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New ‘action plan’ takes aim at health disparities

A new report offers concrete steps to break down barriers to care and highlights best practices from around the U.S.

Audrey Shelto (far right), president and CEO of Blue Cross Blue Shield of Massachusetts Foundation, moderated a panel on Wednesday that marked the release of a new health equity report.Jonathan Wiggs/Globe Staff

One key message quickly emerged when Eboné Carrington and her team at Manatt Health began interviewing people on the front lines of health care about the best ways to tackle the vast racial inequities in Massachusetts: People are tired of talking about the problem. They want to act.

So Carrington, a former New York City hospital chief tapped by Blue Cross Blue Shield of Massachusetts Foundation to pen a vision of what an equitable health care system might look like, decided to pivot. The result is a 20-page Health Equity Action Plan unveiled Wednesday that not only highlights barriers to health equity but details best practices that hospitals and other health care providers have used to break down the barriers to quality care.

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“This toolkit is not, ‘Let’s research it.’ It’s not, ‘Let’s study it again.’ It is, ‘Just do it,’” Carrington said Wednesday at a Boston event to mark the report’s release.

Based on dozens of interviews with community leaders and health care experts, an exhaustive review of efforts across the nation, and a number of focus groups, the report is the latest issued by Blue Cross Blue Shield of Massachusetts Foundation to address racial health inequities. A previous report, from July, estimated that racial health disparities cost the state about $5.9 billion each year in extra health care costs, lost labor productivity, and premature death. That number is expected to nearly double by 2050 without action.

The new effort is part of a broad push across the state by public health officials and health care leaders to harness the attention to racial health disparities highlighted by the COVID-19 pandemic to enact permanent change. Racial health care disparities have long been known to public health officials and state policy makers. A 2012 study found that parts of predominantly African American Roxbury have a life expectancy of less than 59 years, compared to predominantly white Back Bay, just a few miles away, where the life expectancy is 92. Last year, the Boston Public Health Commission redid that study and found that life expectancy in Roxbury had risen to 69 — better, but still concerning.

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Previous efforts to address the disparities have been hampered by a lack of coordination, collaboration, and urgency, according to public health officials and hospital administrators. Many of those present at Wednesday’s event are hoping to change that.

To add to what they billed as a first draft of the best practices in the months ahead, the foundation plans to work closely with one of the entities at the center of those efforts, the Health Equity Compact, a group of 80 people of color that came together in May 2022 to develop a coordinated effort to tackle deeply rooted racial health care disparities in Massachusetts. That group includes many of the state’s leading players in health care and public health, executives from many of the state’s largest hospitals and health care providers, along with representatives from philanthropic organizations, academic institutions, and businesses.

“We need a common framework, a common kind of organizing structure for moving forward,” said Elsie Taveras, chief community health and health equity officer at Mass General Brigham and a member of the Health Equity Compact. “And I think what the report provides is a toolkit, a framework for how organizations can move from documenting an inequity to implementing solutions.”

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In the report, Carrington and her team identified six “essential” components of a racially and ethnically equitable health care delivery system. They include: accessible and affordable care that is easy to navigate; diverse and healthy workforce development; the absence of racism and bias in clinical training and care delivery; data collection to inform decisions; community investments designed to eliminate structural inequities; and, perhaps most significantly, community power and involvement. Successful programs, Carrington noted, have focused on efforts to make patients feel that they are taking part in the decision-making process.

The best practices listed in the toolkit drew from institutions across the nation. Those highlighted included an initiative launched by Cincinnati Children’s Hospital Medical Center in 2015 that helped decrease hospitalizations by 20 percent by partnering with community groups to identify and address barriers to care. And a program at Boston Medical Center that significantly reduced the hospital readmission of mothers who had recently given birth and were at risk for hypertension. It did so by, among other things, providing blood pressure cuffs and using telehealth and other tactics to provide remote support.

In recent months, advocates have been lobbying state legislators and other leaders to pass legislation that would, among other things, create the position of state health equity commissioner and create a new dashboard that integrates data from health systems, insurance companies, and community health assessments.

In the months ahead, the foundation plans to hire a consultant put together a broader repository to track health equity efforts across the state and detail these disparate approaches, so different organizations can learn from one another, rather than start from scratch, said Audry Shelto, president & CEO of Blue Cross Blue Shield of Massachusetts Foundation. The foundation will also fund “action labs,” incubators that serve as space for innovation, collaboration, discussion, and planning for new initiatives, which can drive funding decisions.

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“There’s so many great people in Massachusetts working on this stuff, but we’re not working together,” Shelto said. “This is basically saying, ‘Let’s pull together all the things that are going on in the Commonwealth in silos, and let’s bring them together and try to have a bigger impact by working together.’”



Adam Piore can be reached at adam.piore@globe.com.