From AIS Health: With Equity a Hot Topic, Blues Plans Target Health Disparities

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Reprinted with AIS Health permission from the April 23, 2021 issue of Health Plan Weekly

Spurred in part by the harsh spotlight that the COVID-19 pandemic has shone on health equity issues, the Blue Cross Blue Shield Association (BCBSA) on April 20 unveiled a vast, ambitious initiative that aims to “change the trajectory of heath disparities and re-imagine a more equitable healthcare system.”

Industry experts say that now is the ideal time for such a project to kick off and that the BCBSA and its 35 member plans are well-positioned to take on such a challenge. To succeed, though, the Blues plans will need to build crucial trust among the populations they’re hoping to help, and they must act as the conduit for grassroots efforts that health insurers can’t handle on their own.

“There’s never been a time that has both incredible critical need and public openness to a strategy like this, so seeing BCBSA launch this strategy on a large scale is really exciting,” says Nancy Pealing, M.D., chief quality officer at ConsejoSano, a health care technology company specializing in culturally aligned outreach to Medicaid plan members.

Jerry Vitti, founder and CEO of Heathcare Financial, Inc., says BCBSA’s effort is a “part and parcel” of the many ways health plans are working to address social determinants of health (SDOH). “But with their coordinated national strategy running alongside the crucial community-based aspect, BCBSA is addressing health equity on a whole new level,” he adds.

Destiny-Simone Ramjohn, vice president of community health and social impact at CareFirst BlueCross Blue Shield, tells AIS Health that the initiative was accelerated in part by the pandemic. “This wasn’t something that just emerged overnight, but it’s certainly something that we remain committed to and applying that equity lens across all that we do,” she says.

BCBSA’s National Health Equity Strategy will involve efforts such as “collecting data to measure disparities, scaling effective programs, working with providers to improve outcomes and address unconscious bias, leaning into partnerships at the community level, and influencing policy decisions at the state and federal levels,” according to a press release from the association. The initiative will focus specifically on four conditions that BCBSA says disproportionately affect communities of color: maternal health, behavioral health, diabetes and cardiovascular conditions.

In 2021, Blues plans will first focus on maternal health — setting a public goal of reducing racial disparities by 50% over five years — followed by behavioral health, with efforts to tackle the other two conditions kicking off in later years.

The Blues association says it will evaluate its work to reduce maternal health disparities using metrics such as the Centers for Disease Control and Prevention’s Severe Maternal Morbidity measures, and BCBSA will report results annually. The release also notes that “BCBS companies currently have a range of maternal health programs supporting women of color during their pregnancies.”

CareFirst Focused on Infant Mortality

Indeed, the imperative to improve the health of mothers and babies in vulnerable communities has been on CareFirst’s radar for some time, says Ramjohn. More than a decade ago, after learning that Baltimore had one of the worst infant mortality rates in the country, CareFirst began to support a “massive citywide effort” to change that, Ramjohn tells AIS Health. One of the “astonishing outcomes” of that initiative, she says, is the fact that Baltimore’s infant mortality rate had dropped by 30% as of 2019.

Through such efforts, CareFirst has learned that “one of the things that is really, really significant is that community partnerships are essential — we know that most of what contributes to your health happens outside of your doctor’s office, that community health happens in places where we live, work and play,” Ramjohn says. “And so, a part of our role [and] our challenge in the work ahead is, what are the resources that we can provide to better equip community health organizations for success?”

“What we don’t want to do is send healthy moms back to sick communities,” she adds. “Those environmental conditions are essential and a core part of the kinds of solutions that we will be implementing.”

Independence Blue Cross, meanwhile, has pursued its own initiatives to improve the health of mothers and babies. In a press release, the insurer noted that it has worked with AmeriHealth Caritas on a project that focuses on improving outcomes for expectant mothers in North Philadelphia, and created Baby Blueprints, which uses predictive modeling to learn how social determinants impact high-risk maternity patients, among other efforts.

BCBSA’s focus on improving infant and maternal health comes after HHS, in December 2020, released an action plan with the goal of reducing the maternal mortality rate by 50%, reducing low-risk Cesarean deliveries by 25% and achieving blood pressure control in 80% of women of reproductive age with hypertension, all by 2025.

Data Can Help Drive Change, Plans Say

While health insurers cannot single-handedly tackle the deeply rooted social issues that drive inequality in the U.S., experts say they still have a powerful role to play alongside other stakeholders.

“Plans are the conduit. They have the ability to funnel data, financial resources, and members to the right community partners,” ConsejoSano’s Pealing tells AIS Health. “They also have the ability to advocate for policies that will improve care and outcomes for their members, [and they] have the ability to set the tone and the agenda, as well as shaping the public perception of their members.”

“I don’t expect to see a Blue Cross plan sending their member services team to build houses for members experiencing homelessness,” she adds. “I do hope to see plans investing funds into community programs that can help members with these barriers, and also investing in the tools that will help connect members to the services.”

Ultimately, to be successful BCBSA’s initiative will require “financial investment, policy changes, partnership with local BCBS plans and community-based organizations, including providers,” Pealing says. “It’s also going to require intentional efforts to build trust between historically undervalued communities and the health care system. Trust will be the hardest, but most critical aspect.”

Earning community trust will be critical if CareFirst and its fellow Blues want to collect the data they will need to advance their health equity initiatives, Ramjohn acknowledges.

“One of the things that we should be transparent about is that some of this data is not something that we collect today, so a huge part of this [health equity] strategy involves ensuring that we are…driving the collection and appropriate use of demographic data,” she says. “That means that we must take an appropriate approach to standardizing data collection, addressing barriers both related to trust and transparency for the responsible use of that data and information, and the willingness of individuals to voluntarily provide it.”

Insurer Analyzes SDOH Risk Scores

CareFirst has made some headway, she notes, through a partnership with an organization called Socially Determined, which assigns individual risk scores “along a set of core SDOH dimensions at the member level.” The insurer has used that member-level data as part of a larger analysis into SDOH factors at the community level, Ramjohn says. “What the analysis revealed to us was that individuals don’t experience these compromised SDOH factors in a silo, but really in clusters. So if you are compromised with financial insecurity, then you’re also more likely to have a cluster of economic insecurity and also housing insecurity. That data is going to allow us to plan more complex interventions that really do drive, I think, better health outcomes and ultimately reduce the total cost of care.”

Paper Spotlights Data Collection Barriers

For its part, Blue Shield of California recently teamed up with Manatt Health to produce a white paper that delves into common health plan race/ethnicity (R/E) data collection challenges and how California can help mitigate them. In the Golden State, the paper notes, “two-thirds of commercial health plans, half of Medicaid plans, and more than a quarter of Medicare plans have race data missing for more than half of their membership, with ethnicity data sparser still.”

Some of the major barriers to collecting such data include inconsistent regulatory requirements, inconsistent use of data categorization standards and individuals’ reluctance to voluntarily share R/E data with their health plans, Manatt and Blue Shield of California say. To solve those problems, the paper recommends developing a health information exchange capacity “as a centralizing source of R/E data for plans and providers” and requiring health plans to collect standardized R/E data across all regulated lines of business.

Read more about the BCBSA initiative at https://bit.ly/32BYE5p and find the Manatt paper at https://bit.ly/3dHsUlH. Contact Pealing and Vitti via Joe Reblando at joe@joereblando.com, and Ramjohn via Rebecca Hollamon at rebecca.hollamon@carefirst.com.

by Leslie Small