A data-backed perspective on systemic change

As a clinician, Dr. Irene Dankwa-Mullan has long seen bias and discrimination affect patients in the health system.

“It’s not acceptable,” said Dankwa-Mullan, chief health equity officer and deputy chief health officer at IBM Watson Health, IBM Corporation. “As a physician-researcher, a public health physician, a frontline primary care physician, an internist and now as an industry chief medical officer, I’ve witnessed firsthand how obstacles to health such as physician bias and discrimination, lack of equity-oriented health benefits and diversity in clinical trials data, along with screening guidelines that do not take factors such as race and ethnicity into account, all lead to health disparities.”

Those inequities have been starkly exposed during the coronavirus pandemic, Dankwa-Mullan notes, with people of color suffering far higher COVID-19 infection, hospitalization and death rates. And the hard truth long predates the pandemic: Americans of color often receive lower-quality health care than their white peers.

But while such disparities are well recognized, their root causes and potential solutions are less clear.

A first step is collecting the kind of hard data that has long been elusive in addressing inequities in health care.

“A commitment to racial equity and social justice includes transparently collecting and reporting demographic data, identifying disparities, understanding population needs, and tailoring interventions to close gaps in care,” Dankwa-Mullan wrote in a recent Health Affairs blog post she co-authored with Dr. Bruce Sherman, Hema Karunakaram, Leah Kamin, Tiffani Bright and Dr. Kyu Rhee. “Ultimately, for organizations to identify and eliminate gaps in their programs, ensure equitable quality care, and address health disparities, the collection of employee health data by race and ethnicity must be improved.”

Simply put, “We have to first learn what we don’t know before we can know what steps to take,” said Sherman, a medical adviser with the National Alliance for Healthcare Purchaser Coalitions.

A health plan’s first step

Like many health plans, Massachusetts’ largest not-for-profit insurer lacked comprehensive demographic data on its own members. But Blue Cross Blue Shield of Massachusetts was determined to begin identifying racial and ethnic inequities in health care this year, as a first step in creating a better system with access to quality care for all.

“We need to better understand the racial and ethnic makeup of our membership so we can measure inequities, identify their causes and design effective solutions,” said Dr. Mark Friedberg, an internist and Blue Cross' Senior Vice President of performance measurement and improvement.

So, starting Jan. 1, Blue Cross invited its 2.8 million members to share information about their race, ethnicity and preferred language on its member portal.

The health plan will use the information it collects to improve its programs and services, including the quality of care members receive, the experiences they have as patients and their direct experiences with the insurer, Friedberg said. He added, “Most importantly, we will be transparent. We will keep the larger community apprised of what we learn and how we plan to address the issues we uncover.”

That transparency begins today, as the health plan announces plans to incorporate equity measures in its payment contracts with physicians and hospitals, and reports the results of the state’s first review of racial inequities in health plan claims for 1.3 million Massachusetts members. The findings are available in a publicly accessible database.

A commitment to act is important, Dankwa-Mullan said.

“Simply collecting race and ethnicity data does not automatically lead to reductions in disparities,” she said. “The data should be analyzed, measured, benchmarked, reported and used as a vehicle to implement new and tailored programs.”

A move toward better health care for all

Many employers already have race and ethnicity data, as well as the means to analyze it, said Sherman, who has done extensive research on health care utilization and costs. And there is a business case to be made for such efforts.

“Research has shown that improvements in employee health and wellbeing are associated with enhancements in business performance,” Sherman noted. “This is a way to use data to make strategic investments in employees and create business value.”

“Employers and health plans are already making decisions based on data and evidence,” agreed Dankwa-Mullan. “But if they are not making these decisions based on inclusive data, then they are not making decisions that match their diverse membership.”

Addressing inequities can lead to better health care for everyone, Dankwa-Mullan said.

“A commitment to health equity is a vehicle to the ultimate success in health care—improved quality and clinical effectiveness while decreasing costs,” she said. “My over two decades of experience has taught me that while the factors that contribute to health inequities are diverse and complex and will take time and hard work to eliminate, the health care community can start now by making health equity a strategic priority championed by leadership.”

And there is an additional imperative to begin this work now: “Collecting, analyzing and reporting race and ethnicity data is essential for fighting the pandemic.”

How you can help

Sharing race and ethnicity information can lead to profound, positive change, Dankwa-Mullan said.

“Disclosing your race or ethnicity has the potential to impact initiatives and investments related to diversity and inclusion, in addition to improving and personalizing services such as preventative health, early detection and disease management related to conditions common to specific racial or ethnic groups,” she said.

_{PHOTO OF Dr. MARK FRIEDBERG BY NICOLAUS CZARNECKI}