Background on Health Equity
The HPC’s mission is to advance a more transparent, accountable, and equitable health care system through its independent policy leadership and innovative investment programs. The HPC’s overall goal is better health and better care – at a lower cost – for all residents across the Commonwealth.
The HPC’s 2012 statute explicitly directs the agency to address health care disparities:
“The commission shall establish goals that are intended to reduce health care disparities in racial, ethnic and disabled communities and in doing so shall seek to incorporate the recommendations of the health disparities council and the office of health equity.”
The HPC is committed to addressing these disparities while advancing health equity and promoting social and economic justice.
Imperative for Action
In 2020, the disparate impact of COVID-19 on communities of color and ongoing injustices of police brutality across the country exposed systemic racism and deeply embedded structural inequities.
Health inequities in the Commonwealth have been well documented by the Massachusetts Department of Public Health (DPH), the Center for Health Information and Analysis (CHIA), the Office of the Attorney General, the HPC, and others.
Racial inequities are not unique to the health care system but are reflected in persistent health disparities and increased disease burden for communities of color. In addition to their impact on health and well-being, inequities result in higher health care spending and an imbalanced distribution of resources.
Racism Directly Affects Health Outcomes
The social determinants of health (SDOH) are factors that contribute to an individual’s medical and behavioral health outcomes and to predicting population health (e.g., socioeconomic status, food access, education, and opportunity for employment). While structural inequities and prejudices such as homophobia, ableism, and xenophobia have impacts on SDOH, racism has been proven to also have a direct and harmful impact on health.
Racism both influences social determinants and is an independent factor in health outcomes.
It is pivotal to acknowledge and address the impact of systemic racism as health equity work is implemented.
Source: Boston Public Health Commission’s Racial Justice and Health Equity Initiative; available: http://www.bphc.org/whatwedo/health-equity-social-justice/racial-justice-health-equity-initiative/Documents/RJHEI%202015%20Overview%20FINAL.pdf
Health Equity Principles
- The HPC acknowledges the pervasiveness of health inequities – and the systemic racism that underlies them – and that eliminating inequities is integral to achieving the HPC's mission of better health and better care at a lower cost for all residents of the Commonwealth.
- The HPC continually educates itself about the impact of systemic racism and promotes diversity, equity, and inclusion in the workplace in order to more fully cultivate the culture of anti-racism within our agency.
- Advancing health equity in the Commonwealth is a shared responsibility. The HPC actively seeks opportunities to align, partner, and support other state agencies, the health care system, and organizations working for health equity on these goals.
- The HPC’s work is informed and guided by those with lived experience of inequities.
- The HPC embeds health equity concepts in all aspects of its work and applies all four of its core strategies to the goal of advancing health equity in the Commonwealth: research and report, convene, watchdog, and partner.
The HPC's Work to Advance Health Equity
On July 22, 2020, the HPC presented a framework and action plan for advancing health equity and a revised mission statement that centers the goal of equity. The HPC has since fully integrated health equity principles into all of its work and ensures that a health equity lens is applied to all projects. Regular updates on the HPC’s application of the framework are provided at public meetings. A compendium of every update is available on the HPC’s website.
The HPC’s public commitment involves the following:
- Dedicated time in public meetings, including the Annual Health Care Cost Trends Hearings, to highlight issues related to health equity and the HPC’s efforts to address them
- Public updates on progress toward health equity goals in consultation with HPC’s Board, Advisory Council, and staff
- Integration of the best available data on race and ethnicity (or proxy data when quality race/ethnicity data is not available) into all research and data analyses through inter-agency and stakeholder collaboration
- Ongoing collaboration with other state agencies
- Engagement of expert consultants to provide staff training and promote diversity, equity, and inclusion in order to more fully cultivate the culture of anti-racism within the agency
- Systematic review of HPC employee handbook and internal policies
The HPC takes action to advance health equity across its four core strategies: Research and Report, Convene, Partner, and Market Monitor. To achieve its health equity goals, the HPC employs in-house staff and external consultant expertise, flexibility through trust funds, and independent leadership through its governance structure, and is seen as a trusted voice through its history of partnership and collaboration. In addition, the Office of Patient Protection (housed within the HPC) works to effectively safeguard health care consumer protections in the Commonwealth and assists customers in many languages.
Ongoing HPC work focusing on health equity is highlighted in the sections below and will be updated as needed.
Research and Report
- The HPC leverages research publications to elevate topics that call out inequities in the health care system (e.g., DataPoints issues on oral health access and equity and persistent cost-sharing for contraception; Report on Telehealth Use in the Commonwealth; Chartpack on Health Care Workforce Trends and Challenges in the Era of COVID-19). A compendium of recent HPC publications and workstreams that have a focus on equity and disparities is available. These lists will be updated on a regular basis.
- In July 2021, the HPC released the Health Equity Practice and Style Guide, a practical resource developed by and for HPC staff. Its purpose is to promote intentional and consistent use of language and terminology across all agency work products, to encourage reflection among staff as they communicate about equity within their workstreams, and to provide resources, tools (including preferred terms), and HPC-specific use cases. The Guide is a living document, updated by a staff committee and released annually in July.
Convene
- The last three Health Care Cost Trends Hearings (2020 to 2022) prioritized discussion of the disproportionate health disparities experienced by communities of color – especially in light of the COVID-19 pandemic – and the intersecting challenges between cost containment, affordability, and equity, and the impact of price and spending trends on equity in Massachusetts.
- The HPC hosts ad hoc special events and supports other organizations and agencies with events and webinars. This includes providing strategic guidance and support to the Health Equity Compact in advance of their Summit Event on June 13, 2023.
- The HPC convenes investment program awardees to elevate equity topics. Past convenings include a collaborative learning opportunity on health equity and MassUP equity-focused convenings.
- The HPC Advisory Council is a major source of support for the HPC’s health equity work, helping to inform and enhance the HPC’s policy agenda and priorities. The Advisory Council includes a diverse group of health care leaders who meet quarterly to discuss the most important health policy issues of the day. The HPC has prioritized broadening and diversifying the membership of this body over the last 10 years, to encompass more perspectives and lived experiences with the health care system. A current list of Advisory Council membership can be found here.
Partner
- The Cost-Effective, Coordinated Care for Substance Exposed Newborns and their Caregivers (C4SEN) investment program is a quality improvement to expand access to evidence-based, appropriate addiction treatment. C4SEN seeks to support programs that emphasize cultural relevance, acknowledge the effects of structural racism, and take accountability for improving outcomes for marginalized populations.
- Through the interagency “Moving Massachusetts Upstream” (MassUP) initiative” the HPC administers an investment program that provides funding and technical assistance to partnerships between health care providers and community-based organizations who work together to address the upstream (i.e., social, economic, and environmental) causes of poor health outcomes and health inequities.
- The HPC administers the Birth Equity and Support through the Inclusion of Doula Expertise (BESIDE) Investment Program, which intends to address inequities in maternal health outcomes and improve the care and patient experience of Black birthing people by increasing access to and the use of doula services.
- In its latest round of Accountable Care Organization (ACO) Certification, the HPC integrated explicit health equity standards in its payer-agnostic process for certifying ACOs in the Commonwealth.
- The HPC has partnered with MassChallenge HealthTech to host an event series focused on topics related to health equity and innovation. Registration for future events and recordings of past events are available here.
- The HPC engaged in a partnership with the Department of Public Health to administer funding from the State’s Opioid Response in support of projects aimed at addressing inequities in access to medications for opioid use disorder (MOUD) for birthing people with OUD.
- The HPC helps fund and provide staff support to the Executive Office of Health and Human Services’ Quality Measure Alignment Taskforce. Part of this support includes developing standards for race, ethnicity, language, and disability status and sex, sexual orientation, and gender identity data collection and accountability.
Market Monitor
- In reviews of market changes, impacts on access and equity are assessed, including the baseline demographics of the patients served and provider characteristics of the transacting parties, as well as potential impacts from the proposed change.
- Part of the performance improvement plan (PIP) process, reviews of payer and provider performance relative to the health care cost growth benchmark include recognition and assessment of an entity’s baseline position in the market and historic trends, and consider whether spending increases reflect necessary investments to enhance services for historically underserved populations.
- In 2022, the HPC submitted a public comment to the Massachusetts Department of Public Health on Mass General Brigham’s (MGB) Determination of Need filings for three substantial capital expenditures totaling $2.3 billion. The HPC’s analysis of the proposed projects found that they were likely to negatively impact health care market functioning, including access and equity. Specifically, the HPC estimated substantial revenue loss to providers serving higher proportions of public payer, lower socioeconomic status, and BIPOC patients.
Resources
The HPC’s commitment to spotlighting health inequities and ensuring a more equitable health care system for all is a shared goal. Other local, state, and national organizations and groups, both public and private, are undertaking aligned and collaborative efforts to report on health inequities and find solutions to achieve a more equitable future in health care. Some of these resources are listed below.
The Health Equity Compact. The Health Equity Compact (the “Compact”) is group of over 65 leaders of color who aim to advance health equity together in Massachusetts. 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, and public health. Its members are committed to eliminating health inequities as the next chapter of health reform. The Compact hosted its first summit event in June 2023, convening influential leaders from government, health, business, and other diverse sectors who are key to advancing health equity statewide. A recording is available.
Massachusetts Legislature Health Equity Task Force: "A Blueprint for Health Equity." This report was presented to the Massachusetts Legislature in July 2021 and contains recommendations to address historic injustices that led to unequal burden of disease and death during COVID-19 for vulnerable populations.
Massachusetts Attorney General's Office: "Building Toward Racial Justice and Equity in Health: A Call to Action." This report from the Attorney General’s Office highlights longstanding disparities and the disproportionate toll that the COVID-19 pandemic has taken on communities of color in Massachusetts.
Massachusetts COVID-19 Health Equity Advisory Group. The primary function of the advisory group was to generate a series of recommendations for the Commissioner of the Massachusetts Department of Public Health on how the COVID-19 pandemic response could be informed by a health equity lens to ensure equitable access to resources and services, and prevent inequities and disproportionate negative outcomes.
Massachusetts Department of Public Health (DPH) COVID-19 Community Impact Survey. The COVID-19 Community Impact Survey (CCIS) was conducted in Fall 2020 to better understand the immediate and long-term health needs, including social and economic consequences, facing the Commonwealth due to the COVID-19 pandemic. The online anonymous survey was offered to both youth and adults across the Commonwealth by computer, phone, or tablet, and was available in English, Spanish, Portuguese, Simplified Chinese, Traditional Chinese, Haitian Creole, Vietnamese, Khmer, Cape Verdean Creole, Russian, and Arabic.
Racial Justice and Health Equity Framework, Boston Public Health Commission. BPHC’s Health Equity Framework for understanding health inequities shows how racism and other systems of oppression (homophobia, ableism, transphobia, sexism, and xenophobia) have an independent influence on all the social determinants of health and can have a direct impact on health outcomes.
Blue Cross Blue Shield of MA Foundation (BCBSMAF): “Racism and Racial Inequities in Health: A Data-Informed Primer on Health Disparities in Massachusetts.” This 2023 study, commissioned by BCBSMAF in collaboration with the Health Equity Compact, aims to quantify the economic burden of racial and ethnic disparities in health care access, quality, and outcomes.
Massachusetts Taxpayer Foundation (MTF): “Closing the Racial Divide in the U.S. and Massachusetts: A Baseline Analysis.” This 2021 report from MTF statistically documents inequities in wealth, income and employment, education, criminal justice, health care, as well as the potential economic and fiscal gains that could be realized by closing the racial gap.
Rhode Island’s Health Equity Zone (HEZ) Initiative. Rhode Island’s Health Equity Zone initiative is a health equity-centered approach to prevention work that leverages place-based, community-led solutions to address the social determinants of health (SDoH).
Boston University Center for Antiracist Research: Racial Data Lab. The Boston University Center for Antiracist Research represents a collaborative research and education effort across multiple disciplines to build a world where racial equity and social justice prevail. The Center’s COVID Racial Data Tracker (CRDT), in collaboration with the COVID Tracking Project, advocated for, collected, published, and analyzed racial data on the pandemic across the United States. The CRDT was, while active, the most complete race and ethnicity data repository on COVID-19 in the country. The CRDT data and information remains publicly accessible.