Editor’s Note: In a new report for the Blue Cross Blue Shield Foundation of Massachusetts, summarized below, Manatt Health proposes a vision and plan for action—collectively, a statewide Health Equity Action Plan—for achieving a racially and ethnically equitable health care delivery system in Massachusetts. The report is accompanied by a Health Equity Action Plan Toolkit of interventions, policies and programs that health care delivery organizations across the country can deploy to achieve their health equity goals. To download free copies of the full report and toolkit, click here.
Systemic racism, both structural and interpersonal, has long pervaded and been perpetuated by the health care system in America and is rife in care delivery, health coverage and payment policy, social systems that impact health, and other institutions that comprise or support the health care system. Systemic racism manifests in policies, practices, biases and discrimination that contribute to stark and widening health care disparities among racial and ethnic groups.
Within the health care delivery system itself—which encompasses hospitals and health systems, community health centers, community mental health settings, primary care and specialty physician offices, nursing facilities and home health agencies, and other care delivery settings—systemic racism results in inequities. These include poorer access to care as well as poorer care experiences for people of color 1 and those who speak a primary language other than English, as compared to white people.2 These same inequities exist with respect to quality of care and health outcomes. For people who speak a primary language other than English, inequities and health disparities widen and compound; they experience higher rates of medical errors with worse clinical outcomes than English-proficient patients, and they receive lower quality of care.3
Many stakeholders across Massachusetts are actively focused on addressing racism in the health care delivery system and reducing health disparities, but efforts are siloed. The goal of the Health Equity Action Plan is to harness the existing energy, action and funding in Massachusetts through an organizing framework that facilitates communication, alignment and accountability for creating a health care delivery system in which all Massachusetts residents can attain their full potential for health and well-being regardless of race and ethnicity or primary language spoken.4
Health Equity Action Plan Framework
The Health Equity Action Plan is based on the following framework that summarizes learnings from the review of existing health equity frameworks, the landscape scan, nearly 40 stakeholder interviews and consumer focus groups. The framework includes six essential components of a racially and ethnically equitable health care delivery system that, if attained, can help achieve the vision of all people in Massachusetts experiencing high-quality, accessible and timely care from providers who understand and respect their culture. The companion Toolkit includes an inventory of "best of" interventions, policies, and programs that organizations in the health care delivery system can deploy to achieve their health equity goals.
Moving Forward—Implementing the Proposed Health Equity Action Plan
Implementing the Health Equity Action Plan will require stakeholders from across the state, including providers, state regulators, employers, health care payers, communities, philanthropy and others, to collectively commit to creating a racially and ethnically equitable health care delivery system in Massachusetts.
The voices of people with lived experience will be critical to this effort, as those closest to the problem should be closest to the solution. The Blue Cross Blue Shield of Massachusetts Foundation will engage with the Health Equity Compact to collaborate and align as they move this Action Plan forward.
This report presents a proposed structure, high-level process, and timeline for near- and longer-term actions to launch, implement and monitor the Health Equity Action Plan. The implementation structure includes:
- A steering committee that will provide strategic guidance on priorities, stakeholder roles and responsibilities, and monitor progress to help ensure accountability across the state.
- A central organizing entity that will be the “home” for the Health Equity Action Plan structure, responsible for direct implementation of some activities and tracking of others. It will work in collaboration with regional or other entities that are leading health equity initiatives to identify and share activities underway, determine if there are opportunities for coordination and collaboration, and continuously foster information sharing necessary to advance the statewide Health Equity Action Plan.
- Action labs that will serve as the locus for collaborative work among diverse stakeholders from across the state to learn about evidence-based best practices and to identify priority actions and process/outcome measures to create a unified, aligned statewide Health Equity Action Plan.
- Implementation stakeholders (e.g., providers/delivery systems, payers/insurers, government, community-based organizations, employers, academic/educational systems, and philanthropy) that will participate in statewide and local action.
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THE HEALTH EQUITY COMPACT
The Health Equity Compact is a coalition of over 80 Massachusetts leaders of color who seek to dismantle systemic barriers to equitable health outcomes for all residents of the commonwealth. Compact members are high-level executives and experts from a diverse set of health, business, labor and philanthropic organizations, including hospitals, health centers, payers, academic institutions, life sciences and local public health. The Compact’s vision is the elimination of systemic barriers and creation of new structures and processes that will lead to equitable health care and health outcomes for all in Massachusetts. The Compact’s mission is to realize bold statewide policy and institutional practice changes that center racial justice and health equity. The Compact is committed to leveraging its members’ lived experiences and professional expertise to advance health equity in Massachusetts.
For more information, click here.
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Conclusion
Health care disparities across racial and ethnic populations in Massachusetts persist, as they do across the country. People of color and people who speak a primary language other than English experience inequitable access to care and disproportionate rates of morbidity and mortality across multiple access, experience and outcome measures.
Massachusetts is fortunate to have a wealth of community groups, health care organizations and other organizations that have long worked to understand the health care disparities and inequities in the state. There is tremendous momentum and a sense of urgency among stakeholders in Massachusetts to eliminate racial and ethnic disparities in health and advance health equity. The framework and Action Plan are intended to serve as a concrete proposal to launch systematic and coordinated action to achieve the vision where all people in Massachusetts experience high-quality, accessible and timely care from providers who understand and respect their culture.
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1 There is no uniformly used definition of the term “people of color.” While some publications define people of coloras any non-white population, a recent Health Affairs article defines people of coloras “a term used to refer to African Americans, American Indians/Alaska Natives, Asian Americans, Latinos/Hispanics, and Native Hawaiians/other Pacific Islanders.” Braveman, P. A., Arkin, E., Proctor, D., Kauh, T., & Holm, N. (2022). Systemic and structural racism: Definitions, examples, health damages, and approaches to dismantling. Health Affairs, 41(2). Available here.
2 Centers for Disease Control and Prevention. Racism and health. Available here.
3 Anthony, S., Boozang, P., Elam, L., McAvey, K., & Striar, A. (2021). Racism and racial inequities in health: A data informed primer on health disparities in Massachusetts. Blue Cross Blue Shield of Massachusetts Foundation. Available here; in this report, people of color is defined as people who are Black, Asian, or Hispanic/Latino. There was not sufficient data to include populations with American Indian/ Alaska Native (AI/AN) or Native Hawaiian/other Pacific Islanders ancestry.
4 Many stakeholders noted that social systems, such as education, housing, nutrition, and transportation, and related policies outside the direct purview of the health care delivery system play a significant role in people’s health care access and outcomes. This report includes a focus on the health care delivery system’s role in identifying social needs and connecting people to resources to meet those needs, but it does not make recommendations specific to those social systems or policies.