Mapping the Progress of the Coalition to Eliminate Race-Based Medicine

Clinical guidelines and clinical decision tools help doctors determine the best way to care for their patients. Race is, in some cases, still used as one of the variables in those tools even though it is not an objective biological trait. Using race as a variable can adversely influence the care a patient receives — it can also impact their outcomes. The members of the Coalition to Eliminate Race-Based Medicine  — many of which are a part of AHE — have been working together to remove race “adjustments” from 15 commonly used clinical decision support tools that may adversely impact patients’ outcomes and collaborating on alternative best practices that do not reinforce a biological understanding of race.

To learn more about the history and progress of the Coalition, we sat down with Vivian Ogbonnaya. Vivian is the Program Manager for Health Equity on the Clinical Care Innovation team at Independence Blue Cross and has been a key part of the Coalition since its inception.

 

Can you walk us through how the Coalition got started? What was it like bringing on other healthcare systems?

The Coalition to Eliminate Race-Based Medicine (the “Coalition”) was formed in 2022 when Independence Blue Cross (“IBX”) brought together stakeholders from health systems across the Philadelphia and New Jersey region to address growing concerns about the use of race and demographic variables in clinical decision support tools. The Coalition’s work was inspired by the New England Journal of Medicine article titled “Hidden in Plain Sight – Reconsidering the Use of Race Correction in Clinical Algorithms,” which highlighted how race-based correction factors in medical algorithms can exacerbate disparities in healthcare. The article called for a critical reexamination of how this may impact health outcomes, which IBX used to establish a roadmap for the Coalition and its work. In identifying Coalition members, IBX focused on regional health systems with which IBX had value-based contracts because we wanted there to be a shared sense of accountability within the Coalition. Bringing together a large group of stakeholders was not a small task. But we were able to do it successfully by grounding the effort in peer-reviewed evidence and creating a space for collaboration that allowed the systems to move forward collectively.

What are the goals of the Coalition?

The main goal of the Coalition is to transition away from using race adjustments in certain clinical decision support tools that may adversely impact patients’ outcomes. To achieve this goal, the Coalition focuses on certain clinical decision-making tools that help guide lung, kidney, and OB-GYN care, among others. Looking at the bigger picture, the Coalition aims to advance structural competence, drive systemic transformation, foster empathic care, and build meaningful partnerships in the region.

How did the Coalition decide on which clinical decision support tools to focus on? Is there potential to add more?

The New England Journal of Medicine article outlined several race-inclusive, clinical-decision support tools that the Coalition used to decide which tools to prioritize. Those tools fall into several categories, including nephrology, obstetrics, urology, pulmonology, endocrinology, oncology, and cardiology. The Coalition is open to looking at other clinical decision support tools that may benefit from transitioning away from using race adjustments in the future. This work is dynamic, and we see the Coalition as a model for other organizations in the healthcare industry as they review clinical practices and see change.

What progress has the Coalition made so far?

All the Coalition members have transitioned away from race adjustments in clinical decision support tools that are used to guide lung, kidney, and OB-GYN care. Thanks to the Coalition, the specific tools that are now considered race-neutral include the Estimated Glomerular Filtration Rate (eGFR), spirometry (a lung function test), the vaginal birth after cesarean (VBAC) calculator, and race-based gestational anemia guidelines. For a clinical decision support tool to qualify as adjusted, each participating health system must formally confirm to IBX that race has been removed from the tool. In addition to adjusting these tools, the Coalition has built a strong, collaborative model through which health systems and health plans can share insights, address challenges, and maintain a steady momentum toward shared goals. This coordinated approach has been key to advancing the work efficiently and effectively.

How do the members of the Coalition work together? Can you give any examples?

The Coalition brings together a variety of voices. This includes clinicians, healthcare researchers, policy experts, and advocates from each health system involved. Everyone contributes a unique perspective. Together, we work to understand how race can contribute to disparities in care, share best practices, build consensus, and implement meaningful change. This inclusive approach creates space for open dialogue and shared decision-making, helping to drive progress across the region.

What does the process of retiring a tool actually look like?

The process starts with an assessment of each Coalition member’s clinical use of the tool. Once this baseline is established, subject matter experts on the tool’s application are engaged to present clinical and academic evidence supporting the rationale for retiring the tool. These speakers, recognized as field experts, bring valuable insights from both clinical experience and academic research that help the Coalition members understand best practices and emerging trends. Next, each Coalition member begins operational planning to implement the change at their health systems. That work is what leads to the final stage: implementation of the adjustment to each Coalition member’s clinical decision support tool. Nonetheless, because this can be a big undertaking, IBX—as the convenor of the Coalition—provides support every step of the way.

Are you measuring long-term outcomes?

Yes, the Coalition tracks implementation of any adjustments that have been made to the clinical-decision support tools. The Coalition’s long-term goal is to be able to submit data from its work to medical journals for publication. Doing so will help educate others who are interested in implementing these types of changes and hopefully lead to positive impacts in care!

About Vivian Ogbonnaya

Vivian Ogbonnaya, MPH, is a Program Manager for Health Equity on the Clinical Care Innovation team at Independence Blue Cross. She has supported the Coalition to Eliminate Race Based Medicine since its inception, leading cross-hospital collaboration to identify, assess, and retire race-based clinical tools. Vivian’s work includes convening Communities of Practice, engaging directly with health system champions, and shaping the Coalition’s roadmap for complex tool transitions.

With a background in public health and health policy, Vivian brings over a decade of experience in project management, strategy development, and stakeholder engagement. Throughout her career, she has designed patient-focused programs, facilitated conferences with high-value industry professionals including representatives from the FDA, NIH, medical schools, health institutions, and has co-authored thought pieces on health equity. She is passionate about advancing systemic change to ensure equitable, evidence-based care.