Massachusetts General Hospital

MASSACHUSETTS GENERAL HOSPITAL Massachusetts General Hospital (MGH) is world-renowned for its excellence in patient care, teaching and research. What is less well-known - but equally compelling - is its historic commitment to underserved communities and patients in Boston and beyond. This commitment is embedded in the hospital’s mission to provide high-quality care for all – regardless of ability to pay. To sustain and enhance its mission, MGH’s programs and activities have expanded steadily over the past 30 years with major support for health centers in low-income communities, the creation of a robust Community Benefit Program. Consider the depth and breadth of the hospital‘s commitment. MGH is the largest private provider of free care in the Commonwealth, serving almost 14,000 uninsured and under-insured patients at an unreimbursed cost of more than $52 million a year to the hospital and another $8.3 million to physicians. MGH is the fifth largest Medicaid provider in the state, treating almost 30,000 patients at a loss of $43 million to the hospital in under-reimbursed care, and another $10.6 million to physicians. These numbers, with a total cost of $113.9 million, are growing rapidly. The hospital fully licenses health centers in Chelsea, Revere, Charlestown, the North End and Back Bay. From humble roots in church basements more than thirty years ago, the MGH health centers last year provided comprehensive primary and specialty care in state of the art facilities to more than 67,000 individuals – many of whom are low income – representing almost 400,000 visits, at an unreimbursed cost of more than $36 million to the hospital. MGH Community Health Associates provides technical assistance, program development and fundraising support to the MGH health centers around public health programs ranging from smoking cessation to breast and cervical cancer screening. The Community Benefit Program (CBP) was created in 1995 with the recognition that the complex issues affecting the health of patients from underserved communities – substance abuse, violence, homelessness and more – cannot successfully be addressed in the doctor’s office alone. The mission of the Community Benefit Program is to “collaborate with underserved communities to make measurable, sustainable improvements in health.” Today the CBP comprises more than 25 programs and is supported by more than $3.5 million from the hospital and Partners HealthCare that leverages an additional $3.4 million from state, federal and private funders. Partners Community Benefit Report 68 Mission Statement Partnership is at the heart of the mission of the MGH Community Benefit Program. That mission is: The MGH Community Benefit Program collaborates with community and hospital partners to build and sustain healthier communities, and to enhance the hospital's responsiveness to patients and community members from diverse cultural and socioeconomic backgrounds. The following principles guide the community benefit program: Health must be defined broadly. Poverty, violence, substance abuse, environmental pollutants, poor housing, and lack of economic opportunity all contribute to ill health and can be defined as public health concerns, and measurably improved. Building trust between the community and the academic medical center is an essential prerequisite to meaningful progress on improving the health of the community. Partnership with community agencies, schools, police, local government and residents is the most effective strategy for making progress on issues in which all players in the community have a stake and a role. Measurable outcomes are essential to determine program efficacy and population impact. Tailoring evaluation measures and strategies to community health improvement efforts is a unique challenge. Community Needs Assessment and Planning Process When the Massachusetts Attorney General’s community benefit guidelines were issued, MGH decided to build upon its decades long history in Chelsea, Revere and Charlestown. Community Benefit Advisory Committees were formed comprising local government, schools, police, citizens, health and human services providers. The charge to the committees was to identify a key community health concern to address collaboratively. Substance abuse among youth in Revere and Charlestown, and youth violence in Chelsea, were identified as priorities. The community health assessments are updated regularly. Two years ago, a comprehensive assessment of health status indicators for Chelsea was compiled, and interviews conducted with fourteen key stakeholders. Youth violence remained the priority. Revere CARES recently completed a new four-year strategic plan, building on the success of the past four years. And in Charlestown, a community that was not ready to address substance abuse nine years ago fully embraced the effort this year as the heroin and OxyContin crisis escalated. 69 Partners Community Benefit Report What began as a series of separate and discrete programs to improve health more than six years ago has evolved into a comprehensive set of partnerships to reduce violence, improve access to care, and reduce and prevent substance abuse among youth. Through these processes, communities have learned to work together to improve health, vitally important to the long-term sustainability of this work. MGH has also benefited enormously. As the result of lessons learned in the community, MGH recognized opportunity to improve services for underserved patients and populations. New services, including domestic violence, substance abuse and child protection services, as well as expanded medical interpreters, have been added to community and hospital-based practices. This past year the MGH Community Benefit Program undertook an overall strategic planning process in preparation for its tenth anniversary. The CBP formed an advisory committee comprised of hospital and community leaders. MGH CB staff, with technical assistance and training from The Medical Foundation, interviewed over 80 key stakeholders in the community and within the hospital. As a result of that process, the CBP established six key priorities including developing programs around obesity and nutrition, communicating its work more effectively, publishing the results in peer reviewed journals, conducting more community-based participatory research, and getting involved in medical education. Recognizing the link between education, economic opportunity and health, the community benefit program is also committed to the academic achievement and career development of Boston Public School students. The hospital has long had a science partnership with the James P. Timilty Middle School in Roxbury. The Community Benefit program formed a partnership with East Boston High School through ProTech, a program to provide high school students paid internships and career exposure. Community Benefit Management The community benefit plan is carried out through the hospital’s Community Benefit Program Office. The director of this program reports to the Chief Medical Officer of the hospital, and has a matrixed reporting relationship to the director of community benefits at Partners HealthCare. There is an annual presentation of the community benefit program to the hospital’s General Executive Committee, the senior leadership and decision-making body of the hospital, as well as to its Trustees. A working group guides each major priority. Finally, the local work is guided through coalitions (e.g. Revere CARES), and regular contact with all partners on the local level. Evaluation Another imperative for the Community Benefit Program is to continuously evaluate the outcomes of programs and to ask the question, “are we making a difference?” To that end, the Community Benefit program works with the MGH/Partners Partners Community Benefit Report 70 Institute of Health Policy to conduct evaluation and measurement of most of the programs. Much of the data included in this report was produced through this office under the leadership and direction of Elizabeth Miller, MD, Ph.D., director of research and evaluation for the CBP. Dr. Miller replaces Georgianna Willis, Ph.D., who played this role for almost nine years with Community Benefit. Recent Developments The Committee on Racial and Ethnic Disparities in Health and Health Care Joseph R. Betancourt, MD, MPH Joan Quinlan In late 2002, Boston Mayor Thomas Menino convened the Boston teaching hospitals to explore their role in eliminating disparities in health and health care among racial and ethnic minorities in the City of Boston. These disparities are well documented nationally and locally. As part of that effort, Peter Slavin, MD, CEO of MGH, created an MGH disparities committee in the spring of 2003, and charged it with identifying and addressing disparities wherever they might exist at MGH. The committee is co-chaired by Dr. Joseph Betancourt, a senior research scientist in the MGH/Partners Institute of Health Policy, and a member of the Institute of Medicine’s (IOM) committee that produced Unequal Treatment, a definitive look at health disparities in America. The Disparities Committee, comprised of senior leaders from throughout the hospital and physician’s organization, divided into subcommittees and launched an ambitious agenda for 2004. Below is a summary of accomplishments for 2004, which was presented both to the Trustees and the General Executive Committee, and an outline of objectives for 2005. Quality Subcommittee Produced a demographic and utilization profile of

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