Blues plan, 12 large healthcare systems join forces to remove racial bias from 15 clinical decision tools

In a major effort to combat healthcare inequalities in the Philadelphia region, Independence Blue Cross is teaming up with 12 large health systems in the region to target 15 medical tests that may hinder minorities from getting the care that they need.

They want to remove race “adjustments” from the tests. For instance, a spirometry test measures lung function. However, the metrics used often incorporate race data and assume that Black and Asian patients have a smaller lung capacity than white patients.

“As a result, the test has failed to detect lung disease in many Black and Asian patients,” according to a press release announcing the program, dubbed the Regional Coalition to Eliminate Race-Based Medicine.

The coalition includes Children’s Hospital of Philadelphia, Doylestown Health, Grand View Health, Jefferson Health, Main Line Health, Nemours Children’s Health, Penn Medicine, Redeemer Health, St. Christopher’s Hospital for Children, Temple Health, Trinity Health Mid-Atlantic and Virtua Health.  

"In many ways, race-based medicine has driven or contributed to the unacceptable health inequities that we see in the Philadelphia region and in other similarly situated communities across the country," said Gregory E. Deavens, CEO of the Independence Health Group, parent company of Independence Blue Cross, in the press release. "Our region is known worldwide as a destination for health care excellence. That’s in large part due to the institutions represented in this regional coalition.

The members say they will work together to eliminate the use of race as a variable in some of the medical tests and find alternative best practices that do not reinforce a biological understanding of race.

"Tthe use of race in many of these calculators is actually harmful, and, in many cases, it perpetuates biased health care inequities," said Kieran Cody, M.D., past president of the Doylestown Hospital medical staff and orthopedic sports medicine specialist, said in the release. "It is important for all members of the healthcare team to objectively examine the way race is used in medicine, to help remove historical ingrained biases, so that all members of our community are provided with the best possible care and the best possible outcomes.”

In addition to spirometry, the coalition plans to focus on:

  • Arteriosclerosis and cardiovascular disease risk estimator
  • Breast cancer surveillance consortium risk calculator
  • Estimated glomerular filtration rate
  • Fracture risk assessment tool
  • Heart failure risk score
  • Kidney donor risk index
  • NCI breast cancer risk assessment tool
  • Osteoporosis risk score
  • Race-based anemia guidelines       
  • Rectal cancer survival calculator
  • Society of thoracic surgeons short term risk calculator
  • Urology stone score
  • UTI calculation guideline
  • Vaginal birth after Cesarean calculator

"We know that race is a social construct, and the elimination of race-based medicine is long overdue and a welcome change to ensure that patients are cared for equitably," Rita Guevara, M.D., director of health equity at St. Christopher’s Hospital for Children, said in the release. "When we recognize that structural inequities, not race, affect the health of our patients and their families, we're able to shift our collective focus to sustainable positive changes in healthcare. We look forward to collaborating with our colleagues in this effort.”