What Incentives Does Captial Blue Cross Have to Spend Less
For years, Blue Cross and other insurers have tied doctors' compensation to the quality of care they provide. But racial equity — the differences in how white patients and people of color are treated — was not a focus until now.
"Like many others, we had an awakening after the George Floyd murder and the COVID pandemic, and the way that that more deeply exposed racism and disparities in health care," said Andrew Dreyfus, chief executive of Blue Cross. "We had to start by looking at the health of our own members, which is not something we had done in a systematic way before."
COVID has disproportionately affected people of color, but disparities existed long before the pandemic. Blue Cross on Thursday released data about its members from 2019 that show Asian, Black, and Hispanic people received lower-quality care, according to several measures.
The data reveal that Asian, Black, and Hispanic patients with Blue Cross insurance were less likely than white patients to receive screenings for colorectal cancer, which was the second-leading cause of cancer deaths in the United States in 2019, according to the Centers for Disease Control. About 64 percent of Black patients had colonoscopies, for example, compared with 71 percent of white patients.
Among adolescents, 69 percent of Black and 70 percent of Hispanic patients went to their doctors for checkups, compared with 80 percent of white patients.
And the rate of life-threatening medical issues during childbirth for Black people was 2.8 percent, more than double the rate for white people.
The analysis also details racial disparities in patients whose diabetes was under control, and who received follow-up care for antidepressants and other medications.
"Our goal is to eliminate disparities," Dreyfus said. "These are unacceptable gaps in care that we need to close.
"We know we can't do it alone. Everyone in the health care system is accountable."
The payment program will apply to doctors who take care of the 2.1 million people with Blue Cross insurance in Massachusetts.
Blue Cross officials are still developing the details of their plan. They're also working to collect better data. Members are not required to report their race, so Blue Cross is asking them to voluntarily share that information. In the meantime, the company is using statistical analysis to estimate disparities in care.
Other insurers, both public and private, are also more focused on the issue of equity, though Blue Cross is the first to roll out this type of financial incentive plan.
State officials plan to redesign MassHealth, the public insurance program for low-income individuals, by requiring hospitals and other health care providers to measure and reduce disparities in care by race, ethnicity, language, disability status, sexual orientation, and gender identity. The plan, which needs federal approval, would tie $500 million of payments to health equity.
The state's second-biggest private insurer, Point32Health, has been working aggressively to collect data on health disparities, as well as how issues such as access to food, housing, and transportation affect people's health, said Dr. Claire Levesque, chief medical officer for commercial products.
Similar to Blue Cross, Point32Health — the company formed through the combination of the Tufts and Harvard Pilgrim health plans — has found racial inequities in diabetes care, maternity care, and mental health care.
Health insurers "have a really big role, and we have embrace it," Levesque said. "We have to push the providers. We have to tell them it's not OK if you take care of white suburban patients well, you have to take care of everyone well."
Health disparities stem from a complex set of issues. A person might skip their colonoscopy, for example, if they can't afford to miss a day of work, or if a language barrier prevents them from understanding how to prepare for the procedure, or from fear or distrust of the medical system.
Two doctors told the Globe that they applauded Blue Cross for working on equity but questioned how much financial incentives would help address deep-rooted problems such as poverty and structural racism.
"It seems that just incentivizing a [primary care physician] by dollar is not even close to being adequate to address some of the drivers of disparities," said Dr. Joe Kimura, chief medical officer at the physician group Atrius Health. "It can't be the only thing."
Dr. Deborah Blazey-Martin, chief of internal medicine and adult primary care at Tufts Medical Center, said it would be more effective for insurers to reduce copays and other costs for patients so they can better afford their care.
"It's not a bad idea to incent the physicians, but I'm not sure that it's necessarily going to be the most powerful place for us to work on disparities," Blazey-Martin said. "When we look at our patients, the reason that they're not getting care oftentimes is because it's too expensive to do so, or they can't take time off work."
Still, Cara V. James, chief executive of Washington-based Grantmakers In Health and former director of the Office of Minority Health at the Centers for Medicare & Medicaid Services, said the insurer's effort is significant. Nationwide, almost two decades of work on health care quality has not reduced racial disparities, she said.
"This is a huge step," James said. "Being intentional about how we focus on that work is critical to moving the needle. It's interesting and really good for Blue Cross Blue Shield of Massachusetts to think about how to incentivize those [better] outcomes."
Priyanka Dayal McCluskey can be reached at priyanka.mccluskey@globe.com. Follow her on Twitter @priyanka_dayal.
Source: https://www.bostonglobe.com/2021/09/23/business/blue-cross-will-reward-doctors-who-close-gaps-care-people-color/
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