Massachusetts Blue Cross unveils ‘pay for equity’ scheme

Blue Cross Blue Shield of Massachusetts entered into value-based agreements with four health systems including Mass General Brigham and Boston Medical Center offering financial incentives to eliminate health disparities among races and ethnicities in outpatient care.

Under the payment plans, the nonprofit insurer will enter into risk-sharing arrangements with providers and provide independent performance payments that are, in part, based on earning capacity. narrow the equity gap in certain quality measures.

The first set of standards includes colorectal cancer screening, diabetes care and control, said Dr. Mark Friedberg, senior vice president of measurement and performance improvement at Blue Cross Blue Shield of Massachusetts. blood pressure monitoring, and more standards will be available as the payment model is rolled out.

“You get paid more if you get high quality in a way that reduces inequality than if you get high quality in a way that doesn’t reduce inequality,” says Friedberg. “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 to bridge disparities, or to provide language or other social services to underserved communities, Friedberg said. full service.

Mass General Brigham, Boston Medical Center Boston Responsible Care, Cambridge, Massachusetts-based Beth Israel Lahey Health, and Dallas-based Stewart Health Care each signed an agreement to join the initiative. . According to the insurance company, these providers care for approximately 550,000 Blue Cross Blue Shield of Massachusetts members.

Payment plan built on Massachusetts Blue Cross service provider Alternative quality contract systemthrough which the insurer will track suppliers’ progress on shared quality measures and stratified results data by race and ethnicity, and then report the results to the providers. grant.

Ann Somers Hogg, senior healthcare researcher at the Christensen Institute, a nonpartisan advisory group, said: wise, and that’s the point where health care in America hasn’t hit it yet. We’ve paid providers for transactions, and as a result we have a system designed to deliver more transactions and deliver more care.”

Creating specific incentives to reduce health disparities is still relatively new, and research and evaluation will be needed to determine if it is effective, Friedberg said.

Blue Cross Blue Shield of Massachusetts hired the Center for Health Organization and Innovation Research at the Berkeley School of Public Health, University of California to act as an independent reviewer. Professor Hector Rodriguez will lead the research team and have full authority to publish his findings, Friedberg said.

To enact a change to address widespread health disparities, Hogg said, many patients will need to be treated by providers that participate in similar payment models.

“There is so much work to do to provide care in different ways to people covered by different insurers,” says Hogg. “For this to be effective and for the financial incentives to be sought by Blue Cross Blue Shield, the provider needs to have that data available to all patients or the incentives must be sufficient.” attractive to action providers regardless of insurance company.”

Blue Cross Blue Shield of Massachusetts plans to include additional safeguards in equity analytics and create more stratification for its data set over time. For example, an insurance company wants to provide financial incentives to close the gap in well-child visits, breast cancer screenings, cervical cancer screenings, and treatment. statin therapy for diabetics. The company wants to stratify that data by sexual orientation, gender identity, language, and disability in its quality data to find other discrepancies.

“The quality of care is not good enough anymore,” says Hogg. “Now it is fair quality.”


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