BCBSA Outlines Next Steps for Health Equity Data Standardization

Blue Cross and Blue Shield Association (BCBSA) and the Blue Cross and Blue Shield companies have urged the healthcare industry to adopt national health equity data collection standards.

The companies released a paper that defines health equity and submits a proposed model for data collection standardization.

According to BCBSA, there are three kinds of inequities: disparities in quality of care, disparities in access to care, and disparities in the prevalence of disease.

In order to identify and address these inequities, the healthcare industry needs to collect health equity data that meets four criteria.

First, the data must be high quality, meaning that it comes from organizations that have high performance and accurate collection strategies. Selection bias, poor and contradicting data validity, and self-reported data can contribute to low data quality and should be avoided.

Second, granular data is key to assessing the complexities of localized disparities. Collecting regional data and individual-level data can improve outreach programs.

Third, disaggregated data allows for greater specificity. In particular, BCBSA pointed out the need for more specific, less aggregated racial categories that can better capture the broad range of races in the US.

Lastly, change-monitoring data is crucial to tracking progress and shifts in health equity and care disparities. Data collection must occur over time to capture change.

“Every data point is a person with a story,” Sean Robbins, executive vice president of external affairs for BCBSA, said in a press release. 

“BCBSA and BCBS companies have an opportunity – and responsibility – to help ensure data accurately and equitably represents every patient we serve. We’re eager to work with policymakers and colleagues across the industry to develop and adopt common industry data standards in pursuit of our shared goal to build a more equitable health care system.”

The paper proposed, not one data collection standard for the US healthcare industry, but three standards to address three areas of care disparities: race, ethnicity, and language (REL), sexual orientation and gender identity (SOGI), and social determinants of health (SDOH).

In REL data, the companies acknowledged that the Office of Management and Budget (OMB) set the standard. Although its racial categories are not broad enough, it would be too difficult to discard their model and create an altogether separate standard. The OMB standard is too embedded.

SOGI data is the least standardized of the three. The paper recommended building on the HL7 project called “Gender Harmony.”

SDOH data has been widely researched, and many payers and employers are taking steps toward better data collection and implementation to address social determinants of health. BCBSA suggested using HL7’s Gravity Project as a baseline for standardization.

“The pandemic reiterated how powerful data can be in identifying gaps in care, generating new solutions and helping meet people where they are,” said Kari Hedges, senior vice president of market solutions at BCBSA. 

“We’ve also learned how difficult it is to make targeted improvements to reduce health disparities without quality data. To make a meaningful difference, we need the full force of the industry. Alignment on standards for collection and use of quality health equity data is a critical step forward in our collective journey to health equity.”

The paper also commented on the imputation and ethical use of health equity data, including assessing bias, transparency, access to data, and data security.

BCBSA concluded with three calls to action. 

First, the payer organization called for the healthcare industry to create a standardized approach to data collection and exchange for REL and SOGI data. Second, BCBSA recommended improving imputation methods. Finally, the payer organization called for the industry to turn to patients for greater clarity on the best data collection methods.