Health Care Without Walls Inc.

Health Care Without Walls (HCWW) offers free, “bridging” health care to homeless women and their children in Greater Boston area shelters, safe houses and family transitional housing sites. This model is a Free Care Program which allows our clients to be seen as walk-ins in the shelter where other survival needs are being met. Formal registration and billing are intentionally set aside in order to improve access, build trust, and reduce as many bureaucratic barriers as possible. Ultimately, our goals include: Improving the health status and quality of life of homeless women and their children; Increasing the number of clinicians trained and dedicated to treating the poor;Meeting the changing health care needs of homeless women aging in the shelter system; and Enhancing the depth of our health care management services.   HCWW measures success by-- (i) meeting program utilization and medical trainee target numbers, (ii) increasing 'milestone' health behaviors such as taking medication as instructed; following through with a medical appointment; or completing a psychiatric exam; (iii) improving patients' clinical metrics such as blood pressure, blood sugar (diabetic women), or annual flu shot compliance; and (iv) setting and achieving health-related goals, such as reducing isolation and depression and improving medication understanding and compliance.

Since our inception, Health Care Without Walls (HCWW) has received statewide and national recognition for our novel and cost-savings approach to the care of homeless women. We have always taken the long view, recognizing that there are no quick fixes and that the key to a successful outcome is developing a trusting relationship. The following strategies and activities are the building blocks for our success today and in the future.   I. Shelter-based 'gap' health care is delivered by HCWW volunteer physicians and part-time, paid nurse care managers at Greater Boston clinics on a drop-in basis. They provide diagnostics, treatment, referrals and health education to fill the gap that exists between the needs of this population and their level of access to the health care system. In 2019, we will serve 1,700 women and children.   II. Community Health Workers provide culturally competent outreach, case management, individualized health education, patient navigator services, social supports, and advocacy for our most vulnerable populations – homeless elderly women and pregnant and post-partum homeless women who are patients at Brigham and Women’s Hospital.   III. Patient navigator services are provided to patients with cognitive impairments and/or mobility problems who need accompaniment to appointments at hospitals, laboratories, or specialists.   IV. Medical training and education are provided to over 100 medical and nursing students and medical residents each year. Each trainee receives a copy of "Medical Care for Homeless Women: A Curriculum for Novice Providers," written by HCWW. The HCWW team prepares clinicians to be compassionate caregivers who are skilled at meeting the needs of the underserved, and we emphasize the important role of volunteerism as a way to effect social change.   V. HCWW’s special programs meet the complex health needs of two vulnerable populations: elderly homeless women and pregnant and post-partum mothers and their babies. Through our Bridges to Elders Program, HCWW acts as the primary care ‘medical home’ to 80 Medicare and MA Medicaid eligible women. Bridges to Moms, launched in 2017, has become a successful program with documented health improvement indicators. It serves homeless pregnant and post-partum women and their babies at Brigham and Women’s Hospital – with the goal of improving health outcomes and maternal bonding.

While there are many Boston-based social service agencies providing some services to homeless women and families, many of them operate independently, siloed by their singular missions. To our knowledge there are no programs that are focused exclusively on the holistic approach that HCWW takes with homeless women: identifying, tracking and closing the gaps between what happens to her when she walks away from the HCWW clinician at one of our sites (i.e. shelter, safe house, etc.) until we see her again. HCWW staff are, literally, the “human passports” that link the internal and external services and programs to the client, seeing her as a whole.   HCWW's staff team is led by Dr. Roseanna Means, who has practiced primary care on the staff of Brigham and Women’s Hospital for 30 years and was the former medical director of Boston Health Care for the Homeless. She has been identified by the Robert Wood Johnson Foundation as a 2010 Community Health Leader for developing a model for homeless health care delivery and has also been recognized by Harvard Medical School for her dedication to teaching and mentoring medical students about the care of homeless women. Dr. Means oversees our clinical team and is spearheading HCWW’s new Bridges to Moms pilot. HCWW’s 17 volunteer physicians are accomplished, dedicated, and are affiliated with pre-eminent teaching institutions and health systems in the Boston area. They bring a range of specialty expertise including internal medicine, family medicine, pediatrics, psychiatry, OB/GYN, dermatology, and emergency medicine. In addition, HCWW maintains a paid staff of 16 part-time nurse care managers. The nurses support our volunteer physicians and provide responsive medical care and care management in our shelter-based clinics. The clinical staff is multilingual speaking Spanish, Portuguese, and Haitian Creole. We have two multi-lingual, community health workers, both of whom are from Boston and bring cultural competence and essential experience accessing community resources. One works with our elderly homeless women at Rosie’s Place and Women’s Lunch Place. She provides outreach, health education, linkages to community resources, and care management in conjunction with the nursing team. The other has just started with our Bridges to Moms program and provides assistance to pregnant and post-partum women at Brigham and Women’s Hospital, with phone calls, transportation, and accompaniment to prenatal visits as well as specialist and laboratory appointments. Finally, HCWW is governed by a diverse Board of Directors who provide fiscal and administrative oversight and offer core professional skills. All ten Board members donate funds and broaden the organization's visibility. The Board meets bi-monthly and holds an Annual Meeting in January. HCWW also receives guidance from a 3-member Executive Advisory Board that provides professional advice and connections.

In 2015, Health Care Without Walls changed its name to reflect the evolution of our organization, highlighting our commitment of bringing health care directly to where it is needed most – beyond traditional medical facilities. HCWW has created and mobilized a community of long-term serving, volunteer physicians and sustained a modest nursing staff in order to respond to the unmet health care needs of homeless women who have fallen through Boston's health care safety net, despite abundant resources. We have provided free medical care via more than 100,000 clinical encounters to homeless women and their children in up to 12 shelters and safe houses. In addition, HCWW has trained nearly 1,000 medical and nursing students and residents in the principals of trauma informed, compassionate care.   As we look ahead to the future, HCWW seeks to demonstrate that contracting with an Accountable Care Organization (ACO) for program services under a global payment contract for it's Bridges to Elders and Bridges to Moms programs. It has shown that it can improve health and save medical costs for these special populations of homeless women. We believe that this “community of services” would fit the criteria for a global payment, creating a sustainable payment model for intensive case management and comprehensive health services, leading to improved health outcomes.