CUTTING EDGE OF DISCOVERY, AND NURTURE CLINICAL AND TRANSLATIONAL RESEARCHERS WITH THE GOAL OF IMPROVING HUMAN HEALTH.STUDIES BY MEDICAL CENTER RESEARCHERS ARE ROUTINELY PUBLISHED IN THE WORLD'S LEADING SCIENTIFIC JOURNALS, INCLUDING NATURE, SCIENCE, THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION AND THE NEW ENGLAND JOURNAL OF MEDICINE, WHICH HELPS TO BRING THE RESEARCH FINDINGS TO CLINICIANS AND PATIENTS BEYOND THE MEDICAL CENTER.

DETAIL ON RESEARCH EFFORTS WHICH WERE UNDERTAKEN AT BIDMC
"DURING THE FISCAL PERIOD COVERED BY THIS FILING ARE BELOW. 1. STRONG ANTIBODY RESPONSE TO MRNA VACCINES DECLINED OVER AN EIGHT-MONTH FOLLOW-UP PERIOD; LOWER INITIAL RESPONSE TO SINGLE-SHOT AD26 VACCINE REMAINED STABLE OVER TIME, RESEARCH SHOWSTHE PERIOD COVERED BY THIS FILING IS THE FISCAL YEAR ENDED SEPTEMBER 30, 2022, DURING WHICH THE COVID-19 PANDEMIC CONTINUED TO DISRUPT LIFE IN THE UNITED STATES AND ACROSS THE GLOBE. RESEARCH CONDUCTED AT BIDMC DURING THIS FISCAL PERIOD HIGHLIGHTS BIDMC'S CONTINUING NATIONAL LEADERSHIP DURING THIS ONGOING PUBLIC HEALTH CRISIS.BASED ON THE STRENGTH OF CLINICAL TRIAL DATA SHOWING THE VACCINES CONFERRED ROBUST PROTECTION AGAINST COVID-19, THE U.S. FOOD & DRUG ADMINISTRATION GRANTED EMERGENCY USE AUTHORIZATION TO TWO MRNA-BASED VACCINES IN DECEMBER 2020, AND TO THE SINGLE-SHOT AD26 PLATFORM VACCINE IN FEBRUARY 2021. AS MILLIONS OF AMERICANS APPROACHED THE ONE-YEAR ANNIVERSARY OF THEIR IMMUNIZATION, QUESTIONS REMAINED ABOUT THE VACCINES' LONG-TERM EFFICACY.IN A PAPER PUBLISHED IN THE NEW ENGLAND JOURNAL OF MEDICINE, A TEAM OF EXPERTS AT BETH ISRAEL DEACONESS MEDICAL CENTER (BIDMC) COMPARED IMMUNE RESPONSES INDUCED BY THE THREE VACCINES OVER AN EIGHT-MONTH FOLLOW-UP PERIOD. THE INVESTIGATORS EVALUATED THE 61 PARTICIPANTS' LEVELS OF VARIOUS ANTIBODIES, T CELLS AND OTHER IMMUNE PRODUCTS AT TWO TO FOUR WEEKS FOLLOWING COMPLETE IMMUNIZATION THE TIME OF PEAK IMMUNITY TO EIGHT MONTHS AFTER VACCINATION. ""THE MRNA VACCINES WERE CHARACTERIZED BY HIGH PEAK ANTIBODY RESPONSES THAT DECLINED SHARPLY BY MONTH SIX AND DECLINED FURTHER BY MONTH EIGHT,"" SAID CORRESPONDING AUTHOR DAN H. BAROUCH, MD, PHD, DIRECTOR OF THE CENTER FOR VIROLOGY AND VACCINE RESEARCH AT BIDMC, WHO HELPED DEVELOP THE AD26 PLATFORM IN COLLABORATION WITH JOHNSON & JOHNSON. ""THE SINGLE-SHOT AD26 VACCINE INDUCED LOWER INITIAL ANTIBODY RESPONSES, BUT THESE RESPONSES WERE GENERALLY STABLE OVER TIME WITH MINIMAL TO NO EVIDENCE OF DECLINE.""ALL THREE VACCINES DEMONSTRATED BROAD CROSS-REACTIVITY TO VARIANTS OF SARS-COV-2, THE VIRUS THAT CAUSES COVID-19. THE FINDINGS HAVE IMPORTANT IMPLICATIONS FOR UNDERSTANDING HOW VACCINE IMMUNITY MAY WANE OVER TIME; HOWEVER, THE PRECISE IMMUNE RESPONSES NECESSARY TO CONFER PROTECTION AGAINST SARS-COV-2 HAS NOT YET BEEN DETERMINED, THE RESEARCHERS POINT OUT. ""EVEN THOUGH NEUTRALIZING ANTIBODY LEVELS DECLINED, STABLE T CELL RESPONSES AND NON-NEUTRALIZING ANTIBODY FUNCTIONS AT 8 MONTHS MAY EXPLAIN HOW THE VACCINES CONTINUE TO PROVIDE ROBUST PROTECTION AGAINST SEVERE COVID-19,"" SAID LEAD AUTHOR AI-RIS Y. COLLIER, MD, A MATERNAL-FETAL MEDICINE SPECIALIST AT BIDMC. ""GETTING VACCINATED (EVEN DURING PREGNANCY) IS STILL THE BEST TOOL WE HAVE TO END THE COVID-19 PANDEMIC."" 2. MATERNAL DEATHS DUE TO HOMICIDES AND SUICIDES CONTRIBUTE TO RISE IN U.S. MATERNAL MORTALITYMATERNAL MORTALITY IN THE UNITED STATES IN ON THE RISE. SCIENTISTS INCREASINGLY RECOGNIZE THAT PREGNANCY-ASSOCIATED DEATHS THOSE DUE TO CONDITIONS UNRELATED TO THE PHYSIOLOGIC EFFECTS OF PREGNANCY ARE IMPORTANT AND POTENTIALLY PREVENTABLE CONTRIBUTORS TO MATERNAL MORTALITY. A STUDY LED BY RESEARCHERS AT BIDMC IDENTIFIED RISK FACTORS FOR PREGNANCY-ASSOCIATED HOMICIDES AND SUICIDES AND HIGHLIGHTED OPPORTUNITIES FOR INTERVENTION. THE TEAM'S FINDINGS APPEAR IN OBSTETRICS & GYNECOLOGY (THE GREEN JOURNAL), PUBLISHED BY THE AMERICAN COLLEGE OF OBSTETRICIANS AND GYNECOLOGISTS.""THESE DEATHS CAN ABSOLUTELY BE PREVENTED,"" SAID CORRESPONDING AUTHOR ANNA MODEST, PHD, MPH, DIRECTOR OF CLINICAL RESEARCH EDUCATION IN THE DEPARTMENT OF OBSTETRICS AND GYNECOLOGY AT BIDMC. ""CERTAIN RISK FACTORS, LIKE MENTAL ILLNESS AND INTIMATE PARTNER VIOLENCE, LOOM LARGE. OUR FINDINGS UNDERLINE THE URGENT NEED FOR INCREASED ATTENTION TO AT-RISK INDIVIDUALS.""THE INVESTIGATORS USED DATA FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION'S NATIONAL VIOLENT DEATH REPORTING SYSTEM, 2008 TO 2019. AMONG WOMEN AND GIRLS AGED 15 TO 44, 21 PERCENT OF HOMICIDES AND 9 PERCENT OF SUICIDES WERE ASSOCIATED WITH PREGNANCY A TOTAL OF 1,300 REPORTED DEATHS. THE RISK OF VIOLENT DEATH WAS HIGHEST DURING PREGNANCY OR THE LATE POSTPARTUM PERIOD (43 DAYS TO ONE YEAR AFTER GIVING BIRTH). FIREARMS WERE USED IN TWO OUT OF THREE HOMICIDES AND ONE IN THREE SUICIDES. AMONG DEATHS IN WHICH CIRCUMSTANCES WERE KNOWN, INTIMATE PARTNER VIOLENCE WAS A SUBSTANTIAL FACTOR IN 57 PERCENT OF HOMICIDES AND 37 PERCENT OF SUICIDES.NON-HISPANIC BLACK WOMEN WERE DISPROPORTIONATELY VICTIMS OF PREGNANCY-ASSOCIATED HOMICIDE. THE HOMICIDE VICTIMS WERE LIKELY TO BE SINGLE AND RELATIVELY YOUNG WITH LIMITED EDUCATION A POPULATION ALSO AT PARTICULARLY HIGH RISK OF BEING HARMED BY RESTRICTIONS ON ABORTION CARE.""AS CLINICIANS ACROSS THE COUNTRY NAVIGATE ENVIRONMENTS IN WHICH PATIENTS ARE NO LONGER ABLE TO MAKE DECISIONS REGARDING THEIR OWN PREGNANCIES, THERE IS AN ESPECIALLY VULNERABLE GROUP WHOSE LIVES AND WELL-BEING ARE AT RISK,"" SAID SENIOR AUTHOR NAIMA T. JOSEPH, MD, MPH, MATERNAL-FETAL MEDICINE PHYSICIAN AT BIDMC. ""IT IS IMPORTANT THAT CLINICIANS CARING FOR PREGNANT PERSONS ASSESS AND ADDRESS RISKS SUCH AS MENTAL HEALTH, SUBSTANCE USE, AND INTIMATE PARTNER VIOLENCE IN THE CLINICAL SETTING IN ADDITION TO ADVOCATING FOR POLICIES THAT MAKE CHILDBEARING SAFE."""

SEVEN:
"INTRANASAL INSULIN SPRAY WARRANTS FURTHER TESTING FOR AGE-RELATED DECLINE, RESEARCHERS SAYAN ESTIMATED 25 PERCENT OF PEOPLE OLDER THAN 65 HAVE TYPE 2 DIABETES, A CONDITION IN WHICH THE BODY CANNOT PRODUCE ENOUGH INSULIN TO EFFECTIVELY MANAGE BLOOD SUGAR. INSULIN PLAYS AN IMPORTANT ROLE IN THE BRAIN, AND PEOPLE WITH PREDIABETES AND DIABETES ARE AT INCREASED RISK OF ALZHEIMER'S DISEASE AND COGNITIVE DECLINE. DELIVERING INSULIN TO THE BRAIN INTRANASALLY ATOMIZED AND SPRAYED THROUGH THE NOSE HAS BEEN SHOWN TO IMPROVE VERBAL MEMORY AND HAS EMERGED AS A POTENTIAL TREATMENT FOR COGNITIVE DECLINE IN THE ELDERLY.A TEAM OF SCIENTISTS AT BIDMC HAVE ASSESSED THE LONG-TERM EFFECTS OF INTRANASAL INSULIN (INI) ON COGNITION AND ON GAIT IN PEOPLE WITH AND WITHOUT TYPE 2 DIABETES MELLITUS. MEMAID, A PHASE 2 RANDOMIZED CONTROLLED CLINICAL TRIAL, PROVIDED EVIDENCE THAT INTRANASAL INSULIN INCREASED THE WALKING SPEED, INCREASED CEREBRAL BLOOD FLOW AND DECREASED PLASMA INSULIN IN PARTICIPANTS WITH TYPE 2 DIABETES, WHILE IT IMPROVED DECISION MAKING AND VERBAL MEMORY IN TRIAL PARTICIPANTS WITHOUT THE DISEASE AND THOSE WITH PRE-DIABETES. THE FINDINGS, PUBLISHED IN THE JOURNAL OF NEUROLOGY, SUGGEST INTRANASAL INSULIN SHOULD BE FURTHER TESTED FOR ITS POSSIBLE UTILITY AS A TREATMENT FOR TYPE 2 DIABETES AS WELL AS A TREATMENT FOR AGE-RELATED FUNCTIONAL DECLINE.""WALKING SPEED IS AN IMPORTANT CLINICAL PREDICTOR OF WELL-BEING IN THE ELDERLY THAT CORRELATES WITH COGNITIVE DECLINE, HOSPITALIZATIONS, DISABILITY AND DEATH,"" SAID CORRESPONDING AUTHOR VERA NOVAK, MD, PHD, OF THE DEPARTMENT OF NEUROLOGY AT BIDMC AND AN ASSOCIATE PROFESSOR OF NEUROLOGY AT HARVARD MEDICAL SCHOOL. ""AT BASELINE, PARTICIPANTS WITH DIABETES WALKED SLOWER AND HAD WORSE COGNITION THAN THE PARTICIPANTS WITHOUT DIABETES, WHO SERVED AS A CLINICAL REFERENCE FOR NORMAL AGING POPULATION.""""THE CONSISTENCY OF THE TRENDS IN THE DATA SHOWING BETTER PERFORMANCE ON WALKING SPEED AND COGNITION FOR INI-TREATED PARTICIPANTS, ESPECIALLY IN THOSE WITH PRE-DIABETES, CARRIES GREAT IMPLICATION FOR POTENTIAL EARLY INTERVENTION USING INI IN THIS POPULATION TO PREVENT OR SLOW DOWN THE PROGRESSION TOWARD ALZHEIMER DISEASE'S RELATED DEMENTIAS,"" SAID LONG NGO, PHD, SENIOR AUTHOR OF THE STUDY AND CO-DIRECTOR OF BIOSTATISTICS DIVISION OF GENERAL MEDICINE AT BIDMC. ""WITH 96 MILLION ADULT AMERICANS, AND INCREASING NUMBER OF YOUNGER PEOPLE HAVING PRE-DIABETES, THIS FINDING ON THE BENEFICIAL EFFECT OF INI DESERVES MORE ATTENTION AND DEFINITIVE CONFIRMATION IN A LARGER TRIAL.""JANUARY 20, 20208. ALZHEIMER'S DISEASE AFFECTS MOST KNOWN BIOLOGICAL PATHWAYS IN THE BRAIN, RESEARCHERS FINDNEARLY SIX MILLION OLDER ADULTS HAVE ALZHEIMER'S DISEASE IN THE UNITED STATES, A NUMBER EXPECTED TO DOUBLE BY 2050. ALREADY THE SIXTH LEADING CAUSE OF DEATH, ALZHEIMER'S DISEASE IS A COMPLEX NEURODEGENERATIVE DISEASE THAT REMAINS POORLY UNDERSTOOD; AS A RESULT, THERE ARE FEW EFFECTIVE TREATMENTS AND NO CURE FOR THE DISEASE.SCIENTISTS AT BIDMC CONDUCTED A SYSTEMATIC ASSESSMENT OF MORE THAN 200,000 SCIENTIFIC PUBLICATIONS TO UNDERSTAND THE BREADTH AND DIVERSITY OF BIOLOGICAL PATHWAYS KEY MOLECULAR CHAIN REACTIONS THAT DRIVE CHANGES IN CELLS THAT HAVE BEEN SHOWN TO CONTRIBUTE TO ALZHEIMER'S DISEASE BY RESEARCH OVER THE LAST 30 YEARS. THE TEAM FOUND THAT, WHILE NEARLY ALL KNOWN PATHWAYS HAVE BEEN LINKED TO THE DISEASE, THOSE MOST FREQUENTLY ASSOCIATED BIOLOGICAL MECHANISMS INCLUDING THOSE RELATED TO THE IMMUNE SYSTEM, METABOLISM AND LONG-TERM DEPRESSION HAVE NOT SIGNIFICANTLY CHANGED IN 30 YEARS, DESPITE MAJOR TECHNOLOGICAL ADVANCES. THE SCIENTISTS' WORK WAS PUBLISHED IN FRONTIERS IN AGING NEUROSCIENCE. ""THE BURDEN OF ALZHEIMER'S DISEASE IS STEADILY INCREASING, DRIVING US TOWARDS A NEUROLOGICAL EPIDEMIC,"" SAID WINSTON A. HIDE, PHD, DIRECTOR OF THE PRECISION RNA MEDICINE CORE FACILITY AT BIDMC. ""OUR FINDINGS SUGGEST THAT NOT ONLY IS THIS DISORDER INCREDIBLY COMPLEX, BUT THAT ITS PATHOLOGY INCLUDES MOST KNOWN BIOLOGICAL PATHWAYS. THIS MEANS THAT THE DISEASE'S EFFECTS ARE FAR BROADER IN THE BODY THAN WE REALIZED.""THE TEAM PERFORMED AN EXHAUSTIVE TEXT SEARCH OF 206,324 PATHWAY-SPECIFIC DEMENTIA PUBLICATION ABSTRACTS PUBLISHED SINCE 1990. NEXT, THEY LOOKED AT 341 KNOWN BIOLOGICAL PATHWAYS AND DETERMINED HOW MANY PUBLICATIONS LINKED A GIVEN PATHWAY TO THE DISEASE. THE RESEARCHERS FOUND THAT 91 PERCENT OF PATHWAYS ALL BUT SEVEN WERE LINKED TO ALZHEIMER'S DISEASE. NEARLY HALF OF THE PATHWAYS WERE LINKED TO ALZHEIMER'S DISEASE IN MORE THAN 100 SCIENTIFIC PAPERS. THEY ALSO FOUND THAT THE TOP-RANKED 30 PATHWAYS MOST FREQUENTLY REFERRED TO IN LITERATURE REMAINED RELATIVELY CONSISTENT OVER THE LAST 30 YEARS, SUGGESTING THAT MOST STUDIES OF THE DISEASE HAVE FOCUSED ON A SMALL SUBSET OF ALL THE KNOWN DISEASE-ASSOCIATED PATHWAYS.""CLINICAL TRIALS AIMING TO EITHER DELAY THE ONSET OR SLOW THE PROGRESSION OF ALZHEIMER'S DISEASE HAVE LARGELY FAILED,"" SAID STUDY FIRST AUTHOR SARAH MORGAN, A POSTDOCTORAL RESEARCHER AT BIDMC DURING THE EXTENT OF THIS RESEARCH. ""GIVEN THAT AN UNEXPECTED DIVERSITY OF PATHWAYS IS ASSOCIATED WITH ALZHEIMER'S DISEASE, A WIDE RANGE OF DISEASE PROCESSES ARE NOT BEING SUCCESSFULLY TARGETED IN CLINICAL TRIALS. WE HYPOTHESIZE THAT COMPREHENSIVELY TARGETING MORE OF THE ASSOCIATED UNDERLYING MECHANISMS IN ALZHEIMER'S DISEASE WILL INCREASE THE CHANCES OF SUCCESS IN FUTURE DRUG TRIALS."""

NINE:
"STUDY REVEALS DISPARITIES AMONG OLDER PATIENTS SEEKING CARDIOVASCULAR CARE AT RURAL HOSPITALS COMPARED TO PATIENTS AT URBAN HOSPITALSIN A NATIONWIDE STUDY OF MEDICARE BENEFICIARIES, RESEARCHERS AT BIDMC EVALUATED DIFFERENCES IN PROCEDURAL CARE AND MORTALITY FOR ACUTE CARDIOVASCULAR CONDITIONS BETWEEN RURAL AND URBAN HOSPITALS. THE PHYSICIAN-SCIENTISTS FOUND SIGNIFICANT DISPARITIES, DEMONSTRATING THAT OLDER ADULTS INITIALLY PRESENTING AT RURAL HOSPITALS ARE LESS LIKELY TO RECEIVE IMPORTANT PROCEDURES AND TREATMENTS FOR HEART ATTACK AND STROKE. MORTALITY RATES WERE ALSO HIGHER AT RURAL HOSPITALS FOR PATIENTS PRESENTING WITH HEART ATTACK, HEART FAILURE OR STROKE THAN AT URBAN HOSPITALS. THE FINDINGS ARE PUBLISHED IN THE JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY.""ALTHOUGH PUBLIC HEALTH AND POLICY EFFORTS TO IMPROVE RURAL HEALTH HAVE INTENSIFIED OVER THE PAST DECADE, OUR FINDINGS HIGHLIGHT THAT LARGE GAPS REMAIN IN THE UNITED STATES,"" SAID CORRESPONDING AUTHOR RISHI K. WADHERA, MD, MPP, MPHIL, A CARDIOLOGIST AT BIDMC AND SECTION HEAD OF HEALTH POLICY AND EQUITY RESEARCH AT THE SMITH CENTER FOR OUTCOMES RESEARCH IN CARDIOLOGY. ""THESE DISPARITIES SUGGEST THAT RURAL ADULTS CONTINUE TO FACE CHALLENGES ACCESSING THE CARE THEY NEED, AN ISSUE THAT HAS LIKELY BEEN MAGNIFIED BY THE RAPID RISE IN RURAL HOSPITAL CLOSURES OVER THE LAST DECADE.""WADHERA AND COLLEAGUES LOOKED AT DATA FROM MORE THAN 2 MILLION MEDICARE BENEFICIARIES AGE 65 OR OLDER WHO WERE HOSPITALIZED WITH ACUTE CARDIOVASCULAR CONDITIONS AT MORE THAN 4,000 URBAN AND RURAL HOSPITALS ACROSS THE US FROM 2016 TO 2018. MEDICARE BENEFICIARIES PRESENTING WITH ACUTE CARDIOVASCULAR CONDITIONS AT RURAL HOSPITALS PATIENTS WERE LESS LIKELY TO RECEIVE PROCEDURAL CARE, SUCH AS CARDIAC CATHETERIZATION FOR PATIENTS EXPERIENCING HEART ATTACK OR THROMBOLYSIS AND ENDOVASCULAR THERAPY FOR THOSE HAVING A STROKE. MOREOVER, MORTALITY RATES WERE HIGHER AMONG PATIENTS PRESENTING AT RURAL HOSPITALS THAN THOSE AT URBAN HOSPITALS. THE RESEARCHERS SUGGEST SEVERAL FACTORS THAT MAY BE CONTRIBUTING TO WORSE OUTCOMES IN RURAL AREAS, DESPITE SIGNIFICANT PUBLIC HEALTH AND POLICY EFFORTS TO REDUCE RURAL-URBAN INEQUITIES. EVEN AS THE RATE OF UNINSURED RURAL AMERICANS DECLINED, A SPATE OF RURAL HOSPITAL CLOSURES OVER THE LAST DECADE HAS RESULTED IN LONGER TRAVEL TIMES AND DELAYS IN EMERGENCY MEDICAL SERVICES AND TREATMENTS. IN ADDITION, RURAL AREAS HAVE EXPERIENCED A DECLINE IN PRIMARY CARE PHYSICIANS AND SPECIALTIES WHICH MAY MAKE ACCESS TO FOLLOW-UP CARE AFTER DISCHARGE MORE DIFFICULT. THESE CHALLENGES, COUPLED WITH WORSE ACCESS TO IMPORTANT REHAB SERVICES MAY CONTRIBUTE TO WORSE OUTCOMES IN RURAL AREAS AND MAY DISPROPORTIONATELY AFFECT MINORITIES.10. RESEARCH SHOWS HYPERTENSION, DIABETES AND OBESITY WORSENED ACROSS THE BOARD, BUT TRENDS REVEAL RACIAL AND ETHNIC DISPARITIESIN A STUDY PUBLISHED IN JAMA, RESEARCHERS AT BIDMC ANALYZED MORE THAN A DECADE'S WORTH OF DATA TO EXAMINE RATES OF CARDIOVASCULAR RISK FACTORS SUCH AS HIGH BLOOD PRESSURE, DIABETES, OBESITY AND SMOKING AMONG US ADULTS FROM 2009 TO MARCH 2020. THE RESEARCHERS OBSERVED A RISE IN HYPERTENSION AND SIGNIFICANT INCREASES IN DIABETES AND OBESITY RATES AMONG YOUNG ADULTS, WITH NO SIGNIFICANT IMPROVEMENT IN CONTROL OF BLOOD PRESSURE OR BLOOD SUGAR. THE SCIENTISTS ALSO OBSERVED SUBSTANTIAL VARIATION IN THESE TRENDS BY RACE AND ETHNICITY.THIS SERIAL CROSS-SECTIONAL STUDY INCLUDED MEDICAL DATA AND SELF-REPORTED INFORMATION FROM 12,924 YOUNG ADULTS AGED 20-44 WHO PARTICIPATED IN THE LONG-RUNNING NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY (NHANES) CONDUCTED BY THE CENTERS FOR DISEASE CONTROL AND PREVENTION. THE TEAM OBSERVED THAT THE PREVALENCE OF HYPERTENSION INCREASED FROM NINE PERCENT DURING 2009-2010 TO 12 PERCENT A DECADE LATER. SIMILARLY, THE RESEARCHERS SAW STATISTICALLY SIGNIFICANT INCREASES IN RATES OF DIABETES, WHICH CLIMBED FROM THREE TO FOUR PERCENT, AND OBESITY, WHICH ROSE FROM 33 TO 41 PERCENT DURING THE STUDY PERIOD. THE PERCENTAGE OF YOUNG ADULTS WITH A SMOKING HISTORY WAS HIGH AND DID NOT CHANGE. IN CONTRAST, RATES OF HIGH CHOLESTEROL DECLINED FROM 41 PERCENT IN 2009-10 TO 36 PERCENT IN 2017-20, A DECREASE THE SCIENTISTS SUGGEST REFLECTS GOVERNMENT REGULATION OF THE USE OF TRANS FATTY ACIDS AND OTHER PARTIALLY HYDROGENATED OILS IN PACKAGED CONVENIENCE FOODS AND FAST-FOOD RESTAURANTS.THE RESEARCHERS FOUND SUBSTANTIAL VARIATION IN PREVALENCE OF RISK FACTORS BY RACE AND ETHNICITY. MEXICAN AMERICANS WERE THE ONLY GROUP TO EXPERIENCE A SIGNIFICANT INCREASE IN DIABETES. OBESITY SIGNIFICANTLY INCREASED ACROSS ALL RACIAL AND ETHNIC GROUPS EXCEPT BLACK ADULTS. WHILE RATES OF HYPERTENSION INCREASED AMONG MEXICAN AMERICANS AND OTHER HISPANIC ADULTS, BLACK ADULTS EXPERIENCED THE HIGHEST RATES OF HYPERTENSION.THE RESEARCHERS ALSO EXAMINED CARDIOVASCULAR RISK FACTOR TREATMENT AND CONTROL RATES AMONG YOUNG ADULTS. TREATMENT RATES FOR HYPERTENSION DID NOT SIGNIFICANTLY CHANGE DURING THE STUDY, WITH ONLY APPROXIMATELY 55 PERCENT OF YOUNG ADULTS WITH HIGH BLOOD PRESSURE RECEIVING TREATMENT. HOWEVER, AMONG THOSE RECEIVING TREATMENT, MORE THAN THREE-QUARTERS OF PEOPLE ACHIEVED TARGET BLOOD PRESSURE IN 2017-20. RATES OF DIABETES TREATMENT WERE ALSO LOW, WITH ONE OUT OF TWO YOUNG ADULTS ON THERAPY FOR THEIR DIABETES. NEARLY HALF OF YOUNG ADULTS ON TREATMENT FOR DIABETES HAD POOR BLOOD SUGAR CONTROL.""THE SUBOPTIMAL TREATMENT RATES FOR HIGH BLOOD PRESSURE AND DIABETES ARE CONCERNING, AND MAY BE BECAUSE MANY YOUNG ADULTS AREN'T AWARE OF THEIR DIAGNOSIS,"" SAID CORRESPONDING AUTHOR RISHI K. WADHERA, MD, MPP, MPHIL, SECTION HEAD OF HEALTH POLICY AND EQUITY AT THE SMITH CENTER FOR OUTCOMES RESEARCH IN CARDIOLOGY AT BIDMC. ""THE RISE IN CARDIOVASCULAR RISK FACTORS THAT WE OBSERVED COULD RESULT IN HIGHER LIFETIME RATES OF HEART ATTACK, STROKE, AND HEART FAILURE, AND HAVE MAJOR PUBLIC HEALTH IMPLICATIONS OVER THE LONG-TERM. OUR FINDINGS SHOULD BE A CALL-TO-ACTION TO INTENSIFY PUBLIC HEALTH AND CLINICAL INTERVENTIONS FOCUSED ON THE PREVENTION AND TREATMENT OF CARDIOVASCULAR RISK FACTORS IN YOUNG ADULTS."""

INTERNAL MEDICINE EDUCATION AT BIDMC
"THE GOAL OF THIS PROGRAM IS TO DEVELOP EACH RESIDENT'S JUDGMENT AND SKILLS TO PROVIDE THE HIGHEST QUALITY MEDICAL CARE. THE MEDICAL CENTER TRAINS RESIDENTS AS ACADEMIC INTERNISTS AND PROVIDES THE FOUNDATION FOR THE PRACTICE OF INTERNAL MEDICINE OR FOR SUBSEQUENT CLINICAL AND RESEARCH TRAINING IN MEDICAL SUBSPECIALTIES. RESIDENTS ARE EXPOSED TO A WIDE ARRAY OF PATIENTS IN VARIOUS INPATIENT AND OUTPATIENT SETTINGS, INCLUDING DIFFERENT UNITS WITHIN BIDMC, DANA FARBER CANCER INSTITUTE, AND WEST ROXBURY VETERANS AFFAIRS MEDICAL CENTER. CLINICAL TEACHING IS A FOCUS AT BIDMC AND IS COMPRISED OF FORMAL AND INFORMAL DAILY ROUNDS AND NOONTIME CONFERENCES. THIS TEACHING PROVIDES THE BASIS OF AN ORGANIZED CURRICULUM FOR ALL MEDICAL INTERNS AND RESIDENTS AT BIDMC.INTERNSHIPTHE INTERNSHIP YEAR EMPHASIZES THE CARE OF PATIENTS IN GENERAL INPATIENT MEDICINE, INTENSIVE CARE MEDICINE, ONCOLOGY, CARDIOLOGY, EMERGENCY MEDICINE AND AMBULATORY CARE UTILIZING BOTH CAMPUSES AND SELECTED OUTSIDE SITES. WORKING AS PART OF A 2-4 PHYSICIAN TEAM WHICH INCLUDES AN OVERSEEING RESIDENT, ATTENDING STAFF AND OFTEN MEDICAL STUDENTS, INTERNS GAIN EXPERIENCE IN THE MANAGEMENT OF PATIENTS WITH A BROAD RANGE OF MEDICAL DISEASES. INTERNS HAVE PRIMARY RESPONSIBILITY FOR THE CARE OF ALL PATIENTS ADMITTED TO THE MEDICAL WARD SERVICE AND ARE CONSIDERED THEIR PATIENT'S PRIMARY INPATIENT DOCTOR FOR THE DURATION OF THE HOSPITALIZATION. THROUGHOUT INTERN YEAR, INTERNS MAINTAIN A LONGITUDINAL CONTINUITY CLINIC EXPERIENCE WHERE THEY DEVELOP A PANEL OF THEIR OWN PRIMARY CARE PATIENTS. DURING MOST OF THE YEAR, WITH THE EXCEPTION OF INTENSIVE CARE ROTATIONS, AN INTERN WILL HAVE CLINIC ONE HALF-DAY PER WEEK. DISTRIBUTED THROUGHOUT THE YEAR ARE FOUR ""AMBULATORY BLOCKS"" OF TWO WEEKS DURATION. DURING THIS TIME THE INTERN IS IN THEIR CONTINUITY CLINIC EVERY AFTERNOON AND ATTENDS OUTPATIENT SPECIFIC DIDACTIC LECTURES DURING THE MORNING HOURS. AS MEMBERS OF THE HARVARD FACULTY, INTERNS PLAY AN IMPORTANT ROLE IN TEACHING, BOTH OF THEIR PEERS AND OF ROTATING MEDICAL STUDENTS. WHILE ON THE MEDICAL WARDS, INTERNS PROVIDE DAILY CLINICAL GUIDANCE AND TEACHING TO THIRD AND FOURTH YEAR MEDICAL STUDENTS. AS PART OF THE AMBULATORY CARE CURRICULUM, INTERNS WILL ALSO HAVE THE OPPORTUNITY TO LEAD PRE-CLINIC CONFERENCES. DURING THE YEAR, THERE ARE SPECIAL INTERN-ONLY EDUCATIONAL ACTIVITIES INCLUDING THE TWICE-WEEKLY INTERN REPORT, MONTHLY INTERN FORUM SESSIONS AND BI-ANNUAL 24-HOUR INTERN RETREATS.JUNIOR AND SENIOR RESIDENCYRESIDENCY SOLIDIFIES CLINICAL AND TEACHING SKILLS AND ALLOWS TRAINEES TO EXPERIENCE LEADERSHIP OF A MEDICAL TEAM. JUNIOR RESIDENCY PROVIDES THE FIRST OPPORTUNITY FOR RESIDENTS TO SUPERVISE HOUSESTAFF TEAMS ON GENERAL MEDICAL SERVICES AND IN THE MEDICAL AND CARDIAC INTENSIVE CARE UNITS. SENIOR RESIDENCY PROMOTES CONSOLIDATION AND REFINEMENT OF THESE SKILLS, WITH ATTENDINGS ALLOWING INCREASING AUTONOMY. THE RESIDENT ON THE SERVICE IS LOOKED ON AS THE TEAM LEADER AND ASSUMES PRIMARY RESPONSIBILITY FOR TEACHING OF THE TEAM. RESIDENCY ALSO PROVIDES OPPORTUNITIES FOR INCREASED ELECTIVE TIME TO SAMPLE SUBSPECIALTY ROTATIONS. THIS PROVIDES ADDITIONAL SPECIALTY TRAINING IN AREAS OF INTEREST. THE ELECTIVE OPPORTUNITIES ARE DIVERSE, RANGING FROM ELECTROPHYSIOLOGY TO MUSCULOSKELETAL MEDICINE TO HEALTH POLICY. RESIDENTS ALSO HAVE THE OPPORTUNITY TO PARTICIPATE IN ONE OF SEVERAL ""TRACKS"" WITHIN THE RESIDENCY PROGRAM IF INTERESTED IN ADDITIONAL SPECIFIC TRAINING RESOURCES AND EXPERIENCES.TEACHING AS A RESIDENTAS MENTIONED ABOVE, RESIDENTS ARE VIEWED AS SOME OF THE PRIMARY TEACHERS WITHIN THE DEPARTMENT OF MEDICINE. SOME OF THESE TEACHING OPPORTUNITIES WILL ALSO BE OBSERVED BY DEPARTMENT FACULTY TO HELP THE RESIDENT REFINE THE STYLE AND EFFECTIVENESS OF THEIR TEACHING. TEACHING OPPORTUNITIES WILL INCLUDE:LEADING INPATIENT MEDICINE ROUNDS: RESIDENTS ARE IN CHARGE OF RUNNING WARD ROUNDS. MEDICAL STUDENTS AND INTERNS PRESENT TO THE RESIDENT DURING ROUNDS. THE ATTENDING HOSPITALIST IS CONSIDERED THE RESIDENT'S CONSULTANT, WITH THE RESIDENT RETAINING THE PRIMARY DECISION-MAKING ROLE FOR THE PATIENTS ON THEIR SERVICE. DURING THE MONTHS ON MEDICAL WARDS, THE CHIEF RESIDENTS AND FIRM CHIEFS ARE ASSIGNED TO DO WALK ROUND ONCE EACH WEEK WITH ONE OF THE RESIDENTS ON THEIR FIRM. THEY WILL OBSERVE THE RESIDENT RUNNING THE WARD ROUNDS AND PROVIDE FEEDBACK ON THE TEACHING SKILLS OBSERVED DURING ROUNDS.LEADING TEACHING ATTENDING ROUNDS: DURING EVERY ROTATION ON THE MEDICAL WARDS, EACH RESIDENT WILL LEAD ONE TO THREE ATTENDING ROUNDS SESSIONS. THE TWO TEACHING ATTENDINGS HELP PROVIDE FEEDBACK ON THE RESIDENT'S SMALL GROUP DISCUSSION AND TEACHING SKILLS. SMALL GROUP PRESENTATIONS: DURING AMBULATORY WEEKS, RESIDENTS WILL LEAD A MAJORITY OF THE PRE-CLINIC CONFERENCES, TYPICALLY PRESENTING EITHER A CHALLENGING AMBULATORY CASE OR AMBULATORY-BASED TOPIC. ONCE DURING RESIDENCY, EACH JUNIOR RESIDENT WILL ALSO PRESENT A JOURNAL ARTICLE OF AMBULATORY CARE SIGNIFICANCE AT AMBULATORY JOURNAL CLUB TO A SMALL GROUP OF THEIR PEERS. INTERNAL MEDICINE GLOBAL HEALTH PROGRAMOUR MISSION IS TO TRAIN LEADERS IN GLOBAL HEALTH TO BE EFFECTIVE PRACTITIONERS IN UNDERSERVED, RESOURCE-LIMITED SETTINGS AND TO DESIGN, MANAGE, IMPROVE AND EVALUATE GLOBAL PUBLIC HEALTH PROGRAMS THAT ADDRESS THE HEALTH PROBLEMS OF THE WORLD'S NEEDIEST POPULATIONS.PROGRAM OBJECTIVES INTRODUCE GLOBAL HEALTH ISSUES TO BIDMC MEDICAL RESIDENTS CONTRIBUTE TO THE HEALTH AND WELL-BEING OF UNDERSERVED POPULATIONS IN BOSTON AND AROUND THE WORLD ENRICH THE MEDICAL KNOWLEDGE AND ENHANCE THE CLINICAL SKILLS OF RESIDENTS BY PRACTICING IN UNIQUE SETTINGS WITH LIMITED RESOURCES EXPAND RESEARCH OPPORTUNITIES ADVANCE THE CAREERS OF BIDMC RESIDENTS IN THE FIELDS OF INTERNATIONAL HEALTH, PUBLIC POLICY AND RESEARCH SITE LOCATIONS BOTSWANA: THE DEPARTMENT HAS A PERMANENT PRESENCE IN BOTSWANA WITH A MEMBER OF OUR DEPARTMENT FULL-TIME AT SCOTTISH LIVINGSTONE HOSPITAL IN MOLEPOLOLE, BOTSWANA. VIETNAM: THE MEDICAL CENTER HAS A PERMANENT PRESENCE IN VIETNAM. PHYSICIAN AND NURSE TRAINING ON HIV/AIDS CARE IN VIETNAM TAKES PLACE THROUGH FUNDING FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION. ADDITIONAL LOCATIONS: THE DEPARTMENT OFFERS ROTATIONS AT THE ALBERT SCHWEITZER HOSPITAL IN GABON AND OTHER INTERNATIONAL SITES. RESIDENTS CAN ALSO DO ROTATIONS THROUGH THE INDIAN HEALTH SERVICE OR AT BIDMC-AFFILIATED COMMUNITY HEALTH CENTERS. GLOBAL HEALTH TRACK LEARNING HOW TO WORK EFFECTIVELY IN RESOURCE-LIMITED SETTINGS REQUIRES BOTH TRAINING AND EXPERIENCE. PARTICIPANTS IN THE GLOBAL HEALTH TRACK WILL PARTICIPATE WITH LEARNERS FROM AROUND THE WORLD IN THE GLOBAL HEALTH EFFECTIVENESS PROGRAM AT THE HARVARD SCHOOL OF PUBLIC HEALTH; THEY WILL ENGAGE IN OUR HOSPITAL-WIDE, YEAR-LONG GLOBAL HEALTH CURRICULUM AND JOURNAL CLUB, AND THEY WILL BE GIVEN THE OPPORTUNITY FOR TWO FIELD EXPERIENCES DURING RESIDENCY."

ROTATIONS AT OTHER TRAINING LOCATIONS
THREE MONTHS OF TRAINING IN PEDIATRIC RADIOLOGY AT THE BOSTON CHILDREN'S HOSPITAL DURING THE SECOND YEAR. FOUR WEEK PROGRAM IN RADIOLOGIC-PATHOLOGIC CORRELATION AT THE ARMED FORCES INSTITUTE OF PATHOLOGY (AIRP) SPONSORED BY THE AMERICAN COLLEGE OF RADIOLOGY IN SILVER SPRINGS, MARYLAND DURING THE THIRD YEAR. ONE MONTH ROTATION AT THE MASSACHUSETTS EYE AND EAR INFIRMARY IN HEAD-AND-NECK RADIOLOGY DURING THE THIRD YEAR.UPON COMPLETION OF THE SECOND YEAR OF RESIDENCY TRAINING, RESIDENTS SELECT AN AREA OF ACADEMIC FOCUS FOR THEIR FOURTH YEAR WHICH WILL GUIDE CHOICES FOR THE 3-MONTH MINI-FELLOWSHIPS AND THE OTHER TWO MONTHS OF ELECTIVE TIME.OUR UNIQUE EDUCATIONAL TRACKSCURRENTLY, SIX TRACKS ARE OFFERED: CLINICAL EDUCATION RESEARCH GLOBAL HEALTH QUALITY IMPROVEMENT HEALTH POLICY/HEALTH ECONOMICSEACH OF THESE TRACKS HAS SPECIFIC CURRICULAR OFFERINGS AND EDUCATIONAL GOALS. MOST OF THE TRACKS ARE LINKED TO SPECIFIC EDUCATIONAL ENDEAVORS. FOR EXAMPLE, A RESIDENT SELECTING THE GLOBAL HEALTH TRACK WILL ENROLL IN THE GLOBAL EFFECTIVENESS CURRICULUM OFFERED BY THE HARVARD SCHOOL OF PUBLIC HEALTH AND WILL SPEND TIME ABROAD PROVIDING CLINICAL RADIOLOGY SERVICES AND UNDERTAKING A GLOBAL HEALTH PROJECT. A RESIDENT SELECTING THE EDUCATION TRACK WILL PURSUE ADVANCED TRAINING IN EDUCATIONAL THEORY AND ADULT LEARNING BY PARTICIPATING IN THE HARVARD MACY PROGRAM FOR PHYSICIAN EDUCATORS AND UNDERTAKE AN EDUCATIONAL PROJECT BASED AT BIDMC OR HARVARD MEDICAL SCHOOL. A RESIDENT CHOOSING THE RESEARCH TRACK WILL PARTICIPATE IN GRANT WRITING WORKSHOPS AND DELVE DEEPLY INTO A RESEARCH PROJECT OF THEIR CHOICE.NO MATTER WHICH TRAINING TRACK, THE EXPECTATION IS THAT EVERY RESIDENT WILL HAVE THE OPPORTUNITY TO UNDERTAKE A SUBSTANTIAL PROJECT DURING RESIDENCY THAT WILL CULMINATE IN PRESENTATION AT A NATIONAL MEETING AND/OR PUBLICATION.*****SURGERY EDUCATION AT BIDMCTHE ROBERTA AND STEPHEN R. WEINER DEPARTMENT OF SURGERY OFFERS EDUCATION OPPORTUNITIES FOR RESIDENTS, FELLOWS AND MEDICAL STUDENTS IN CARDIAC SURGERY, GENERAL SURGERY, NEUROSURGERY, PLASTIC AND RECONSTRUCTIVE SURGERY, PODIATRY, TRAUMA SURGERY, MINIMALLY INVASIVE SURGERY, UROLOGY, AND VASCULAR SURGERY. STUDENTS LEARN THE MOST ADVANCED TECHNIQUES IN A STATE-OF-THE-FACILITY. STUDENTS ALSO HAVE THE OPPORTUNITY TO LEARN MINIMALLY INVASIVE TECHNIQUES AT THE CARL J. SHAPIRO SIMULATION AND SKILLS CENTER, THE FIRST OF ITS KIND TO BE ACCREDITED IN THE COUNTRY AND LOCATED WITHIN THE MEDICAL CENTER.THE MEDICAL CENTER'S DEPARTMENT OF SURGERY IS ONE OF THREE MAJOR TEACHING AND RESEARCH UNITS OF HARVARD MEDICAL SCHOOL'S DEPARTMENT OF SURGERY. AT ALL LEVELS, THE HOUSESTAFF GAIN TRAINING AND PRACTICAL EXPERIENCE IN THE PREOPERATIVE, OPERATIVE, AND POST-OPERATIVE CARE OF PATIENTS. THE PROGRAM EMPHASIZES RESIDENT-FACULTY INTERACTION FOR EDUCATIONAL PURPOSES. TEACHING CONFERENCES AND SEMINARS FOR THE HOUSESTAFF CAPITALIZE ON WORKING RELATIONSHIPS DEVELOPED WITH THE ATTENDING STAFF. UPON COMPLETION OF FIVE YEARS OF SURGICAL TRAINING, RESIDENTS ARE ELIGIBLE FOR THE AMERICAN BOARD OF SURGERY EXAMINATION. DIDACTIC TEACHINGTHE PROGRAM HAS DEDICATED EDUCATION TIME, INCLUDING A STRONG DIDACTIC CONFERENCE SCHEDULE, TO PROVIDE A BASIC FOUNDATION OF SURGICAL KNOWLEDGE AND SKILLS. REQUIRED WEEKLY CONFERENCES INCLUDE: RESIDENT CURRICULUM CONFERENCE / MIS SKILLS LAB SURGICAL SERVICE MORBIDITY/MORTALITY & SURGICAL GRAND ROUNDS COMBINED GI CONFERENCETHROUGHOUT TRAINING, A PRIMARY RESPONSIBILITY OF SENIOR RESIDENTS IS TEACHING MORE JUNIOR RESIDENTS AND THE STUDENTS ON THEIR SERVICE. THEY ARE ALSO RESPONSIBLE FOR THE ASSIGNMENT OF CASES, CLINICAL SUPERVISION OF MEDICAL STUDENTS AND RESIDENTS, AND PREPARING MATERIAL FOR SERVICE AND TEACHING CONFERENCES.BIDMCADDITIONAL INFORMATION REGARDING PROMOTING THE HEALTH OF THE COMMUNITY (SCHEDULE H, PART VI, QUESTIONS 5 AND 6)THE HOSPITAL MAINTAINS AN OPEN MEDICAL STAFF AND AS NOTED IN THIS FORM 990 PARTS I AND VI, THE MAJORITY OF BOARD MEMBERS ARE INDEPENDENT COMMUNITY MEMBERS. ON MARCH 1, 2019, THE BETH ISRAEL LAHEY HEALTH SYSTEM WAS FORMED THROUGH THE COMBINATION OF THE HOSPITALS AND OTHER AFFILIATES OF THREE LEGACY HEALTHCARE SYSTEMS BASED PRIMARILY IN EASTERN MASSACHUSETTS, INCLUDING THE FORMER CAREGROUP HEALTH SYSTEM, THE FORMER LAHEY HEALTH SYSTEM, AND THE SEACOAST HEALTH SYSTEM. BETH ISRAEL LAHEY HEALTH, INC. (BILH) IS NOW THE SOLE MEMBER OF THE HOSPITAL AND NINE ADDITIONAL AFFILIATED HOSPITALS. EACH OF THESE ENTITIES MAY HAVE, IN TURN, SERVED AS THE SOLE MEMBER OF ADDITIONAL AFFILIATES. THE BILH HEALTH SYSTEM IS COMMITTED TO IMPROVING THE HEALTH OF THE COMMUNITIES IT SERVES. AFFILIATED HEALTHCARE SYSTEMAS NOTED IN VARIOUS NARRATIVE DISCLOSURES THAT SUPPORT THIS FORM 990 AND RELATED SCHEDULES FOR THE PERIOD COVERED BY THIS FILING, BILH IS A MASSACHUSETTS NON-PROFIT CORPORATION EXEMPT FROM INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED. BILH IS AN INTEGRATED HEALTHCARE SYSTEM COMMITTED TO EXPANDING ACCESS TO EXTRAORDINARY PATIENT CARE ACROSS EASTERN MASSACHUSETTS AND ADVANCING THE SCIENCE AND PRACTICE OF MEDICINE THROUGH GROUNDBREAKING RESEARCH AND EDUCATION. THE BILH SYSTEM IS COMPRISED OF ACADEMIC AND TEACHING HOSPITALS, A PREMIER ORTHOPEDICS HOSPITAL, PRIMARY CARE AND SPECIALTY CARE PROVIDERS, AMBULATORY SURGERY CENTERS, URGENT CARE CENTERS, COMMUNITY HOSPITALS, HOMECARE SERVICES, OUTPATIENT BEHAVIORAL HEALTH CENTERS, ADDICTION TREATMENT PROGRAMS. BILH'S COMMUNITY OF CLINICIANS, CAREGIVERS AND STAFF INCLUDES APPROXIMATELY 4,000 PHYSICIANS AND 35,000 EMPLOYEES. BILH SERVES AS SOLE MEMBER OF BETH ISRAEL DEACONESS MEDICAL CENTER (BIDMC), MOUNT AUBURN HOSPITAL (MAH), NEW ENGLAND BAPTIST HOSPITAL (NEBH), BETH ISRAEL DEACONESS HOSPITAL MILTON, INC. (MILTON), BETH ISRAEL DEACONESS HOSPITAL NEEDHAM, INC. (NEEDHAM), BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH, INC. (PLYMOUTH), LAHEY CLINIC FOUNDATION, LAHEY HEALTH SHARED SERVICES, WINCHESTER HOSPITAL (WINCHESTER), NORTHEAST HOSPITAL CORPORATION (NHC), NORTHEAST BEHAVIORAL HEALTH CORPORATION (NBHC) AND ANNA JAQUES HOSPITAL). LAHEY CLINIC FOUNDATION SERVES AS THE SOLE MEMBER OF LAHEY CLINIC, INC. AND LAHEY CLINIC HOSPITAL D/B/A LAHEY HOSPITAL AND MEDICAL CENTER. EACH OF THESE AFFILIATES MAY IN TURN SERVE AS MEMBER OF ADDITIONAL ENTITIES WITHIN THE NETWORK OF AFFILIATES.

BILH NETWORK ACCOMPLISHMENTS AND ACTIVITIES
"FISCAL YEAR ENDED SEPTEMBER 30, 2022BILH NETWORK ACCOMPLISHMENTS AND ACTIVITIES FISCAL YEAR ENDED SEPTEMBER 30, 2022SINCE COMING TOGETHER AS A HEALTH SYSTEM, BETH ISRAEL LAHEY HEALTH (""BILH"") HAS CONTINUED TO MAKE SIGNIFICANT INVESTMENTS AND UNDERTAKE INITIATIVES TO IMPROVE ACCESS FOR PATIENTS AND SUPPORT ITS SURROUNDING COMMUNITIES. IN FY 2022 ALONE, BILH INVESTED OVER $8 MILLION IN ITS COMMUNITY HEALTH CENTER PARTNERS AND SAFETY NET AFFILIATES, DEVELOPED ACCESSIBLE PATIENT MESSAGING AND EDUCATION, AND INVESTED OVER $5 MILLION IN SEVERAL BEHAVIORAL HEALTH-FOCUSED INITIATIVES. BETH ISRAEL LAHEY HEALTH PERFORMANCE NETWORK (""BILHPN"") CONTINUES TO OPTIMIZE ITS POPULATION HEALTH-FOCUSED INITIATIVES, INCLUDING THOSE FOCUSED ON ADDRESSING HEALTH DISPARITIES. HIGHLIGHTS OF THE SYSTEM'S EFFORTS INCLUDE: ENHANCED ACCESS FOR MASSHEALTH PATIENTS TO MITIGATE BARRIERS IN ACCESS TO CARE AND INCREASE THE NUMBER OF MASSHEALTH PATIENTS THAT BILH SERVES, THE SYSTEM COMMITTED TO UNIVERSAL NETWORK-WIDE PROVIDER PARTICIPATION IN MASSHEALTH. SPECIFICALLY, AS OF OCTOBER 2020, ALL BILH HOSPITALS AND PROVIDERS EMPLOYED BY BILH OR ON WHOSE BEHALF BILH JOINTLY CONTRACTS HAVE APPLIED TO PARTICIPATE IN SOME FORM OF MASSHEALTH. IN FY 2022, BILH SIGNED A NEW MASSHEALTH ACO CONTRACT WITH BMC HEALTHNET PLAN / WELLSENSE HEALTH PLAN THAT WILL GO INTO EFFECT IN APRIL 2023. AS PART OF THIS CONTRACT, BILHPN WILL EXTEND PARTICIPATION TO ALL ELIGIBLE PRIMARY CARE PROVIDERS (""PCPS"") WHO WERE NOT OTHERWISE PARTICIPATING IN A MASSHEALTH ACO. WHILE ALL ELIGIBLE BILHPN PCPS WERE PARTICIPANTS IN A FORM OF MASSHEALTH, SOME PCPS HAVE PREVIOUSLY NOT PARTICIPATED IN A MASSHEALTH ACO. DURING FY 2022, BILH DEVELOPED AND REFINED A MULTICULTURAL MARKETING, ADVERTISING, AND OUTREACH PLAN WITH THE PURPOSE OF EXPANDING ACCESS FOR UNDERSERVED POPULATIONS, INCLUDING MASSHEALTH PATIENTS, IN TARGETED BILH SERVICE AREAS. IMPLEMENTATION OF THAT PLAN WILL OCCUR IN FY 2023. INVESTMENTS IN UNDERSERVED COMMUNITIES BILH HOSPITALS HAVE CREATED STRONG CONNECTIONS TO A NETWORK OF AFFILIATED HOSPITALS AND HEALTH CENTERS THAT PROVIDE COMMUNITY-BASED CARE TO HISTORICALLY UNDERSERVED POPULATIONS. IN THE REGIONS THAT THEY SERVE, THE SAFETY NET AFFILIATES (""SNAS"") AND COMMUNITY CARE ALLIANCE (""CCA"") COMMUNITY HEALTH CENTERS (""CHCS"") ARE THE CORNERSTONE OF BILH'S DELIVERY SYSTEM REGARDING COMMUNITY-BASED CARE FOR MASSHEALTH AND HISTORICALLY UNDERSERVED PATIENTS.O CCA CHCS INCLUDE BOWDOIN STREET HEALTH CENTER, CHARLES RIVER COMMUNITY HEALTH, THE DIMOCK CENTER, FENWAY HEALTH, AND SOUTH COVE COMMUNITY HEALTH CENTER. O SNAS INCLUDE CAMBRIDGE HEALTH ALLIANCE AND SIGNATURE HEALTHCARE BROCKTON HOSPITAL. BILH CONTINUES TO INVEST IN THE CCA CHCS AND SNAS, ENABLING THEM TO EXPAND THEIR CAPABILITIES AND CARE FOR MORE HISTORICALLY UNDERSERVED PATIENTS. IN FY 2022, BILH INVESTED OVER $8 MILLION IN ITS CHCS AND SNAS, IN ADDITION TO ENGAGING IN REGIONAL PLANNING AND COLLABORATIVE PROGRAM DEVELOPMENT. THESE INVESTMENTS REPRESENT ONLY A PORTION OF A MUCH LARGER COMMUNITY BENEFITS INVESTMENT PORTFOLIO THAT IS DESCRIBED IN GREATER DETAIL IN THIS AND OTHER BILH NETWORK TAX FILINGS. BILH IS EXPLORING OPPORTUNITIES WITH CHCS IN ESSEX AND MIDDLESEX COUNTIES. FOR EXAMPLE, BILH HAS ESTABLISHED A TELEHEALTH PILOT PROGRAM BETWEEN PHYSICIANS AT ADDISON GILBERT AND BEVERLY HOSPITALS AND PATIENTS AT NORTH SHORE COMMUNITY HEALTH CENTER. COMMITMENT TO BEHAVIORAL HEALTH CARE BETH ISRAEL LAHEY HEALTH BEHAVIORAL SERVICES IS THE LARGEST MENTAL HEALTH AND SUBSTANCE USE DISORDER NETWORK IN EASTERN MASSACHUSETTS. WITH A FOCUS ON COMMUNITY HEALTH, BILH BEHAVIORAL SERVICES SUPPORTS THE NEEDS OF CHILDREN, TEENS, AND ADULTS THROUGH A RANGE OF OPTIONS, FROM INPATIENT CARE TO COMMUNITY-BASED PROGRAMS. IN FY 2022, BILH INVESTED OVER $5 MILLION IN THE FOLLOWING BEHAVIORAL HEALTH INITIATIVES: THE COLLABORATIVE CARE MODEL, CENTRALIZED BED MANAGEMENT PROGRAM, AND MEDICATION ASSISTED THERAPY (""MAT"") AS OF SEPTEMBER 30, 2022, 60 OF 78 EMPLOYED PRIMARY CARE PRACTICES2 ARE PARTICIPATING IN THE IMPACT MODEL, WITH 12 NEW SITES ADDED FROM THE PREVIOUS YEAR. THE IMPACT MODEL (ALSO REFERRED TO AS THE ""COLLABORATIVE CARE"" MODEL) IS A BEHAVIORAL HEALTH INTEGRATION MODEL, WHICH INVOLVES INTRODUCING PRIMARY CARE PATIENTS WHO ARE IDENTIFIED THROUGH SCREENINGS AND DIRECT REFERRALS TO AN EMBEDDED BEHAVIORAL HEALTH CLINICIAN. BILH HAS CONTINUED TO EXPAND ITS BRIDGE CLINICS AT ADDISON GILBERT AND BEVERLY HOSPITALS, INCREASING SAME-DAY ADMISSION FOR MAT PATIENTS FROM 24 TO 40 HOURS PER WEEK, OBTAINING ADDITIONAL STAFF, AND EXPANDING ITS INDUCTION PROGRAM. BILH HAS EXPANDED ITS SYSTEM-WIDE SUBSTANCE USE DISORDER TASKFORCE, DEFINING NEW PATHWAYS FOR CONNECTING BILH PRIMARY CARE TEAMS WITH COMMUNITY ACUTE DETOX AND OTHER ADDICTION-BASED SERVICES, INCREASING THE CAPACITY OF BILH PCPS TO PRESCRIBE MEDICATIONS IN SUPPORT OF OFFICE-BASED ADDICTION TREATMENT, AND PROVIDING EDUCATIONAL TRAININGS TO PCPS TO SCREEN AND TREAT SUBSTANCE USE DISORDERS. THE PRACTICE OF MAT INDUCTION AND REFERRAL IN THE ED AT BID-PLYMOUTH CONTINUED IN FY 2022, WITH RECOVERY NAVIGATORS, AN ADDICTION LPN NURSE, AND A PSYCHIATRIC NP AS AVAILABLE RESOURCES TO PATIENTS. BID-PLYMOUTH ALSO CONTINUED ITS PARTNERSHIP WITH AREA COALITIONS TO HAND OUT SUPPLIES AND RESOURCES, INCLUDING NARCAN, TO THOSE PATIENTS WHO ARE RESIDENTS OF THE AREA AND WHO PRESENT TO THE BID-PLYMOUTH EMERGENCY ROOM WITH AN OPIOID OVERDOSE. ADDITIONAL INFORMATION ON BEHAVIORAL HEALTH IS BELOW."

THREE:
"BILHPN SUPPORTS AND IMPROVES ACCESS, QUALITY AND EFFICIENCY OF PATIENT-CENTERED CARE BY LEVERAGING BEST PRACTICES IN CLINICAL EXCELLENCE AND DATA ANALYTICS TO HELP PROVIDERS IMPROVE PATIENT HEALTH OUTCOMES. FOR EXAMPLE, BILHPN'S CARE MANAGEMENT TEAM WORKS WITH THE HIGHEST-RISK PATIENTS IN AN EFFORT TO EDUCATE THEM ON THEIR DISEASE, IMPROVE MEDICATION COMPLIANCE, AND HELP THEM NAVIGATE THE COMPLEXITIES OF THE HEALTHCARE SYSTEM. THE GOAL OF BILHPN'S CARE MANAGERS IS TO IMPROVE OUTCOMES FOR PATIENTS WHILE AVOIDING UNNECESSARY EMERGENCY ROOM VISITS OR HOSPITAL STAYS. DURING FY 2022, BILH UNDERTOOK SEVERAL INITIATIVES TO IMPROVE POPULATION HEALTH AND PATIENT CARE, INCLUDING: O BILHPN'S QUALITY TEAM DEVELOPED AND IMPLEMENTED EIGHT TEXT-BASED OUTREACH CAMPAIGNS FOR PATIENTS, ADDRESSING CANCER SCREENINGS, IMMUNIZATIONS, AND DIABETES CARE TO IMPROVE POPULATION HEALTH METRICS.O BILHPN CONTINUED TO OPTIMIZE ITS ENTERPRISE-WIDE POPULATION HEALTH DATA WAREHOUSE TO IDENTIFY PATIENTS WITH CARE GAPS. THROUGH COLLABORATION WITH BILH PHYSICIAN LEADERS, BILHPN MODIFIED PRACTICE WORKFLOWS AND CREATED OUTREACH PROGRAMS TO CLOSE IDENTIFIED GAPS. THESE EFFORTS RESULTED IN BILH REACHING MORE PATIENTS.O DURING FY 2022, BILHPN AND THE BILH OFFICE FOR DIVERSITY, EQUITY AND INCLUSION CO-LED EFFORTS TO INCREASE ACCESS AND IMPROVE OUTCOMES FOR UNDERSERVED POPULATIONS, WITH A FOCUS ON CLOSING DISPARITIES IN DIABETES CARE FOR BLACK AND HISPANIC PATIENTS. ONE AREA OF COLLABORATION CENTERED AROUND A $1.8 MILLION GRANT FROM THE INSTITUTE OF HEALTHCARE IMPROVEMENT / BLUE CROSS BLUE SHIELD OF MASSACHUSETTS THAT ALLOWED THE SYSTEM TO HIRE AND EMBED PATIENT NAVIGATORS WITHIN ITS MOST DIVERSE PRACTICES TO ASSIST PATIENTS ALONG THE CONTINUUM OF CARE. BILH BEHAVIORAL HEALTH SERVICESTHE BETH ISRAEL LAHEY HEALTH NETWORK (BILH) IS COMMITTED TO THE BEHAVIORAL HEALTH NEEDS OF THE PATIENTS AND COMMUNITIES SERVICED. BELOW ARE SOME OF ACTIVITIES THAT BILH BEHAVIORAL SERVICES (BILHBS) HAS PROVIDED TO THE PATIENTS AND COMMUNITIES SERVED BY BILH AND ITS AFFILIATED ENTITIES. BILHBS (WHICH INCLUDES THE ACTIVITIES OF BILH'S TAX-EXEMPT AFFILIATE NORTHEAST BEHAVIORAL HEALTH CORP) IS THE LARGEST NETWORK OF MENTAL HEALTH AND SUBSTANCE USE DISORDER SERVICES IN EASTERN MASSACHUSETTS. BILHBS' NETWORK OF BEHAVIORAL HEALTH CARE INCLUDES SERVICES FOR CHILDREN AND ADULTS RANGING FROM INPATIENT TREATMENT TO COMMUNITY-BASED PROGRAMS. SERVICES INCLUDE: INPATIENT PSYCHIATRIC AND DETOXIFICATION TREATMENT; EMERGENCY PSYCHIATRIC AND MOBILE EMERGENCY SERVICES TEAMS; OUTPATIENT MENTAL HEALTH AND ADDICTION TREATMENT; INDIVIDUAL/COUPLE/FAMILY THERAPY; MEDICATION ASSISTED TREATMENT PROGRAMS; AND SCHOOL-BASED AND HOME-BASED COUNSELING FOR YOUTH AND THEIR FAMILIES.AS NOTED PREVIOUSLY, SINCE ITS CREATION IN MARCH 2019, BILH HAS CONTINUED TO INVEST SIGNIFICANTLY IN IMPROVING ACCESS TO BEHAVIORAL HEALTH CARE THROUGH A SYSTEM-WIDE APPROACH TO CARE DELIVERY. AS ONE OF SEVERAL ONGOING INITIATIVES, BILH HAS MADE A MULTI-YEAR COMMITMENT TO PROVIDE BEHAVIORAL HEALTH SUPPORT TO ITS EMPLOYED PRIMARY CARE PRACTICES USING AN EVIDENCE-BASED APPROACH KNOWN AS THE IMPACT MODEL. BY THE END OF FY 2022, BILH HAD IMPLEMENTED THE IMPACT MODEL IN 74.36% OF ITS EMPLOYED PRIMARY CARE PRACTICES AS PART OF ITS COLLABORATIVE CARE PROGRAM IMPLEMENTATION. IN MARCH 2021, BILHBS LAUNCHED ITS CENTRALIZED BED FINDING TEAM. THIS TEAM IS PART OF A BILHBS CENTRAL CALL CENTER, WHICH CENTRALIZES CALLS TO BILHBS' THREE EMERGENCY SERVICE PROGRAM (ESP) CATCHMENT AREAS REDUCING REDUNDANCIES ACROSS THE AGENCY AND STREAMLINING ALL CALLS TO ONE CENTRAL SERVICE. THIS CENTRALIZED BED FINDING TEAM IS RESPONSIBLE FOR CONDUCTING BED SEARCHES FOR PATIENTS SEEN THROUGH THE ESP AND WHO ARE AWAITING AN INPATIENT PSYCHIATRIC PLACEMENT. THIS TEAM DIRECTLY INCREASES THE AVAILABILITY OF CLINICIANS TO CONTINUE TO SEE PATIENTS IN THE EMERGENCY DEPARTMENT (ED) AND THE COMMUNITY WHO ARE EXPERIENCING A BEHAVIORAL HEALTH AND/OR CO-OCCURRING SUBSTANCE USE DISORDER CRISIS WHILE OTHER TEAM MEMBERS SEARCH FOR AVAILABLE INPATIENT PLACEMENTS. THIS INITIATIVE SUPPORTS DECREASED RESPONSE TIME TO RESPONDING TO NEW PATIENTS IN CRISIS AND REDUCES ED BOARDING TIME FOR PATIENTS WHO CAN BE SAFELY MANAGED IN THE COMMUNITY.IN FY2022, THE STATE OF MASSACHUSETTS SET FORTH THE MASSACHUSETTS BEHAVIORAL HEALTH ROADMAP TO INCLUDE FOUR PRIMARY OUTCOMES IN EFFORTS TO ADVANCE HEALTH EQUITY: (1) THE DEVELOPMENT OF COMMUNITY BEHAVIORAL HEALTH CENTERS (CBHCS); (2) SHIFTING BEHAVIORAL HEALTH EMERGENCY SERVICES TO THE COMMUNITY FROM THE EMERGENCY DEPARTMENTS; (3) TREATMENT ON DEMAND (OUTPATIENT EVALUATION AND TREATMENT); AND (4) BEHAVIORAL HEALTH HELP LINE. IN RESPONSE TO THIS MOVEMENT, BILHBS RECEIVED AN AWARD TO OPERATE A CBHC IN THE LAWRENCE LOCATION AND BEGAN THE PLANNING TO PIVOT EMERGENCY SERVICES TEAMS TO SERVE THE BILH SYSTEM EMERGENCY DEPARTMENTS. BILHBS SERVES APPROXIMATELY 35,000 UNDUPLICATED INDIVIDUALS ANNUALLY, OFFERING A FULL CONTINUUM OF CARE FOR CHILDREN AND ADULTS. SERVICES RANGE FROM INPATIENT TO HOME AND COMMUNITY-BASED SERVICES. BILHBS OPERATES OVER 250 BEDS IN 9 FACILITIES FOR CLIENTS REQUIRING ACUTE PSYCHIATRIC CARE, DETOXIFICATION AND RESIDENTIAL STEP-DOWN SERVICES. DURING THE PERIOD COVERED BY THIS FILING, COMMUNITY-BASED SERVICES INCLUDED MOBILE EMERGENCY SERVICES TEAMS IN THREE CATCHMENT AREAS AND HOME-BASED COUNSELING FOR ADULTS, YOUTH AND THEIR FAMILIES. BILHBS ALSO PROVIDED SERVICES IN 63 MIDDLE AND HIGH SCHOOLS, AS WELL AS 9 POLICE DEPARTMENTS. IN ADDITION, BILH'S COMMUNITY CRISIS STABILIZATION (""CCS"") UNITS IN LAWRENCE AND SALEM, WHICH TYPICALLY CARE FOR PATIENTS WITH MENTAL HEALTH ISSUES, INCREASED THEIR ABILITY TO TREAT PERSONS WITH CO-OCCURRING SUBSTANCE USE DISORDERS. THE CCS UNITS CONTINUE TO BE ABLE TO INDUCT PATIENTS WITH OPIOID USE DISORDER (OUD) ON BUPRENORPHINE AND ARE ALSO ABLE TO MAINTAIN PATIENTS WHO ARE ALREADY ON ANY OF THE THREE FDA APPROVED MEDICATIONS FOR THE TREATMENT OF OUD. THESE UNITS ARE SEEING AN INCREASE IN THE NUMBER OF PATIENTS WITH METHAMPHETAMINE DISORDERS AND HAVE DEVELOPED A PROTOCOL TO MANAGE WITHDRAWAL SYMPTOMS IN THIS POPULATION."