Health plans

Health plans should address health inequalities as part of their core work

HHealthcare businesses and organizations across the country grapple with health inequalities, spurred by devastating disparities in the pandemic’s toll as well as the delay reckoned with the racial injustice that followed. the murder of George Floyd.

Some have been there for a while. Others are just getting started. But all of them have a lot of work to do.

We work for Blue Cross Blue Shield of Massachusetts (BCBSMA), a private, not-for-profit health care plan that has long made diversity, equity and inclusion a priority in its business, its hiring, its culture. business and community work. But directly addressing racial inequalities in healthcare was not part of the company’s core work as an insurer.


To address this, our organization recently launched the Commonwealth of Massachusetts’ first collaborative effort between a health plan and the medical community designed specifically to eliminate health inequalities. Its goal is to improve health care for all plan members across all racial and ethnic groups.

Because we know that other plans also want to address inequalities, we share the approaches taken so far.


Start Addressing Health Inequalities Through Data Collection

Collecting data is a difficult and laborious process. So when there is long-standing evidence that racial and ethnic minority populations have received poorer quality health care in the United States, it is tempting to jump straight to solutions without first measuring the disparities locally.

It is a mistake. Without local data, it is impossible to be responsible for significant and lasting improvement over time in the communities served.

Our health plan encountered immediate obstacles in this first step. Race and ethnicity data was missing for over 90% of members. So our organization began to invite its members to self-report their race and ethnicity, supplementing this with data shared by employer clients and health systems.

Because we didn’t want a lack of perfect data to slow progress, we imputed data on member race and ethnicity using the RAND Bayesian Improved Surname Geocoding method, an approach commonly used when self-reported data is incomplete. This method uses a person’s last name in the U.S. Census and the racial and ethnic makeup of their neighborhood to produce a set of probabilities that an individual belongs to one of a set of mutually exclusive racial and ethnic groups. . While analyzes based on imputed data are likely to underestimate the true magnitude of inequalities, they are a good place to start and can be used to begin to tackle the inequalities they identify.

Share the data. A health plan cannot remedy inequalities dealt with in a vacuum. We began sharing confidential reports with the large health systems in our coverage network in the summer of 2021, each showing inequalities of care within their organizations – for example, whether black patients were receiving appropriate medication to control asthma attacks run at the same rate as white patients – and how they stack up against patients in other health systems.

The BCBSMA will also make available to its employer clients reports showing the disparities in care between employees of different races. As a health plan, the impetus to do so is clear: Clients pay the same amount for health insurance regardless of their race, ethnicity or neighborhood, and should receive care of the same quality. It is a business as well as a moral imperative.

Let discoveries drive improvement

Our company has made data about inequalities in care public so that it can be useful to the wider community, which can hold BCBSMA accountable for improvement over time. Drawing on 2019 data for 1.3 million of our business members in Massachusetts, our analysts looked at 48 metrics widely used to monitor performance in important dimensions of healthcare and found strong disparities in the vast majority of measures.

For example, Asian, black, and Hispanic members were less likely than non-Hispanic white members to be screened for colorectal cancer. The rates of life-threatening medical problems during childbirth for black members of the health plan were more than double those of non-Hispanic white members. And black and Hispanic members were 15 to 20 percent less likely than non-Hispanic white members to receive the recommended management of antidepressant medications.

Such disparities are pervasive in American health care. But these are humiliating results for a health care system that has long been committed to providing quality, affordable care to all of its members.

These findings prompt our organization to do better. Equity of care is now a fourth strategic priority for our company, on par with quality care, affordable care and an unparalleled consumer experience.

Collaborate with the medical community

The BCBSMA has worked with healthcare systems for more than a decade through its Alternative Quality Contract, which replaced the fee-for-service model and supports and rewards clinicians’ efforts to improve the quality and value of care that ‘they dispense.

Our company is now building on this model, together with the Institute for Healthcare Improvement, to help healthcare systems in our value-based payment programs improve equity of care with a newly established collaboration. By working together, we will determine how best to measure inequalities in access and care, and create programs designed to eliminate these inequalities.

We will also create new contracts that will reward clinicians for providing care of equal quality to people of all races and ethnicities. We know clinicians want to eliminate inequalities in care, and these contracts will give them a business case to do so, just as our payment models have long been structured to reward clinicians’ efforts to improve quality and value.

Equity is the unfinished business of health care reform

The inequalities that our organization and many others are working to address are centuries old and extend far beyond health care. But we believe that health plans, working with their members, employer clients, community partners and the medical community, can make significant changes to reduce them.

As a first step, health plans and other payers can do what the BCBSMA did: calculate their own quality measures, produce internal health equity reports based on those measures, and publish those reports. This will strengthen the capacity of insurers to be responsible for improving the quality of care for all in their health system. And by incorporating equity measures into their incentive programs, payers can help the medical community close equity gaps.

The past 20 months have been a constant reminder that healthcare does not exist in a vacuum – it affects our economy, our schools, our mental health and national health. Eliminating disparities in health care helps create healthier, more productive and more resilient communities and workplaces, and ensures that health plans live up to their commitment to provide high-quality coverage to all of their workers. members.

In recent years, health plans and the medical community have made progress in expanding access to health care and health coverage, and have worked to improve quality and safety. Now is the time – it is high time – to put racial inequalities at the center of the work to create a better health care system.

Andrew Dreyfus is President and CEO of Blue Cross Blue Shield of Massachusetts. Sandhya Rao is an Internist and Medical Director and Senior Vice President of BCBSMA.