Blue Cross Blue Shield of Massachusetts Becomes First Health Plan in Market to Incorporate Equity Measures Into Its Payment Models

BOSTON, Sept. 23, 2021 /PRNewswire/ -- Blue Cross Blue Shield of Massachusetts (Blue Cross) today shared the results of a new analysis of racial and ethnic inequities in health care and became the first health plan in Massachusetts to announce it will incorporate equity measures — differences in the quality of care across racial and ethnic groups — into its contracts and payment programs with clinicians who care for Blue Cross members.

In keeping with a commitment announced earlier this year to act as a leader in addressing health inequities, 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 at https://www.bluecrossma.org/myblue/equity-in-health-care/health-equity-report.

"It has long been known that racial inequities have devastating consequences across American health care, and the pandemic has made that clear to all of us in the past year," said Blue Cross president and CEO Andrew Dreyfus. "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."

For its analysis, 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

Full results available at https://www.bluecrossma.org/myblue/equity-in-health-care/health-equity-report

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. 

"We're committed to working collaboratively with the medical community to identify the underlying causes of racial inequities and to find ways to close these gaps," said Dr. Sandhya Rao, Blue Cross' chief medical officer. "We know clinicians can't do this alone – we have a shared responsibility to address and eliminate inequities, and our collective efforts will ultimately improve health care for all our members, across every racial and ethnic group."

Equity Measures and Payment Models
One of the primary ways Blue Cross will address inequities in its members' care is by 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.

"As a health plan, we have a responsibility to address inequities directly with our members and by supporting the clinicians who serve them," said Dr. Mark Friedberg, senior vice president for performance measurement & improvement at Blue Cross. "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."

"I am grateful for Blue Cross' commitment to improving the equity of our health systems by encouraging its provider network to view the urgency of the moment as a time to take decisive action," said Beya Jimenez, senior account director at The Lazu Group and a member of Blue Cross' Health Equity Council. "Through Blue Cross' leadership, we are witnessing a unique approach to health equity that encompasses the values needed to emerge triumphant against racial and systemic barriers in health care."

Commitment to Addressing Health Inequities & Racial Justice 
Blue Cross' recent work to address racial inequities also includes launching a fully in-house Spanish-language member call center and making its website available in five additional languages - Spanish, Portuguese, Russian, Chinese (Simplified), and Vietnamese.

Blue Cross also supported a variety of statewide efforts to help provide equitable access to COVID-19 vaccines, including funding transportation, sponsoring the Vax Express, and partnering with Equity Now & Beyond to host vaccine clinics and provide educational outreach in immigrant communities across Massachusetts.

Additionally, the company launched new $350,000 Racial Equity and Justice grants to support Black, Indigenous, People of Color (BIPOC)-led not-for-profit organizations focused on addressing racial injustice in Massachusetts communities. Blue Cross will continue to provide additional direct financial support via charitable investments to a wide range of organizations working to advance racial equity and social justice.

The Blue Cross Blue Shield of Massachusetts Foundation has made addressing racial inequities in health care one of its three focus areas, along with access to care and mental health. The Foundation works with its partners to identify policies that present barriers to equitable access to health care and coverage for people of color, and to diversify the workforce and leadership of health care organizations. In addition, the Foundation this year launched seven focus groups across the Commonwealth to discuss with BIPOC-led organizations what they see as the solutions to structural racism and racial inequities in health care.

Methodology
The member race and ethnicity data underlying Blue Cross's analyses were imputed using the RAND Bayesian Improved Surname Geocoding (BISG) method, which is a commonly used approach when self-reported data are incomplete. It is likely that analyses based on imputed data underestimate the true magnitude of inequities. For this reason, Blue Cross is currently engaged in a major effort to collect self-reported race and ethnicity data from members directly. Future versions of these analyses will transition from imputed data to member self-reported race and ethnicity data.

Blue Cross invites members to share information about their race, ethnicity, and preferred language when they log into the company's member portal, MyBlue. Knowing more about its 2.8 million members will help Blue Cross do its part to create a better, more equitable health system.

About Blue Cross Blue Shield of Massachusetts
Blue Cross Blue Shield of Massachusetts (bluecrossma.org) is a community-focused, tax-paying, not-for-profit health plan headquartered in Boston. We are committed to the relentless pursuit of quality, affordable and equitable health care with an unparalleled consumer experience. Consistent with our promise to always put our members first, we are rated among the nation's best health plans for member satisfaction and quality. Connect with us on Facebook, Twitter, YouTube, and LinkedIn.

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SOURCE Blue Cross Blue Shield of Massachusetts