Berkshire Health Systems (BHS) has long been a leader in rural healthcare in the commonwealth, relying on innovative care models and careful planning to maintain access to quality care across the region. As home to two of Massachusetts’ four Critical Access Hospitals (CAHs), and the commonwealth’s only system to operate more than one CAH, BHS has demonstrated how alternative care models can not only maintain, but also strengthen access to care across rural communities. For the system, the critical access model is a core element of the organization’s long-term strategic plan and an essential tool for bringing the BHS mission to life.

Fairview Hospital consistently ranks among the nation’s top CAHs 13 years running. Recognizing the success of this model at Fairview Hospital, BHS leadership worked for many years in collaboration with its Congressional delegation to identify and support changes to the federal CAH requirements, opening a path for BHS to reopen North Adams Regional Hospital, which had operated as a satellite facility under Berkshire Medical Center’s license for a decade after closing under its previous ownership. In 2024, this goal became a reality, and BHS successfully reopened North Adams Regional Hospital as a fully licensed Critical Access Hospital.

Today, both North Adams Regional Hospital and Fairview Hospital play a crucial role in BHS’s operating model. Leveraging the organization’s flagship community teaching hospital, Pittsfield’s Berkshire Medical Center, alongside CAHs in northern and southern Berkshire County, BHS delivers essential local services while seamlessly connecting patients to higher levels of care when needed. Coupled with a robust outpatient network, clinics, pharmacies, and home care, this model keeps care coordinated, accessible, and community based.

By building a system that links award-winning expertise with community-based care, BHS continues to set the standard for how CAHs can sustain rural health for generations.

Recruitment has always been particularly challenging in rural areas, worsened by the impact of COVID-19 on the national healthcare workforce shortage. In 2021, Berkshire Health Systems (BHS), like peers nationwide, relied heavily on travel clinicians and other short-term solutions to support its workforce and provide continued access to care. While these solutions addressed an immediate need, BHS needed to be forward-thinking in exploring innovative paths to meaningfully bolster its workforce in the long term. BHS decided to develop a pipeline of skilled clinicians in Berkshire County called the Career Pathways Program.

Through BHS’s Career Pathways Program, the system offers paid, structured training opportunities that open doors to in-demand clinical roles. Career Pathways combines in-house training, full-time pay and benefits, and academic partnerships with local educational leaders like Berkshire Community College and McCann Technical School. In fact, in 2023, BHS collaborated with Massachusetts College of Liberal Arts (MCLA) to launch a new four-year Bachelor of Science in Nursing Program with a paid, Pathways component for eligible students. This growing “earn while you learn” model has become a leading example of how a health system can use local investment to transform both careers and care delivery in its community.

Within Career Pathways, BHS currently offers multiple paid training tracks, each tied to clear roles and advancement opportunities:

1. • Nursing Assistant: Acute care training in direct patient care, that can bridge to long-term nursing careers.
   • Medical Assistant: Full-time paid program with classroom and hands-on practice experiences.
   • Licensed Practical Nurse (LPN): Work-and-learn progression from entry-level to LPN roles.
   • Associate Degree in Nursing (ADN): Support through ADN into registered nursing positions, easing rural barriers.
   • Bachelor of Science in Nursing (BSN): New four-year program with MCLA for local BSN pipeline.
   • Respiratory Therapist: Targeted placements for hard-to-fill rural specialty roles.
   • Sonography: Training in high-demand imaging positions.
   • Biomedical Engineering: In-house talent for clinical equipment support.
   • As of October 1, 2025, the Pathways Program has produced measurable, system-wide impact:
   • 250 graduates of the Modified Nursing Assistant Program with 178 currently employed
   • 139 graduates of the Medical Assistant program, with 87 currently employed
   • 53 graduates of the Associate Degree in Nursing program, with 52 currently employed and 127 currently enrolled
   • 47 graduates of the Licensed Practical Nurse program, with 34 currently employed
   • 12 students currently enrolled in the Respiratory Therapist Program
   • 2 students enrolled in the Sonography program

Unlike health systems that rely primarily on external pipelines, BHS has deliberately built a comprehensive internal pathway structure that supports workforce development for hundreds of local residents per year and allows the organization to take a step toward revitalizing the region through the creation of new jobs. Thanks to its unique model of coupling high-level training with paid employment and benefits, the BHS Pathways Program also reduces barriers to access for community members who were previously unable to join the field due to economic or logistical challenges. Together with the funding provided through MassHire grants and the organization’s education partners, this long-term, locally anchored investment has positioned BHS as a statewide leader in healthcare workforce development and as a model for how rural systems can create their own sustained talent pipelines.

In 1910, the Flexner Report set forth the structure and processes of U.S. medical education. In the century that followed, medicine’s approach to clinical education changed very little.

Meanwhile, the fields of education, neurobiology, and social and cognitive psychology advanced greatly, propelling our understanding of how people learn. In 2004, Harvard Medical School and Cambridge Health Alliance aimed to further students’ scientific and clinical learning, sense of duty, and humanistic care. The result was a breakthrough innovation—the first academic longitudinal integrated clerkship. This program, the Harvard Medical School Cambridge Integrated Clerkship (HMS-CIC), redesigned the core clinical training in medical school by translating the principles of the empirical sciences of learning into a new educational structure.

This rigorous approach to learning and caregiving ensures and advances students’ knowledge and skills and their commitment to patients. The new model creates meaningful and authentic roles for students. Rather than serving as brief, peripheral participants on inpatient teams, HMS-CIC students assume heightened roles through apprenticeship under experienced faculty. In the HMS-CIC, students and their faculty specialists together care for a panel of patients over the course of one year, with the highest standards, accountability, and extended engagement with their patients. The HMS-CIC has demonstrated highly successful outcomes for learning and retention, patient care, and transferability across specialties, institutions, and contexts. After multiple academic studies produced strong outcome data, the innovation achieved wide reach—furthering clinical education transformation nationwide (now more than 30% of U.S. schools) and worldwide (nearly half the schools in Canada and Australia among many other nations). The HMS-CIC is now driving innovations across the continuum of medical education and advancing the discourse in health professions education more generally.

• Reinventing the Third-Year Medical Student

Long before urgent care became a standard part of the healthcare landscape, Emerson identified a critical access gap: patients relied on the Emergency Department for non-emergent conditions, driving up costs, increasing wait times, and straining hospital capacity. Emerson acted early, adopting urgent care as a deliberate strategy to redesign access and create a more appropriate, convenient, and cost-effective entry point into the healthcare system.

Over the past decade, Emerson expanded this vision by opening three urgent care locations across the region and supporting more than 48,000 patient visits annually. These sites ensure patients can access care where and when they need it. Building on this foundation, Emerson introduced virtual urgent care to further remove barriers and launched Emerson Health Connected Care—an innovative, concierge-light model that partners with local employers to proactively guide employees to the right care at the right time. Together, these efforts reflect a forward-thinking approach that improves patient experience, reduces unnecessary Emergency Department utilization, and strengthens community health.

As demand for digestive health services grew, particularly for endoscopy and colorectal cancer screening—Emerson recognized an opportunity to fundamentally rethink care delivery. Providers traditionally delivered these services in hospital settings, where they often cost more and offered less convenience for patients.

In 2022, Emerson opened a dedicated outpatient Digestive Health and Endoscopy Center, intentionally shifting care to a more accessible, patient-centered, and cost-efficient model. Emerson designed this facility to meet patients where they are, offering streamlined scheduling, a comfortable setting, and high-quality care outside of the hospital environment.

The Digestive Health Center expands access to essential screenings, including colonoscopies that support early cancer detection, and aligns with a broader industry shift toward ambulatory care. Emerson continues to lead in this space by proactively adapting care delivery models to improve outcomes, lower costs, and better meet growing patient demand.

In the 1990s, it was widely believed that strength training was dangerous for older people. While some research existed on strength training in healthy people in their 60s and 70s, there were almost no studies on significantly older adults with frailty in long-term care settings. Hebrew SeniorLife’s research institute aimed to test that widespread belief through two studies led by Dr. Maria Fiatarone Singh. The studies explored the effects of strength training on long-term care residents in their 80s and 90s. The study results did more than challenge beliefs — they impacted how people view aging and strength! According to a pilot study, over just eight weeks of training, nine residents aged 87 to 96 showed an average strength increase of 174%! Researchers didn’t observe the cardiovascular problems that doctors feared. A follow-up study in the New England Journal of Medicine in 1994 saw tremendous gains in those doing progressive resistance training, including a 113% average increase in leg strength, improved walking speed, stair climbing ability, and spontaneous physical activity.

• The Study That Redefined How We View Strength Training and Aging

Hebrew SeniorLife has established the Lunder CareForce Institute, supported by a generous commitment from the Lunder Foundation, to address the growing shortage of frontline health care workers by offering comprehensive training and career advancement in health and aging-related programs. The Institute also provides support for individuals who face language, technology, or financial obstacles to pursuing education.  It builds on the success of the nursing assistant training program, which was established in 2021 to help employees seeking to change their career paths and others attain their certifications.

The Institute provides opportunities for nursing assistant training and other programs designed to advance career opportunities for frontline staff. It aims to reduce barriers by providing financial support, English language and computer training, and academic and life coaching.

Hebrew SeniorLife is offering nursing assistant training and is partnering with other skilled nursing facilities to train more student groups. It is also partnering with employers to guarantee job placement after students successfully complete training and certification.

Hebrew SeniorLife plans to start a licensed practical nurse training program and, ideally, programs for more advanced nursing degrees, creating even more career pathways for interested individuals. Over the next ten years, Hebrew SeniorLife estimates it can reach more than 3,000 students in Massachusetts alone, including current employees, through a variety of training programs.  This project is funded by the Senator Kenneth J. Donnelly Workforce Success Grant (Workforce Competitiveness Trust Fund FY’24-25 Appropriation). This grant initiative is administered by Commonwealth Corporation on behalf of the Executive Office of Labor and Workforce Development and the Workforce Skills Cabinet.

• Hebrew SeniorLife Establishes Lunder CareForce Institute to Support Health Care Career Advancement

A Level II Trauma Center title is the second-highest designation a hospital can earn and indicates that it can accept the most seriously injured patients in a medical emergency. Clinically, it can perform the same services and procedures as a Level I Trauma Center; the only difference involves academic and research requirements.

For decades, Rhode Island offered the closest hospital with advanced trauma care for patients in southeastern Massachusetts. Travel to Providence cost precious time, delaying the start of critical care.

In 2017, Southcoast Health identified the critical need for a trauma center in the South Coast region and embarked upon the journey with a full assessment of resources that would be required, followed by months of planning and internal investment.

Then, in 2021, St. Luke’s Hospital earned official designation from the Massachusetts Department of Public Health as a Level II Adult Trauma Center – becoming the first and only Level II Trauma Center in the Massachusetts EMS Region 5 serving southeastern Massachusetts.

Today, the center treats more than 2,000 patients annually.

• Congressman Keating visits St. Luke’s to tour Level II Trauma Center
• New Trauma Clinic at St. Luke’s Hospital – Southcoast Health

When COVID-19 struck, Southcoast Health knew that the most effective way to get people tested was to meet them where they were – community centers, local businesses… even fishing boats and piers.

New Bedford is one of the country’s most important fishing centers. Roughly 390 million pounds of seafood a year come through the city. A third of that is fished locally, while the rest comes from other countries and is processed here. With so many employees working in close contact, the docks and processing plants could have become a COVID “superspreader” site, but Southcoast Health partnered with the city’s health department on a testing initiative to turn mobile units normally used as flu clinics into free COVID-19 testing centers that could test processing plant employees and meet ships at the pier. With results available in 24 to 48 hours, Southcoast healthcare workers could vet crew members during the two- to three-day windows they remain on shore between fishing trips. This testing program was so innovative and successful that it was covered by National Geographic magazine.

When vaccines became available, Southcoast Health adopted a similar approach, meeting people where they were with convenient vaccination clinics across the region. Ultimately, we administered 114,000+ vaccine doses in the first year.

• Much of America’s seafood comes through this city. Here’s how it controlled COVID-19. | National Geographic

UMass Memorial Health launched its virtual idea platform, Innovation Station, in 2012 to encourage caregivers to collaborate and develop actionable solutions to frontline challenges. Since then, the platform has achieved a caregiver participation rate of 95% and supported the implementation of more than 200,000 ideas. Innovation Station empowers frontline teams to identify efficiency gaps, address everyday operational challenges, and surface issues the system might not otherwise detect. Over the past year alone, the platform has implemented more than 15,000 ideas and delivered $50 million in cost savings and revenue generation.

• 135,000 ideas and counting: How UMass Memorial Health drives change

UMass Memorial Health continues to lead in home-based care programs, including Hospital at Home, Subacute Rehab at Home, and Mobile Integrated Health. These innovative solutions not only work to address persistent capacity challenges across UMass Memorial Health, but they also advance important health equity efforts by increasing access to timely, high-quality care.

1. UMMH has a nationally recognized Hospital at Home program, which has seen over 3,000 patients since its launch in 2021. Serving more than 20 cities and towns in central Massachusetts, the program provides patients with high-quality, hospital-grade care in the comfort and familiarity of their own home. The program is equipped with a team of field nurses and the organization’s mobile integrated health paramedics to meet the needs of patients with acute conditions or illnesses with low complication rates, including COVID-19, the flu, urinary tract infections, acute kidney injuries, and other acute conditions. The program offers at-home, hospital-level nursing care twice a day, telemedicine visits, delivery of food and supplies, and transportation for testing.
   • UMass Memorial creates digital hospital to centralize care and provide patient assistance throughout Central Mass.
   • UMass Memorial readies for remote and AI tech with new ‘digital hospital’
2. Subacute Rehab at Home brings skilled nursing and rehabilitative care to patients’ homes – offering medication delivery, vital monitoring, food and supply delivery, respiratory care, diagnostic testing, transportation assistance, and interpreter services. Through a telehealth-enabled tablet, the program allows patients to receive 24/7 access to their care team. This innovative program allows patients to heal in the comfort of their own homes while also helping to shorten hospital length of stay and facilitate successful discharges.
3. Mobile Integrated Health is an innovative care model that provides on-demand care from highly skilled paramedics using portable diagnostics and remote monitoring capabilities to assess symptoms and share with UMMH experts in real time. The program operates from UMMH’s Digital Hub, a 20,000-square-foot, state-of-the-art space for digital medicine services and virtual care delivery.
   •  Paramedic response program for adults with intellectual, developmental disabilities to launch in October