Incentives to improve care among people of color
Not feeling well? Go to the doctor. Simple advice, but not as simple in practice. Racial and ethnic inequity and disparities in health care exist across the country, and this includes how we access and receive medical services.
Black Americans seek care from a private physician’s office at two-thirds the rate of whites, instead opting to receive care from an emergency department or hospital outpatient center. Reasons for this may include limited access to care, an individual’s socioeconomic situation or a general mistrust of the medical system, to name a few. But choosing an emergency department visit over a trip to a primary care physician can leave patients with limited or no access to preventative health benefits such as routine screenings and health checks, drawing a parallel with poorer health outcomes across a number of conditions. These visits also cost more. For common ailments, the cost of a visit to the emergency department in 12 times higher than treatment at a physician’s office.
While there is no smoking gun solution to ending racial disparities and inequities in health care, in Massachusetts, the state’s largest private health insurer is taking intentional steps to help improve medical care for people of color.
"We regard health care as a social justice issue. It is not enough to talk about it. We are taking real action to eliminate racial inequities in care,” said Andrew Dreyfus, president and CEO at Blue Cross Blue Shield of Massachusetts (BCBS MA). “We know we can’t do it alone, but we need to be part of the solution.”
As COVID-19 disproportionally impacted communities of color and sharpened the focus on racial health inequities the company took a deeper look at medical claims from more than 1.3 million of their members. Results from the health equity report uncovered racial and ethnic inequities in the quality of care for a majority of measures commonly used to monitor performance on important dimensions of care and service including: chronic conditions such as diabetes, heart disease and asthma; mental health; women’s health; preventative care as well as testing and treatment.
For years BCBS MA, like many insurers, tied physician compensation to overall quality of care, but without separate or additional payment based on how patients of different races were treated. Now, armed with performance data on equity measures, the health plan will offer financial incentives to physician practices that address racial disparities in health care services and treatment. These incentives will be tied to improvements in rates of racial inequity and overall health outcomes and will be implemented as early as 2023.
BCBS MA is the first health plan in the commonwealth to incorporate health equity measures into payment programs and has already shared detailed data from the report with clinical partners allowing them to see how their practice compared to others in terms of racial inequities in care.
Since BCBS MA members are not required to report race, the company used statistical analysis to estimate disparities in care as part of the health equity report. Going forward, efforts are underway to collect better data and improve available information.
“As a health plan, one of the most powerful tools we have to help guide positive change is the way we pay clinicians who care for our members,” added Dreyfus.