Addressing health care disparities: Blue Cross commits to reducing racial disparities in maternal health

This is part of a series of articles on how Blue Cross and its health care providers are working to address health care disparities in Michigan.

The Blue Cross Blue Shield Association is working with its affiliate companies across the country — including Blue Cross Blue Shield of Michigan — to reduce racial disparities in maternal health by 50% in five years. BCBSA has compiled a report, Racial Disparities in Maternal Health, that examines trends and risk factors among white, Black and Hispanic communities in hospital births covered by Blue Cross and Blue Shield commercial insurance from 2018 to 2020.

“The emphasis on racial disparities is key because, when normalized for all social determinants of health, the only factor that remains attributable as a root cause of the disparity is unconscious bias,” said Dr. Patricia Ferguson, physician consultant with Senior Health Services, Emergent Holdings. “Unconscious bias, explicit bias, micro aggression or any form of disparate practice at the point of contact which impacts health care delivery must be acknowledged, recognized and addressed as severely as the unfortunate consequences outlined in this report.”

Key findings

Here are some key findings from the report:

• Women in majority Black communities have a 63% higher rate of severe maternal morbidity — unexpected outcomes from labor and delivery that affect a woman’s health, including death — than women in majority white communities.
• Women in majority Hispanic communities have a 32% higher rate of severe maternal morbidity than women in majority white communities.
• Compared to white mothers, Black and Hispanic mothers are at least 100% more likely to experience adult respiratory distress syndrome, sepsis and ventilation in their first year after having a baby.
• Black and Hispanic mothers are also more likely than white mothers to experience eclampsia, shock, acute heart failure and acute renal failure.

Unconscious bias

Black mothers have existing chronic conditions that put them at a higher risk for complications after having a baby at a rate that’s twice that of white mothers, including:

• Anemia
• Hypertension
• High body mass index
• Preeclampsia

These risk factors are well documented. Ferguson said many of the causes of death for newly postpartum women of color are preventable, but often providers may not be asking the right questions because they make assumptions about an individual based on their own biases.

Unconscious, or implicit, biases are automatic associations we make, influenced by our own reservoir of memories, experiences, exposures and more. Everyone has them. But, in the field of medicine, unconscious biases can have significant impacts on patient care. That’s why it’s important to address the root cause.

A patient’s characteristics — including the clothes they wear, weight, sex and sexuality, knowledge of their own health, socioeconomic status, behavioral health condition, first language, insurance status, skin color and age — can trigger unconscious bias that can influence the thinking of health care providers, and the kind of care delivered. Acknowledging bias is often the first step to addressing its role in how we make decisions.

Maternal health: A focus area

Maternal health is also one of five focus areas of Blue Cross Blue Shield of Michigan’s health equity strategy. Blue Cross formed a Maternal Health Workgroup in June to look closely at maternal health and severe maternal morbidities among our members.

“By the end of the year, it’s expected that the workgroup will identify specific initiatives, goals and measures to address pre-natal and post-natal care, provide unconscious bias education for maternal care specialists and increase awareness of women’s health, with a specific focus on helping to manage comorbidities, among other action items,” said Bridget Hurd, vice president, Inclusion and Diversity.

Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.