Mass. Blue Cross to Incorporate Equity Measures Into Payment Programs

Sept. 28, 2021
Health plan releases data on disparities across a range of categories for children and adults, including preventive and condition-specific care

As it released the results of an analysis on racial and ethnic inequities in healthcare, Blue Cross Blue Shield of Massachusetts said it was the first health plan in Massachusetts to announce it will incorporate equity measures into its contracts and payment programs with clinicians.

The company reviewed 2019 administrative and health data from more than 1.3 million Massachusetts members and identified racial disparities that, in many cases, represent lower-quality care for Black, Asian, and Hispanic members on 48 industry-standard measures that Blue Cross tracks as part of its ongoing quality assurance operations. The data are now accessible to the public.

Blue Cross examined disparities across a range of categories for children and adults, including preventive and condition-specific care. For care delivered in 2019 to commercial members, examples of the company's findings include:

• Asian, Black, and Hispanic members were less likely than White non-Hispanic members to receive screenings for colorectal cancer (67.0% for Asian, 63.8% for Black, 65.4% for Hispanic, vs 70.8% for non-Hispanic White members).

• Rates of severe maternal morbidity (life-threatening medical issues during childbirth) for Black commercial members were more than double that of White non-Hispanic members (2.8% vs 1.2%).

• Rates of adolescent well-care visits were lower for Black and Hispanic members than for White non-Hispanic members (68.9% for Black, 70.3% for Hispanic vs 80.2% for non-Hispanic White members).

 • Black and Hispanic members were approximately 15-20% less likely than White non-Hispanic members to receive recommended antidepressant medication management.

"It has long been known that racial inequities have devastating consequences across American healthcare, and the pandemic has made that clear to all of us in the past year," said Blue Cross President and CEO Andrew Dreyfus, in a statement. "Measurement is a critical first step in addressing those disparities. We're publishing these results to hold ourselves accountable for progress toward our goal of eliminating racial inequities in the care our members receive."

In addition to releasing these findings publicly, Blue Cross has shared with its clinical partners more detailed data showing how their practices compare with others in terms of racial inequities in care. Blue Cross' employer customers will have the option of receiving similar data for their employees.

Blue Cross will address inequities in its members' care iby incorporating equity measures into its payment models starting in 2023.

Blue Cross and the Institute for Healthcare Improvement (IHI) this month launched a new collaborative intended to assist physicians and hospitals enrolled in the health plan's value-based payment model in their efforts to improve the equity of care and prepare them for equity-based financial incentives linked to improvements in racial inequities in care.

In a recent interview with Healthcare Innovation, IHI President and CEO Kedar Mate, M.D., spoke about the significance of Blue Cross’ initiative. “It gives us an early indication of where there are opportunities to improve in the BCBSM-covered population,” he said. “Once you've got the data, and you've got the information about disparities, you’ve got to do something about it. What we have found at IHI is that when you apply a disciplined approach to change management, systems will take actions and providers will take actions to actually change the circumstances and improve care performance.”

"As a health plan, we have a responsibility to address inequities directly with our members and by supporting the clinicians who serve them," said Mark Friedberg, M.D., senior vice president for performance measurement & improvement at Blue Cross, in a statement. "Our aim is to produce meaningful, measurable, and sustainable improvements in the equity of care. Payment is necessary but not sufficient to do this. So starting now, we are sharing data on inequities and engaging our provider network in collaborative efforts to address them."

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