Monica Bharel, MD, MPH

2011-2012

Senior Public Health Advisor, Advanced Clinical, Boston, MA; Former Massachusetts Commissioner of Public Health

Dr. Monica Bharel is a senior public health advisor helping technology companies to solve public health challenges, using the power of data and analytics to drive innovations and advance health opportunity for all. She is currently working at Google, through Advanced Clinical, focused on climate change, behavioral health, and access to care.

Dr. Monica Bharel most recently served as a Senior Advisor to the Mayor of Boston.  She was appointed by Mayor Wu to lead the city’s response to the humanitarian crisis in the area known as Mass and Cass. She oversaw a public health, equity-led approach focused on individual medical and treatment needs. This transformative process has included offering low threshold housing and shelter options to unsheltered individuals with a focus on building an intermediate and long term plan to address the intersecting issues of homelessness, substance use disorder and mental health.

She previously served as Commissioner of the Massachusetts Department of Public Health. Dr. Bharel served as the Commonwealth’s chief physician from 2015-2021. She helped lead the state’s aggressive response to the opioid crisis and was dedicated to reducing health disparities and developing data-driven, evidence-based solutions for keeping people healthy. Dr. Bharel led the Massachusetts public health response to the COVID-19 pandemic.

As Commissioner, Dr. Bharel oversaw a public health workforce of nearly 3000 and an expansive department addressing issues, from environmental health to injury prevention to infectious diseases.  Under her leadership, Massachusetts ranked nationally as among the healthiest states in the nation.

Dr. Bharel is a board-certified internist who has practiced general internal medicine for more than 20 years, including at Massachusetts General Hospital, Boston Medical Center, neighborhood health centers, the Veterans Administration and 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 dedication to underserved and vulnerable populations. Prior to becoming Commissioner, she was Chief Medical Officer of Boston Health Care for the Homeless.

She holds a Master of Public Health degree through the Commonwealth Fund/Harvard University Fellowship in Minority Health Policy. She holds a 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.

December 24, 2014 | Boston Globe
Doctor for poor chosen as Mass. health commissioner: Baker’s choice known for working with homeless, vulnerable in state
May 9, 2014 | Boston Business Journal
Outside the Box: Monica Bharel of Boston Health Care for the Homeless Program

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.

May 24, 2012
Dr. Monica Bharel has received the Harvard School of Public Health (HSPH) Albert Schweitzer Award
May 1, 2012
"Why Public Health? Monica Bharel" by Harvard School of Public Health

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