4A (Expenses $ 75603207 including grants of $ 248943) (Revenue $ 68234207)
SEE SCHEDULE O

4B (Expenses $ 52543298 including grants of $ 0) (Revenue $ 50428376)
SEE SCHEDULE O

4C (Expenses $ 12312485 including grants of $ 0) (Revenue $ 18568985)
SEE SCHEDULE O

FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS
SUPPLEMENTAL INFORMATION FOR SCHEDULE H PART V, SECTION BFINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS COMMUNITY HEALTH IMPROVEMENT SERVICES AND CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPSBETH ISRAEL DEACONESS HOSPITAL-MILTON (BID-MILTON) AFFILIATIONBETH ISRAEL LAHEY HEALTH (BILH) IS THE SOLE MEMBER OF BETH ISRAEL DEACONESS HOSPITAL-MILTON (BID-MILTON OR HOSPITAL). THE BILH NETWORK OF AFFILIATES IS AN INTEGRATED HEALTH CARE 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.BID--MILTON COMMUNITY BENEFITS MISSION STATEMENT THE MISSION OF BID--MILTON IS TO PROVIDE FREE OR LOW-COST PROGRAMS THAT ADDRESS UNMET HEALTH AND WELLNESS NEEDS OF RACIALLY, ETHNICALLY, AND LINGUISTICALLY DIVERSE COMMUNITIES IN MILTON, RANDOLPH, AND QUINCY, IN A MANNER SHAPED BY COMMUNITY INPUT, ALIGNED WITH HOSPITAL RESOURCES, AND GUIDED BY OUR OBJECTIVE TO DELIVER HIGH-QUALITY CARE WITH COMPASSION, DIGNITY, AND RESPECT.BID--MILTON COMMUNITY BENEFITS MISSION IS FULFILLED BY: INVOLVING BID--MILTON 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 BID--MILTON'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 BID-MILTON'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, HEALTH CARE 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, BID-MILTON PROVIDED COMMUNITY HEALTH IMPROVEMENT SERVICES, COMMUNITY BENEFITS OPERATIONS AND CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS OF $490,046 AS REPORTED ON THIS SCHEDULE H, PART I, LINES 7E AND 7I. COMMUNITY BENEFITS LEADERSHIP/TEAMTHE BID-MILTON'S BOARD OF TRUSTEES ALONG WITH ITS CLINICAL AND ADMINISTRATIVE STAFF IS COMMITTED TO IMPROVING THE HEALTH OF OUR COMMUNITY BY PROVIDING EXCEPTIONAL, PERSONALIZED HEALTH CARE WITH DIGNITY, COMPASSION, AND RESPECT. BID-MILTON'S COMMUNITY BENEFITS DEPARTMENT, UNDER THE DIRECT OVERSIGHT OF BID-MILTON'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 BID-MILTON'S IMPLEMENTATION STRATEGY, ENSURING THAT HOSPITAL POLICIES AND RESOURCES ARE ALLOCATED TO SUPPORT PLANNED ACTIVITIES. BID-MILTON COMMUNITY BENEFITS PROGRAM IS SPEARHEADED BY THE COMMUNITY BENEFITS AND RELATIONS MANAGER. THE COMMUNITY BENEFITS AND RELATIONS MANAGER HAS DIRECT ACCESS AND IS ACCOUNTABLE TO THE BID-MILTON PRESIDENT AND THE BILH VICE PRESIDENT OF COMMUNITY BENEFITS AND COMMUNITY RELATIONS, THE LATTER OF WHOM 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 BID-MILTON COMMUNITY BENEFITS ADVISORY COMMITTEE (CBAC) WORKS IN COLLABORATION WITH BID-MILTON'S HOSPITAL LEADERSHIP, INCLUDING THE HOSPITAL'S GOVERNING BOARD AND SENIOR MANAGEMENT TO SUPPORT BID-MILTON'S COMMUNITY BENEFITS MISSION TO SERVE ITS PATIENTS COMPASSIONATELY AND RESPECTFULLY, TO IMPROVE THE HEALTH AND WELL-BEING OF RESIDENTS IN BID-MILTON'S COMMUNITY. THE CBAC PROVIDES INPUT INTO THE DEVELOPMENT AND IMPLEMENTATION OF BID-MILTON'S COMMUNITY BENEFITS PROGRAMS IN FURTHERANCE OF BID-MILTON'S COMMUNITY BENEFITS MISSION. THE MEMBERSHIP OF BID-MILTON'S CBAC ASPIRES TO BE REPRESENTATIVE OF THE CONSTITUENCIES AND PRIORITY COHORTS SERVED BY BID-MILTON'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. BID-MILTON'S CBAC MEMBERS INCLUDE: RITA BAILEY, COORDINATOR OF HEALTH SERVICES, QUINCY PUBLIC SCHOOLS TIM CAREY, DIRECTOR OF PROGRAM DEVELOPMENT, SOUTH SHORE ELDER SERVICES DR. DAURICE COX, CEO, BAYSTATE COMMUNITY SERVICES CATHERINE DENNY, CEO, CHOICE COMMUNITY SUPPORTS RICHARD DOANE, EXECUTIVE DIRECTOR, INTERFAITH SOCIAL SERVICES DR. NANCY DREW, PRIMARY CARE PHYSICIAN BILH MELISSA DROHAN, SOCIAL WORKER, BID-MILTON MARIAN GIROUARD-SPINO, CHIEF SYSTEM INTEGRATION & QUALITY OFFICER, ASPIRE HEALTH ALLIANCE TINA HO, INTEGRATED SERVICE LEAD OF FAMILY AND COMMUNITY ENGAGEMENT, QUINCY ASIAN RESOURCES MELISSA HORR-POND, SENIOR PRINCIPAL PLANNER, CITY OF QUINCY CAROLINE KINSELLA, PUBLIC HEALTH DIRECTOR, TOWN OF MILTON LAUREANE MARQUEZ, COMMUNITY BENEFITS MANAGER, BID-MILTON VICKI MCCARTHY, MILTON RESIDENT REV. BAFFOUR NKRUMAH-APPIAH, PASTOR, FIRST BAPTIST CHURCH, RANDOLPH KRISTEN SCHLAPP, CHIEF OPERATING OFFICER, QUINCY COMMUNITY ACTION PROGRAMS CYNTHIA SIERRA, CEO, MANET COMMUNITY HEALTH CENTERS CHRISTINE STANTON, EXECUTIVE DIRECTOR, MILTON COUNCIL ON AGING HEIDI STUCKER, ASSISTANT DIRECTOR OF PUBLIC HEALTH, METROPOLITAN AREA PLANNING COUNCIL KATELYN SZAFIR, EXECUTIVE DIRECTOR, SOUTH SHORE YMCA SARA TAN, EXECUTIVE DIRECTOR, ENHANCE ASIAN COMMUNITY ON HEALTH CHRISTINE TANGISHAKA, RANDOLPH RESIDENT BRIAN TATRO, EXECUTIVE DIRECTOR, MILTON HOUSING AUTHORITY JEANNETTE TRAVALINE, EXECUTIVE DIRECTOR, RANDOLPH CHAMBER OF COMMERCE MICHELLE TYLER, DIRECTOR OF PLANNING, TOWN OF RANDOLPH DIN SHIH, BID-MILTON BOARD OF TRUSTEES

COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY
MOST 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 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. BID-MILTON COMPLETED ITS MOST RECENT NEEDS ASSESSMENT IN SEPTEMBER 2022. THAT CHNA WAS APPROVED BY THE BID-MILTON BOARD OF TRUSTEES ON SEPTEMBER 12, 2022. THE ACCOMPANYING IMPLEMENTATION STRATEGY FOR THE MOST RECENT CHNA WAS ALSO ADOPTED BY THE BOARD ON SEPTEMBER 12, 2022 WHICH IS WITHIN THE TIMELINE REQUIRED BY THE TREASURY REGULATIONS UNDER 501(R). THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND THE ASSOCIATED IMPLEMENTATION STRATEGY (IS) REPRESENT THE CULMINATION OF A YEAR OF WORK AND WERE BORNE LARGELY OF BID-MILTON'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 BID-MILTON ASSESS COMMUNITY HEALTH NEEDS, ENGAGE THE COMMUNITY, IDENTIFY PRIORITY HEALTH ISSUES AND CREATE A COMMUNITY HEALTH STRATEGY THAT DESCRIBES HOW BID-MILTON, 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, BID-MILTON COMPLETED ITS LAST ASSESSMENT IN SEPTEMBER 2022. THE GEOGRAPHICAL FOCUS OF BID-MILTON'S MOST RECENTLY COMPLETED COMMUNITY HEALTH NEEDS ASSESSMENT ENCOMPASSES THE CITY OF QUINCY AND TOWNS OF MILTON AND RANDOLPH.COMMUNITY HEALTH ISSUES AND PRIORITY COHORTS FOR BID-MILTON'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).BID-MILTON'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 COMMUNITIES OF QUINCY, MILTON AND RANDOLPH IN ITS CBSA, AS FOLLOWS: YOUTH LOW-RESOURCED POPULATIONS OLDER ADULTS RACIALLY, ETHNICALLY AND LINGUISTICALLY DIVERSE POPULATIONS INDIVIDUALS WITH DISABILITIES2022 COMMUNITY HEALTH NEEDS ASSESSMENTSUMMARY OF APPROACH AND METHODSBID-MILTON'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 BID-MILTON'S CBSA, ESPECIALLY THE POPULATION SEGMENTS THAT ARE OFTEN DISADVANTAGED, FACE DISPARITIES IN HEALTH-RELATED OUTCOMES, AND WHO HAVE BEEN HISTORICALLY UNDERSERVED. BID-MILTON'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, BID-MILTON CONDUCTED 19 ONE-ON-ONE INTERVIEWS WITH KEY COLLABORATORS IN THE COMMUNITY, FACILITATED THREE FOCUS GROUPS WITH SEGMENTS OF THE POPULATION FACING THE GREATEST HEALTH-RELATED DISPARITIES, ADMINISTERED A COMMUNITY HEALTH SURVEY INVOLVING MORE THAN 500 RESIDENTS, AND ORGANIZED TWO COMMUNITY LISTENING SESSIONS. (SCHEDULE H, PART V, SECTION B, QUESTIONS 3 AND 5). ULTIMATELY, THE ASSESSMENT PROCESS COLLECTED INFORMATION FROM MORE THAN 600 COMMUNITY RESIDENTS, CLINICAL AND SOCIAL SERVICE PROVIDERS AND OTHER COMMUNITY PARTNERS.2022 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESSDETAIL OF APPROACH AND METHODSBID-MILTON RELIED ON NUMEROUS PRIMARY AND SECONDARY DATA SOURCES TO ANALYZE THE HEALTH STATUS AND NEED LEVEL THROUGHOUT THEIR CBSA. BID-MILTON COLLECTED DATA FROM A NUMBER OF SOURCES INCLUDING PRIMARY QUANTITATIVE AND QUALITATIVE DATA, AS WELL AS SECONDARY DATA. EXAMPLES OF SECONDARY DATA SOURCES THAT BID-MILTON 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, BID-MILTON CONDUCTED 19 KEY INFORMANT INTERVIEWS THAT ENGAGED COMMUNITY-BASED ORGANIZATIONS, CLINICAL AND SOCIAL SERVICE PROVIDERS, PUBLIC HEALTH OFFICIALS, ELECTED/APPOINTED OFFICIALS AND OTHER KEY COLLABORATORS THROUGHOUT BID-MILTON'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 BID-MILTON'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 BID-MILTON'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 PROCESSFOCUS GROUPS AND COMMUNITY FORUMS (SCHEDULE H, PART V, SECTION B, LINE 5)BID-MILTON CONDUCTED THREE COMMUNITY FOCUS GROUPS AND HELD TWO COMMUNITY LISTENING SESSIONS THAT ENGAGED 77 RESIDENTS IN BID-MILTON'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 SIGNATURE HEALTHCARE BROCKTON HOSPITAL AND OTHER BILH HOSPITALS.BID-MILTON HAS BEEN INTENTIONAL IN ENSURING THAT VARIED EXPERIENCES AND PERSPECTIVES, REFLECTIVE OF BID-MILTON'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, EMAILS TO LARGE NETWORKS, PUBLIC LIBRARIES, FAITH-BASED COMMUNITIES, COMMUNITY EVENTS AND SENIOR HOUSING FACILITIES TO HELP ENSURE DIVERSE REPRESENTATION IN THE CHNA. THE BID-MILTON 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 PROCESS
REVIEWING 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 BID-MILTON COMMUNITY BENEFITS ADVISORY COMMITTEE (CBAC) AND HELD A VIRTUAL COMMUNITY FORUM PRESENTING RESULTS. IDENTIFY BID-MILTON'S COMMUNITY BENEFITS PRIORITY COHORTS, GEOGRAPHIC FOCUS, AND COMMUNITY HEALTH PRIORITIES. ANALYZE BID-MILTON'S EXISTING COMMUNITY BENEFITS ACTIVITIES WHICH WERE INFORMED BY THE 2019 CHNA AND SUBSEQUENT 2020 2022 IMPLEMENTATION STRATEGY THAT WERE COMPLETED BY BID-MILTON 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 OLDER ADULTS RACIALLY, ETHNICALLY AND LINGUISTICALLY DIVERSE POPULATIONS INDIVIDUALS WITH DISABILITIESBID-MILTON'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 HEALTH CARE 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 BID-MILTON'S COMMUNITY BENEFITS INITIATIVES DURING THE FISCAL YEARS ENDED 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, BID-MILTON 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 CHIP PROCESS WHICH WAS COMPLETED BY BID-MILTON 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 POPULATIONBID-MILTON COMPLETED ITS 2019 ASSESSMENT IN SEPTEMBER OF 2019. THE GEOGRAPHICAL FOCUS OF BID-MILTON'S 2019 CHNA ENCOMPASSES THE CITY OF QUINCY AND TOWNS OF MILTON AND RANDOLPH.TARGET POPULATIONS FOR BID-MILTON'S COMMUNITY BENEFITS INITIATIVES WERE 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).BID-MILTON'S TARGET POPULATIONS FOCUS ON MEDICALLY UNDERSERVED AND VULNERABLE GROUPS OF ALL AGES IN THE TOWNS OF MILTON AND RANDOLPH AND THE CITY OF QUINCY, AS FOLLOWS: YOUTH OLDER ADULTS LOW- TO MODERATE-INCOME INDIVIDUALS AND FAMILIES INDIVIDUALS WITH CHRONIC AND COMPLEX CONDITIONS RACIAL/ETHNIC MINORITIES AND NON-ENGLISH SPEAKERS2019 COMMUNITY HEALTH NEEDS ASSESSMENTSUMMARY OF APPROACH AND METHODSTHE CHNA USED A PARTICIPATORY, COLLABORATIVE APPROACH TO LOOK AT HEALTH IN ITS BROADEST CONTEXT. THE ASSESSMENT PROCESS INCLUDED SYNTHESIZING EXISTING REGIONAL DATA ON SOCIAL, ECONOMIC AND HEALTH INDICATORS AS WELL AS INFORMATION FROM COMMUNITY-BASED SURVEYS AND FOUR FOCUS GROUPS. COMMUNITY DIALOGUES AND KEY INFORMANT INTERVIEWS WERE CONDUCTED WITH INDIVIDUALS FROM ACROSS THE MILTON, QUINCY AND RANDOLPH COMMUNITIES THAT COMPRISE THE NORFOLK COUNTY 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., YOUTH AND FOREIGN LANGUAGE SPEAKERS) (SCHEDULE H, PART V, SECTION B, QUESTIONS 3 AND 5). ULTIMATELY, THE QUALITATIVE RESEARCH ENGAGED APPROXIMATELY 313 PEOPLE. BID-MILTON HIRED JOHN SNOW, INC. TO CONDUCT AND MANAGE THE CHNA PROCESS UNDERTAKEN DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2019, AND JSI WORKED CLOSELY WITH BID-MILTON COMMUNITY BENEFITS STAFF THROUGHOUT THE PROCESS. THE MOST RECENT CHNA WAS DESIGNED AS A THREE-PHASE PROCESS: PHASE ONE INVOLVED PRELIMINARY ASSESSMENT AND ENGAGEMENT ACTIVITIES, INCLUDING: COLLECTION AND ANALYSIS OF QUANTITATIVE DATA TO CHARACTERIZE COMMUNITY CHARACTERISTICS AND DISEASE BURDEN KEY INFORMANT INTERVIEWS WITH HOSPITAL LEADERSHIP, LOCAL SERVICE PROVIDERS, AND COMMUNITY STAKEHOLDERS AN EVALUATION OF BID-MILTON'S CURRENT PORTFOLIO OF COMMUNITY BENEFITS ACTIVITIESPHASE TWO INVOLVED TARGETED ENGAGEMENT ACTIVITIES, INCLUDING: ADDITIONAL INTERVIEWS WITH HOSPITAL LEADERSHIP, CLINICAL PROVIDERS AND COMMUNITY STAKEHOLDERS DISSEMINATION AND ANALYSIS OF A COMMUNITY HEALTH SURVEY TO CAPTURE RESIDENTS' PERCEPTIONS OF BARRIERS TO GOOD HEALTH, LEADING HEALTH ISSUES, VULNERABLE POPULATIONS.

FOCUS GROUPS WITH IDENTIFIED UNDERSERVED POPULATIONS
PHASE THREE INVOLVED A SERIES OF STRATEGIC PLANNING AND REPORTING ACTIVITIES, INCLUDING: MEETINGS WITH THE CBAC AND CBSLT (INCLUDING MEMBER OF THE BOARD OF TRUSTEES) TO PRESENT CHNA FINDINGS, PRIORITIZE COMMUNITY HEALTH ISSUES, IDENTIFY VULNERABLE POPULATIONS, AND DISCUSS POTENTIAL RESPONSES CREATION OF A RESOURCE INVENTORY TO CATALOG LOCAL ORGANIZATIONS, SERVICE PROVIDERS, AND COMMUNITY ASSETS THAT HAVE THE POTENTIAL TO ADDRESS IDENTIFIED NEEDS LITERATURE REVIEW OF EVIDENCE-BASED STRATEGIES TO RESPOND TO IDENTIFIED HEALTH PRIORITIES DEVELOPMENT OF A FINAL CHNA REPORT AND IMPLEMENTATION STRATEGY2019 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESSDETAIL OF APPROACH AND METHODSTHE ASSESSMENT PROCESS INCLUDED SYNTHESIZING EXISTING REGIONAL DATA ON SOCIAL, ECONOMIC AND HEALTH INDICATORS AS WELL AS INFORMATION FROM THE DISSEMINATION AND ANALYSIS OF A COMMUNITY HEALTH SURVEY TO CAPTURE RESIDENTS' PERCEPTIONS OF BARRIERS TO GOOD HEALTH, LEADING HEALTH ISSUES, VULNERABLE POPULATIONS, ACCESSIBILITY OF HEALTH SERVICES AND OPPORTUNITIES FOR THE HOSPITAL TO IMPROVE THE SERVICES THEY OFFER TO THE COMMUNITY. TO REACH A BROAD RANGE OF COMMUNITY MEMBERS, A COMMUNITY HEALTH SURVEY WAS DEVELOPED TO CAPTURE INFORMATION DIRECTLY FROM COMMUNITY RESIDENTS. RESPONDENTS WERE ASKED FOR THEIR OPINION ON LEADING SOCIAL DETERMINANTS OF HEALTH, CLINICAL HEALTH ISSUES, VULNERABLE POPULATIONS, ACCESS TO CARE, AND OPPORTUNITIES FOR THE HOSPITAL TO IMPROVE COMMUNITY HEALTH PROGRAMMING. JSI WORKED WITH BID-MILTON AND THE CHNA STEERING COMMITTEE TO DEVELOP THIS SURVEY. SURVEYS WERE AVAILABLE ONLINE, THROUGH THE SURVEY MONKEY PLATFORM, IN ENGLISH. HARD-COPIES OF THE SURVEY WERE MADE AVAILABLE IN ENGLISH, HAITIAN CREOLE, VIETNAMESE, AND CHINESE. BID-MILTON WORKED WITH LOCAL COMMUNITY ORGANIZATIONS, BUSINESSES, AND STAKEHOLDERS TO DISTRIBUTE THE SURVEY TO COMMUNITY RESIDENTS, INCLUDING THOSE WHO ARE TYPICALLY HARD-TO-REACH (E.G. NON-ENGLISH SPEAKERS). QUANTITATIVE DATA FROM A BROAD RANGE OF SOURCES WAS COLLECTED AND ANALYZED TO CHARACTERIZE COMMUNITIES IN BID-MILTON'S CBSA, MEASURE HEALTH STATUS, AND INFORM A COMPREHENSIVE UNDERSTANDING OF THE HEALTH-RELATED ISSUES. SOURCES INCLUDED: U.S. CENSUS BUREAU, AMERICAN COMMUNITY SURVEY 5-YEAR ESTIMATES (2013-2017) 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 (FY 2013-2017) MASSACHUSETTS HEALTHY AGING COLLABORATIVE, COMMUNITY PROFILES (2018) TO AUGMENT THE QUANTITATIVE DATA FROM MDPH, JSI WORKED WITH THE MASSACHUSETTS HEALTH DATA CONSORTIUM (MHDC) AND THE MASSACHUSETTS CENTER FOR HEALTH INFORMATION AND ANALYSIS (CHIA) TO OBTAIN 2018 INPATIENT HOSPITAL DISCHARGE DATA FOR ALL OF THE MUNICIPALITIES IN BID-MILTON'S SERVICE AREA.2019 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESSKEY INFORMANT INTERVIEWS WITH INTERNAL AND EXTERNAL STAKEHOLDERS (SCHEDULE H, PART V, SECTION B, LINE 5)BID-MILTON, WITH THE HELP OF JOHN SNOW, INC., CONDUCTED 17 KEY INFORMANT INTERVIEWS. INTERVIEWEES INCLUDED REPRESENTATIVES FROM HOSPITAL LEADERSHIP, MUNICIPAL LEADERSHIP, THE BUSINESS COMMUNITY, PUBLIC HEALTH DEPARTMENTS, SOCIAL SERVICE PROVIDERS, SCHOOLS, FAITH-BASED COMMUNITIES, AND COMMUNITY HEALTH COALITIONS. KEY INFORMANT INTERVIEWS WERE DONE TO CONFIRM AND REFINE FINDINGS FROM SECONDARY DATA, TO PROVIDE COMMUNITY CONTEXT, AND TO CLARIFY NEEDS AND PRIORITIES OF THE COMMUNITY. INTERVIEWS WERE 30-60 MINUTES LONG AND WERE CONDUCTED BY PHONE USING A STRUCTURED INTERVIEW GUIDE CREATED BY JSI. 2019 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESSFOCUS GROUPS AND COMMUNITY FORUMS (SCHEDULE H, PART V, SECTION B, LINE 5)FOUR FOCUS GROUPS WITH IDENTIFIED UNDERSERVED POPULATIONS WERE ALSO HELD. JSI CONDUCTED FACILITATED FOCUS GROUPS WITH COMMUNITY COALITIONS, INCLUDING REPRESENTATIVES FROM LOCAL HEALTH DEPARTMENTS AND HEALTH/SOCIAL SERVICE ORGANIZATIONS (COMMUNITY HEALTH NETWORK AREA 20 (BLUE HILLS), DEMOGRAPHIC SEGMENTS OF THE COMMUNITY (ENHANCE ASIAN COMMUNITY ON HEALTH IN QUINCY), AND REPRESENTATIVES FROM THE FAITH-BASED COMMUNITY (FIRST BAPTIST CHURCH IN RANDOLPH). BID-MILTON ALSO COLLABORATED WITH THE MILTON SUBSTANCE ABUSE PREVENTION COALITION (MILTON SAPC) IN NUMEROUS FOCUS GROUPS OF HIGH SCHOOL STUDENT ATHLETES. THE MILTON SAPC FACILITATED A FOCUS GROUP OF MALE AND FEMALE TEAM SPORTS CAPTAINS, MOSTLY 11TH AND 12TH GRADE STUDENTS, AS WELL AS THREE CLASSROOMS. THEY INCORPORATED BID-MILTON'S FOCUS GROUP QUESTIONS INTO THEIR FACILITATION GUIDE. MILTON SAPC AND THEN SHARED THEIR NOTES AND RESULTS OF THE FOCUS GROUP WITH BID-MILTON TO INCLUDE IN THIS CHNA. THESE FOCUS GROUPS ALLOWED FOR THE COLLECTION OF INFORMATION TO AUGMENT FINDINGS FROM SECONDARY DATA AND KEY INFORMANT INTERVIEWS, AND EXPLORATION OF STRATEGIC AND PROGRAMMATIC OPTIONS TO ADDRESS IDENTIFIED HEALTH ISSUES, SERVICE GAPS, AND/OR BARRIERS TO CARE. PARTICIPANTS WERE RECRUITED BY BID-MILTON, REPRESENTATIVES FROM HOST ORGANIZATIONS, AND FACILITATORS. FOCUS GROUPS WERE APPROXIMATELY 60 MINUTES AND WERE CONDUCTED IN-PERSON USING A STRUCTURED GUIDE CREATED BY JSI. DETAILED NOTES WERE TAKEN AT EACH SESSION. APPENDIX A INCLUDES SESSION DATES, A DESCRIPTION OF PARTICIPANTS, AND A FOCUS GROUP GUIDE. 2019 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESSREVIEWING RESULTS AND COMPILING THE COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY DOCUMENTSTHE BID-MILTON COMMUNITY HEALTH IMPLEMENTATION STRATEGY WAS DEVELOPED BY A TEAM COMPRISED OF HOSPITAL LEADERSHIP, PATIENT ADVOCACY, MEDICAL STAFF, PUBLIC RELATIONS AND COMMUNITY REPRESENTATION. THE GROUP REVIEWED PROGRESS TOWARD GOALS AND OBJECTIVES OF THE PRIOR THREE-YEAR PERIOD, AS WELL AS THE CURRENT DATA COLLECTED THROUGH THE CHNA, TO HELP ENVISION AND DEFINE PRIORITY AREAS FOR THE FUTURE. THE IMPLEMENTATION STRATEGY IDENTIFIED PRIORITY AREAS AND DEFINED GOALS, ALONG WITH OBJECTIVES FOR EACH GOAL AND DRAFTED STRATEGIES TO OPERATIONALIZE THESE OBJECTIVES. 2019 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESSKEY FINDINGSBID-MILTON'S CHNA RESULTED IN KEY FINDINGS RELATED TO SOCIAL DETERMINANTS OF HEALTH, BEHAVIORAL HEALTH, CHRONIC DISEASES AND THEIR RISK FACTORS AND NAVIGATING THE SYSTEM/ACCESS TO CARE. THE FOLLOWING ARE BRIEF SUMMARIES OF SOME OF THE ASSESSMENT'S KEY FINDINGS. A FULL REVIEW OF THE QUANTITATIVE AND QUALITATIVE INFORMATION THAT WAS COLLECTED FOR THIS ASSESSMENT AND THAT LED THE CBAC AND THE CBLT TO IDENTIFY THE ISSUES THAT WERE PRIORITIZED BY THE ASSESSMENT IS INCLUDED IN THE FULL BODY OF THE CHNA. SOCIAL DETERMINANTS OF HEALTH CONTINUE TO HAVE A SUBSTANTIAL IMPACT ON MANY SEGMENTS OF THE POPULATION. ONE OF THE DOMINANT THEMES FROM THE ASSESSMENT'S FINDINGS WAS THE IMPACT THAT THE UNDERLYING SOCIAL DETERMINANTS OF HEALTH ARE HAVING ON THOSE LIVING IN THE CBSA. THE SEGMENTS OF THE POPULATION MOST CHALLENGED BY THESE ISSUES ARE OLDER ADULTS, LOW-INCOME INDIVIDUALS/FAMILIES, RACIAL/ETHNIC MINORITIES, NON- ENGLISH SPEAKERS, AND THOSE WITH DISABILITIES OR WITH CHRONIC / COMPLEX CONDITIONS. MORE SPECIFICALLY, THESE SEGMENTS STRUGGLE WITH FINANCIAL INSECURITY, SAFE/AFFORDABLE HOUSING, TRANSPORTATION, ACCESS TO HEALTHY/AFFORDABLE FOOD, LACK OF SOCIAL SUPPORT, SOCIAL ISOLATION, AND LANGUAGE ACCESS ISSUES. THESE ISSUES IMPACT MANY PEOPLE'S AND FAMILIES' ABILITY TO ACCESS OR PAY FOR THE SERVICES, HOUSING, FOOD, OR OTHER ESSENTIAL ITEMS THEY NEED AND/OR TO LIVE A HAPPY, FULFILLING, PRODUCTIVE LIFE. THE BURDEN OF SUBSTANCE USE AND MENTAL HEALTH ISSUES. MENTAL HEALTH AND SUBSTANCE USE ISSUES CONTINUE TO BE ONE OF THE REGION'S MOST PREVALENT AND CHALLENGING ISSUES AND ARE HAVING A PROFOUND IMPACT ON INDIVIDUALS, FAMILIES, AND COMMUNITIES THROUGHOUT THE CBSA. THESE ISSUES ARE ALSO A MAJOR BURDEN ON THE HEALTH AND SOCIAL SERVICE SYSTEM. HEALTH AND SOCIAL SERVICE PROVIDERS, PUBLIC HEALTH AGENCIES, FIRST-RESPONDERS, AND COMMUNITY-BASED ORGANIZATIONS ARE CONFRONTED ON A DAILY BASIS WITH PEOPLE STRUGGLING WITH ACUTE OR CHRONIC CONDITIONS AND STRUGGLE TO PROVIDE OR LINK THEM TO THE CARE THEY NEED. WITH RESPECT TO MENTAL HEALTH ISSUES, DEPRESSION/ANXIETY, STRESS, SOCIAL ISOLATION, AND THE IMPACTS OF TRAUMA ARE THE LEADING ISSUES. WITH RESPECT TO SUBSTANCE USE, THE OPIOID CRISIS CONTINUES TO HAVE A TREMENDOUS IMPACT ON THE REGION, ALONG WITH ALCOHOL USE, MARIJUANA USE, AND VAPING IN YOUTH. THE FACT THAT PHYSICAL, MENTAL HEALTH, AND SUBSTANCE ISSUES ARE SO INTERTWINED COMPOUNDS THE IMPACT OF THESE ISSUES. OF PARTICULAR CONCERN ARE THE INCREASING RATES OF OPIOID USE AND THE IMPACTS OF TRAUMA

METRICS AND STATUS UPDATE:
"NUMBER OF COMMUNITY MEMBERS TRAINED IN MENTAL HEALTH FIRST AID (FY20: 20; FY21: SUSPENDED DUE TO COVID-19, FY22: 47; 2 COMMUNITY FACILITATORS TRAINED TO TEACH TEEN MENTAL HEALTH FIRST AID) NUMBER OF FIFTH-GRADE STUDENTS PARTICIPATING IN BOTVIN LIFE SKILLS CURRICULUM AND % REPORTING CHANGES IN KNOWLEDGE/BEHAVIOR FY20: 204 STUDENTS PARTICIPATED WITH 92.2% OF STUDENTS REPORTED LEARNING SOMETHING NEW ABOUT TOBACCO/VAPING TO HELP THEM DETER USE AND 82.8% OF STUDENTS INDICATED LEARNING A NEW COPING SKILL TO MANAGE STRESS AND ANXIETY. FY21: 268 STUDENTS PARTICIPATED WITH 87% OF STUDENTS REPORTED LEARNING SOMETHING NEW ABOUT TOBACCO/VAPING TO HELP THEM DETER USE AND 82% OF STUDENTS INDICATED LEARNING A NEW COPING SKILL TO MANAGE STRESS AND ANXIETY. FY22: 260 STUDENTS PARTICIPATED, BUT DATA WAS NOT COLLECTED DUE TO SCHOOL STAFFING RESOURCES. NUMBER OF GETTING THE TEENS OUT PROGRAM EVENTS HELD BY QUINCY ASIAN RESOURCES AND NUMBER OF TEENAGERS AND PARENTS WHO PARTICIPATED (FY20: N/A PROGRAM BEGAN FY22; FY21: N/A PROGRAM BEGAN FY22; FY22: 6 EVENTS HELD WITH 150 TEENAGERS AND 28 PARENTS PARTICIPATING). NUMBER OF MILTON PUBLIC SCHOOL STAFF MEMBERS TRAINED TO IMPLEMENT EVIDENCE-BASED CURRICULUM ""UNDERSTANDING TRAUMA AND ITS IMPACT"" TRAINING (FY20: N/A, PROGRAM BEGAN FY22; FY21: N/A, BEGAN FY22: 432 STAFF MEMBERS TRAINED WITH 12 SOCIAL EMOTIONAL LEARNING LEADS IDENTIFIED). NUMBER OF HOURS OF SUPPORT AND SPACE NEEDS FOR AL-ANON, ALATEEN, CHADD, OVEREATERS ANONYMOUS, ALCOHOLICS ANONYMOUS, AND NEW MOMS SUPPORT GROUPS (FY20, 159 HOURS OF SUPPORT AND SPACE NEEDS PROVIDED FOR. FY21: SUPPORT GROUPS SUSPENDED DUE TO COVID-19 FY22: SUPPORT GROUPS SUSPENDED DUE TO COVID-19). NUMBER OF MENTAL HEALTH EDUCATION EVENTS AND NUMBER OF PARTICIPANTS (: FY20: 8 WEBINARS WITH132 COMMUNITY MEMBERS; FY21: 2 VIRTUAL PRESENTATIONS WITH 100 COMMUNITY MEMBERS ATTENDING; FY22: CADCA TRAINING AND RECRUITMENT OF 5 YOUTH MEMBERS FOR MILTON YOUTH ADVOCATES FOR CHANGE COALITION).COMMUNITY PARTNERS: MILTON PUBLIC SCHOOLS, MILTON SUBSTANCE ABUSE PREVENTION COALITION, ASPIRE HEALTH ALLIANCE, RANDOLPH EDUCATIONAL COLLABORATIVE, QUINCY ASIAN RESOURCESGOAL 2: ENHANCE ACCESS TO MENTAL HEALTH AND SUBSTANCE USE SCREENING, ASSESSMENT, AND TREATMENT SERVICESTARGET POPULATION: YOUTH, OLDER ADULTS, LOW- TO MODERATE-INCOME POPULATIONS, INDIVIDUALS WITH CHRONIC/ COMPLEX CONDITIONS, IMMIGRANTS AND NON-ENGLISH SPEAKERSPROGRAMMATIC OBJECTIVES: 2.1 PROMOTE CROSS-SECTOR PARTNERSHIP, COLLABORATION, AND INFORMATION SHARING ACROSS THE BROAD HEALTH SYSTEM TO ADDRESS ACCESS TO MENTAL HEALTH AND SUBSTANCE USE SERVICES.2.2 INCREASE ACCESS TO CLINICAL AND NON-CLINICAL SUPPORT SERVICES FOR THOSE WITH MENTAL HEALTH AND SUBSTANCE USE ISSUES, WITH AN EMPHASIS ON PRIORITY POPULATIONS.2.3 INCREASE ACCESS TO PEER SUPPORT GROUPS FOR THOSE WITH MENTAL HEALTH AND SUBSTANCE USE AND THEIR FAMILY, FRIENDS, AND CAREGIVERS.2.4 REDUCE INAPPROPRIATE USE OF ED AND OTHER ACUTE CARE SERVICES.2.5 INCREASE ACCESS TO SCREENING, EDUCATION, REFERRAL, AND PATIENT ENGAGEMENT SERVICES FOR THOSE IDENTIFIED WITH OR AT-RISK OF MENTAL HEALTH AND SUBSTANCE USE ISSUES IN CLINICAL AND NON-CLINICAL SETTINGS, WITH AN EMPHASIS ON PRIORITY POPULATIONS.2.6 INCREASE ACCESS TO INSURANCE, PATIENT NAVIGATION SUPPORT, AND OTHER ENABLING/ SUPPORTIVE SERVICES FOR THOSE WITH MENTAL HEALTH AND SUBSTANCE USE ISSUES, WITH AN EMPHASIS ON PRIORITY POPULATIONS.2.7 INCREASE ACCESS TO PEER RECOVERY COACHES FOR THOSE WITH SUBSTANCE USE/MISUSE ISSUES.2.8 REDUCE ELDER HEALTH ISOLATION AND DEPRESSION.2.9 PROVIDE SUPPORT TO INCREASE THE NUMBER OF PRACTICE SETTINGS WITH INTEGRATED BEHAVIORAL HEALTH AND PRIMARY CARE/SPECIALTY CARE SERVICES.COMMUNITY ACTIVITIES/STRATEGIES: PARTICIPATE IN TASK FORCES AND COALITIONS TO PROMOTE COLLABORATION, SHARE KNOWLEDGE, AND COORDINATE COMMUNITY HEALTH IMPROVEMENT ACTIVITIES. SUPPORT THE INTERFACE MENTAL HEALTH HOTLINE, WHICH PROVIDES EDUCATION AND REFERRAL SERVICES FOR THOSE SEEKING MENTAL HEALTH COUNSELING SERVICES. SUPPORT EFFORTS TO DEVELOP INTEGRATED BEHAVIORAL HEALTH SERVICES (MENTAL HEALTH AND SUBSTANCE USE) IN PRIMARY CARE AND OTHER SPECIALTY CARE SETTINGS (IMPACT MODEL) FOR THOSE WITH OR AT-RISK OF MENTAL HEALTH ISSUES, INCLUDING SCREENING, ASSESSMENT, AND TREATMENT. EXPLORE PARTNERSHIPS WITH ELDER SERVICE PROVIDERS TO PROMOTE CARE COORDINATION AND REDUCE ISOLATION THAT REACH OUT TO AND SERVE ISOLATED OLDER ADULTS NOT CURRENTLY ENGAGED IN COUNCIL ON AGING ACTIVITIES. EXPLORE PARTNERSHIPS WITH LOCAL HEALTH DEPARTMENTS, SUBSTANCE USE PROVIDERS, AND BID-MILTON DEPARTMENTS TO IMPLEMENT PEER RECOVERY COACH PROGRAMS GEARED TO LINKING THOSE WITH SUBSTANCE USE/MISUSE ISSUES TO PEER RECOVERY COACHES WHO PROVIDE RECOVERY, CASE MANAGEMENT, AND NAVIGATION SUPPORT. SUPPORT EFFORTS TO DEVELOP A BID-MILTON BRIDGE PROGRAM FOR THOSE SUFFERING FROM SUBSTANCE USE DISORDER THAT SCREENS, IDENTIFIES, ASSESSES, INITIATES TREATMENT, AND LINKS PARTICIPANTS TO LONG-TERM SUD SERVICES IN THE COMMUNITY.METRICS AND STATUS UPDATE: BID-MILTON PARTICIPATION IN MILTON SUBSTANCE ABUSE PREVENTION COALITION AND GRANT FUNDING TO SUPPORT COALITION WORK (FY20: ACTIVE MEMBER AND PROVIDED $8,000 IN GRANT FUNDING; FY21: ACTIVE MEMBER AND PROVIDED $8,000 IN GRANT FUNDING; FY22: ACTIVE MEMBER $8,000 PROVIDED IN GRANT FUNDING). NUMBER OF INDIVIDUALS SERVED BY INTERFACE (FY20: 44 INDIVIDUALS SERVED FROM DECEMBER 2019 TO NOVEMBER 2020; FY21: 44 CHILDREN AND 19 ADULTS SERVED FROM DECEMBER 2020 TO MAY 2021; FY22: 44 CHILDREN AND 21 ADULTS SERVED FROM JUNE 2021 TO NOVEMBER 2021 AND 24 CHILDREN AND 16 ADULTS SERVED FROM DECEMBER 2021 TO APRIL 2022). NUMBER OF PATIENTS SERVED BY BEHAVIORAL HEALTH CLINICIANS EMBEDDED INTO PRIMARY CARE PRACTICES (FY20: 94 PATIENTS SEEN AT TWO PRIMARY CARE OFFICES; FY21: 363 PATIENTS SEEN AT TWO PRIMARY CARE OFFICES, FY22: 368 PATIENTS SEEN AT THREE PRIMARY CARE OFFICES). NUMBER OF PATIENTS SCREENED AND TRANSFERRED TO TREATMENT BY PEER RECOVERY COACHES EMBEDDED IN THE BID-MILTON EMERGENCY DEPARTMENT (FY20: 133 PATIENTS SCREENED, RESULTING IN 89 PATIENTS BEING TRANSFERRED TO TREATMENT; FY21: 145 PATIENTS SCREENED, RESULTING IN 98 PATIENTS (68%) TRANSFERRED TO TREATMENT; FY22: 813 PATIENTS SCREENED WITH 518 (64%) TRANSFERRED TO TREATMENT). NUMBER OF PATIENTS RECEIVING EMERGENCY PSYCHIATRIC EVALUATIONS IN BID-MILTON'S EMERGENCY DEPARTMENT TO PRESCREEN FOR PLACEMENT IN AN INPATIENT PSYCHIATRIC UNIT AND/OR CRISIS STABILIZATION UNIT TO REDUCE INAPPROPRIATE ED BOARDING (FY20:515 PATIENTS; FY21: 689 PATIENTS; FY22: 275 PATIENTS). PARTNERSHIPS WITH ELDER SERVICE PROVIDERS NOT EXPLORED DUE TO COVID AND LIMITED STAFF RESOURCES.COMMUNITY PARTNERS: MILTON BOARD OF HEALTH, MILTON SUBSTANCE ABUSE PREVENTION COALITION, ASPIRE HEALTH ALLIANCE, GOSNOLD, INC., BILH PRIMARY CAREPRIORITY AREA 2: CHRONIC AND COMPLEX CONDITIONS AND THEIR RISK FACTORSHEART DISEASE, STROKE, AND CANCER ARE THE LEADING CAUSES OF DEATH IN THE NATION AND THE COMMONWEALTH. AN ESTIMATED 6 IN 10 DEATHS MAY BE ATTRIBUTED TO THESE THREE CONDITIONS COMBINED. IF WE INCLUDE RESPIRATORY DISEASE (E.G., ASTHMA, COPD) AND DIABETES, WHICH ARE IN THE TOP 10 LEADING CAUSES ACROSS ALL GEOGRAPHIES, THEN WE CAN ACCOUNT FOR THE VAST MAJORITY OF CAUSES OF DEATH. ALL OF THESE CONDITIONS ARE TYPICALLY CONSIDERED TO BE CHRONIC AND COMPLEX AND CAN OFTEN STRIKE EARLY IN LIFE, OFTEN RESULTING IN PREMATURE DEATH. WITHIN THIS PRIORITY AREA, ACCORDING TO THOSE WHO PARTICIPATED IN INTERVIEWS, FOCUS GROUPS, THE COMMUNITY MEETING, AND THE COMMUNITY HEALTH SURVEY, CARDIOVASCULAR DISEASE, CANCER, DIABETES, AND ALZHEIMER'S DISEASE AND OTHER DEMENTIAS WERE THE HIGHEST PRIORITY. IT IS ALSO IMPORTANT TO NOTE THAT THE RISK FACTORS FOR NEARLY ALL CHRONIC/COMPLEX CONDITIONS ARE MUCH THE SAME, INCLUDING LACK OF PHYSICAL ACTIVITY, POOR NUTRITION, OBESITY, TOBACCO USE, AND ALCOHOL USE. GOAL 1: ENHANCE ACCESS TO HEALTH EDUCATION, SCREENING, REFERRAL, AND CHRONIC DISEASE MANAGEMENT SERVICES IN CLINICAL AND NON-CLINICAL SETTINGS TARGET POPULATION: YOUTH, OLDER ADULTS, LOW- TO MODERATE-INCOME POPULATIONS, INDIVIDUALS WITH CHRONIC/COMPLEX CONDITIONS, IMMIGRANTS AND NON-ENGLISH SPEAKERSPROGRAMMATIC OBJECTIVES: 1.1 INCREASE THE NUMBER OF PEOPLE WHO ARE EDUCATED ABOUT CHRONIC DISEASE RISK FACTORS AND PROTECTIVE BEHAVIORS.1.2 INCREASE THE NUMBER OF ADULTS WHO ARE ENGAGED IN EVIDENCE-BASED SCREENING, COUNSELING, SELF-MANAGEMENT SUPPORT, CHRONIC DISEASE MANAGEMENT, REFERRAL SERVICES, AND/OR SPECIALTY CARE SERVICES FOR PRIMARY CARE, DIABETES, HYPERTENSION, ASTHMA, CANCER, AND OTHER CHRONIC/ COMPLEX CONDITIONS.1.3 INCREASE THE NUMBER OF PEOPLE WITH CHRONIC/COMPLEX CONDITIONS WHOSE CONDITIONS ARE UNDER CONTROL."

COMMUNITY ACTIVITIES/STRATEGIES:
"PARTICIPATE IN TASK FORCES AND COALITIONS TO PROMOTE COLLABORATION, SHARE KNOWLEDGE, AND COORDINATE COMMUNITY HEALTH IMPROVEMENT ACTIVITIES. ORGANIZE BID-MILTON ""LECTURE SERIES"" IN COMMUNITY-BASED SETTINGS RELATED TO AWARENESS, EDUCATION, AND THE MANAGEMENT OF CHRONIC AND COMPLEX CONDITIONS PROVIDE WELLNESS, FITNESS EDUCATION AND OTHER EVENTS AS PART OF COMPREHENSIVE CHRONIC DISEASE MANAGEMENT PROGRAM. PROVIDE EVIDENCE-BASED HEALTH EDUCATION ON RISK/PROTECTIVE FACTORS, AND SELF- MANAGEMENT SUPPORT PROGRAMS THROUGH PARTNERSHIPS WITH COMMUNITY-BASED ORGANIZATIONS WITH AN EMPHASIS ON PRIORITY POPULATION SEGMENTS. SUPPORT SCREENING, EDUCATION, AND REFERRAL PROGRAMS IN CLINICAL AND NON-CLINICAL SETTINGS THAT SCREEN, EDUCATE, AND REFER PATIENTS IN NEED OF FURTHER ASSESSMENT AND CHRONIC DISEASE MANAGEMENT SUPPORTS. PROVIDE COMMUNITY HEALTH GRANTS TO COMMUNITY PARTNERS TO SUPPORT EVIDENCE-BASED PROGRAMS THAT PROMOTE HEALTH EDUCATION, SCREENING, REFERRAL, AND CHRONIC DISEASE MANAGEMENT FOR PRIORITY POPULATIONS.METRICS AND STATUS UPDATE: BID-MILTON PARTICIPATION IN RANDOLPH COMMUNITY WELLNESS COALITION (FY20: N/A HOSPITAL JOINED IN FY21; FY21: ACTIVE MEMBER; FY22: ACTIVE MEMBER). NUMBER OF HEALTH LECTURES CONDUCTED BY BID-MILTON MEDICAL STAFF AND EMPLOYEES AND NUMBER OF PARTICIPANTS (FY20: 4 LECTURES WITH 167 PARTICIPANTS; FY21: 6 LECTURES WITH 57 PARTICIPANTS; FY22: 0 LECTURES DUE TO LACK OF STAFFING/CAPACITY). NUMBER OF COMMUNITY MEMBERS TRAINED AND CERTIFIED IN CPR (FY20: 24; FY21: CLASSES SUSPENDED DUE COVID-19; FY22: CLASSES SUSPENDED DUE TO LACK OF STAFFING CAPACITY). NUMBER OF FREE YOGA CLASSES CONDUCTED AT HOSPITAL AND NUMBER OF PARTICIPANTS (FY20: 7 CLASSES WITH 10 PARTICIPANTS; FY21: CLASSES SUSPENDED DUE TO COVID-19; FY22: CLASSES SUSPENDED DUE TO COVID-19). NUMBER OF ""MY LIFE, MY HEALTH DIABETES SELF-MANAGEMENT WORKSHOPS"" CONDUCTED, NUMBER OF PARTICIPANTS, % REPORTING CHANGE IN BEHAVIOR AND NUMBER OF PARTICIPANTS PROVIDED WITH 3-MONTH YMCA MEMBERSHIP FY20: 2 WORKSHOPS AND 19 PARTICIPANTS WITH 70% OF REPORTING A CHANGE IN BEHAVIOR TO BETTER MANAGE THEIR DIABETES, 3 PARTICIPANTS PROVIDED WITH FREE 3-MONTH YMCA MEMBERSHIP; FY21: 1 WORKSHOP AND 10 PARTICIPANTS WITH 80%REPORTING A CHANGE IN BEHAVIOR TO BETTER MANAGE THEIR DIABETES, 7 PARTICIPANTS PROVIDED WITH FREE 3-MONTH YMCA MEMBERSHIPS; FY22: 1 WORKSHOP 7 PARTICIPANTS WITH 45% REPORTING A CHANGE IN BEHAVIOR TO BETTER MANAGE THEIR DIABETES AND 6 PARTICIPANTS PROVIDED WITH FREE 3-MONTH MEMBERSHIPS TO THE YMCA). NUMBER OF BLACK AND HISPANIC PATIENTS WITH ELEVATED A1C SCREENED AND PROVIDED WITH PRIMARY CARE NAVIGATION TO REDUCE THEIR A1C LEVELS (FY20: N/A PROGRAM BEGAN; FY22; FY21: N/A, PROGRAM BEGAN FY22; FY22: TOTAL NUMBER OF BLACK AND LATINX PATIENTS WITH A1C OF 8.5 OR ABOVE REDUCED FROM 85 TO 29. OF THE 29 PATIENTS, ALL WERE SCREENED FOR SOCIAL DETERMINANTS OF HEALTH WITH TWO PATIENTS BEING REFERRED TO COMMUNITY HEALTH WORK FOR ASSISTANCE WITH FOOD AND TRANSPORTATION INSECURITY). NUMBER OF PATIENTS SCREENED FOR LUNG CANCER (FY20: 307, FY21: 508, FY22: 646). NUMBER OF PATIENTS SCREENED FOR CHOLESTEROL AND BLOOD CHEMISTRY INDICATORS (FY20: 36; FY21: SUSPENDED DUE TO COVID-19 RESTRICTIONS; FY22: SUSPENDED DUE TO COVID-19 RESTRICTIONS). NUMBER OF EPI PENS PROVIDED TO MILTON BOARD OF HEALTH FOR FLU CLINICS (FY20: 2; FY21: 2; FY22: 2). NUMBER OF ""PREVENT T2: DIABETES PREVENTION WORKSHOPS"" WORKSHOPS CONDUCTED IN CHINESE TO EDUCATE AND MAKE BEHAVIOR CHANGES AND NUMBER OF PARTICIPANTS (FY20: 1 WORKSHOP WITH 8 PARTICIPANTS; FY21: FIVE VIRTUAL WORKSHOPS WERE CONDUCTED WITH 82 PARTICIPANTS; FY22: TWO BILINGUAL COACHES WERE TRAINED IN THE PROGRAM. 11 COMMUNITY MEMBERS PARTICIPATED IN ONE WORKSHOP WITH 5 PARTICIPANTS SHOWING IMPROVEMENTS IN A1C. AN ADDITIONAL 150 COMMUNITY MEMBERS PARTICIPATED IN A PRE-DIABETES INFORMATIONAL WORKSHOP). NUMBER OF OLDER ADULTS IN AFFORDABLE HOUSING RECEIVING EDUCATIONAL MATERIALS, PARTICIPATING IN INDIVIDUALIZED COUNSELING AND EDUCATIONAL CLASSES/COFFEE CHATS WITH NUTRITIONIST (PROGRAM BEGAN IN FY22: 121 RECEIVED WRITTEN EDUCATIONAL MATERIALS, 7 OF WHICH PARTICIPATED IN INDIVIDUALIZED COUNSELING; 32 IN GROUP EDUCATION CLASSES AND 8 IN COFFEE CHATS).COMMUNITY PARTNERS: SOUTH SHORE YMCA, ENHANCE ASIAN COMMUNITY ON HEALTH (EACH), MILTON COUNCIL ON AGING, BID-MILTON MEDICAL STAFF, SIMON C. FIREMAN COMMUNITYGOAL 2: REDUCE THE PREVALENCE OF VAPING/TOBACCO USE TARGET POPULATION: YOUTH, OLDER ADULTS, LOW- TO MODERATE-INCOME POPULATIONS, INDIVIDUALS WITH CHRONIC/COMPLEX CONDITIONS, IMMIGRANTS AND NON-ENGLISH SPEAKERSPROGRAMMATIC OBJECTIVES: 2.1 INCREASE THE NUMBER OF PEOPLE WHO QUIT SMOKING CIGARETTES, VAPING, OR USING E-CIGARETTES.2.2 INCREASE ACCESS TO TOBACCO, VAPING/E-CIGARETTE CESSATION PROGRAMS.COMMUNITY ACTIVITIES/STRATEGIES: ORGANIZE, FACILITATE, OR SUPPORT SMOKING CESSATION PROGRAMS GEARED TO REDUCING TOBACCO, VAPING AND E-CIGARETTE USE.METRICS AND STATUS UPDATE: NUMBER OF STUDENTS COMPLETING INTERVENTION WORKSHOPS AFTER BEING CAUGHT VAPING, NUMBER OF PARENT PRESENTATIONS COMPLETED AND NUMBER OF STUDENTS PARTICIPATING IN VAPING CURRICULUM REPORTING INCREASED KNOWLEDGE (FY20: 14 10TH GRADE STUDENTS WHO WERE DEEMED AT-RISK (CAUGHT VAPING ON SCHOOL GROUNDS) COMPLETED INTERVENTION WORKSHOPS, 2 PARENT PRESENTATIONS WERE HELD AT 2 DIFFERENT HIGH SCHOOLS; FY21: 204 STUDENTS WERE PRESENTED WITH THE VAPING CURRICULUM WITH97% REPORTING THEY LEARNED NEW INFORMATION ABOUT HEALTH RISKS, PEER INFLUENCE AND PRESSURE, MEDIA USE AND TACTICS AND VAPING WITHDRAWAL; FY22: N/A, PROGRAM ENDED FY21). NUMBER OF NICOTINE ANONYMOUS SUPPORT GROUPS HELD (FY20: 7 MEETINGS HELD FROM SEPTEMBER 2019-MARCH 2020, BUT WERE SUSPENDED REST OF YEAR DUE TO COVID-19; IN-PERSON SUPPORT GROUPS WERE SUSPENDED FY21 AND FY22 DUE TO COVID-19).COMMUNITY PARTNERS: QUINCY PUBLIC SCHOOLS, MILTON SUBSTANCE ABUSE PREVENTION COALITIONPRIORITY AREA 3: SOCIAL DETERMINANTS AND ACCESS TO CAREA DOMINANT THEME FROM THE ASSESSMENT WAS THE TREMENDOUS IMPACT THAT UNDERLYING SOCIAL DETERMINANTS OF HEALTH, PARTICULARLY ACCESS TO AFFORDABLE HOUSING, TRANSPORTATION, POVERTY/EMPLOYMENT, AND FOOD INSECURITY HAVE ON THE ENTIRE POPULATION. THE SOCIAL DETERMINANTS OF HEALTH ARE OFTEN THE DRIVERS OR UNDERLYING FACTORS THAT CREATE OR EXACERBATE MENTAL HEALTH ISSUES, SUBSTANCE MISUSE, AND CHRONIC/COMPLEX CONDITIONS. THESE SOCIAL DETERMINANTS OF HEALTH, PARTICULAR POVERTY, UNDERLIE THE ACCESS TO CARE ISSUES THAT WERE PRIORITIZED IN THE ASSESSMENT: NAVIGATING THE HEALTH SYSTEM (INCLUDING HEALTH INSURANCE), CHRONIC DISEASE MANAGEMENT, AND ACCESS TO CULTURALLY AND LINGUISTICALLY COMPETENT CARE.GOAL: ENHANCE ACCESS TO CARE AND REDUCE THE IMPACT OF SOCIAL DETERMINANTSTARGET POPULATION: YOUTH, OLDER ADULTS, LOW- TO MODERATE-INCOME POPULATIONS, INDIVIDUALS WITH CHRONIC/COMPLEX CONDITIONS, IMMIGRANTS AND NON-ENGLISH SPEAKERSPROGRAMMATIC OBJECTIVES: 1.1 INCREASE PARTNERSHIPS AND COLLABORATION WITH SOCIAL SERVICE AND OTHER COMMUNITY-BASED ORGANIZATIONS.1.2 INCREASE EDUCATIONAL OPPORTUNITIES RELATED TO THE IMPORTANCE AND IMPACT OF SOCIAL DETERMINANTS.1.3 INCREASE ACCESS TO CULTURALLY APPROPRIATE AND RESPONSIVE CARE.1.4 ENSURE ACCESS TO PREVENTIVE MEASURES, TESTING, SCREENING, AND TREATMENT FOR THOSE AT-RISK OR EXPOSED TO COVID-19 AND MITIGATE THE IMPACTS OF THE PANDEMIC ON THE SOCIAL DETERMINANTS OF HEALTH.1.5 DECREASE THE NUMBER OF PEOPLE WHO STRUGGLE WITH FINANCIAL INSECURITY/RENT INSECURITY.1.6 INCREASE ACCESS TO LOW-COST HEALTHY FOODS WITH AN EMPHASIS ON PRIORITY POPULATION SEGMENTS.1.7 INCREASE ACCESS TO AFFORDABLE, SAFE TRANSPORTATION OPTIONS WITH AN EMPHASIS ON PRIORITY POPULATION SEGMENTS.1.8 INCREASE THE NUMBER OF PEOPLE ASSISTED WITH INSURANCE AND OTHER PUBLIC PROGRAM ENROLLMENT, AND PATIENT NAVIGATION.1.9 INCREASE ACCESS TO SOCIAL EXPERIENCES FOR THOSE WHO ARE ISOLATED AND LACK FAMILY/CAREGIVER AND OTHER SOCIAL SUPPORTS.COMMUNITY ACTIVITIES/STRATEGIES: COMMUNITY BENEFIT AND OTHER HOSPITAL STAFF PARTICIPATE IN COALITION AND OTHER COMMUNITY MEETINGS TO PROMOTE COLLABORATION, SHARE KNOWLEDGE, AND COORDINATE COMMUNITY HEALTH IMPROVEMENT ACTIVITIES. PROVIDE COMMUNITY HEALTH GRANTS TO COMMUNITY PARTNERS TO SUPPORT EVIDENCE-BASED PROGRAMS THAT ADDRESS SOCIAL DETERMINANTS AND ACCESS TO CARE (E.G., QUINCY COMMUNITY ACTION PROGRAM). ORGANIZE FRESH TRUCK OUTINGS PROGRAM TO PROVIDE FRESH, LOCALLY GROWN PRODUCE TO LOW- TO MODERATE-INCOME, UNDERSERVED POPULATIONS. SUPPORT THE BLESSINGS IN A BACKPACK PROGRAM IN SCHOOL-BASED SETTINGS TO PROMOTE FOOD ACCESS AND NUTRITION EXERCISE FOR LOW- TO MODERATE-INCOME FAMILIES. SUPPORT THE GROCERY SHOPPING TOURS PROGRAM TO PROVIDE NUTRITION EDUCATION AND FOOD ACCESS TO LOW- AND MODERATE-INCOME POPULATIONS LIVING IN PUBLIC HOUSING, COUNCILS ON AGING, AND OTHER COMMUNITY VENUES."

ORGANIZE WELLNESS AND NUTRITION EDUCATION EVENTS IN PARTNERSHIP WITH
"COMMUNITY PARTNERS TARGETING OLDER ADULTS, LOW- TO MODERATE-INCOME INDIVIDUALS AND FAMILIES, AND THOSE AT-RISK OF CHRONIC DISEASE. ENHANCE ACCESS TO HEALTHY FOOD FOR OLDER ADULTS AND LOW- TO MODERATE-INCOME INDIVIDUALS AND FAMILIES. PROVIDE ENROLLMENT COUNSELING/ ASSISTANCE AND PATIENT NAVIGATION SUPPORT SERVICES TO UNINSURED OR UNDERINSURED RESIDENTS TO ENHANCE ACCESS TO CARE. PROVIDE LINGUISTICALLY AND CULTURALLY APPROPRIATE HEALTH EDUCATION AND CARE MANAGEMENT SUPPORT THOUGH TARGETED COMMUNITY EVENTS FOR THOSE WITH OR IDENTIFIED AS AT-RISK OF CHRONIC/ COMPLEX CONDITIONS WITH AN EMPHASIS ON PRIORITY POPULATIONS. EXPLORE TRANSPORTATION ACCESS PARTNERSHIPS WITH REGIONAL TRANSPORTATION PARTNERS AND OTHER COMMUNITY PARTNERS TO ENHANCE ACCESS TO AFFORDABLE, SAFE, ACCESSIBLE TRANSPORTATION OPTIONS.METRICS AND STATUS UPDATE: BID-MILTON PARTICIPATION IN RANDOLPH COMMUNITY WELLNESS COALITION (FY20: N/A HOSPITAL JOINED FY21; FY21: ACTIVE MEMBER; FY22: ACTIVE MEMBER). NUMBER OF INDIVIDUALS AND HOUSEHOLDS SERVED BY HOMELESSNESS PREVENTION SPECIALISTS AND AVERAGE DOLLAR AMOUNT RECEIVED FOR RENTAL ASSISTANCE (FY20: 31 INDIVIDUALS FROM 16 HOUSEHOLDS WORKED WITH HOMELESS PREVENTION SPECIALISTS, WITH EACH FAMILY RECEIVING AN AVERAGE OF $844 IN RENTAL ASSISTANCE; FY21: 34 INDIVIDUALS FROM 15 HOUSEHOLDS WORKED WITH HOMELESS PREVENTION SPECIALISTS, WITH EACH FAMILY RECEIVING AN AVERAGE OF $844 IN RENTAL ASSISTANCE; FY22: 27 INDIVIDUALS FROM 15 HOUSEHOLDS WORKED WITH HOMELESS PREVENTION SPECIALISTS, WITH EACH FAMILY RECEIVING AN AVERAGE OF $900 IN RENTAL ASSISTANCE). NUMBER OF CHILDREN AND PARENTS PARTICIPATING IN 8-WEEK PRESCHOOL PLAYGROUP SERIES WHOSE EDUCATIONAL PRESCHOOL EXPERIENCE WAS INTERRUPTED BY THE COVID-19 PANDEMIC (FY20: N/A PROGRAM BEGAN FY22; FY21: N/A PROGRAM BEGAN FY22; FY22: 25 CHILDREN AND 18 PARENTS PARTICIPATED IN THE WEEKLY ACTIVITIES, WITH MAJORITY OF CHILDREN DEMONSTRATING IMPROVEMENT IN AT LEAST ONE DEVELOPMENTAL AREA). NUMBER OF DOMESTIC VIOLENCE SURVIVOR CLIENTS PROVIDED WITH EMERGENCY ECONOMIC ASSISTANCE AND ENROLLED IN ECONOMIC EMPOWERMENT CLASSES TO MAINTAIN HOUSING AND ACCESS HEALTHY FOOD (FY20: N/A PROGRAM BEGAN FY22; FY21: N/A PROGRAM BEGAN FY22; FY22: EIGHT SURVIVORS WERE PROVIDED WITH EMERGENCY ECONOMIC ASSISTANCE AND ENROLLED IN ECONOMIC EMPOWERMENT CLASSES). NUMBER OF POUNDS OF ORGANIC FRUITS AND VEGETABLES PROVIDED TO THE FRIENDLY FOOD PANTRY IN RANDOLPH (FY20: N/A PROGRAM BEGAN FY22; FY21: N/A, PROGRAM BEGAN FY22; FY22: 280 LBS). NUMBER OF ELEMENTARY AGED CHILDREN RECEIVING SUPPLEMENTAL FOOD FOR WEEKS THROUGH THE BLESSINGS IN BACKPACK PROGRAM (FY20: 50; FY21: 65; FY22: PROGRAM SUSPENDED BY SCHOOL DUE TO STAFF SHORTAGES). NUMBER OF COMMUNITY MEMBERS PARTICIPATING IN GROCERY SHOPPING TOURS WITH REGISTERED DIETITIANS (FY20: 8 COMMUNITY MEMBERS WERE PROVIDED WITH EDUCATION TOURS AND $25 GIFT CARDS TO FRUIT CENTER MARKETPLACE TO PURCHASE HEALTHY GROCERIES; FY21: TOURS SUSPENDED DUE TO COVID-19; FY22: TOURS SUSPENDED DUE TO STAFFING SHORTAGES). NUMBER OF ""SNACK PACKS"" PROVIDED TO LOW-RESOURCED OLDER ADULTS (FY20: N/A PROGRAM BEGAN IN FY21; FY21: 1,500 ""SNACK PACKS"" DELIVERED; FY22: PROGRAM NOT OFFERED BY PARTNERING AGENCY). NUMBER OF CULTURALLY APPROPRIATE CHINESE STYLE LUNCHES PREPARED AND PROVIDED TO OLDER ADULTS DURING COVID-19 (FY20: N/A PROGRAM BEGAN FY21; FY21: 600 MEALS FY22: 600 MEALS). NUMBER OF COMMUNITY MEMBERS ENROLLED IN/ASSISTED WITH FINDING HEALTH INSURANCE (FY20: ASSISTED 262, ENROLLED 70 IN MASS HEALTH, 22 IN COMMONWEALTH CARE, AND 23 FOR HEALTH SAFETY NET; FY21: ASSISTED 223, ENROLLED 112 IN MASS HEALTH, 66 IN COMMONWEALTH CARE, 45 FOR HEALTH SAFETY NET; FY22: ASSISTED 445, ENROLLED 155 IN MASS HEALTH, 74 IN COMMONWEALTH CARE, 89 FOR THE HEALTH SAFETY NET). NUMBER OF FACE-TO-FACE AND PHONE ENCOUNTERS CONDUCTED BY BID-MILTON INTERPRETER SERVICES (FY20: 4,905 ENCOUNTERS IN 42 LANGUAGES; FY21: 6,890 IN 51 LANGUAGES; FY22: 6,567 IN 53 LANGUAGES). NUMBER OF NEW PRIMARY CARE/FAMILY PRACTITIONERS RECRUITED TO INCREASE ACCESS TO HEALTHCARE IN QUINCY AND RANDOLPH (FY 20: 2, FY21: 7, FY22: 2). BID-MILTON PARTICIPATION IN THE BLUE HILLS REGIONAL COORDINATING COUNCIL (BHRCC) (FY20: ACTIVE MEMBER; FY21: ACTIVE MEMBER; FY22: ACTIVE MEMBER). DOLLAR AMOUNT OF FREE TAXI VOUCHERS PROVIDED TO PATIENTS WITH NO ACCESS TO TRANSPORTATION FOR MEDICAL CARE (FY20: $3,523; FY21: $2,623; FY22: $6,978).COMMUNITY PARTNERS: QUINCY COMMUNITY ACTION PROGRAMS, BLUE HILLS COMMUNITY HEALTH NETWORK ALLIANCE (CHNA 20), DOVE, MILTON EARLY CHILDHOOD ALLIANCE, BROOKWOOD COMMUNITY FARM, FRIENDLY FOOD PANTRY, ASIAN AMERICAN SERVICE ASSOCIATION, SOUTH SHORE ELDER SERVICES, RANDOLPH PUBLIC SCHOOLSGOAL: PROMOTE INDEPENDENCE AND AGING IN PLACETARGET POPULATION: OLDER ADULTS PROGRAMMATIC OBJECTIVES:2.1 REDUCE FEAR OF FALLING2.2 REDUCE FALLS2.3 INCREASE ACTIVITY LEVELS2.4 REDUCE PREVENTABLE EMERGENCY DEPARTMENT AND INPATIENT VISITS2.5 INCREASE THE NUMBER OF OLDER ADULTS LIVING INDEPENDENTLY IN THEIR HOMESCOMMUNITY ACTIVITIES/STRATEGIES: SUPPORT SAFETY AT HOME PROGRAM FOR OLDER ADULTS TO PROMOTE AGING IN PLACE AND REDUCE FALLS. ORGANIZE MATTER OF BALANCE WORKSHOPS FOR PRIORITY POPULATIONS.METRICS AND STATUS UPDATE: SAFETY AT HOME PROGRAM NOT EXPLORED DUE TO COVID-19 AND LIMITED STAFF RESOURCES. NUMBER OF WORKSHOPS CONDUCTED AND NUMBER OF COMMUNITY MEMBERS PARTICIPATING (FY20: N/A PROGRAM BEGAN IN FY22; FY21: N/A PROGRAM BEGAN IN FY22; FY22: FIVE MATTER OF BALANCE WORKSHOPS WERE CONDUCTED WITH 75 COMMUNITY MEMBERS PARTICIPATING).COMMUNITY PARTNERS: MILTON COUNCIL ON AGING, ENHANCE ASIAN COMMUNITY ON HEALTH (EACH)COMMUNITY PARTNERSBETH ISRAEL DEACONESS HOSPITAL MILTON 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 NEW WAY RECOVERY CENTER ASIAN AMERICAN SERVICE ASSOCIATION ASPIRE HEALTH ALLIANCE BAY STATE COMMUNITY SERVICES BID-MILTON PATIENT FAMILY ADVISORY COUNCIL BLUE HILLS REGIONAL COORDINATING COUNCIL BLUE HILLS REGIONAL HEALTH NETWORK (CHNA 20) BROOKWOOD COMMUNITY FARM CURRY COLLEGE DOVE, INC ENHANCE ASIAN COMMUNITIES ON HEALTH FATHER BILLS & MAINSPRING HOUSE FIRST BAPTIST CHURCH, RANDOLPH FRIENDLY FOOD PANTRY FULLER VILLAGE GOSNOLD RECOVERY SERVICES INTERFAITH SOCIAL SERVICES MANET COMMUNITY HEALTH CENTERS MAY INSTITUTE METROPOLITAN AREA PLANNING COUNCIL MILTON BOARD OF HEALTH MILTON CHAMBER OF COMMERCE MILTON COUNCIL ON AGING MILTON COALITION FORMERLY KNOWN AS MILTON SUBSTANCE ABUSE PREVENTION COALITION MILTON EARLY CHILDHOOD ALLIANCE MILTON HOUSING AUTHORITY MILTON POLICE DEPARTMENT MILTON PUBLIC LIBRARY MILTON PUBLIC SCHOOLS MILTON YOUTH ADVOCATES FOR CHANGE QUINCY ASIAN RESOURCES QUINCY BOARD OF HEALTH QUINCY CHAMBER OF COMMERCE QUINCY COMMISSION ON DISABILITIES QUINCY COMMUNITY ACTION PROGRAMS QUINCY FAMILY RESOURCE CENTER QUINCY PUBLIC SCHOOLS QUINCY POLICE DEPARTMENT RANDOLPH BOARD OF HEALTH RANDOLPH CHAMBER OF COMMERCE RANDOLPH COMMUNITY WELLNESS PLAN STEERING COMMITTEE RANDOLPH COMMUNITY PARTNERSHIP RANDOLPH EDUCATIONAL COLLABORATIVE RANDOLPH INTERGENERATIONAL COMMUNITY CENTER RANDOLPH PUBLIC SCHOOLS RANDOLPH VETERAN AFFAIRS SIGNATURE HEALTHCARE SIMON C. FIREMAN COMMUNITY SOUTH COVE COMMUNITY HEALTH CENTER SOUTH SHORE ELDER SERVICES SOUTH SHORE YMCA UNITED PARKWAY METHODIST CHURCHAS DESCRIBED IN DETAIL IN THIS SUPPORTING NARRATIVE TO THE FORM 990 SCHEDULE H, BETH ISRAEL DEACONESS HOSPITAL-MILTON 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 BETH ISRAEL DEACONESS HOSPITAL-MILTON'S COMMUNITY BENEFITS ACTIVITIES FOR THE FISCAL PERIODS SEPTEMBER 30, 2023, SEPTEMBER 30, 2024 AND SEPTEMBER 30, 2025, EXAMPLES OF IDENTIFIED NEEDS THAT WILL NOT BE MET IN THESE YEARS ARE SUPPORTING EDUCATION ACROSS THE LIFESPAN, STRENGTHENING THE BUILT ENVIRONMENT (I.E., IMPROVING ROADS/SIDEWALKS AND ENHANCING ACCESS TO SAFE RECREATIONAL SPACES/ ACTIVITIES), ADDRESSING ENVIRONMENTAL HEALTH AND CLIMATE CHANGE, ADDRESSING THE AFFORDABILITY OF CHILDCARE, ADDRESSING THE DIGITAL DIVIDE, AND SUD PEER SUPPORT GROUPS."

IN ADDITION, THERE WERE SOME NEEDS IDENTIFIED IN THE 2019 CHNA
THAT ARE NOT INCLUDED IN THE 2019 IS AND WHICH HAVE GUIDED THE BID-MILTON'S COMMUNITY BENEFITS ACTIVITIES THE PERIOD FOR THE FISCAL PERIOD COVERED BY THIS FILING. BID-MILTON WILL BE UNABLE TO ADDRESS THESE NEEDS DUE TO LIMITED FINANCIAL RESOURCES AND THAT THEY WERE OUTSIDE OF THE ORGANIZATION'S SPHERE OF INFLUENCE AND INVESTMENTS IN OTHER AREAS WERE BOTH MORE FEASIBLE AND LIKELY TO HAVE GREATER IMPACT. AS A RESULT, BID-MILTON RECOGNIZED THAT OTHER PUBLIC AND PRIVATE ORGANIZATIONS IN ITS CBSA AND THE COMMONWEALTH WERE BETTER POSITIONED TO FOCUS ON THESE ISSUES. BID-MILTON 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 BETH ISRAEL DEACONESS HOSPITAL-MILTON'S PRIMARY TOOL FOR ASSESSING THE HEALTH CARE 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 BETH ISRAEL DEACONESS HOSPITAL-MILTON CARES FOR ITS COMMUNITY BY PROVIDING FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS. AS DEMONSTRATED IN THIS SCHEDULE H, 12.87% OF BETH ISRAEL DEACONESS HOSPITAL-MILTON'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, BETH ISRAEL DEACONESS HOSPITAL-MILTON'S MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND IMPLEMENTATION STRATEGY WERE COMPLETED AND APPROVED BY THE BOARD OF TRUSTEES 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.BIDMILTON.ORG/EVENTS-AND-EDUCATION/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 BETH ISRAEL DEACONESS HOSPITAL-MILTON FILED WITH THE ATTORNEY GENERAL'S OFFICE. EMERGENCY CARE ACCESSIN ADDITION, AS NOTED IN THIS FORM 990, SCHEDULE H, PART V, SECTION A, BETH ISRAEL DEACONESS HOSPITAL-MILTON IS A GENERAL MEDICAL AND SURGICAL 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 ASSISTANCEBETH ISRAEL DEACONESS HOSPITAL-MILTON'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 $778,559 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, BETH ISRAEL DEACONESS HOSPITAL-MILTON 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 $778,559 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, BETH ISRAEL DEACONESS HOSPITAL-MILTON 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 ENSURE LOW-INCOME POPULATIONS DO NOT COVER THE COST OF SERVICES PROVIDED. DURING THE FISCAL PERIOD COVERED BY THIS FILING, BETH ISRAEL DEACONESS HOSPITAL-MILTON GENERATED $1,332,045 RELATED TO TREATING MEDICAID PATIENTS WHICH WAS LESS THAN THE COST OF CARE PROVIDED BY BID-MILTON FOR SUCH SERVICES BY $1,755,571 AS REPORTED ON THIS SCHEDULE H, PART I LINE 7B. DURING THE FISCAL PERIOD COVERED BY THIS FILING, 9.9% OR 23,624 OF BID- MILTON'S PATIENT ENCOUNTERS WERE WITH MEDICAID PATIENTS. IN ADDITION, 51.4% OR 122,846 OF THE HOSPITAL'S PATIENT CASES WERE WITH MEDICAID PATIENTS. MEDICARE IS THE FEDERALLY SPONSORED HEALTH INSURANCE PROGRAM FOR ELDERLY OR DISABLED PATIENTS, AND BETH ISRAEL DEACONESS HOSPITAL-MILTON PROVIDES CARE TO PATIENTS WHO PARTICIPATE IN THE MEDICARE PROGRAM. DURING THE FISCAL PERIOD COVERED BY THIS FILING BID- MILTON GENERATED $47,168,312 RELATED TO TREATING MEDICARE PATIENTS. THE COSTS OF PROVIDING CARE TO MEDICARE PATIENTS EXCEEDED REVENUE BY ($4,346,764). OF THESE AMOUNTS, REVENUE OF $106,678,022 IS RELATED TO THE PROVISION OF THE FOLLOWING DEPARTMENTS: INPATIENT, SDC, OBSERVATION, ENDOCRINOLOGY, EMERGENCY RM, PAIN MANAGEMENT, CLINIC, OPD LAB, PHYSICAL THERAPY, AND IMAGING, 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 16,234,382. IN RESPONSE TO THE FORM 990, SCHEDULE H, PART III, LINE 8, ALTHOUGH BID-MILTON 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, BID-MILTON 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 12.87%.BAD DEBTSIN ADDITION TO CHARITY CARE AND SHORTFALLS IN PROVIDING SERVICES TO PATIENTS INSURED UNDER STATE AND FEDERAL PROGRAMS, BETH ISRAEL DEACONESS HOSPITAL-MILTON 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 $3,173,897 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), JOSLIN DIABETES CENTER 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 FOOTNOTES
REVENUES 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 ACCESSAS PREVIOUSLY NOTED IN THIS FILING, FOR THE PERIOD COVERED BY THIS FILING, BETH ISRAEL LAHEY HEALTH SERVED AS THE SOLE MEMBER OF BETH ISRAEL DEACONESS HOSPITAL - MILTON AND BETH ISRAEL DEACONESS MEDICAL CENTER (MEDICAL CENTER OR BIDMC) IS A SISTER ENTITY TO BID-MILTON. THE MEDICAL CENTER IS A NATIONALLY RECOGNIZED ACADEMIC MEDICAL CENTER AND TEACHING HOSPITAL OF HARVARD MEDICAL SCHOOL. ASSOCIATED PHYSICIANS OF HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER (APHMFP) IS AN INTEGRALLY RELATED PHYSICIAN PRACTICE OF BIDMC AND IS ALSO EXEMPT FROM INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED. APHMFP PHYSICIANS PROVIDE AROUND THE CLOCK PHYSICIAN PATIENT CARE COVERAGE AND MEDICAL DIRECTION OF THE BID-MILTON EMERGENCY DEPARTMENT. THESE PHYSICIANS ARE ALL CERTIFIED OR BOARD-ELIGIBLE IN LEVEL 1 TRAUMA. THE BID-MILTON 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 BETH ISRAEL DEACONESS HOSPITAL-MILTON IS DEDICATED TO PROVIDING FINANCIAL ASSISTANCE TO PATIENTS WHO HAVE HEALTH CARE 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 BID-MILTON AS WELL AS PROVIDERS WHO FOLLOW BID-MILTON'S FINANCIAL ASSISTANCE POLICY. A LIST OF ALL PROVIDERS WHO PROVIDE CARE WITHIN BID-MILTON AS WELL AS INFORMATION INDICATING IF THE LISTED PROVIDERS FOLLOW BID-MILTON'S FINANCIAL ASSISTANCE POLICY IS INCLUDED IN APPENDIX 5 TO THE FINANCIAL ASSISTANCE POLICY. BETH ISRAEL DEACONESS HOSPITAL-MILTON 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 EFFECTIVE ON OR ABOUT AUGUST 15, 2020FINANCIAL 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 ASSISTANCE PUBLIC 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.

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 BID-MC, DANA FARBER CANCER INSTITUTE, AND WEST ROXBURY VETERANS AFFAIRS MEDICAL CENTER. CLINICAL TEACHING IS A FOCUS AT BID-MC 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 BID-MC.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 HOUSE STAFF 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 BID-MC 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 BID-MC 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 BID-MC-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. HOSPITAL-WIDE GLOBAL HEALTH PROGRAM THE BID-MC GLOBAL HEALTH PROGRAM IS A HOSPITAL-WIDE PROGRAM AVAILABLE TO ALL BID-MC 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 BIDMC
"THE 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.ROTATIONS AT OTHER TRAINING LOCATIONS DURING THE SECOND AND THIRD YEARS OF TRAINING INCLUDE: 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 BID-MC 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 MORBID-ITY/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.BIDM-ADDITIONAL INFORMATION REGARDING PROMOTING THE HEALTH OF THE COMMUNITY (SCHEDULE H, PART VI, QUESTIONS 5 AND 6)OPEN MEDICAL STAFF AND COMMUNITY BOARDTHE 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.AFFILIATED HEALTH CARE SYSTEMAS NOTED BELOW AND THROUGHOUT THIS FILING, BIDM IS A MEMBER OF THE BETH ISRAEL LAHEY HEALTH (BILH) NETWORK OF AFFILIATES. AS 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. BETH ISRAEL LAHEY HEALTH'S (BILH) MISSION IS TO SUPPORT ITS AFFILIATES AND THOSE AFFILIATES' MISSIONS TO IMPROVE THE HEALTH OF PATIENTS, THEIR FAMILIES AND THE COMMUNITIES SERVED. BILH STRIVES TO ACCOMPLISH THIS MISSION BY PROVIDING SERVICES TO ITS AFFILIATES WHICH SUPPORT THE DELIVERING THE HIGH-QUALITY HEALTH CARE THAT EVERY PATIENT DESERVES. BILH BELIEVES THAT EFFECTIVE CARE IS EASILY ACCESSIBLE AND SIMPLE TO ACCESS SO IT IS BILH'S FOCUS TO PROVIDE PATIENTS WITH CARE THAT IS IN CLOSE PROXIMITY AND CONVENIENT REGARDLESS OF WHERE PATIENTS LIVE, THEIR HEALTH HISTORY OR STAGE OF LIFE.BETH ISRAEL LAHEY HEALTH (BILH) IS THE PARENT AND A SUPPORT ORGANIZATION OF THE BILH NETWORK OF AFFILIATES. THE NETWORK COMPRISES AN INTEGRATED HEALTH CARE DELIVERY 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 INCLUDES 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 AND ADDICTION TREATMENT PROGRAMS. BILH'S COMMUNITY OF CLINICIANS, CAREGIVERS AND STAFF INCLUDES APPROXIMATELY 4,000 PHYSICIANS AND 35,000 EMPLOYEES.DURING THE FISCAL PERIOD COVERED BY THIS FILING, BILH SERVED AS THE SOLE MEMBER 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 HEALTH SHARED SERVICES (LHSS), LAHEY CLINIC FOUNDATION (LCF), WINCHESTER HOSPITAL (WINCHESTER), NORTHEAST HOSPITAL CORPORATION (NHC) WHICH INCLUDES BEVERLY, ADDISON GILBERT AND BAYRIDGE HOSPITALS, NORTHEAST BEHAVIORAL CORPORATION (NBHC), ANNA JAQUES HOSPITAL (AJH), THE BETH ISRAEL LAHEY HEALTH PERFORMANCE NETWORK (BILHPN) AND THE BETH ISRAEL LAHEY HEALTH PHARMACY. THE LAHEY CLINIC FOUNDATION IN TURN SERVED AS THE SOLE MEMBER OF LAHEY CLINIC INC, AND LAHEY CLINIC HOSPITAL D/B/A LAHEY HOSPITAL & MEDICAL CENTER (LHMC). THE ENTITIES LISTED HERE MAY HAVE ALSO, IN TURN, SERVED AS MEMBER TO OTHER NETWORK AFFILIATES. AS A SUPPORT ORGANIZATION OF THESE ENTITIES, BILH PROVIDES CENTRALIZED SERVICES AND SUPPORT TO ITS AFFILIATES IN AREAS SUCH AS MANAGEMENT, STRATEGIC PLANNING, HUMAN RESOURCES AND BENEFITS, DEVELOPMENT AND FUNDRAISING, LEGAL SERVICES, FINANCE, TREASURY, INVESTMENT, INSURANCE, COMPLIANCE AND TAXATION AS WELL AS PATIENT CARE CONTRACTING AND OTHER SERVICES.BILH'S SUPPORT OF ITS AFFILIATES ENABLES THE NETWORK AS A WHOLE TO ACCOMPLISH ITS PRIMARY MISSION OF IMPROVING THE HEALTH OF PATIENTS, THEIR FAMILIES AND THE COMMUNITIES SERVED. BILH STRIVES TO ACCOMPLISH THIS MISSION BY DELIVERING THE HIGH-QUALITY HEALTH CARE THAT EVERY PATIENT DESERVES. BILH BELIEVES THAT EFFECTIVE CARE IS EASILY ACCESSIBLE AND SIMPLE TO USE SO IT IS BILH'S FOCUS TO PROVIDE PATIENTS WITH CARE THAT IS IN CLOSE PROXIMITY AND CONVENIENT REGARDLESS OF WHERE PATIENTS LIVE, THEIR HEALTH HISTORY OR STAGE OF LIFE AND BILH IS ACCOMPLISHING THIS GOAL BY PROVIDING SUPPORT TO EACH OF ITS AFFILIATES, PROVIDING AN ORGANIZATIONAL STRUCTURE AND OPERATING MODEL WHICH IS DRIVEN BY FOUR DEEPLY INTERCONNECTED DOMAINS DESIGNED TO ADVANCE MEANINGFUL PARTNERSHIPS ACROSS ORGANIZATIONS, CARE SETTINGS, SPECIALTIES, AND GEOGRAPHIES TO ENSURE BILH PATIENTS RECEIVE THE CARE THEY NEED IN THE COMMUNITIES WHERE THEY LIVE AND WORK.BILH IS DELIVERING ON THE PROMISE TO BILH PATIENTS AND COMMUNITIES TO EXPAND ACCESS AND PROVIDE EXTRAORDINARY CARE, WHILE ALSO ADVANCING MEDICINE THROUGH DISCOVERY AND EDUCATION. BILH IS ACCOMPLISHING THIS MISSION BY PROVIDING SUPPORT TO ITS AFFILIATES WHICH INCLUDE:1. A PHYSICIAN ENTERPRISE THAT ENCOMPASSES THE SYSTEM'S NETWORK OF EMPLOYED PRIMARY CARE AND SPECIALTY PHYSICIANS LOCATED THROUGHOUT OUR REGION;2. A HOSPITAL AND AMBULATORY SERVICES GROUP THAT INCLUDES WORLD-CLASS ACADEMIC MEDICAL CENTERS AND TEACHING HOSPITALS WITH AFFILIATIONS WITH HARVARD MEDICAL SCHOOL AND TUFTS UNIVERSITY SCHOOL OF MEDICINE; LEADING COMMUNITY HOSPITALS; A RENOWNED ORTHOPEDICS HOSPITAL; AND COMPREHENSIVE AMBULATORY CENTERS;3. A POPULATION HEALTH ENTERPRISE THAT EMBRACES A NEW MODEL OF CARE TO IMPROVE THE HEALTH OF ALL THOSE SERVED BY BILH; THE POPULATION HEALTH DOMAIN INCLUDES THE SYSTEM'S CLINICALLY INTEGRATED NETWORK OF AFFILIATED PROVIDERS AND VITAL SERVICES, INCLUDING BEHAVIORAL HEALTH AND HOME CARE SERVICES;4. A ROBUST NETWORK OF ADMINISTRATIVE AND OPERATIONAL SERVICES TO ADVANCE STRATEGIC GOALS, BOTH LOCALLY AND AT THE SYSTEM LEVEL, THAT OFFERS EXPERTISE AND STANDARDIZED RESOURCES BASED ON BEST PRACTICES.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."

LIMITED ACCESS TO BEHAVIORAL HEALTH (MENTAL HEALTH AND SUBSTANCE USE)SERVICE
DESPITE THE PREVALENCE OF MENTAL HEALTH AND SUBSTANCE USE ISSUES AND THE IMPACT THAT THESE ISSUES ARE HAVING ON INDIVIDUALS, FAMILIES, AND COMMUNITIES, THE BEHAVIORAL HEALTH SERVICE SYSTEM IN THE REGION IS EXTREMELY LIMITED. THERE ARE MAJOR SHORTAGES OF SPECIALIZED PROVIDERS - SUCH AS PSYCHIATRISTS, THERAPISTS, ADDICTION SPECIALISTS, AND CASE MANAGERS - WHO ARE CAPABLE OF PROVIDING THE FULL BREADTH OF PREVENTIVE, SCREENING, ASSESSMENT, TREATMENT, AND RECOVERY SUPPORT SERVICES THAT THE COMMUNITY NEEDS. THIS IS PARTICULARLY TRUE FOR THOSE WHO HAVE LIMITED ENGLISH SKILLS OR DIFFERENT CULTURAL PERSPECTIVES WHO REQUIRE MORE SPECIALIZED CARE, SUCH AS RECENT IMMIGRANTS, RACIAL/ETHNIC MINORITIES, AND LGBTQ INDIVIDUALS. UNINSURED INDIVIDUALS, THOSE COVERED BY MEDICAID, AND THOSE IN LOW- TO MODERATE-INCOME BRACKETS ALSO STRUGGLE TO ACCESS OR PAY FOR THE SERVICES THEY NEED AND TO FIND PROVIDERS WHO ARE ABLE TO TAKE THEIR COVERAGE OR INSURANCE.HIGH RATES OF CHRONIC AND ACUTE PHYSICAL HEALTH CONDITIONS. ANOTHER MAJOR FINDING FROM THE ASSESSMENT IS THE HIGH RATES OF CHRONIC AND COMPLEX CONDITIONS THAT EXIST FOR MANY OF THE LEADING PHYSICAL HEALTH CONDITIONS (E.G., HEART DISEASE, HYPERTENSION, CANCER, AND ASTHMA) IN THE CBSA. IN MANY COMMUNITIES, THE RATES OF ILLNESS AND DEATH ARE STATISTICALLY HIGHER THAN THE RATES FOR THE COMMONWEALTH, INDICATING A PARTICULARLY SIGNIFICANT PROBLEM. EVEN IN THE COMMUNITIES WHERE THE RATES ARE LOWER THAN THE COMMONWEALTH AVERAGE, CHRONIC PHYSICAL HEALTH CONDITIONS, SUCH AS HEART DISEASE, CANCER, STROKE, DIABETES, AND RESPIRATORY DISEASE, ARE STILL BY FAR THE LEADING CAUSES OF DEATH.HIGH RATES OF THE LEADING HEALTH RISK FACTORS (E.G., LACK OF NUTRITIONAL FOOD AND PHYSICAL ACTIVITY, ALCOHOL/ILLICIT DRUG USE, AND TOBACCO USE). BASED ON INFORMATION GATHERED FROM FOCUS GROUPS, INTERVIEWS, COMMUNITY MEETINGS, THE COMMUNITY HEALTH SURVEY, AND QUANTITATIVE SOURCES, THE ASSESSMENT FOUND THAT THERE WERE SUBSTANTIAL CONCERNS RELATED TO THE LEADING HEALTH RISK FACTORS, SUCH AS HEALTHY EATING, PHYSICAL ACTIVITY, OBESITY, TOBACCO USE/VAPING, ALCOHOL USE, AND STRESS. MANY OF THOSE WHO WERE INVOLVED IN THE ASSESSMENT BELIEVED THAT THERE WAS A NEED FOR MORE HEALTH EDUCATION AND A GREATER EMPHASIS ON HEALTH PROMOTION AND ILLNESS PREVENTION.CHALLENGES NAVIGATING THE SYSTEM AND COORDINATING NEEDED SERVICES. ANOTHER MAJOR THEME FROM THE INTERVIEWS, FOCUS GROUPS, AND COMMUNITY MEETINGS CONDUCTED FOR THE ASSESSMENT WAS THE CHALLENGES THAT MANY PEOPLE IN THE CBSA FACE NAVIGATING THE HEALTH AND SOCIAL SERVICE SYSTEM. THERE WAS A GENERAL SENSE THAT THERE WAS A BROAD RANGE OF HEALTH AND SOCIAL SERVICES AVAILABLE IN THE REGION BUT THAT MANY DID NOT KNOW WHERE TO GO FOR SERVICES OR STRUGGLED TO ACCESS THE SERVICES EVEN IF THEY KNEW WHERE TO GO. ONCE AGAIN, THE POPULATION SEGMENT WHO STRUGGLE MOST TO NAVIGATE THE SYSTEM ARE OLDER ADULTS, LOW-INCOME INDIVIDUALS/FAMILIES, RACIAL/ETHNIC MINORITIES, NON-ENGLISH SPEAKERS, AND THOSE WITH CHRONIC / COMPLEX CONDITIONS. MANY PEOPLE SAID THAT IF THERE WAS A RESOURCE INVENTORY THAT WOULD HELP RESIDENTS ACCESS SERVICES, ALONG WITH COUNSELORS OR CASE MANAGERS WHO COULD FURTHER ASSIST PEOPLE TO OBTAIN AND ACCESS THE SERVICES THEY NEEDED.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 BID-MILTON'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 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 BID-MILTON, 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 CENTER 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 BID-MILTON WERE IMPACTED BY THIS UNFORESEEN HEALTH CRISIS AND IN THE ABSENCE OF REGULATORY GUIDANCE TO THE CONTRARY, BID-MILTON NEEDED TO QUICKLY REASSESS AND PIVOT TO MEET THE NEW AND PREVIOUSLY UNEXPECTED COMMUNITY NEEDS. AS SUCH, IN RESPONSE TO THE COVID-19 CRISIS BID-MILTON'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: ENSURE ACCESS TO PREVENTIVE MEASURES, TESTING, SCREENING AND TREATMENT FOR THOSE AT-RISK OR EXPOSED TO COVID-19 AND MITIGATE THE IMPACTS OF THE PANDEMIC ON THE SOCIAL DETERMINANTS OF HEALTH.THE ACTIONS TAKEN TOWARD ADDRESSING THESE NEEDS ARE INCLUDED FURTHER IN THIS NARRATIVE SUPPORT ALONG WITH BID- MILTON'S DETAILED DESCRIPTION OF ACTIVITIES UNDERTAKEN TO MEET THE COMMUNITY NEEDS. COMMUNITY HEALTH NEEDS ASSESSMENTMAKING THE CHNA AND IMPLEMENTATION STRATEGY WIDELY AVAILABLEBID-MILTON STRIVES TO ADDRESS THE PRIORITY AREAS IN ITS CHNA AND IMPLEMENTATION STRATEGY.AS NOTED ABOVE, BID-MILTON 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 BID-MILTON WEBSITE AT:HTTPS://WWW.BIDMILTON.ORG/ASSETS/BID-MILTON-CHNA-REPORT-2022.PDF IN ADDITION TO THE CHNA, BID-MILTON COMPLETED ITS MOST RECENT IMPLEMENTATION STRATEGY DURING ITS FISCAL YEAR ENDED SEPTEMBER 30, 2022 (TAX YEAR 2021). THE IMPLEMENTATION STRATEGY IS AVAILABLE ON THE BID-MILTON WEBSITE AT:HTTPS://WWW.BIDMILTON.ORG/ASSETS/BID-MILTON-COMMUNITY-BENEFITS-STRATEGY-2023-25.PDF IN ADDITION, AS NOTED ABOVE, BID-MILTON COMPLETED ITS PREVIOUS CHNA DURING ITS FISCAL YEAR ENDED SEPTEMBER 30, 2019 (TAX YEAR 2018). THAT CHNA IS AVAILABLE ON THE BID-MILTON WEBSITE AT: HTTPS://WWW.BIDMILTON.ORG/ASSETS/UPLOADS/COMMUNITY-BENEFITS/BID-MILTON-2019-FINAL-CHNA-REPORT-WITH-APPENDICES.PDF FINALLY, THE IMPLEMENTATION STRATEGY ASSOCIATED WITH THE CHNA COMPLETED DURING BID-MILTON'S FISCAL YEAR ENDED SEPTEMBER 30, 2019 (TAX YEAR 2018) IS AVAILABLE ON THE BID-MILTON WEBSITE AT: HTTPS://WWW.BIDMILTON.ORG/ASSETS/BID-MILTON-IMPLEMENTATION-STRATEGY.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, BID-MILTON'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 BID-MILTON FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2022 WHICH ARE REPORTED HERE. A SUMMARY OF BID-MILTON'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, BID-MILTON 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: MENTAL HEALTH AND SUBSTANCE USEGOAL 1: ADDRESS STIGMA ASSOCIATED WITH MENTAL HEALTH AND SUBSTANCE USE ISSUESGOAL 2: ENHANCE ACCESS TO MENTAL HEALTH AND SUBSTANCE USE SCREENING, ASSESSMENT, AND TREATMENT SERVICES PRIORITY AREA 2: CHRONIC/COMPLEX CONDITIONS AND THEIR RISK FACTORSGOAL 1: ENHANCE ACCESS TO HEALTH EDUCATION, SCREENING, REFERRAL, AND CHRONIC DISEASE MANAGEMENT SERVICES IN CLINICAL AND NON-CLINICAL SETTINGSGOAL 2: REDUCE THE PREVALENCE OF VAPING/TOBACCO USEPRIORITY AREA 3: SOCIAL DETERMINANTS OF HEALTH AND ACCESS TO CAREGOAL 1: ENHANCE ACCESS TO CARE AND REDUCE THE IMPACT OF SOCIAL DETERMINANTSGOAL 2: PROMOTE INDEPENDENCE AND ""AGING IN PLACE""COMMUNITY HEALTH NEEDS ASSESSMENTAPPROACH TO ADDRESSING HEALTH NEEDS (SCHEDULE H, PART V, SECTION B, LINE 11)BID-MILTON RECOGNIZES ITS ROLE AS A LOCAL COMMUNITY HOSPITAL IN A LARGER HEALTH SYSTEM AND KNOWS THAT TO BE SUCCESSFUL IN ADDRESSING HEALTH PRIORITIES AND IMPROVE HEALTH OUTCOMES; IT NEEDS TO COLLABORATE WITH ITS COMMUNITY PARTNERS AND THOSE IT SERVES. BID-MILTON'S CHNA AND THE ASSOCIATED IMPLEMENTATION STRATEGY WERE COMPLETED IN CLOSE COLLABORATION WITH BID-MILTON'S STAFF, ITS HEALTH AND SOCIAL SERVICE PARTNERS, AND THE COMMUNITY AT LARGE. BID-MILTON'S COMMUNITY BENEFITS PROGRAM EXEMPLIFIES THE SPIRIT OF COLLABORATION THAT IS SUCH A VITAL PART OF THE HOSPITAL'S MISSION.BID-MILTON CURRENTLY SUPPORTS SEVERAL EDUCATIONAL, OUTREACH, COMMUNITY HEALTH IMPROVEMENT, AND HEALTH SYSTEM STRENGTHENING INITIATIVES WITHIN THE CBSA. IN SO DOING, BID-MILTON COLLABORATES WITH MANY PUBLIC HEALTH AND SOCIAL SERVICE ORGANIZATIONS.BID-MILTON IS AN ACTIVE PARTICIPANT IN THE BLUE HILLS COMMUNITY HEALTH ALLIANCE (CHNA 20). JOINING WITH SUCH GRASS-ROOTS COMMUNITY GROUPS AND RESIDENTS, BID-MILTON STRIVES TO CREATE A VISION FOR BOTH CITY-WIDE AND NEIGHBORHOOD-BASED HEALTH IMPROVEMENT. IN WORKING WITH THE CHNA 20, BID-MILTON BECAME AN ACTIVE MEMBER AND FUNDER OF THE BLUE HILLS REGIONAL COORDINATING COUNCIL (BHRCC). THE BHRCC SUPPORTS HEALTHY COMMUNITIES BY ADDRESSING MOBILITY AND TRANSPORTATION ACCESS BARRIERS FOR OLDER ADULTS AND OTHER VULNERABLE POPULATIONS. WORKING WITH OUR REGIONAL PARTNERS AND MEMBER ORGANIZATIONS, IN ALIGNMENT WITH THE MA DEPARTMENT OF TRANSPORTATION, THE GOVERNOR'S COUNCIL ON HEALTHY AGING, THE WHO/AARP HEALTHY AGING DESIGNATION CRITERIA AND THE MA GATEWAY CITIES INITIATIVE, THE BHRCC CONDUCTED A DEEPER COMMUNITY NEEDS ANALYSIS EXPOSING THE ROOT CAUSES OF ACCESS DISPARITIES AND DESIGNED A REGIONAL PLAN TO CLOSE GAPS, STRENGTHEN STRUCTURAL AND SYSTEMIC INADEQUACIES, AND INCREASE UTILIZATION OF PUBLIC AND PRIVATE SYSTEMS.ANOTHER IMPORTANT PARTNERSHIP IS BID-MILTON'S INVOLVEMENT WITH THE MILTON SUBSTANCE ABUSE PREVENTION COALITION. BID-MILTON WORKS ALONGSIDE THE COALITION'S COMMUNITY STAKEHOLDERS, PROFESSIONALS, STUDENTS, AND TOWN LEADERS TO WORK COLLABORATIVELY ON REDUCING, PREVENTING, AND ADDRESSING SUBSTANCE ABUSE AND RELATED MENTAL HEALTH CHALLENGES IN OUR TOWN OF MILTON, PRIMARILY AMONGST YOUTH.THE HOSPITAL IS ALSO ACTIVELY INVOLVED WITH THE TOWN OF RANDOLPH'S COMMUNITY WELLNESS PLAN. BID-MILTON HAS SERVED ON THE TOWN'S COMMUNITY PUBLIC HEALTH WORKING GROUP AND SCHOOLS WORKING GROUP SINCE 2020 AND ACTS AS A PARTNER ORGANIZATION WORKING ALONGSIDE MUNICIPAL LEADERS, RESIDENTS AND COMMUNITY ORGANIZATIONS TO IDENTIFY AND IMPLEMENT STRATEGIES TO ADDRESS MENTAL HEALTH, ACCESS TO HEALTHCARE, FOOD INSECURITY WHILE PROMOTING HEALTH EQUITY TO MEET THE NEEDS OF THOSE MOST IMPACTED BY CHRONIC DISEASE AND POOR HEALTH OUTCOMES SUCH AS IMMIGRANTS, YOUTH, AND OLDER ADULTS.BID-MILTON IS COMMITTED TO IMPROVING THE HEALTH AND WELL-BEING OF RESIDENTS THROUGHOUT ITS SERVICE AREA AND BEYOND. WORLD-CLASS CLINICAL EXPERTISE AND EDUCATION, ALONG WITH AN UNDERLYING COMMITMENT TO HEALTH EQUITY ARE THE PRIMARY TENETS OF ITS MISSION. THE HOSPITAL IS DEDICATED TO COLLABORATING WITH COMMUNITY PARTNERS AND RESIDENTS AND WILL CONTINUE TO DO SO IN ORDER TO MEET ITS COMMUNITY BENEFITS OBLIGATIONS.A FULL UPDATE ON BID-MILTON'S HEALTH PRIORITIES AND ASSOCIATED GOALS IS INCLUDED BELOW.FY22 SCHEDULE HIMPLEMENTATION STRATEGY UPDATEPRIORITY AREA 1: MENTAL HEALTH AND SUBSTANCE USE AS IT IS THROUGHOUT THE COMMONWEALTH AND THE NATION, THE BURDEN OF MENTAL AND SUBSTANCE USE ON INDIVIDUALS, FAMILIES, COMMUNITIES, AND SERVICE PROVIDERS IN BID-MILTON'S SERVICE AREA IS OVERWHELMING. NEARLY EVERY KEY INFORMANT INTERVIEW, FOCUS GROUP, AND COMMUNITY MEETING INCLUDED DISCUSSIONS ON THESE TOPICS. FROM A REVIEW OF THE QUANTITATIVE AND QUALITATIVE INFORMATION, DEPRESSION, ANXIETY/STRESS, SOCIAL ISOLATION, OPIOIDS, ALCOHOL, AND E-CIGARETTE/VAPING WERE THE LEADING ISSUES IN THIS DOMAIN. DESPITE INCREASED COMMUNITY AWARENESS AND SENSITIVITY ABOUT THE UNDERLYING ISSUES AND ORIGINS OF MENTAL HEALTH AND SUBSTANCE USE ISSUES, THERE IS STILL A GREAT DEAL OF STIGMA RELATED TO THESE CONDITIONS. THERE IS A GENERAL LACK OF APPRECIATION FOR THE FACT THAT THESE ISSUES ARE OFTEN ROOTED IN GENETICS, PHYSIOLOGY, AND ENVIRONMENT RATHER THAN AN INHERENT, CONTROLLABLE CHARACTER FLAW. THERE IS, HOWEVER, A DEEP APPRECIATION FOR AND A GROWING UNDERSTANDING OF THE ROLE THAT TRAUMA PLAYS FOR MANY OF THOSE WITH MENTAL AND/OR SUBSTANCE USE ISSUES, WITH MANY PEOPLE USING ILLICIT OR CONTROLLED SUBSTANCES TO SELF-MEDICATE AND COPE WITH LOSS, STRESS, ABUSE, PAIN, AND OTHER UNRESOLVED TRAUMATIC EVENTS. GOAL 1: ADDRESS STIGMA ASSOCIATED WITH MENTAL HEALTH AND SUBSTANCE USE ISSUES TARGET POPULATION: YOUTH, OLDER ADULTS, LOW-TO-MODERATE INCOME POPULATIONS, INDIVIDUALS WITH CHRONIC/ COMPLEX CONDITIONS, IMMIGRANTS, AND NON-ENGLISH SPEAKERSPROGRAMMATIC OBJECTIVES: 1.1 INCREASE COMMUNITY EDUCATION AND AWARENESS OF SUBSTANCE USE/MISUSE AND HEALTHY MENTAL, EMOTIONAL, AND SOCIAL HEALTH.1.2 REDUCE THE STIGMA ASSOCIATED WITH MENTAL ILLNESS/ MENTAL HEALTH AND SUBSTANCE USE/MISUSE, AND ADDICTION.COMMUNITY ACTIVITIES/STRATEGIES: ORGANIZE MENTAL HEALTH FIRST AID TRAININGS IN TARGETED COMMUNITY-BASED SETTINGS TO RAISE AWARENESS, REDUCE STIGMA, AND EDUCATE RESIDENTS AND SERVICE PROVIDERS ABOUT MENTAL HEALTH AND SUBSTANCE USE. PROVIDE COMMUNITY HEALTH GRANTS TO LOCAL DEPARTMENTS OF HEALTH OR OTHER COMMUNITY-BASED PARTNERS TO SUPPORT EVIDENCE-BASED PROGRAMS THAT PROMOTE MENTAL HEALTH AND SUBSTANCE USE EDUCATION AND PREVENTION. ORGANIZE MENTAL HEALTH AND SUBSTANCE USE SUPPORT GROUPS FOR THOSE WITH OR RECOVERING FROM MENTAL HEALTH OR SUBSTANCE USE AND THEIR FAMILY/FRIENDS/CAREGIVERS TO RAISE AWARENESS, REDUCE STIGMA, EDUCATE, AND PROMOTE COPING/RECOVERY. SUPPORT COMMUNITY-BASED HEALTH EDUCATION EVENTS WITH COMMUNITY PARTNERS TO RAISE AWARENESS, AND EDUCATE ON RISK/PROTECTIVE FACTORS, AND SERVICES AVAILABLE IN THE COMMUNITY."

FINANCIAL ASSISTANCE POLICY TRANSLATIONS
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, HAITIAN CREOLE, SIMPLIFIED CHINESE, TRADITIONAL CHINESE, AND VIETNAMESE. (SCHEDULE H PART V SECTION B QUESTION 16I)FINANCIAL ASSISTANCE POLICY WIDELY 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.BIDMILTON.ORG/FOR-PATIENTS-AND-VISITORS/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 POLICY PLAIN 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 BETH ISRAEL DEACONESS HOSPITAL-MILTON'S 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 SPANISH, HAITIAN CREOLE, SIMPLIFIED CHINESE, TRADITIONAL CHINESE, AND VIETNAMESE, CAN BE FOUND ON THE BETH ISRAEL DEACONESS HOSPITAL-MILTON'S WEBSITE AT: HTTPS://WWW.BIDMILTON.ORG/FOR-PATIENTS-AND-VISITORS/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 BILLED LOOK 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 RESEARCH
AS NOTED THROUGHOUT THIS FILING BIDM IS PART OF THE BETH ISRAEL LAHEY HEALTH NETWORK OF AFFILIATES. BETH ISRAEL DEACONESS MEDICAL CENTER (BIDMC) IS A TERTIARY CARE ACADEMIC MEDICAL CENTER IN BOSTON AND A SISTER ENTITY OF BIDM. AS PART OF THE SAME NETWORK, THE RESEARCH IN WHICH BIDMC ENGAGES SUPPORTS NOT ONLY THE MISSION AND CARE FOR BIDMC PATIENTS AND COMMUNITIES BUT ALSO HELPS TO IMPROVE PATIENT CARE FOR THE COMMUNITIES OF OTHER BILH AFFILIATES AND BEYOND. THE DETAIL BELOW PROVIDES BACKGROUND ON THE RESEARCH ACTIVITIES AT BIDMC DURING THE FISCAL PERIOD COVERED BY THIS FILING. 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 1,800 ACTIVE FEDERAL, INDUSTRY AND FOUNDATION SPONSORED PROJECTS AND MORE THAN 2,400 ACTIVE EXEMPT, EXPEDITED, AND FULL BOARD-REVIEWED CLINICAL RESEARCH STUDIES. BIDMC RESEARCH IS LED BY MORE THAN 260 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. THE MEDICAL CENTER ENGAGES IN RESEARCH IN ALL OF THE FOLLOWING DISCIPLINES: ANESTHESIA, CRITICAL CARE, AND PAIN MEDICINE EMERGENCY MEDICINE MEDICINE ALLERGY AND INFLAMMATION CARDIOVASCULAR MEDICINE CENTER FOR VASCULAR BIOLOGY RESEARCH CENTER FOR VIROLOGY AND VACCINE RESEARCH CLINICAL INFORMATICS CLINICAL NUTRITION ENDOCRINOLOGY EXPERIMENTAL MEDICINE GASTROENTEROLOGY GENERAL MEDICINE AND PRIMARY CARE GENETICS GERONTOLOGY HEMATOLOGY AND ONCOLOGY HEMOSTASIS AND THROMBOSIS IMMUNOLOGY INFECTIOUS DISEASE INTERDISCIPLINARY MEDICINE AND BIOTECHNOLOGY MOLECULAR AND VASCULAR MEDICINE NEPHROLOGY PULMONOLOGY RHEUMATOLOGY SIGNAL TRANSDUCTION TRANSLATIONAL RESEARCH TRANSPLANT IMMUNOLOGY NEONATOLOGY NEUROLOGY OBSTETRICS AND GYNECOLOGY ORTHOPAEDIC SURGERY PATHOLOGY PSYCHIATRY RADIOLOGY SURGERY CARDIAC SURGERY CENTER FOR MINIMALLY INVASIVE SURGERY NEUROSURGERY PLASTIC AND RECONSTRUCTIVE SURGERY VASCULAR SURGERY TRANSPLANT INSTITUTERESEARCH 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. FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS GRADUATE MEDICAL EDUCATION AS NOTED THROUGHOUT THIS FILING, BIDM IS PART OF THE BETH ISRAEL LAHEY HEALTH NETWORK OF AFFILIATES. BETH ISRAEL DEACONESS MEDICAL CENTER (BIDMC) IS A TERTIARY CARE ACADEMIC MEDICAL CENTER IN BOSTON AND A SISTER ENTITY OF BIDM. AS PART OF THE SAME NETWORK, THE ACADEMIC TEACHING AND TRAINING IN WHICH BIDMC ENGAGES SUPPORTS NOT ONLY THE BIDMC MISSION, CARE FOR BIDMC PATIENTS AND COMMUNITIES BUT BIDMC'S COMMITMENT TO TRAINING THE MEDICAL PROFESSIONALS OF TOMORROW ALSO HELPS TO IMPROVE PATIENT CARE FOR THE COMMUNITIES OF OTHER BILH AFFILIATES AND BEYOND. THE DETAIL BELOW PROVIDES BACKGROUND ON THE TEACHING ACTIVITIES AT BIDMC DURING THE FISCAL PERIOD COVERED BY THIS FILING.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 60 ACCREDITATION COUNCIL FOR GRADUATE MEDICAL EDUCATION (ACGME) APPROVED CLINICAL RESIDENCY AND FELLOWSHIP PROGRAMS WITH 785 RESIDENTS AND CLINICAL FELLOWS. IN ADDITION, THE MEDICAL CENTER HAS 52 NONSTANDARD CLINICAL FELLOWSHIP PROGRAMS WITH 60 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 PROGRAMS
THE 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 UROLOGYRESIDENCY 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. OVER HALF OF THESE PROGRAMS (59 OF 109) 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 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 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 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, MINIMALLY INVASIVE BARIATRIC SURGERY, NEUROSURGERY/ORTHO SPINE, ORTHOPAEDIC HAND SURGERY, ORTHOPAEDIC SPINE SURGERY, 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-INTEGRATEDADDITIONAL 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) IS AFFILIATED WITH HARVARD MEDICAL SCHOOL AND IS BASED AT BETH ISRAEL DEACONESS MEDICAL CENTER (BID-MC), A 57,000 VISIT PER YEAR LEVEL I TRAUMA CENTER. RESIDENTS ROTATE AT CHILDREN'S HOSPITAL BOSTON, BROCKTON HOSPITAL, CAMBRIDGE HOSPITAL, TUFTS MEDICAL CENTER, ST. VINCENT HOSPITAL, ST. LUKE'S HOSPITAL, MOUNT AUBURN 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 BID-MC. PROMOTING THE ADMINISTRATIVE ASPECTS OF EMERGENCY MEDICINE IS ANOTHER GOAL OF THE BID-MC 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.