Boston Medical Center

The Rx Foundation’s support for the Boston Medical Center was inspired by an article in Politico in December 2017 titled “The ‘Frequent Flyer’ Program That Grounded a Hospital’s Soaring Costs.” It describes how Parkland Memorial Hospital in Dallas created an information-sharing network with community-based social service organizations that gets health care to the most vulnerable people – before they show up in the emergency room. It improves their health, while reducing hospital costs. The question that arose for us was: Could we do this in Boston?

We reached out to Boston Medical Center, which has long been committed to caring for all people regardless of ability to pay, and were introduced to Dr. Megan Sandel, Co-Director of the GROW Clinic and a nationally recognized expert on housing and child health. We found that we shared an interest in addressing the medical complexities of the chronic homeless through supportive housing, but Dr. Sandel’s view was that the challenge was not simply a lack of data but a broader misalignment of systems from end to end in supportive housing.

We, therefore, provided a planning grant of $124,000 to Boston Medical Center for Dr. Sandel and her team to lay the groundwork for a sustainable funding model that would provide medical coordination and end-to-end supportive housing services, targeting high-cost high-need patients experiencing homelessness. The grant included engagement of key stakeholders in the health system, the City of Boston, the State government, and social service agencies.

A subsequent grant of $125,000 funded build-out of the analytic capacity needed to support efforts to increase access to housing, including a methodology for data matching and deeper analytics on patients experiencing housing instability and homelessness. A third grant of $125,000 funded work toward creating a national model for end-to-end housing and health partnerships: building data infrastructure; piloting low-barrier supportive housing, and engaging the City, the State, and health systems in expanding resources for medically and behaviorally complex homeless individuals and families. This also enabled crucial data-sharing.

In total, the Rx Foundation provided $374,000 over four years to create this capacity. A crucial byproduct, however, was the relationships that had been built between health care providers, government officials, and the homeless services community. Based on those relationships, the Mayor’s Office asked Boston Medical Center to convert the former Roundhouse Hotel – with City and State funding – into a 60-bed, low-barrier, transitional, housing facility with a sobering center and medication-assisted treatment. The facility opened in January 2022.

The Rx Foundation’s initial planning grant had yielded broader capacity-building and an analytic infrastructure that facilitated data-sharing and collaboration. The resulting relationships had led to the creation of a freestanding supportive housing facility to address the medical complexities of the chronic homeless. This overall initiative now offers a multi-faceted model for other cities.