On the heels of Black Maternal Health Week—created to raise awareness about racial disparities in maternal health—one of the nation’s largest health insurance companies is taking a stand.
Today, the Blue Cross Blue Shield Association (BCBSA) announced it is launching a new national health equity strategy to address racial health disparities, starting with the maternal health crisis.
Through today’s announcement, the national association of 35 independently operated Blue Cross Blue Shield companies with 107 million combined members, is committing to reduce racial disparities in maternal health by 50% in five years.
“We have been on this journey for some period of time, but we need to lean in more substantially,” said Kim Keck, president and CEO of BCBSA. “We need to set bold goals.”
Black women in the U.S. are 2.5 times more likely than white women to die during pregnancy, delivery, or in the period following pregnancy, and 3.5 times more likely to die than Hispanic women, according to the CDC. Approximately two-thirds of maternal deaths are considered preventable.
In a recent Q&A with STAT, Vice President Kamala Harris cited two major obstacles to maternal health equity: systemic disparities and implicit bias.
Dr. Stacy Tessler Lindau, professor of obstetrics and gynecology and medicine at the University of Chicago, traces these issues to the early days of her field.
“Obstetrics itself, as a medical practice and profession, was born by white men experimenting on, exploiting, and doing violence to enslaved Black women during and after their pregnancies,” Lindau said. “We have neither reckoned with nor repaired this history and so its legacy continues.”
The BCBSA move may be an important step toward that reckoning. Keck thinks the U.S. is at a tipping point and that it’s past time to address racial disparities in healthcare.
“Where you live or the color of your skin should not determine how long you live or how high a quality of life you have,” Keck said. “It has been known forever, but we’ve got to address it. The time is now.”
Black maternal mortality has become such a crisis in the U.S. that some Black women are afraid to go to the hospital to deliver their babies, according to Dr. Jackie Walters, an Atlanta-area obstetrician/gynecologist and Married to Medicine star. She has joined the BCBSA health equity initiative in collaboration with a National Advisory Panel on Health Equity that BCBSA is convening to guide the effort.
“I have started to see more and more patients come into the office, expressing their fears around dying in childbirth,” said Walters. “Almost an overwhelming number of women are coming in and talking about being afraid to go to the hospital.”
Some women simply don’t go to the hospital at all, Walters said, instead staying home to deliver their babies.
Achieving BCBSA’s goal will ultimately require rebuilding trust among women of color. But according to Keck, the effort needs to start with some fundamental first steps, such as improving consistency of race, ethnicity, and language (REL) data across Blue Cross Blue Shield health plans nationwide.
“You can’t manage what you can’t measure,” she said.
On top of foundational components such as REL data, Keck said BCBSA will also aim to scale local programs that are already improving maternal health outcomes. At the national level, she said BCBSA will look for opportunities to create systemic changes, such as paying for unconscious bias training for participating healthcare providers and requiring or providing incentives for providers to close specific gaps pertaining to maternal health.
“Health insurers have a critical role to play because they hold the purse strings and behavior follows money in healthcare,” said Lindau.
Lindau sees opportunity for health insurers to create value-based reimbursement models which reward outcomes and create incentives for obstetric care providers to keep pregnant people healthy. Healthcare providers who are reimbursed this way have more flexibility to provide nonmedical services and supports, such as doulas and midwives, nutrition services, housing, and transportation. These services can, according to Lindau, buffer toxic stress and support wellness during pregnancy, labor, and the postpartum period.
In contrast, fee-for-service payments reward healthcare providers financially for providing more services. Taken to the extreme, a neonatal intensive care unit (NICU) admission may be lucrative for the hospital, but terrible for the patient. “This dynamic has to change,” said Lindau.
Keck agrees that value-based payment models can create the right incentives to make sure women get the services they need. Such payment arrangements could require participating providers to address critical drivers of bad outcomes, such as hypertension or hemorrhaging—factors that can cause pregnancy complications and have long-term health consequences.
In addition to the role insurers can play in improving maternal health outcomes, Walters sees important roles for consumers, who may need education to become their own advocates, and healthcare providers, who may need education to recognize their unconscious biases.
The benefits of a three-pronged approach with insurers, consumers, and providers may accrue to all parties and American society more broadly. To realize that potential, though, Walters believes everyone must contribute.
“We all want a healthy community where we have a healthy mom who goes home with a healthy baby and we all have to have a voice,” Walters said. “I’m open to everybody getting involved in furthering the cause so that we can stop women dying and sending babies home without their moms.”
Keck shares this collaborative mindset. To other health insurers, she has an invitation: “Join us. We can’t do this alone.”