BCBS Massachusetts signs value-based contracts incorporating equity measures

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Blue Cross Blue Shield of Massachusetts is touting itself as the first in the state, and one of the first in the country, to create a financial payment model rewarding health systems and physicians for eliminating racial and ethnic inequities in care.

Four of the state’s largest healthcare systems have signed the agreements, which link financial incentives to improvements in health equity. They include Steward Healthcare Network, Beth Israel Lahey Health (BILH), Mass General Brigham and Boston Accountable Care Organization (BACO), which is part of Boston Medical Center. 

Together, these systems provide care to more than 550,000 Blue Cross members.


The new contracts will initially focus on measuring and rewarding equity in care in several clinical areas where inequities have been identified, including colorectal cancer screenings, blood pressure control and care for diabetes. Additional categories will be added as the payment model evolves.

The Center for Healthcare Organization and Innovation Research (CHOIR) at the UC Berkeley School of Public Health will conduct an independent external evaluation of Blue Cross’ efforts to advance health equity, using qualitative and quantitative methods to examine and publish the effects of the initiative.

“We believe nearly all clinicians already want to reduce racial and ethnic inequities in care,” said Dr. Mark Friedberg, senior vice president, 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.”

Friedberg said Blue Cross encourages and supports participating organizations to extend their equity improvement initiatives to all of their patients – even those whose health plans have not yet introduced financial incentives linked to health equity.


It’s not the first time BCBS Massachusetts has turned its focus to equity. In May, in an attempt to address disparities in where venture capital funding was being directed, the insurer launched a Health Equity Business Accelerator, a program meant to lend financial, strategic and mentorship support to founders of color.

The program will be focused on “creating equitable healthcare services and solutions,” according to Blue Cross.

Accelerator participation includes a $150,000 investment, as well as nine months of tailored programming delivered in conjunction with partners such as the Capital Network and Healthbox to help accelerate growth and foster innovation.

Blue Cross Blue Shield Massachusetts signaled its focus on equity in 2021 when it made a number of investments, including a grant program to support nonprofits led by Black, Indigenous and other people of color (BIPOC); a first-to-market approach to collecting race and ethnicity data to address inequities in the care members receive; expanding marketing efforts to better reach a more diverse audience, with messages focused on addressing gaps in care and improving overall health; and new investments and support for minority-owned businesses.

Those efforts were enabled by $350,000 Racial Equity and Justice Grants that support BIPOC-led not-for-profit organizations focused on addressing racial injustice in Massachusetts communities.


“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.”

Twitter: @JELagasse
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