Gabriel Perna | January 12, 2021
COVID-19 has revealed inequities damaging the health care system for Black and Hispanic communities. In the city of Chicago, recent data shows that Latinos have the highest COVID-19 infection rates (18 percent), while Black Chicagoans have the highest rate of deaths.
In fact, there are multiple studies across the country that show Black, Hispanic, and Asian patients had significantly higher rates of COVID-19 infection, hospitalization, and death compared to White counterparts. Moreover, the pandemic has also had a greater financial and emotional impact on Blacks and other minorities, according to a research effort from Kaiser Family Foundation and The Undefeated.
Disparities are just one reason Blue Cross Blue Shield of Illinois (BCBSIL) has launched the Health Equity Hospital Quality Incentive Pilot Program with multiple Illinois-area providers and hospitals. The program will offer approximately $100 million in funding to participating hospitals to help serve BCBSIL members in Illinois communities who are often most at risk of contracting COVID-19.
“We envision this pilot as an opportunity to offer much needed financial support to hospitals and health systems across the state. We’ve gone through this period where our health care system shut down, except for emergent care. It began to reopen over the course of summer, but the return to care has been a bit slower than anticipated. That was the primary driver, but we also recognized in COVID-19, health disparities have been front and center. This is an opportunity for us to bring attention to the need to address disparities in care,” says Derek Robinson, MD, vice president and chief medical officer for Blue Cross and Blue Shield of Illinois.
At the same time BCBSIL has launched this pilot with Memorial Health System and UI Health, the insurer announced an “Institute for Physician Diversity.” Through this effort, BCBSIL will partner with academic medical centers, teaching hospitals, and not-for-profit associations and aim to diversify the physician workforce. Recent studies from the Association of American Medical Colleges (AAMC) show that many ethnicities are vastly underrepresented in this area of medicine.
Health Evolution spoke with Robinson about the health equity problems of COVID-19, some of the biggest challenges he foresees with this $100 million investment, and more.
Health Evolution: What are some of the specific health equity problems plaguing the City of Chicago that have been exposed by the COVID-19 pandemic?
Robinson: One of the things we’ve seen, not just in Chicago, but across the state and across the country, is that many chronic conditions are endemic in minority communities. We’re talking about cardiovascular disease, diabetes, obesity, and respiratory conditions like asthma. These are conditions that existed prior to COVID-19 and what we learned early on in the pandemic is individuals with these conditions have higher rates of hospitalization and death from infection.
That called attention to understanding why we have these disparities across different social determinants of health. One of the primary roots of this issue is we haven’t valued all communities equally. That’s across a number of different sectors including health care. There’s a large body of evidence that minority communities are less likely to receive the appropriate standard care or treatment within the health care system.
If we look at the Health Equity Hospital Quality Incentive Pilot Program, one of the things that we seek to do is ensure everyone has a fair opportunity to get as healthy as they can be. That requires us to have a historical context view about the disparities of care that exist in our communities. It also requires us to ensure our system is serving all populations equally, and that we’re actually measuring to reduce and eliminate disparities in care.
Health Evolution: Speaking of measuring, this is a big investment by BCBSIL – what are some of the goals you hope to accomplish?
Robinson: Those metrics and goals are across a few areas. First, we approach this with the long game in mind. The disparities we’re seeking to reduce and eliminate didn’t occur overnight, so they’re going to take some time. One, it requires structural changes in how we evaluate care that’s delivered and how we deliver quality and improvement.
One of the first major goals of the program is to broadly ensure our hospitals and health systems are collecting data on race, ethnicity and language for patients that receive care. That will be expanded over a multi-year effort to collect data on sexual orientation and gender identity. Collecting that data sets the foundation to look at all aspects of quality of care and look at them through those lenses, to any of those sub populations. That’s what gives you the foundation to address disparities in care that exist. That’s a major component.
Derek Robinson, MD, Blue Cross Blue Shield of Illinois
There are a number of quality measures that hospitals and health systems use each day to evaluate care providers on the inpatient and outpatient side. We’re asking them to review those aspects by looking through the lens of race, ethnicity, preferred language, sexual orientation and gender identity to see where disparities exist. And then setting goals for seeing statistical improvement in addressing disparities over time.
We’ve leaned in on maternal and infant health. Taking a step back, COVID has shined a spotlight on disparities that make the virus a higher risk. A lot of them predated COVID. We know that disparities in maternal and infant health are significant. Minority women have a higher rate of dying in the first year [after birth] and the infant mortality rate is higher. We’re focusing on using the Joint Commission’s maternal hemorrhage and maternal hypertension bundles to ensure best practices in terms of managing the care for pregnant moms are being delivered across all populations. That’s another area of focus.
Health Evolution: What will be some of the biggest challenges you foresee with this pilot?
Robinson: One of the biggest challenges we’re addressing with this process is making sure the focus is on identifying and improving disparities in care. You have to distinguish the fact that there are overall health disparities in terms of health status and then you have disparities in how care is delivered. The topic of disparities in care has not been a core component of discussions between health insurers and providers. This program brings that into focus. In my experience, when you marry these objectives to goals and financial incentives, it sets the stage to drive improvement. What gets measured is what gets done. When we bring that into a program like this, we prioritize it and give it financial resources.
Health Evolution: At the same time, you’ve launched the Institute for Physician Diversity, where does that need come from?
Robinson: In March of 2019, we convened teaching hospitals, academic medical centers, nonprofit organizations, and medical associations across the state to focus on the topic of physician diversity and understand where there are opportunities going forward. We also brought in some large national organizations, like the AAMC and the Accreditation Council for Graduate Medical Education (ACGME). What we found is that our physician workforce does not represent racial and ethnic diversity of our communities at a state level or at a city level in Chicago. That’s not a new phenomenon, it’s been around a while but what’s new is this country is becoming more ethnically diverse, yet our trend of producing more African American, Latino, Asian and Native American physicians has been stagnant.
One of the things that came out of the day-long summit is that health insurance companies have a unique opportunity to convene stakeholders in medical education to be an accelerant to improving these disparities in the physician workforce. That’s the impetus for the development of the Institute for Physician Diversity. And it ties into the hospital pilot program because built into that program is a commitment to ensure the physician workforce generated by academic medical centers and teaching hospitals better reflects the diversity of the communities they serve.
Health Evolution: What advice do you have for health care CEOs in tackling these major health equity issues?
Robinson: These compelling times require us to roll up our sleeves and be courageous and innovative. We don’t have all of the answers or the perfect solution to get started, but it’s important to get started. And it’s important to acknowledge both the historical context of racial disparities in health care, as well as the human lives that will benefit from the important work that we’re doing. This is not a zero-sum game. This is an approach where we all win. It’s important not only according to the health of our citizens, but it’s important to our economy and the health of our businesses as well. Among the many things COVID has made clear to us is that the health of our communities has a significant impact on our economy.
homepage image: @DrDRobinson