Care Transformation Center Blog

It's not you, it's us: How Mass General is addressing bias in health care

by Jasmaine McClain and Catherine Castillo

Dr. Joe Betancourt
Dr. Joe Betancourt

Advisory Board Senior Analysts Jasmaine McClain and Catherine Castillo spoke with Dr. Joe Betancourt of the Disparities Solutions Center at Massachusetts General Hospital to learn more about the center’s approach to eliminating health care disparities nationwide and lessons learned from the field.

Q: To kick off the conversation, can you tell us about the Disparities Solutions Center?

Dr. Betancourt: At the Disparities Solutions Center, we focus on finding strategic solutions for reducing racial and ethnic disparities in health care and sharing them across the industry.

The Disparities Leadership Program is the primary way we train health care leaders on this work. Through the program, participants can create a strategic plan to address disparities at their respective institutions, or advance a current project they have started in this area. We shepherd them through the process and share best practices for collecting data, setting performance metrics, and developing interventions and evaluating results.

Q: As we transition to value-based care, have you seen an increased interest in the services provided by the Disparities Solutions Center?

Dr. Betancourt: There’s no doubt that people care more about addressing health care disparities in the transformation to value-based care. We are moving from paying for quantity of services to quality of services. This makes the value and quality of the interaction between all patients and caregivers a lot more critical.

Q: You’ve spoken publicly in a recent CNN interview about the “not-me” problem, or the idea that doctors believe their own clinical decisions are not impacted by the personal characteristics of their patients. As we’re discussing the physician-patient relationship, can you talk more about the impact of bias?

Dr. Betancourt: In January, WebMD published the results of a survey on burnout and bias including 16,000 physicians that demonstrates the problem affects all of us. In the survey, 40% of physicians now agree they have biases. Notably, the group that led as the most biased was actually ER physicians. The emergency room is a perfect storm for stereotypes—think about the stress, time constraints, degree of multi-tasking and level of risk involved. Unfortunately, the ER is also a portal for many vulnerable populations into the health care system.

Knowing this, we align our work at the Disparities Solutions Center with caregivers, and health care organizations’ aspirations, rather than focusing on blame or guilt. My job is not to get caught in semantics. My job is to help people change.

Q: We hear providers express concern about the complexity required to provide quality care for all patients. Have you seen any particularly effective solutions to address health care disparities in your work?

Dr. Betancourt: Frankly, we have so many new pressure points to address today. For example, if you’re treating a diabetes patient, it’s not enough to give them the right medication if they don’t have a place to exercise safely in their community or access to fresh fruits and vegetables. There is a lot of energy and focus on holistically addressing the needs of vulnerable populations because that is where the financial margins will be.

There is a need for creative solutions, but there’s really a much bigger need for basic infrastructure—getting leadership to buy in and collecting the relevant data, for instance. There are a lot of initiatives that are not so “innovative” or “creative” that have to be built as a foundation first.

That being said, there’s a lot of work being done with the use of health information technology. For example, telemedicine and text message reminders can address the needs of vulnerable populations. We’re seeing lots of disruptive innovation in this space.

For more information on our research on health disparities, email us at healthdisparities@advisory.com.

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