Massachusetts Medical Society: Reducing Health Care Disparities in Massachusetts

Reducing Health Care Disparities in Massachusetts

Massachusetts is a pioneer in universal health coverage, has one of the highest insured rates in the country, and faces lower than national average rates of racial and ethnic disparities in key health areas.

However, access to primary care physicians in certain parts of the state is still a problem, said MMS President Ronald Dunlap, M.D., at the 2014 MMS Public Health Leadership Forum.

Dr. Dunlap pointed out the inverse relationship between the number of MassHealth patients and the number of providers in those areas; as a result of this relationship, disadvantaged communities have shortages of PCPs.

An MMS survey of providers conducted in February and March 2014 indicated that providers who accept Medicaid face numerous challenges, including administrative burden, poor reimbursement, and lack of referrals to subspecialists under the payment model.

Focus on Effective Interventions

“We need to focus our efforts on interventions that bridge communities and health systems to achieve equity in health outcomes,” said John Ayanian, M.D., M.P.P., director of the Institute for Healthcare Policy and Innovation at the University of Michigan. At the April 8 forum, he highlighted three policy approaches that have the potential to create equity in the health care system: expansion in insurance coverage, coordination of care, and performance measures.

Another panelist, Joel Weissman, Ph.D., discussed what he called the “seven terrors of the Fire Swamp,” the potential pitfalls in using pay-for-performance measures to reduce disparities. He recommended policy solutions including collecting race, ethnicity, and language data to stratify quality performance measures; targeting improvement to underlying factors such as language and access barriers; rewarding provider improvement, as well as threshold attainment; and requiring transparency in disparities measurement.

Patient, Community Engagement Key

All of the speakers on the expert panel stressed the importance of community engagement in addressing the social determinants of health outcomes, including access to care. While most physicians agree patients’ social needs are as important to address as their medical conditions, they are typically not confident in their capacity to address these problems, according to Sonia Sarkar, chief of staff to the CEO at Health Leads, a Boston-based organization which facilitates physicians’ referring patients to student advocates who are trained to help patients access resources such as transportation and food.

Technology is also a key element in patient engagement and could help reduce barriers such as a lack of reliable access to PCPs. “We are not pushing the boundaries of what patients can do,” said John Moore, M.D., Ph.D., who urged the adoption of the conceptual framework of the “patient as apprentice.” Technology is redesigning the system so the patient and physician can make shared decisions in managing chronic diseases. In Dr. Moore’s recently published study, 100 percent of patients in the experimental group (who monitored their own health with “health coaches”) achieved their blood pressure goals in three months at a cost of $70 per patient per year, compared to the typical cost of care of $250.

To learn more about health care disparities and MMS’s educational activities on the topic, visit

—Komal Karnik
MMS Public Health Staff

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