The Health Policy Commission is one of the leading watchdogs in Massachusetts fighting health disparities. But at its annual cost-trends hearing last month, a panel on health equity noted that the HPC itself lacks diversity.

Founded 10 years ago, the HPC’s mission is to create a more transparent, accountable and equitable health care system. But the commission is entirely white — and with only four women among the 11 total board members, including the new chair, Deborah Devaux.

Some state health care leaders question what goes unseen by an all-white commission — and want to know how it can address health equity when it lacks representation itself.

“It’s easy to miss what’s right there in front of you,” Manny Lopes, executive vice president, public markets and government relations at Blue Cross Blue Shield of Massachusetts, said.

Covid-19 disproportionately affected communities of color in both treatment and vaccine rollouts, and such systemic disparities — which predate the pandemic — have created issues with trust, accessibility and opportunities to be treated by providers within one’s own community, according to leaders.
Lopes said the inequities lead to less effective care that results in higher costs to individuals and to the system.

Hispanic and Black residents are 110% and 60% more likely respectively, to rely on the ER, a sign of a lack of access, according to a recently released Center for Health Information and Analysis study. While the HPC isn’t the only group responsible for advocating for health equity, health leaders across the state say more representation on the board could help address some of health care’s biggest problems.

“We look at the Health Policy Commission, really, as a commission who’s asking some of those tough questions. If the people aren’t there who really understand how these communities function,” Lopes said, “if they’re not at the table, then they’re not asking sometimes some of the basic questions that they should be asking.”

How are HPC members appointed?

HPC board members are appointed by the governor, attorney general and state auditor.

There are statutes that mandate certain requirements for each member including expertise in issues like behavioral health, consumer advocacy, medical technologies, labor organization, insurance and finance. There also has to be a health economist and a primary care physician on the board.

Attorney General Maura Healey’s office said it has appointed commissioners who have contributed to containing Massachusetts health care costs. Thomas Dalton, deputy press secretary, said Healey understands the need for diversity on the HPC, and all public boards.

“Our office has been committed to working with appointing authorities and elected officials to achieve gender parity and diverse representation in government,” he said.

A spokesperson for Gov. Charlie Baker declined to comment, while state Auditor Suzanne Bump said that the qualifications for her appointments are dictated by the statutory laws.

Statutory constrictions?

Juan Lopera, chief diversity, equity and inclusion officer at Beth Israel Lahey Health, said that the statutory requirements limit more inclusive participation. The roles are unpaid, meaning that most people who are qualified are retired, and are also less likely to be people of color.

“Sometimes we don’t have equitable criteria,” Rosa Colon-Kolacko, chief diversity, equity and inclusion officer at Tufts Medicine, said. “It’s going back to changing the system versus wishing that the system will deliver something different.”

Michael Curry, CEO of the Massachusetts League of Community Health Centers, said that because people have been historically locked out of opportunities, like governor and attorney general, that has a ripple effect on staff decisions and policies.

“The white men who typically get nominated for these roles are no more brilliant than the Black and Brown people who are younger in this movement and in this work. They’re just retired. The reality is there’s a wealth of talent who could bring fresh perspective, depth, history, experience, training to this policy work, but the statutory language is barring that talent from coming to the table,” he said.

Curry said ethics laws also play a role. Members of the HPC cannot be employed by a health care entity in order to limit conflicts of interest, but Curry said it is “prohibitive and burdensome” and people could sign agreements and disclose potential conflicts instead.

“We have to understand that the ultimate objective is to get thought leaders at the table and not have language prohibit us, the ethics rules prevent us,” he said.

Amy Rosenthal, executive director of Health Care For All, added that there’s responsibility on everyone, including white people, to focus on issues of racial justice.

“It’s less about placing blame or being angry — and I know some people have every right to be angry — the goal of this isn’t to attack people,” she said. “More to say, let’s make these changes.”

Strides made by the HPC

All health care leaders acknowledged that the HPC has made strides on equity, especially through data sharing and accountability on affordability.
“We have the utmost respect for every single member of that commission, so as much as we want to push for change, we also look up every single one of those members,” Lopera said.

The HPC has taken the first step, Lopes said, to recognize the link between affordability and equity. The second piece, he said, is taking a stronger look at where data doesn’t exist to address unanswered questions.

With the first woman chair and a new governor and attorney general coming into power, leaders are hopeful for change.
As change comes, Colon-Kolacko said it is important to trust that good ideas can come from anyone.

“They need to understand not to fear that people of color are taking my place,” she said. “We are accountable for creating healthy communities, and if we don’t share that power with others, we’re not going to make that a reality.”

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