Whether the discussion is among payers, healthcare systems, clinicians, researchers or government officials, health equity is now a common topic. Increasingly, when discussing the gap between the status quo and the safe, high-quality healthcare we all need and deserve, many organizations are realizing that improving health equity is both a moral imperative and an economic one as the business case for equity is well-documented.
Achieving health equity will take commitment. Blue Cross Blue Shield of Massachusetts (BCBSMA) has stated that racism is a public health crisis and racial inequity in healthcare is a social justice issue. Accordingly, BCBSMA has been making direct investments in care delivery systems to help achieve more equitable outcomes. We hope these efforts to improve health equity at scale can be a model for other payer organizations.
In 2021, BCBSMA, with support from the Institute for Healthcare Improvement (IHI), launched its Equity Action Community, a learning community of 16 health systems from across Massachusetts. Their goal is to accelerate progress toward closing racial and ethnic inequities in clinical care by providing opportunities for these health systems to engage in tailored workshops, learning sessions and one-on-one consultations.
One way BCBSMA is helping to set health system partners up for long-term success is through essential investments in data collection systems and practices. Gathering more accurate, self-reported patient information on race, ethnicity, language, sexual orientation and gender identity, for example, helps health systems identify equity gaps in key performance areas. According to the US Agency for Healthcare Research and Quality, “Addressing [healthcare] disparities must begin with the fundamental step of bringing the nature of the disparities and the groups at risk for those disparities to light by collecting healthcare quality information stratified by race, ethnicity and language data.”
We may have data that tells us we have improved our diabetes and hypertension care or increased the number of our patients getting cancer screenings. But, without accurate and stratified data, we have no way of knowing whether patients in all population groups are benefiting from our efforts or only some. For example, researchers often find health inequities by race and ethnicity when analyzing data on chronic illness and cancer screenings. By collecting accurate data and employing stratification, we can see that our efforts are accessible to all.
At the start, many participating health systems lacked this foundational data to guide the implementation of changes to close equity gaps in clinical care. Now, health systems are prioritizing the collection of race, ethnicity and language (REaL) data to aid in identifying gaps in equity. Additionally, data gathered by BCBSMA are used to create a publicly available health equity report card on BCBSMA’s own performance in addition to sharing data with Massachusetts’ largest health systems and individual provider groups.
Another essential form of investment is to fund initiatives that directly address inequities faced by patients in Massachusetts and support the clinicians who serve them. BCBSMA funded $25 million in grants, administered by IHI, to healthcare systems in Massachusetts to reduce racial and ethnic inequities, predominantly across four clinical areas where inequities are most common: diabetes, high blood pressure, well-child visits and colorectal cancer screening. Healthcare systems have used the funding to support interventions such as community health workers, mobile screening vans, interprofessional care clinics and expanded visit hours.
Working across healthcare to advance health equity
The actions we have described are practical, specific and high-impact. We also recognize that every healthcare sector has a role to play in advancing health equity. We and our fellow payers, individual practitioners, healthcare organizations, professional societies and pharmaceutical, research and biotechnology organizations must each do our part to improve care for historically and currently underserved populations. Doing this will be most effective with a coordinated, cross-sector approach.
BCBSMA looks forward to continuing to aid in the movement to advance health equity in partnership with providers, health systems and other organizations. The Rise to Health Coalition, an initiative bringing together stakeholders from across the healthcare ecosystem to address deeply rooted health inequities in our country, aims to transform healthcare through coordinated and collective action. We hope all individuals, and organizations of all sizes, recognize that they can take steps to create a more equitable and healthier future for all.
Laura Carr, PharmD, is a Director, Provider Performance at Blue Cross Blue Shield of Massachusetts. Nikki Tennermann, LICSW, MBA, is a Senior Project Director at the Institute for Healthcare Improvement.
For more information or if you have any questions about BCBSMA’s Equity Action Community please contact [email protected]. For more information on the Rise to Health Coalition, visit https://www.risetohealthequity.org.