Massachusetts Blue Cross unveils ‘pay-for-equity’ program

Blue Cross Blue Shield of Massachusetts has entered into value-based arrangements with four health systems including Mass General Brigham and Boston Medical Center that offer financial incentives for eliminating racial and ethnic health disparities in outpatient care.

Under the payment programs, the nonprofit insurer will enter into risk-sharing agreements with providers and offer standalone performance payments that are, in part, based on their ability to close equity gaps in certain quality measures.

The first set of standards includes colorectal cancer screening, diabetes care and blood pressure control, with more to come as the payment model gets underway, said Dr. Mark Friedberg, senior vice president of performance measurement and improvement at Blue Cross Blue Shield of Massachusetts.

“You will be paid more if you achieve high quality in a way that reduces inequities than if you achieve high quality in a way that doesn’t reduce inequities,” Friedberg said. “You’re leaving money on the table if you don’t improve equity over time.”

That money could be used to create sustainable funding for targeted interventions that remedy disparities, or to provide language or other social services to underserved communities, Friedberg said.

Mass General Brigham, the Boston Medical Center’s Boston Accountable Care Organization, Cambridge, Massachusetts-based Beth Israel Lahey Health, and Dallas-based Steward Health Care each entered into agreements to participate in the initiative. These providers care for approximately 550,000 Blue Cross Blue Shield of Massachusetts members, according to the insurer.

The payment program builds on the Massachusetts Blue Cross carrier’s Alternative Quality Contract system, through which the insurer will track providers’ progress on shared quality measures and outcomes data that it stratifies by race and ethnicity, then report the findings to providers.

“It’s always wise to align financial incentives to the outcomes you’re seeking to achieve, and that’s where healthcare in the US has fallen short,” said Ann Somers Hogg, senior healthcare research fellow at the Christensen Institute, a nonpartisan think tank. We’ve paid providers for transactions and, as a result, we have a system designed to deliver more transactions and to provide more sick care.”

Creating incentives specific to reducing health disparities is still relatively new, and will require research and evaluation to determine whether it can be effective, Friedberg said.

Blue Cross Blue Shield of Massachusetts tapped the Center for Healthcare Organization and Innovation Research at the University of California, Berkeley School of Public Health to serve as an independent evaluator. Professor Hector Rodriguez will lead the team and have discretion to publish its findings, Friedberg said.

In order to enact change that rectifies health disparities broadly, more patients would need to be treated by providers participating in similar payment models, Hogg said.

“It’s too much work to deliver care in different ways for people insured by different insurance companies,” Hogg said. “In order for this to be effective, and for the financial incentives to the incentivize behavior Blue Cross Blue Shield is looking for, either the providers need to have that data at hand for all patients or the incentives have to be enticing enough for the provider to act regardless of who the insurer is.”

Blue Cross Blue Shield of Massachusetts plans to include additional safety measures in equity analyzes and to create more stratifications to its datasets over time. For example, the insurer would like to offer financial incentives to close disparities in well-child visits, breast cancer screenings, cervical cancer screenings and statin therapy for patients with diabetes. The company wants to stratify those data by sexual orientation, gender identity, language and disability status within its quality data to find other disparities.

“Quality of care is no longer good enough,” Hogg said. “Now it’s fair quality.”

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