Goal / Mission

The goal of this project was to determine Blue Cross Blue Shield of Minnesota’s (BCBC MN) role in alleviating upstream factors to health and to position itself as a positive influence for change in all sectors of healthcare. BCBS MN hoped to reduce inequities affecting diverse and underserved communities through an organizational and systemic approach to racial and health equity. To do so, BCBS MN committed to installing internal institutional equity policies guided by equity steering committees at all levels of organizational work.

Description

Equity policies at the institutional level have taken several approaches throughout the years to influence upstream factors of health for vulnerable communities in terms of inequities related to insurance access, health care treatment, food insecurity, unhealthy food systems, chronic disease disparities, commercial tobacco use, cancer care, pandemic resource allocation, and other social determinants to healthy living. Blue Cross Blue Shield of Minnesota sought to adapt policies enacted by its own state health department also known as the Minnesota Department of Human Services (MN DHS) Policy on Equity. Adoption of this landmark department-wide Policy on Equity at MN DHS was the first of its kind to be adopted by a department of state government in the United States. BCBS MN worked to adapt the Health in All Policies (HiAP) approaches taken by MN DHS to all sectors of the organization’s work to push for equity centered healthcare, insurance access, and employment.

Health in All Policies (HiAP) approach to state and local government and nonprofit planning and decision-making is an emerging method to advance health equity. HiAP takes health impacts into account in decisions that are made in all government sectors. The implementation of HiAP is built around a core set of ideas: promoting health equity outside of the health sector; collaborating across sectors; benefitting multiple partners; engaging with diverse communities and stakeholders; and modifying existing structures and procedures.

BCBS MN’s leadership and administration adopted the policy in 2018 when stakeholders were able to express their strategy and vision and obtain critical mass in a deliberate internal campaign. They created strong internal model policy language to put in place. The strong equity policy included a timeline, scope of work, accountability measures, reporting mechanism, executive oversight, funding ties, support from leadership for enactment, and mode of monitoring. It also required extensive human and political capital and support from leadership.

Implementation Process

The implementation process began with promoting a mission of integrity and impact within the community and organizational public policy. Important factors considered were power dynamics at an institutional level and the ability to apply change lever strategy (a method of designing wide ranging and lasting positive change beyond the immediate focus) to pursue a policy campaign internally. BCBS MN began to identify internal champions and leaders that are able to place pressure and influence on crafting organizational change. This involves working with senior leadership to prioritize the policy as a crucial part of an organization’s values and work and finding ways to fully integrate the ideas into practice at every level.

BCBS adapted the policy language implemented at the Minnesota Department of Human Services into an agency, enterprise, and organization wide policy with no exemptions. This includes implementation work around areas such as content creation, and application internally and outside of work. BCBS MN created a protocol and set this up to apply to contract and procurement and HR and DEI work, baseline and influence policy agenda and community partnerships and external work as well using a comprehensive ecological in approach. The policy used a framework for racial justice and health equity that was explicit in terms and and not exclusive to anyone. It applied ideals and principles of health equity to social determinants of health and focused on minimizing upstream factors that affect and health care including prevention.

Some challenges to the policy work and effectiveness of protocols include resistance by employees and vendors who question a need for such policy today. It is crucial to have policy champions and sernior administrative backing as full and comprehensive policy adoption ended up stalling with leadership. Challenge – policy ownership and authority is not high enough – needs a senior executive or board champions and more organizational power.

Impact / Results / Accomplishments / Outcomes

The impact of this project was for BCBS MN to adopt organization-wide equity focused policies to help change work culture. Adoption and implementation of policies allowed for more focus on vulnerable communities and the ability to incorporate community coalition input into ever evolving policies around insurance access, healthcare, and health education.

The direct results of these policies are the narrow and real success in creating a process for systems and socio-cultural change. In order for this to happen, BCBS MN leveraged the collaborative work efforts of interdisciplinary leaders to think about racial and health equity. Indirect results include giving associates across the organization a reference point for accountability for racial and health equity work and a citation point to support the work as they ran into any resistance.

However, the policy enactment needs improvement and is not quite meeting objectives. Current policy is lacking accountability, leadership, organizational dialogue, and culture immersiveness. Equitable policy is officially in place but there is a gap of practice. No real internal cultural transformation and cultural shift have occurred and thus the impact of the policy is reduced in terms of potency and integrity of the policy. The challenge is to overcome barriers to policy ownership. Leadership authority is not high enough as there needs to be a senior executive or board member acting as champions and greater organizational power. This will continue to be a challenge as Blue Cross Blue Shield of MN is an insurance organization and therefore a risk averse organization as an insurer.

Lessons Learned

The success of BCBS MN’s experience in embedding equity in health systems through provisions for internal equity policies and creation of steering committees to drive these policies can be applied and adapted through the following lessons learned:

• Policy change requires broad, planned structural solutions pursued in an equitable manner. One cannot rely on a narrow approach or individuals with good intentions or enlightenment to create change
• Racism permeates all levels of society and all institutions. Often there’s a mismatch of diagnosis for the problem in pursuing individual approaches to racism. In order to get at the root of the problem, one needs to have a structural rather than an individual approach.
• It is important to build power and support through community involvement and input in creating equity policies

About this Promising Practice (Contact information)

1. Organization(s): Blue Cross Blue Shield of Minnesota
2. Primary Contact(s): Rod Lew – APPEAL Staff; [email protected] and BCBC MN staff Vayong Moua; [email protected]
3. Authors: APPEAL Staff with informant interviews from BCBC MN staff Vayong Moua
4. Topic(s): Equity Policies, Organizational and Institutional Policy Change
5. Source: APPEAL Staff with informant interviews from BCBC MN staff Vayong Moua
6. Date of Publication: N/A
7. Date of Implementation: 2018
8. Location: Minnesota
9. More details (web address for study): https://open.mitchellhamline.edu/mhlr/vol44/iss4/4/
10. Target Audience: Health Insurance Agencies, Policy makers, Tobacco Control Programs, State Agencies, Community Based Organizations, Tobacco Control Coalitions