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Patients are struggling to make ends meet. Here's how Boston Medical Center put $3M back in their patients' pockets.

May 24, 2018

    It's no secret that financial hardship significantly impacts a patient's ability and willingness to seek treatment and to follow care regimens. As a result, lower income is tied to worse health outcomes and utilization patterns. For example, low-income patients are up to 44% more likely to experience 30-day hospital readmissions compared with higher-income individuals.

    To keep patients engaged in upstream, low-acuity care that can prevent exacerbation or avoidable acute episodes, provider organizations should look to address patients' underlying clinical and non-clinical risk factors—such as financial need—side-by-side.

    An underserved patient population

    As the largest safety net hospital in New England, 487-bed Boston Medical Center (BMC) cares for a largely low-income population: approximately 59% of their patient population is considered under-served. When pediatricians at BMC realized that that their patients' parents weren't filing for tax credits despite their financial needs—or were losing hundreds of dollars paying for tax preparation despite the availability of free tax assistance programs across the city—they brought tax assistance into the doctor's office.

    The resulting program, StreetCred, works by integrating tax assistance and entitlement enrollment services directly into primary care clinic workflow.

    How the StreedCred program works

    StreetCred is advertised in the waiting room, but physicians are also trained to ascertain whether their patients' parents are struggling financially, and, if so, whether they're eligible for the Earned-Income Tax Credit (EITC). Those who would benefit from StreetCred can meet with tax assistance volunteers either immediately following their medical appointment, or at another time that they can schedule according to their convenience. Tax assistance volunteers set up shop in empty rooms in the clinic or cordon off space in the building lobby for privacy, and they spend an hour helping patient families file their taxes.

    StreetCred Operations Pervade Clinic Space to Provide On-site Financial Assistance

    While each clinic funds an IRS-mandated program supervisor, supervisors and volunteers alike receive free training either online or from a local tax coalition, minimizing staff-related costs. Volunteers themselves come from the local chapter of the Volunteer Income Tax Assistance (VITA) coalition, from the health system (e.g. non-patient-facing staff who want to interact with the population they serve), or from medical and other graduate schools.

    "The beauty of StreetCred is that it's integrated into clinic operations, and it's not stigmatized,' says Lucy Marcil, a BMC pediatrician and co-founder of the StreetCred program. "This is money they've earned."

    Part of the volunteer's role is opening up patients' eyes about additional benefits they could be receiving; according to Dr. Marcil, many low-income patients don't file for benefits like the EITC because they simply aren't aware of them. Of the approximately 250 families StreetCred surveyed in 2016 and 2017, 63% did not know what the EITC was, 23% reported not knowing whether they had ever received it, and 20% had not filed taxes the previous year.

    In this sense, StreetCred isn't just providing a Band-Aid solution: By directly providing tax assistance support and education about entitlement programs, the StreetCred team ensures that patients are aware of benefits available to them, and empowers them to seek these out in the future. For patients who aren't ready to do that on their own, StreetCred will be there to help.


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