Payers, Physicians

What tools do payers have to advance health equity? Here’s what BCBS of Massachusetts is leveraging

Blue Cross Blue Shield of Massachusetts is leveraging data and value-based contracts to reduce disparities it has observed and publicly revealed within its own patient population, while also providing financial support to groups that help physicians address health equity.

There are early indications that advancing health equity is going beyond just lip service and is taking central priority at healthcare organizations of all stripes.

It was a theme that panelists at the 40th annual J.P. Morgan Healthcare conference taking place virtually this week returned to over and over be they employers, providers or payers and no matter the session topic.

Insofar as action goes, one payer that is on the forefront of putting words to action appears to be Blue Cross Blue Shield of Massachusetts. In a panel discussion on health equity Wednesday, Dr. Sandhya Rao, the plan’s chief medical officer expanded upon the announcement in September where the plan said that it would incorporate  equity measures into its contracts and payment programs with clinicians who care for Blue Cross members.

“For us, following the murder of George Floyd and seeing the inequities that became so apparent during the early days of the Covid pandemic, we really looked inwards to say, “What role do we play as a health plan in this problem?” Rao said in the panel discussion.

The questions revealed that the plan has two levers on which to pull: data and physician payment. Rao described the latter as being one of the most impactful things that a payer does and one that can shape investment. These two levers then led the payer to actively try and do the following things:

  • Collect data on race.
    In fact BCBS of Massachusetts has already shared publicly some of the concerning race-based healthcare data points the effort has unveiled. They include that Asian, Black, and Hispanic members were less likely than White non-Hispanic members to get screened 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%). While data on race is not of good quality, BCBS for about a year has been asking its patient population to voluntarily disclose their race through the BCBS app. Providers are doing the same thing, so BCBS of Massachusetts is able to access this information as well.
  • Incorporate race-based outcomes with physician-payment plans and value-based contracts “What’s very exciting for me, as a practitioner, is that we are incorporating both of those things – the data and the measurement – into a collaboration we have with providers in Massachusetts,” Rao said. So far, providers in that state who are reimbursed by BCBS of Massachusetts have been in value-based contracts for more than a decade where they are paid and incentivized on value and not volume based on providers achieving quality and efficiency measures. Now, the payer is adding race-based incentives, where providers will be able to get financial incentives if they can demonstrate that they are closing the gap in outcomes experienced by people of color.
  • Providing infrastructure support
    Recognizing that providers are under tremendous pressure with Covid and generally, and cannot achieve these goals without some financial support, BCBS is providing a $25 million grant to the Institute for Healthcare Improvement, which the latter will use to distribute to provider groups to support their work in reducing disparities in outcomes experienced by people of color. “

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