How Blue Cross Blue Shield Association is tackling the crisis in racial health disparities

Kim Keck, president and CEO of the Blue Cross Blue Shield Association (BCBSA), discusses how the group’s newly launched National Health Equity Strategy to confront the nation’s crisis in racial health disparities, and how it plans to reduce racial disparities in maternal health by 50% in five years.

Video transcript

- As we know, the pandemic has thrown into sharp [INAUDIBLE] racial disparities in health care. And the Blue Cross Blue Shield Association is trying to tackle that problem in various specific ways. Kim Keck is with us now. She's the Blue Cross Blue Shield Association president and CEO. Our Anjalee Khemlani, our health care reporter, is also with us.

So Kim, one of the things that you all are targeting is reducing racial disparities in maternal health specifically by 50% in five years. Now, through the lens of the Blue Cross Blue Shield organizations, talk to me about the steps to get there. How do you do it?

KIM KECK: Yeah, great to be with you. And thanks for the opportunity to have the conversation. Look, this isn't a one-dimensional issue. So it doesn't have a one-dimensional solution. So there are many ways we'll get at what we call racial disparities in health care because we have a crisis in this country. And as we know, the color of your skin or the neighborhood you live in shouldn't impact your health, shouldn't actually create a health outcome, but too often it does.

So there's a number of things we're doing both existing-- building rather on existing program but taking new approaches. so working with providers, community leaders, certainly patients and others to address root cause issues is just one example, getting at things like unconscious bias training, closing gaps in care, and incenting providers to do that in new and meaningful ways. But look, this is a bold goal. We're holding ourselves accountable to reduce maternal health disparities by 50% in five years.

ANJALEE KHEMLANI: And Kim, I wonder when you talk about being able to look at this, there already has been a history, at least in the last 10 years, of various insurers or health providers looking at health equity in different ways, social determinant of healths being one of those things. So what way is this different? How-- how is this different than, say, the various pilot programs and experimental sort of programs within these departments and insurance agencies in the past?

KIM KECK: Yeah, absolutely. So we do have many programs underway. And many more need to be implemented and really candidly scaled. So for example, we have one new program in Michigan. Blue Cross Blue Shield of Michigan is something like 20,000 providers in that one state. And that plan is making unconscious bias training available to more than 20,000, but it's in the neighborhood.

So across the country, Blue Cross Blue Shield has a network of about 1.7 million providers. So just think for a second if we scale this to even 10% of those providers, right? We could have 170,000 health care providers with this one additional tool to overcome biases and treat patients of color with the same high-quality health care that everyone deserves.

But it's certainly more. It's building on another program we have. CareFirst is a program in the mid-Atlantic. They've been working on racial disparities for some time, but it's a multi-stakeholder approach, right? This is about things like prenatal nutrition.

This is about things like getting babies access to seeing their pediatrician, home visits if you like. This is community health workers coming together and actually addressing issues in the home. This one program in Baltimore has actually reduced infant mortality by about 30% in the last several years. So scaling those programs would be some of the examples I'd give you.

But this is even broader than that, right? This is getting at those root causes. This is getting at closing gaps in care. This is building on a pledge we took a year ago, June of 2020, where 36 at the time Blue Cross Blue Shield companies came together and said we are committing to a pledge for meaningful change in health disparities and systemic racism and injustice in our communities. But this is the next chapter in that by articulating and speaking with so many about our long-term goals to address these issues.

ANJALEE KHEMLANI: So explain to me how this converts into something scalable and especially the impact of who bears the burden of the cost in this process. Because in order to expand these programs, the problem has been that it costs more than the return that you get for-- for addressing some of these issues. How do you address that problem?

KIM KECK: Well, first and foremost, ineffective care is the most expensive care at all. So we have to start by addressing some of the root cause issues because we have a crisis in this country. So we'll be holding ourselves accountable to things like measuring our success over time. And look, we're going to be identifying the works-- the ways rather that work best and the best ways to work, I guess I'd say.

One of the measures we will use to your point of measuring success and really understanding if these programs work is using something the CDC publishes which is called severe maternal morbidity. So again, we're focused on maternal health in the short come-- in the short term rather. And looking at that metric will give us an idea if we're making progress. That measure, SMM as it's called, measures unexpected outcomes of labor and delivery with significant both short-term and long-term consequences to a woman's health.

- And Kim, you talked about incentivizing your members towards these goals. Do you have any sticks? I mean, those are the carrots. Do you have any sticks also that you can use?

KIM KECK: Yeah, we do. And some of those are sort of frozen carrots sometimes we call them. But because think about a stick, right, as a potential to say, here, we're-- this is what I'll call a bundle of care. And if you don't address things like the kinds of conditions that get underlying-- that create rather underlying complications in maternal health like hypertension or even hemorrhaging, right, if you don't address those, we won't pay you. It's part of our reimbursement to you.

So certainly, there are those. But again, it's not just this relationship between the payer and the provider, right, the health plan and the physician. This is certainly more broad than that. And-- and we're excited to start and have this conversation. But those would be sort of a frozen carrot that I would offer for today.

- Gotcha. Well, obviously, a lot at stake here. So good luck in your journey to meeting this goal. Kim Keck, Blue Cross Blue Shield Association president and CEO, and our Anjalee Khemlani. Thanks to you both. Appreciate it.