Health equity focus in new BCBS Massachusetts value-based care model

Health equity is taking center stage in the Bay State with a new value-based care model from Blue Cross Blue Shield Massachusetts (Blue Cross). The model will provide incentives for some of the region’s largest health systems to meet defined health equity and care access benchmarks in an effort to reduce disparities for historically underserved populations.

Steward Healthcare Network, Beth Israel Lahey Health, Mass General Brigham, and Boston Accountable Care Organization, Inc., a part of Boston Medical Center, will participate in the inaugural version of the model. Together, they serve more than half a million Blue Cross beneficiaries.

“For more than a decade, we’ve collaborated with physicians and hospitals via our Alternative Quality Contract, which replaced the fee-for-service model and instead rewards clinicians’ efforts to improve the quality and value of the care they deliver,” said Andrew Dreyfus, CEO of Blue Cross. “We’re now building on that model to help health systems in our value-based payment programs improve equity. As a health plan, this is the most important tool we have to work toward a health system that provides affordable, quality, and equitable care to all our members.”

Initially, participants in the model will be held to specific benchmarks for providing key screening and chronic disease management services, including colorectal cancer screenings, blood pressure control, and care for diabetes. In the future, Blue Cross aims to add more items to the list.

“We are proud to sign onto an agreement that marks an important step forward towards providing equitable care to patients,” said Joseph Weinstein, MD, Steward Health Care Network’s chief physician executive. “Our clinicians are working diligently to break down barriers to health equity, and this partnership is a powerful tool in our mission to ensure we continue to deliver high-quality care at a sustainable cost.”

If successful at hitting the benchmarks, participants will receive financial incentives as a reward.

The Center for Healthcare Organization and Innovation Research (CHOIR) at the UC Berkeley School of Public Health will conduct an independent analysis of the model to determine both the quantitative and qualitative impacts of the strategy.

Blue Cross is one of the first commercial payers to overtly tie incentives to health equity, but the effort is just one part of an overall trend toward recognizing disparities and tying improvements to payments.

Earlier this year, the Centers for Medicare and Medicaid Services (CMS) took a similar approach by integrating socioeconomic factors into the payment structure for the Enhancing Oncology Model (EOM).

Geared toward community oncologists, the model requires participants to engage in specific health equity activities such as offering round-the-clock care access, assessing patients for social determinants of health (SDOH), and expanding their care navigation services.  The model also allows for higher monthly payments for dual-eligible beneficiaries to account for the generally enhanced needs of people at the lower end of the socioeconomic spectrum.

The majority of state-level Medicaid programs also prioritize health equity, particularly around maternal health outcomes, behavioral health, and vaccinations. As of July 2021, eleven states use health disparities as a performance measure tied to financial outcomes, using a combination of performance bonuses, capitation withholds, and value-based payments to incent providers.

Extending this strategy into the commercial health plan world is a positive step for beneficiaries—and for providers who have long expressed frustration with not having the financial resources to address the known needs of their patients.

Related Article: Small and rural hospitals fall behind on addressing social determinants of health

“We believe nearly all clinicians already want to reduce racial and ethnic inequities in care,” said Mark Friedberg, MD, senior vice president of performance measurement & improvement at Blue Cross. “By incorporating equity measures into our payment models, we intend to create an explicit business case for large health care systems to increase their investments in developing, expanding and sustaining programs that produce measurable improvements in equity.”

2023 is likely to see even more concrete efforts to integrate health equity, access, and inclusion into the value-based care ecosystem as a new generation of digital tools, paired with innovative payment structures, enables more comprehensive outreach to vulnerable communities.

Hopefully, Blue Cross’s model will open the floodgates for other commercial payers to adopt similar strategies for addressing deeply rooted disparities in communities across the nation.

Jennifer Bresnick is a journalist and freelance content creator with a decade of experience in the health IT industry. Her work has focused on leveraging innovative technology tools to create value, improve health equity, and achieve the promises of the learning health system.