Following the death of George Floyd and the many disparities exacerbated by the COVID-19 pandemic, Blue Cross Blue Shield of Massachusetts began asking what role it could play as a health plan.
The two strategies the organization recognized it had access to were data quality and physician payments, said Sandhya Rao, M.D., chief medical officer of BCBS Massachusetts.
“Without great data, it’s really hard to take action and to learn and study the problem,” Rao said during a panel discussion at the virtual J.P. Morgan Healthcare Conference Tuesday.
That’s why the organization began collecting data on race and looking at quality measures across racial groups. It shared those data publicly as a step in taking accountability, Rao said, and also is sharing it with provider and employer groups to observe trends together.
During the panel discussion on health equity, experts acknowledged the challenges of addressing inequities and the steps they have taken to mitigate them.
Collecting data can be tricky in itself. Providers can be uncomfortable asking patients for information and may assume patients are uncomfortable disclosing it. “The perception that they won’t give it is a misperception we need to overcome,” said Cara James, Ph.D., president and CEO of Grantmakers In Health.
“Only white people are afraid to talk about race,” echoed Ryan Schmid, president and CEO of Vera Whole Health. His organization has been asking patients to self-report that data and so far, has received positive feedback, he said.
Even for those eager to collect data, however, few standards exist on how to do it consistently. Federal guidelines exist but have not been updated since 1997, James said. Grantmakers In Health, in partnership with the Commonwealth Fund and others, recently put out recommendations on this issue. Existing data being collected are also not being leveraged to their full potential—not being analyzed from an equity lens, James noted.
BCBS Massachusetts is incorporating data and progress metrics into payment models. Over the next three years, the organization expects to incorporate financial incentives around closing racial inequities, Rao said. While so far the feedback from the provider community has been positive, that won’t be the only thing that contributes to eradicating centuries’ worth of structural racism. Community-provider partnerships are also key.
The Centers for Medicare & Medicaid Services, meanwhile, is funding medical residencies in rural communities as one way of stimulating wider access to care and fostering providers’ understanding of those patient populations, explained Meena Seshamani, M.D., Ph.D., deputy administrator and director of the Center for Medicare. The agency is also working with providers and payers to address social determinants and expand accountable care organizations in rural and underserved communities. Read more about the agency’s strategy here.
James emphasized the need for healthcare stakeholders to have conversations on this topic with other sectors—creating a “business case” for health equity. Her organization has begun receiving pushback from some on the equity conversation, so she worries the window for implementation and action is closing.
Equity needs to be thought of as a long-term approach, beyond this pandemic and into the inevitable next.
“It’s not a project; it’s not an initiative. It really has to be woven into the fabric of an ecosystem," Schmid concluded.