Year after year, it's the same story: the maternal mortality rate in the U.S. is rising, and pregnant women of color are dying at disproportionate rates. The Blue Cross Blue Shield Association unveiled a national strategy on Tuesday that aims to halve racial disparities in maternal care through a combination of data collection, scaling existing local initiatives and lobbying for state and federal policy changes.
"Your health shouldn't depend on the color of your skin or the neighborhood you live in. That's just unacceptable, unconscionable, and we can have an impact where we can change the trajectory of racial disparities," said Kim Keck, president of the not-for-profit association, which represents the 35 Blues plans across the nation.
BCBSA's initiative aims to cut what the Centers for Disease Control and Prevention call the severe maternal morbidity statistics, which codify 21 different health conditions, like heart failure, that can lead to unexpected labor and delivery outcomes and impact a woman's health. From 1993 to 2014, the rate of these conditions increased nearly 200%, according to the most recent CDC data available. Women of color were disproportionately diagnosed.
In 2019, Black women were about 2.5 times more likely to die from pregnancy-related causes than white women. Even in low-risk pregnancies, Black women were more likely to require C-sections than white people, with a five percentage point difference separating the two racial groups.
"It's a crisis, and it's unconscionable that we actually live with this," Keck said.
To bridge these disparities, BCBSA aims to scale local programs like its B'More for Healthy Babies initiative, a partnership with the Baltimore City Health Department that educates and engages the community about weight loss programs and unsafe sleep conditions, and has led to a 28% reduction in infant mortality. BCBSA also aims to scale an initiative in Minnesota that increased reimbursement and promoted doula training in underserved areas, and sponsor unconscious bias training among more providers nationwide.
At a broader policy level, the association plans to lobby for increased data collection on racial health disparities in maternal healthcare. It also stands in support of the Black Maternal Health Momnibus Act, a package of 12 bills aimed at diversifying the maternal care workforce, funding community health organizations and investing in the social determinants of health, like access to nutritious food.
The initiative comes after the White House announced its inaugural "Black Maternal Health Week" last week. It also follows the CDC for the first time naming racism as a threat to public health and the COVID-19 pandemic's highlight of racial health disparities. The conversation stems from a pledge BCBSA made in June 2020, after the killing of George Floyd, a Black man, at the hands of a white police officer, Keck said.
"This is not a one-dimensional issue, so there's not a one-dimensional solution," Keck said.
Later this year, BCBSA plans to expand its focus to bridging racial disparities in behavioral health, an initiative it says will overlap with its work around maternal care. Its complete, multi-year strategy will also target inequities in diabetes diagnoses and cardiovascular conditions. The HHS Office of Minority Health found that, in 2018, Black individuals were twice as likely to die from diabetes, and 30% more likely to die from heart disease, than whites.
Keck said there was no dollar amount associated with its overarching plan, but "it's really the outcomes that we're looking to drive." BCBSA will report its results annually.
Its strategy is guided by the nine members of its National Advisory Panel on Health Equity, who include Tracey Brown, CEO of the American Diabetes Association; Dr. Marshall Chin; Richard Parrillo, a professor at the University of Chicago; Gilbert Darrington, CEO of the federal-qualified health centers Health Services; Adaeze Enekwechi, a professor at George Washington University; Maria Gomez, president and CEO of Mary's Center community health organization in Washington D.C.; Rachel Hardeman, a professor at the University of Minnesota; March of Dimes CEO Stacey Stewart; Richard Taylor, CEO of the ImbuTec construction company; and YMCA of the USA CEO Kevin Washington.
"We spend a lot of money on care in this country and, at the end of the day, ineffective care is the most expensive care of all," Keck said. "We want to prevent that from happening. Ineffective care is not where any of us want to spend our money."