Monica Bharel, MD, MPH

2011-2012

Commissioner, Massachusetts Department of Public Health, Boston, MA

As Commissioner of the Massachusetts Department of Public Health, Dr. Monica Bharel serves as the Commonwealth’s chief physician. She helps lead the state’s aggressive response to the opioid crisis and is dedicated to reducing health disparities and developing data-driven, evidence-based solutions for keeping people healthy. She was appointed to her position by Governor Charlie Baker in February 2015.

Dr. Bharel oversees a public health workforce of nearly 3000 and an expansive department comprised of eight bureaus and offices responsible for a range of programs, from environmental health to infectious diseases, injury prevention, to maternal and child health. In addition, the department licenses health professionals and facilities that impact public health, and operates the state public health laboratory and four public health hospitals.

Under Dr. Bharel’s leadership, the Department was awarded national accreditation by the Public Health Accreditation Board and, in 2017, Massachusetts was named the healthiest state in the nation by America’s Health Rankings Annual Report which cited among other measures, the state’s low prevalence of obesity and high vaccination rates. Massachusetts is one of few states to experience a decrease in opioid overdose deaths following multiple new initiatives including its Prescription Drug Monitoring Program, creation of core competencies to enable medical students with enhanced training regarding prescription drug misuse, and expanded access to medication-assisted addiction treatment and enhanced recovery support services. 
Also in 2017, Dr. Bharel spearheaded creation of the Public Health Data Warehouse, a unique state-of-the-art tool involving multiple linked data sets across state government. This tool, developed within the newly created Office of Population Health, has proven invaluable for helping combat the opioid epidemic, garnering national attention as a model for the use of data to better understand complex health issues.

Dr. Bharel has been a voice for effective health policy, advocating for raising to 21 the age for tobacco and e-cigarette sales to reduce teen smoking and vaping; and passage of new regulations for testing blood lead levels in young children. She has led the transformation of community health investments to increase healthful opportunities for all.

Dr. Bharel has practiced general internal medicine for more than 20 years including at Massachusetts General Hospital, Boston Medical Center, in neighborhood health centers, the Veterans Administration, and at nonprofit organizations. She has served on the faculty of Harvard Medical School, Boston University Medical School, and Harvard School of Public Health, and has been recognized for her passionate dedication to underserved and vulnerable populations. Prior to becoming Commissioner, she served as the Chief Medical Officer of Boston Health Care for the Homeless, the largest nonprofit organization for homeless individuals in the country.

She received her Master of Public Health degree through the Commonwealth Fund/Harvard University Fellowship in Minority Health Policy. She holds her medical degree from Boston University School of Medicine and completed a residency and chief residency in internal medicine at Boston City Hospital/Boston Medical Center.

May 9, 2014 | Boston Business Journal

As a physician at Boston Health Care for the Homeless Program since 2003, Dr. Monica Bharel knows the work she and her staff do to build trust with the more than 12,000 patients the program sees annually at nearly 80 shelters and other sites around the city is just as important as the medical care she delivers.

Health Care Utilization and Cost among Homeless Medicaid Recipients

Objectives:

The goal of this project was to understand utilization and expenditure patterns for homeless individuals in order to include this marginalized segment of our population in health care reform efforts.

Background: 

Homeless individuals are vulnerable members of our society who live in challenging circumstances and suffer from high rates of medical and behavioral health illnesses. Homeless individuals die younger and have a shorter life expectancy than other poor individuals. They are also high users of the medical system, including the emergency department and acute hospital systems. As we reform our health care delivery and payment system, we will need to better understand their unique medical characteristics and health care utilization patterns. 

Methods:        

Three organizations were involved in analysis of two datasets. Boston Health Care for the Homeless Program (BHCHP) has spent the last two decades providing health care  and access to homeless individuals in Boston. MassHealth, Massachusetts’ Medicaid program, is an important partner of BHCHP, as almost 80% of BHCHP patients have MassHealth coverage. The third partner is the University of Massachusetts Medical School that manages the MassHealth claims database. BHCHP patients seen in 2010 with MassHealth coverage constituted the first database. This information was merged  with MassHealth claims data.

Results:          

Claims data was evaluated on 6,494 patients. Consistent with clinical suspicion and past studies, the data show high burdens of disease. 68% of patients had mental illness, 60% with a substance use disorder and 64% with a specified chronic medical illness. Additionally, data show high hospital and ED usage with 21% of patients having 5 or more visits to the ED in a year with associated high expenditures.

Future Directions:

Homeless individuals have an extraordinarily high burden of medical and mental health disease and have a high level of health care utilization. Future studies are needed comparing this population to other Medicaid populations. Innovative program design for homeless high users will also provide valuable ability to evaluate improvements in health care quality and utilization as we reform our health care system.

Preceptor and Sponsoring Agency:

  • Bob Taube, Boston Health Care for the Homeless Program
  • Wen-Chieh Lin, UMass Medical School Center for Health Policy and Research
  • Lori Cavanaugh, MassHealth