Fostering innovation in health equity

Massachusetts health care organizations are finding new ways to address inequities in care for Black and Latino patients, according to an independent study that is the first to examine the success of an innovative partnership between the state’s largest nonprofit health plan and clinicians in its network.

“What Blue Cross Blue Shield of Massachusetts is doing is really innovative—no other large payer has prioritized racial equity and quality using financial incentives with robust technical assistance” in its contracts, said Hector Rodriguez, professor of health policy and management at University of California, Berkeley’s School of Public Health and lead author of the study, which was sponsored by the Commonwealth Fund.

The groundbreaking program, launched by Blue Cross Blue Shield of Massachusetts in 2021, provided $25 million in infrastructure-building grant money to 12 health care organizations – all of which take part in the health plan’s value-based payment model — designed to eliminate racial and ethnic inequities in health care. It also created a learning collaborative where clinicians can share challenges and best practices, receive expert coaching and test solutions. The effort prepared groups to sign landmark contracts with the insurer that reward them for reducing health inequities across their entire patient population—not just for Blue Cross members.

“Health care organizations are giving increased attention to advancing racial equity. Blue Cross, however, is among a handful of commercial payers that have taken concrete steps to reduce racial and ethnic disparities in care for all patients—not just their own,” Rodriguez said. “BCBSMA has taken an altruistic approach to build strong foundations for data collection and equity improvement. It has not been shy about making investments that benefit the greater good of a group and other payers’ patients as well as their own.”

Promoting action

Rodriguez’s study synthesized 44 interviews with participants in the learning collaborative, which is facilitated by health care non-profit IHI.

“The collaborative learning system allowed for multiple provider groups to efficiently design and test clinical and community-based interventions,” the study found.

For example: Clinicians reported testing pilot projects aimed at reducing racial and ethnic disparities in breast and colorectal cancer screening and hypertension and diabetes management, such as community health worker outreach, mobile clinics, home health visits and strategies to improve transportation access.

The study also noted the health care organizations found novel ways to address one major challenge that has long bedeviled researchers: a lack of self-reported data about race and ethnicity. Rather than letting that slow them down, the organizations used Census data and demographic analysis to identify the best practice sites to test interventions.

“We heard from many participants that the learning collaborative promotes action and helps them overcome barriers they may encounter,” Rodriguez said. “They also appreciated the ability to work together. Here, they can leave competition at the door and embrace a shared interest in advancing equitable care.”

And, the study notes, the model may help make health care more affordable as well: “Learning collaboratives,” researchers wrote, “have the potential to reduce the overall cost of (quality improvement) because of the ability to import best practices.”

“It’s wonderful to see the Berkeley team’s independent review that shows our model is already making a difference,” agreed Dr. Mark Friedberg, a primary care physician and head of performance measurement and improvement at Blue Cross. “We believe in the importance of independent evaluation for all of our efforts, including our quality initiatives and now our equity work.”

Sustainable solutions

Study participants underscored the need for continued investment and expertise to drive this work forward.

“Participants said the grant money from Blue Cross was an important foundational investment, but they noted that to continue making sustainable improvements in equity, they need to prioritize funding internally and hire staff with specific knowledge of how Black and Latino communities engage with the health care system,” Rodriguez said.

Rodriguez and his team will continue to report on the Blue Cross model, with more evaluations planned for the coming year.

Addressing decades-old barriers will require constant learning, Friedberg and Rodriguez noted, and independent research is part of that process.

“There is a learning orientation running through all of this work that will be vital for its success,” Rodriguez said. “Groups are learning from one another through the collaborative, and our evaluation of this work is helping Blue Cross learn about program challenges and opportunities moving forward.”