Continuing to be a leader in the “pay-for-equity” movement, Blue Cross Blue Shield of Massachusetts announced that four of the state’s largest healthcare systems have signed agreements that link financial incentives to improvements in health equity.
The four health systems are Steward Healthcare Network, Beth Israel Lahey Health, Mass General Brigham and Boston Accountable Care Organization Inc., which is part of Boston Medical Center. Together, these systems provide care to more than 550,000 Blue Cross members.
“For more than a decade, we’ve collaborated with physicians and hospitals via our Alternative Quality Contract, which replaced the fee-for-service model and instead rewards clinicians’ efforts to improve the quality and value of the care they deliver,” said Andrew Dreyfus, CEO of Blue Cross, in a statement. “We’re now building on that model to help health systems in our value-based payment programs improve equity. As a health plan, this is the most important tool we have to work toward a health system that provides affordable, quality and equitable care to all our members.”
The nonprofit Blue Cross, which has 2.9 million members, said the new contracts will initially focus on measuring and rewarding equity in care in several clinical areas where inequities have been identified, including colorectal cancer screenings, blood pressure control and care for diabetes. Additional categories will be added as the payment model evolves.
The Center for Healthcare Organization and Innovation Research (CHOIR) at the UC Berkeley School of Public Health will conduct an independent external evaluation of Blue Cross’ efforts to advance health equity, using qualitative and quantitative methods to examine and publish the effects of this initiative.
“We believe nearly all clinicians already want to reduce racial and ethnic inequities in care,” said Mark Friedberg, M.D., senior vice president, performance measurement & improvement at Blue Cross, in a statement. “By incorporating equity measures into our payment models, we intend to create an explicit business case for large health care systems to increase their investments in developing, expanding and sustaining programs that produce measurable improvements in equity.”
Friedberg noted that Blue Cross encourages and supports participating organizations to extend their equity improvement initiatives to all of their patients — even those whose health plans have not yet introduced financial incentives linked to health equity.
Many of the health systems in Massachusetts have their own efforts under way to reduce disparities in care. Two years ago, integrated academic healthcare system Mass General launched the United Against Racism initiative. This foundational program outlined a plan to confront the many impacts of racism both within the organization and throughout the collective community. These efforts, organized around patient care, community health, and workforce equity, are an organizational commitment enabled by a long-term, multimillion-dollar investment.
“This health equity partnership with Blue Cross is aligned with our organizational mission to eliminate racism and builds upon our investments within our own system and the communities we serve,” said Niyum Gandhi, chief financial officer and Treasurer at Mass General Brigham, in a statement. “We are proud to join Blue Cross and other local health systems to ensure that equity is at the heart of patient care strategy.”
“While these systems are among the first to take part in these payment contracts, we’re eager to add additional healthcare organizations in Massachusetts,” said Sarah Iselin, Blue Cross’ CEO-elect. “Our goal is to engage as many physicians and hospitals in equity improvement as we can.”
In keeping with its commitment to address health inequities, Blue Cross gathers and publishes data each year for more than 1.2 million of its commercial Massachusetts members. This data has revealed racial and ethnic inequities in many areas of patient care. In partnership with the clinicians in its network, the health plan is using its data to make meaningful change and work toward the shared goal of eliminating racial disparities in the care Blue Cross members receive.
As part of that work, Blue Cross funded $25 million in Institute for Healthcare Improvement grants to support physician practices and hospitals with Alternative Quality Contracts in their efforts to eliminate racial and ethnic inequities in care and share learning across institutions.
