Sustainability bonds enable Boston Medical Center to expand ESG initiatives

In February, Boston Medical Center Health System issued $232 million in sustainability bonds, enabling it to build on decades of community-oriented initiatives.

Issuing sustainability bonds, as they’re known in the finance industry, is a way for organizations to fund environmentally friendly and socially impactful projects through investor support. 

Such financing opportunities aren’t just “nice things to have,” BMC Health System President and Interim CEO Dr. Alastair Bell said. "They actually can, with sustained effort, feed back into the core business model and financial structure of organizations."

In this case, the proceeds will allow the 514-bed academic medical center to continue renovations, which the organization says have so far led to a 42% reduction in campus energy consumption. BMC will add 70 new inpatient beds, five new operating rooms and pre- and post-operating areas, along with improving outpatient services. The facilities house many of BMC’s programs aimed at addressing social determinants of health.

February’s bond issuance represents the health system’s latest effort to meet the needs of patients “in ways beyond only healthcare services,” as Bell put it.

Other programs include BMC’s food pantry, which opened in 2001 and distributes 600,000 pounds of food a year to address low-income patients’ dietary needs and curb nutrition-related illnesses. The pantry is stocked in part with food harvested from BMC’s farm, which sits on the roof of its power plant building.

The health system has also established an array of programs offering financial wellness counseling, free legal aid for immigration and housing security, workforce development and violence prevention programs for their patients.

“We’re able to alter their life course trajectory … by exposing them to opportunities to change their socioeconomic lane,” said Dr. Thea James, president of mission and associate chief medical officer.

The efforts directly tie back into the needs of BMC’s communities, which are disproportionately people of color and low-income people, Bell said.

“I sort of view the work that we do as bordering on a moral imperative,” Bell said. “The levels of inequities we see in health outcomes are pretty profound. It is something that I think the whole healthcare sector should be committed to working to resolve and really looking at.”

Systemic change

Though many of BMC’s programs address the symptoms of disparities, health system leadership recognized the need to study the causes too, James said.

She co-directs the Health Equity Accelerator, launched in 2021 with the aim of identifying the reasons for inequities; studying and implementing solutions, including changes in clinical practices; and publishing results.

The Accelerator is first tackling the areas with the greatest apparent racial and socioeconomic disparities in health outcomes: pregnancy, cancer and diabetes. It has also been prioritizing research on behavioral health and access to COVID-19 vaccinations throughout the pandemic.

More than a year before the Accelerator's public launch, researchers began investigating clinical discrepancies. They have found disparities in diagnostic and treatment times where pregnancy is concerned, said Elena Mendez-Escobar, co-executive director of the accelerator and BMC’s executive director of strategy. Black and Hispanic births account for 75% of BMC’s 3,000 babies delivered annually. The Accelerator discovered Black patients experience a 1.7 higher rate of severe complications during birth compared with white patients, particularly regarding preeclampsia that can only be cured by delivery.

In cases requiring emergency C-sections, making the decision was taking twice as long with Black patients, James said. In 2020, BMC clinicians implemented a standardized protocol that was further refined the following year, significantly closing the gap in “decision-to-incision time.”

The Accelerator is waiting on more data as more patients give birth. But readmissions for hemorrhaging from preeclampsia have decreased 50% in the last six months, according to Mendez-Escobar. The system has also connected more than 350 patients with remote monitoring technology to ensure complications are detected in time, Mendez-Escobar said.

Correction: An earlier version of this story misstated the location of the BMC rooftop farm.