Boston Medical Center is redefining the role healthcare providers play in improving the health and welfare of the city’s residents. Now impact investors can have a hand in fostering better outcomes, too.

Brigham and Women’s Hospital. Mass General. Boston Children’s. All world-class healthcare providers that call Boston home. Yet despite the city’s reputation as a medical mecca, there’s a disturbing health divide among Bostonians—often separated by only a short drive. Someone from leafy Back Bay-Beacon Hill can expect to live until 92 on average. But just a few miles away in Roxbury, the average life expectancy plummets to just 59!

How can neighbors living two miles apart be separated by a 33-year “death gap” ? Much of the divide stems from unequal access to vital social needs that support better health and wellness—a familiar gulf across urban America that undermines social cohesion.

It’s also a gap that Boston Medical Center (BMC), the city’s safety-net hospital, has long sought to close. As one of the largest and busiest providers of trauma and emergency services in New England, BMC serves more than one million patients a year. With 57% of its visitors hailing from underserved populations, and over 40% of its revenues from Medicaid, BMC has come up with some creative solutions.

Take Street Cred, an unconventional program designed to use patients’ waiting-room downtime to offer free tax-preparation services. This way, BMC can connect low-income patients with government-assistance programs that provide much needed funds that can be used toward rent or utility bills. In 2017 alone, Street Cred returned over $725,000 to roughly 300 families eligible for the Earned Income Tax Credit.

Street Cred—and other wraparound services like it—spell opportunity for investors who want to make an impact with their investments. The opportunity is plentiful in municipal impact portfolios, which are designed to deliver financial returns while improving social outcomes and benefiting the environment, specifically in underserved communities. Impact investors see a 33-year difference in life expectancy between bordering zip codes as a significant societal breakdown—one that they refuse to accept.

Fortunately, Boston Medical doesn’t accept it either.

Working to Put Its Hospital Out of Business

One reason BMC stands out is its aspirational business plan: putting itself out of business. Not in the traditional sense, but by expanding its reach well beyond the physical confines of a hospital to address the root causes of dependency on hospital services. If Doctors Without Borders is working to transcend geographic boundaries, BMC is working to transcend traditional notions of healthcare by creating a hospital without walls.

By delivering a comprehensive array of programs and services, Boston Medical Center is extending its reach into surrounding neighborhoods to make the city’s communities less dependent on brick-and-mortar hospitals for its collective health and welfare.

Innovators like BMC share a common vision. As the old fee-for-service healthcare model slowly gives way to the new world of population health management, these hospitals are shedding the traditional notions of what it means to provide care. Instead, they’re addressing the social determinants of health: substandard housing, poor systems of education, neighborhood violence, drug addiction, and food insecurity. Beyond genetics, these issues lie at the root of disparate health outcomes.

From Housing to “Food Prescriptions” to Children’s Books

Consider some of BMC’s other innovative initiatives—several of which have spread nationwide:

Reach Out and Read incorporates early literacy into pediatric care; every child who visits BMC leaves with a book in tow. Across the country, 4.7 million children have received more than 7 million books.

Preventive Food Pantry/ Rooftop Farm/Teaching Kitchen provide “prescriptions” for supplemental foods that promote physical health, prevent future illness, and facilitate recovery. For instance, the pantry sources fresh produce from BMC’s Rooftop Farm: 4,614 pounds from more than 25 crops in 2017 alone.

Housing Assistance recognizes that homelessness (which afflicts one quarter of BMC’s patients) can exacerbate health problems. That’s why BMC is pumping $6.5 million over five years into affordable housing projects throughout Boston’s most underserved neighborhoods.

Not Your Parents’ Healthcare

A 33-year difference in life expectancy is analogous to the difference between oil rich Norway ($70,812 GDP per capita) and Lesotho (a landlocked nation wholly encircled by South Africa with $998 GDP per capita). This is a reality that disturbs many and sounds a clarion call to action.

Thankfully, there’s a whole new generation of medicine driven by overall community health—and a whole new generation of sustainability-minded investors to invest in it. Success is being redefined in the healthcare space and we believe safety net hospitals will ultimately be better rewarded for keeping their communities healthier. And that’s a good thing for everyone.

For more on impact investing, explore The Pulse, a Bernstein podcast series featuring long-term investing trends, and for additional thought leadership on reponsible investing, check out the related blogs here.


1 Ansell, David A., The Death Gap, 2017.

The views expressed herein do not constitute research, investment advice, or trade recommendations and do not necessarily represent the views of all AB portfolio-management teams.

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