Table 2.

Equity Action Community Themes and Illustrative Quotes

The IHI collaborative process as a key component of the initiative, enabling the 12 provider groups to interact and formulate plans together	“[IHI sessions are] a great convening of others towards a similar goal… In order to drive this type of transformative change, I think you have to have something like this.” –AQC group Executive and provider “BCBSMA… has definitely spurred the continued focus on equity… as opposed to… our own internal work that had been happening before.” – AQC group provider “Since we're very new to this space, we want to be thoughtful of how we approached it.” – AQC group provider
BCBSMA grant funds, administered by IHI through the learning collaborative, motivated provider group participation, and facilitated external input, but the AQC groups found that implementing equity-based interventions required more resources and effort than anticipated after receiving the grants.	“Teams initially [received] $250,000 to participate in just the [learning collaborative]… And now [more] money is getting out the door, teams are engaged and we've seen some good results from teams.” – BCBSMA Executive “[When] a team wants to improve diabetes care, hypertension care, or the maternal experience… they may not have data that shows a disparity between groups they serve. [This] means there is often a larger upfront period where they explore their own system for data that indicates a gap exists." – IHI Coach “We'll be looking for [ways] to keep [the] programs sustainable. And then of course, keeping a very close eye on metrics that can cost us like readmissions, ED visits, et cetera. And that can take a lot of time, but the hope is that we'd be able to reduce utilization so that when the grant is no longer funded, we'll be funding it ourselves.” – AQC group Executive and provider “It's not just the money. [BCBSMA has] also matched data capability with the provider organization's data capabilities.” – IHI Executive “[W]e did a full… bottoms up budget calculation over a five year period… And you know, the grant is 2 million…But what we guesstimated…is about a hundred million over a five year type of investment.” – AQC Stakeholder “I sat in on one meeting, where [BCBSMA and IHI stakeholders] were saying… ‘You're not gonna lose money,’ which is good at least for the first few years, but eventually you're gonna need to close these disparities in care.” – AQC group provider “And it's just a challenge because I think taking time to do those system changes… is really hard when you're already so resource strapped and time strapped. But I think that's one of the biggest areas [of] focus…how will we make these changes sustainable? And how do we not just focus on adding more but changing steps within the processes that aren't working?” – IHI Coach
Expertise in QI and health equity was considered very important to provider groups to support their testing of new interventions to reduce racial and ethnic disparities in quality of care.	“The majority of [race and ethnicity] questions… indicators are blank. So when we first pulled our data… it was limited… because of all of our systems that don't always work [share information].” – AQC group provider “Patients may ask, ‘why do you need to know that?’ We need to make sure our staff feels they have the appropriate responses to those questions.” – AQC group provider “We have the clinical meetings with them and then there's another meeting about data collection… [This] is helping people to know that [clinical interventions are] what we need to do now… And then…we meet one-on-one [to] think through… barriers, and…. to start to work on those things…. And we can come up with a solution to a [clinical problem] and pilot that solution to get things done.” – IHI Coach “We are in the process of deploying the resources that Blue Cross and IHI provided to us, targeting diabetes interventions. And having the support of a consultant to discuss what we're doing in the PDSA cycles and doing process mapping and so on has been helpful while we wait to start [the pilot].” – AQC group provider

AQC, Alternative Quality Contract; ED, Emergency Department; IHI, Institute for Healthcare Improvement; PDSA, Plan-Do-Study-Act cycles; QI, quality improvement.