This case describes how Boston Medical Center, a hospital and safety net organization, changed its strategic approach to health equity after realizing that previous efforts were not sufficient to address the health disparities among their patients. In 2021, the Health Equity Accelerator was formed to coordinate this strategic approach, which adopted race-based disparities as their primary focus. Over three years the Accelerator demonstrated impressive reductions in racial and ethnic disparities in health outcomes among pregnant women and patients with diabetes. These results reinforced their drive to scale their innovative approach, and set an example for other institutions nationwide. However, scaling presented significant challenges: balancing replicable and standardized "off the shelf" solutions with distributing a "methodology" to enable other institutions to identify their own solutions to inequities in their patient population.