Boston Medical Center is Leading the Way in Social Impact

Brian Urban:

Yes, this is the Healthcare Rethink podcast. I'm your host, Brian Urban, and today we're talking about how a health system can accelerate health equity. And who better to help us understand how this can be done than the director of innovation for Boston Medical Center's Health Equity Accelerator? None other than Sheila Phicil. Sheila, thank you so much for joining our little show here today.

Sheila Phicil:

Thank you for having me, Brian. Really happy to be here.

Brian Urban:

This is going to be a ton of fun. I've given you zero prep work, which we just talked about before we started recording. Which is my fault, but it'll be a beautiful show in any regard because of your background being so pertinent to what needs to happen in healthcare today. And I just think our audience is going to fall in love with your work and what you're representing on a day-to-day basis. So with that said, you didn't just wake up one day and become the director of innovation for Boston Medical Center's Health Equity Accelerator. It was a build in your career. You have an awesome background. I want to go back before your work at Dana-Farber Cancer Center, before your quality projects with the VA, before your MPH, Boston University. Let's go back to young Sheila. How did you find your path getting into the work that you do today?

Sheila Phicil:

That's a great question, Brian. So I was raised first generation Haitian-American in Central Florida in Orlando. And anyone who's first generation knows you learn a lot of skills just navigating that childhood because you become a translator, cultural broker, navigator for your family, helping as they assimilate and learn how to thrive in the circumstances or environment they find themselves in. And as a firstborn, it was doubly my responsibility to figure that out and support my family through those growth phases, but there's one thing in particular about my childhood. My mother, who is a devout Christian, loved missionary work. And whenever she would ask me what do you want to be when you grow up, the implied answer was that I was going to be a medical missionary, which was the combination of the immigrant's dream of their children becoming something that they thought was really important to society, like a doctor, or engineer, or lawyer.

But she also loved missionary work, so very young it got instilled in me this idea of going into places, going into communities where people were underserved and helping meet their needs. And that really birthed in me at a very young age a sense of responsibility and accountability for what's happening in other parts of my community or in the world that is not allowing people to thrive. Interestingly enough, my journey started really early because at eight years old I actually became a co-host of a children's radio show where I was talking about ... It was very biblically based, but essentially sharing with kids and trying to inspire them to not wait to grow up to be what they wanted to be.

And that grew into a whole nonprofit organization and I was hosting talent shows, and started dance teams, and choirs and really just created a platform in the Haitian community where children and youth could really practice their talents and do these amazing things. Even grew that into a TV show at one point, so that's where I first got my experience in leadership, community organizing and learning about what it means to be in community and really listen to what people want and being an advocate. Not many people know that about me, but that was where I got my start.

Brian Urban:

I could not have found that in my preliminary research leading up to our conversation today. That is an astounding, I'd say, life milestone to be able to contribute to youth in a very positive, influential manner. That is beautiful. And probably I'm guessing some other things came out of that entrepreneurial side of your mind with Phacilitate, which is a really cool play on words with your last name and a consulting play that you have outside of your lovely world and work within Boston Medical Center. You just do so many things. This is another thing I did not know. I love that. That is awesome. Can we find this? Can our audience find this?

Sheila Phicil:

So this was work that I started in the late '90s, so before internet, before Facebook.

Brian Urban:

This is deep, deep [inaudible 00:05:50] stuff.

Sheila Phicil:

I have some recordings on cassette tape of a lot of our shows and things like that, which I've been working on digitizing. My mom really wants me to put this out there again, but it's been a slow process.

Brian Urban:

Well, then you're an old hat with podcasting and these types of mediums then. So I was right to not prepare you for anything, so that's good. So cool to know that part of your background. So Sheila, I want to dive a little bit into the future here, now having that context for our audience. You and Dr. James and Dr. Mendez lead the strategy and implementation work around the Health Equity Accelerator at Boston Medical Center. Looking at it, you can see that it's designed with a purpose to address and to attempt to close and potentially eliminate health disparities by geography, by race and also improve the trajectory of life for a lot of the people that you serve, which is a really cool way of phrasing how you help with the mission oriented to your work. So let's get some more understanding on this Health Equity Accelerator. Tell us the story of it and where you are today.

Sheila Phicil:

Yeah, so this year will be three years since the accelerator was formed. And I'll start back a little bit ways in terms of the history of Boston Medical Center. Our system that's been around for a long time, since the late 1800s, we were the first public hospital in the country. It was set up to serve patients who couldn't afford to pay for services. So it's kind of built into our DNA as an organization and institution, that we're here to do the best and provide the best clinical care for those who probably otherwise couldn't afford it. And Boston Medical Center has been on this journey of really listening to and responding to the needs of our patients. Obviously as the demographics of Boston has really evolved, we have a very diverse community, a lot of different ethnicities. Some statistics like seven out of 10 of our patients identifies people of color.

30% speak a primary language other than English and at least half of our patients are on public insurance, like Medicaid, or uninsured. So we have been in this where we've seen our patients show up in our emergency room. So for example, Dr. Thea James, she is an emergency room physician, so she's seen firsthand what it looks like when patients show up to get clinical care. And in talking to them and having conversations, you start to understand that it's really these upstream factors and institutional and structural issues and disinvestment in community that are really exacerbating and leading to these unequal health outcomes. And as an institution, we've been inching away at this with lots of different tools and interventions, including setting up one of the first in the nation preventive food programs. So we have a rooftop garden and an onsite food pantry. So if patients tell us that they don't have food at home, they can walk out with groceries.

In our pediatric clinics, we have folks that can help parents prepare their taxes so they can take advantage of child tax credits and get a little bit more income. And we've created a violence intervention programs through our emergency room department. This was led by Dr. Thea James. Again, one of the first in the nation. We've structured medical legal partnerships so we can really help patients navigate some legal issues and barriers, but what we found, interestingly, despite doing a lot of that work for many years, obviously COVID, George Floyd, racial reckoning. A lot of institutions were pausing to think about the times that we were in and were making commitments in terms of inequality and racism and things like that. And our institution, we took a different approach, meaning we pause and did a deep reflection. All of our systems leaders were really brought into this very well managed process that Elena and her team really helped shape where we had deep conversations, but where we also looked at our own data.

So we looked at what were the outcomes for our patients by race, looking across all kinds of different metrics, including clinical outcomes, process metrics, patient satisfaction scores, all the rest. And what we found was that our outcomes did not really differ from what we were seeing locally and nationally in terms of racial health inequities. So it became apparent that we really needed to be more focused on solving for what was happening within our walls of our institution, but also maybe even outside of our institution that was leading to these inequities. So that's how the accelerator came to be.

Brian Urban:

That is a tremendously detailed walkthrough of the history of BMC itself and then why the underpinnings of who you are are based on how you help people. And I think it's really just a cool thing that you're doing inside the community and then also inside your own walls in terms of a medical center. So I'm really excited to dive a little bit deeper, Sheila, into what the team is today. So there are different buckets of programmatic level health that you have with those that are pregnant that you're mentioning in terms of child tax credits that a tax advisor can help with, so that's tremendously helpful. Those lifestyle social health needs are being filled. Cancer, infectious disease, chronic care and behavioral health are some other buckets, too, but you have a team of navigators that sit behind this and drive interventions and start to close some of these challenges for the lives being served. So can you tell us a little bit more about the navigators that sit on this team? Because they're like the workforce as a part of the strategy that you're rolling out.

Sheila Phicil:

Absolutely. So we use our navigators very strategically and one thing I'll say is they are probably one of the most valuable resources you can have in a hospital setting. But the way that our payment system is set up, we're not reimbursed for those services. And I didn't start by mentioning that Boston Medical Center, we are a safety net hospital and we're the largest in New England, serving a high portion of Medicaid patients. And we know that Medicaid payments tend to lag behind commercial payers, so it kind of sets the context for the financial environment we live in. So we have to be very creative in terms of how we meet the needs of our patients. And thankfully our payment models being mostly in a ACO, accountable care organization, like value-based care type of model, we're very incentivized and aligned to really do what's best for our patients to keep them healthy.

So where you'll find navigators in our system, they are often embedded in specific programs or in specific clinical departments. And the roles that they serve can vary depending on how they're designed, but, for example, in our pediatrics clinics you can find housing navigators where their role is really to help patients apply for housing, get them through the process and help them make that transition. You'll also find navigators who can help patients connect with resources in the community if they have needs around, for example, getting transportation to an appointment or getting access to employment or applying for a job. And we have a really great system of looking at and addressing social determinants of health. We call our program Thrive. So when patients come into our clinics, our primary care clinics, OBGYN, geriatrics and others, they're asked a series of questions about their living situation, so their housing, access to food, transportation, utilities, employment and other questions.

So we're capturing that information as patients are coming into these appointments and in the moment we're actually able to share resources with them based on the way that they're answering the questions. And we also have a website that houses a directory of resources, thousands of organizations across Massachusetts that can help with very specific needs. And we can search by zip code, by language, or even veteran status, for example, to connect patients with resources. So our navigators are experts in using those tools to connect our patients with the resources that fit the need that they're trying to address.

Brian Urban:

I love that you went into that depth, Sheila, because no matter what, there needs to be a human to human touchpoint when we're talking about additional needs that sit outside of a clinical perspective, medical perspective. Such that it's being able to afford utility payments, being able to relocate housing if you're needing to move and childcare and other transportation needs, food, everything under the sun there. And it's tough to supplement data. It's one thing to have a survey, but it's another thing to have an actual navigator, someone who knows the geography, knows the other organizations that can get plugged in from a service perspective and help somebody. That is so core, again, to Boston Medical Center and how you've grown. It's kind of interesting. I love everything you were describing. It was making me think actually about Chicago at Rush Medical Center, which is a teaching medical institution as well, but they also consider themselves a safety net and they're taking on some big challenges there.

So you share similar philosophies from the leadership down to the impact makers, so very cool. I just wanted to call that out, that there's a lot of similarities there. And I feel like safety net hospitals, the way you're describing it, I feel like your model and your approach and how you're paid and incentivized should be replicated more toward the rest of larger healthcare systems. And perhaps there'd be more of a prioritization on social health than just clinical health. Do you think that philosophy would maybe come into play if everyone took more of a safety net hospital approach to their healthcare business model?

Sheila Phicil:

Absolutely. And some of this work we do, I'll say a little bit out of necessity because we see and understand that our patients are often living in situations and circumstances that are outside of their control. But I think every community benefits from institutions, particularly healthcare institutions, that are very mindful of the social context and able to provide culturally relevant and culturally humble care for patients. So definitely I'm seeing a trend where people are at least having this conversation more. We more regulations even at the federal and state level that are requiring that health systems, health plans are understanding and collecting information around health related social needs. So those changes are definitely coming. I think one of the things that would really help us accelerate this is as we're understanding and interpreting what it means to unpack the patient's social needs, that we're centering patients in that conversation.

And that's something that we've been very much focused on at BMC. So when we recently went through a redesign of our THRIVE tool, we're now calling it THRIVE 2.0, we brought patients in as collaborators, not just as a focus group, to look at our tools, look at our process, look at the questions that we were asking and provide direct feedback on what was working for them, what wasn't, what their expectations were, how they expected to be asked those questions. And it really completely blew us away in terms of some of the things that we learned, the feedback that they gave us, even some questions that they asked us to add on to our tool that we hadn't considered before, like questions around immigration. We have a huge influx of migrants in Massachusetts. They even asked for us to add a question on growing and managing their money.

They wanted to know how do I build credit, how do I buy a home, how do I open a bank account? All of those things contribute. But one thing I'll say, and this has been Dr. Thea James' vision, is even for safety net hospitals changing the narratives of what it means to be in this space. So we're not just connecting patients with resources that are charity focused or meant to be used in perpetuity, like food stamps or housing subsidies, but really empowering patients to have access to the knowledge and resources that can help them uplift themselves. So whether that's a living wage job or a low interest or no interest loan to open a business so they can build assets and other things. So even as an institution at BMC, we've been focused on and starting to, and we've done actually, many initiatives around economic mobility, workforce development. So that we're not just bringing people onto services that are meant to be used in perpetuity, but can really build generational wealth and wellbeing.

Brian Urban:

Yes, I love that you went that way because it's damn near impossible now to break generational poverty. But when we're talking about the new to the US, you can start to have a new generation of strong economic stability that will carry on through more and more generations. So I love the approach that you're taking because it's very difficult to fix the former I mentioned. And then your approach with the ladder is just so beautiful, but you're helping in a very dynamic way. I just absolutely love this. And who someone that has a background in being a cultural broker themselves, which you stated earlier, and I love that phrasing, I want to take that by the way and see if I can use it somehow, that is a really cool.

I'm curious, you have a lot of partnerships. I think that's visible externally of John Hancock. You have Mass Mutual. Are you finding you're getting more partnerships that's of a community nature, community health services, those that supply different needs, clothes, foods, transportation that are already coming equipped with a cultural competency or that you're helping them with cultural competency and you're going along the journey together? So I'm curious of new partnerships that might be coming in and how you're helping them or how you're seeing them come really well equipped maybe to help immediately.

Sheila Phicil:

Yeah, so that has been probably one of the biggest accelerators of our impact. So first of all, we have a dynamic trailblazing vice president of community engagement and external affairs, Petrina Martin Cherry, who's also part of the leadership team and has done a phenomenal job of building this incredible ecosystem of partnerships that are internal to our organization and external. And we've been very intentional about reaching out to other anchor institutions and developing relationships with police departments, with public schools, with local YMCAs. And we've also benefited from, for example, the philanthropic arms of Red Sox and other major institutions in Boston as well, sports teams and others. So what we found is we've been able to kind of work at all levels of those institutions to be able to leverage the attention and the convening power of Boston Medical Center to focus them on the needs of the community that we're hearing.

So for example, we've been able to convene conversations with our attorney general's office around how do we support returning citizens? That's work that we're just kicking off. That is an exciting partnership that Petrina is leading, but we also at the grassroots level have found these amazing community-based organizations that are led by very diverse, but incredibly knowledgeable and expert leaders who the community trusts. So these includes faith leaders like Pastor Kiki, who is a well-known Haitian pastor in the community. It includes organizations like Leadership Brainery, where they're actually helping students go into graduate programs and they're focusing on folks from underrepresented and marginalized communities. So we have a very diverse array of partnerships. We also work with ABCD, which is a longstanding institution in Boston that offers services everything from ESL language courses, childcare support, applying for jobs, job training. We work with Jewish vocational services. They do quite a bit around workforce development, so our partnerships are very wide and they serve a lot of different needs.

Brian Urban:

Wow. First of all, I am just so motivated to just follow the path of what you've begun at this Health Equity Accelerator at Boston Medical Center in my own work in my world here at FinThrive because you speak so passionately about it. And obviously having a public health background has given you a very good perspective on not just being interdisciplinary, but being hyper focused on precision health of a community and next generation public health really is what I see coming out of your work that's not just based in virology and disease, causal pathways and infectious disease. You are of the next generation that is helping solve a lot of socioeconomic gaps that we've had on the US society for a long, long time.

So just love that. So praising you of course and I'm curious of where you all are going with these partnerships that you mentioned. So let's get to the big question here, Sheila. Five plus years out, what will be the greatest contribution your work at the Health Equity Accelerator, Boston Medical Center will have? What's the big thing you think it will turn into and give to the lives you serve?

Sheila Phicil:

Well, I think what I would like to see happen, and I think we're very much on the way to that, first, is being able to be a model of how to provide clinical care to a diverse population, coming with lots of different needs and complexities in a way that honors their lived experience, is understanding of our history in this country, including racism, and is able to deliver care in a way where people are able to get the best outcomes, so really eliminating the gaps that we're seeing in racial health inequities. And we're starting to see some of this already in some of our interventions around maternal health, diabetes care. We're seeing some amazing initial results, some of which have been published, particularly in the area of how do we serve patients that are dealing with preeclampsia, for example, and patients that have diabetes. So we are already on that path of developing our own internal systems to eliminate any discrepancies or variations in how we serve our patients so that we can give them what they need.

So that would be huge for us and continue to do that. I think the other part of it is continuing to lead by example of what it means to shift from a charity based model as a safety net hospital to an equity focused model. So that as a healthcare institution, we are a major employer, we are a major spender and we are a major influencer in our community. How do we marshal those resources and bring other people along so that the way that we're investing in our community brings about the greatest community assets and agency and empowers people at the local level to make decisions that work for them and their family and uplift them generationally. So I think we're definitely starting to see some of that and people are much less baffled by this idea of a hospital being able to be the entry point to helping someone switch socioeconomic lanes. Which is, again, Thea James' dream, but I do think that is definitely possible.

Brian Urban:

Yeah, I love that. It shouldn't be just on the hospital health plans of a Blue Cross Blue Shield license, nature private health plans, those that are just an MA. They need to contribute federal government down with CMS, focusing now more on maternal health, reducing maternal mortality for all populations, especially African-American women who have been suffering for many, many years due to the gap in patient provider communication and just knowledge and cultural competency. Aside from the bedrock of our challenges with racism and poverty, I think it's going to take us all and I love that BMC is one of the leading voices and doers of that. And man, I'm just a found fan of Sheila Phicil. This is so exciting. I'm going to continue to follow your work. I know our audience is going to be motivated to check out what the Health Equity Accelerator at Boston Medical Center is doing on a quarter to quarter, year to year basis. So thankful to have you on our show and laying out this vision ahead. And I'm just so thankful. Thank you, Sheila. This is amazing.

Sheila Phicil:

Thank you, and I appreciate the opportunity to talk about this. Obviously it's something I'm super passionate about, and I'm so grateful to have the privilege to work in this every day, but it's not one institution or one person or one team of people that can do this. We definitely need to get more folks on board.

Brian Urban:

Amen. Well said. The director of Innovation for Boston Medical Center's Health Equity Accelerator, Sheila Phicil. Thank you again for joining our show. Love the Haitian pride, love your story, love the impact that you're having. And for more exciting insights and excerpts, please visit us finthrive.com.