Colorado to Collect Providers’ Sexual Orientation, Ethnicity Data

Clinicians in Colorado will soon be asked — though not required — to give the state demographic information that includes their ethnicity and sexual orientation as part of an effort to build more culturally diverse provider networks.

Under a rule that took effect on March 2, Colorado Options — the state’s Affordable Care Act exchange — will require plans to “collect the following demographic data voluntarily submitted by network providers and their front office staff for the carriers’ Colorado Option standardized plans,” including information on ethnicity and sexual orientation.

The rule, which resulted from a law passed last year by the Colorado legislature that established the Colorado Option program, also asks insurers to collect the same information — again voluntarily — from patients. The law says that the plan must have a provider network “that is culturally responsive and reflects the diversity of its enrollees and be no more narrow than the most restrictive nonstandardized plan offered by the carrier.”

The law’s backers had originally hoped to publish the demographic information in order to help patients choose physicians that they felt comfortable with. But after backlash from physicians, the state decided to make reporting the information voluntary, and to have plans report the data to the state only in the aggregate, reported Kaiser Health News/NPR.

The regulation also requires health plans to “create a process for their Colorado Option standardized plan network providers and providers’ front office staff to annually report on the anti-bias, cultural competency, or similar training that providers and their front office staff have taken in the last year designed to assist covered persons who experience higher rates of health disparities and inequities.” The rule sets a timetable for training to be completed — 50% of a plan’s providers and front-office staff must have completed the training by Jan. 1, 2023; 75% by Jan. 1, 2024; and 90% by Jan. 1, 2025.

The Colorado Medical Society did not respond by press-time to a MedPage Today email about the rule. But Kevin Klauer, DO, JD, CEO of the American Osteopathic Association (AOA), said that although the AOA supports the idea of culturally diverse provider networks, legislation such as this might not be the best way to achieve this. “We are supportive conceptually of creating [provider] networks that are representative … of the patients they care for; that is a wonderful goal,” he said in a phone interview. However, “we are not supportive of legislative solutions that interfere with the patient/physician relationship.”

“If the patient and the physician wants to disclose that information, they can do so,” he continued, but “legislative solutions, even well-intentioned, oftentimes have unintended consequences.” Klauer noted that it makes sense that the legislature likely intended for things to go farther than just collecting aggregate demographic data. “If the only goal is to is to take the aggregated information and just confirm that your network is representative of the patients that will be cared for, that’s one good step, but … does it matter if your network is diverse if the patients don’t know where to get that care? They don’t know which clinicians have the attributes they’re looking for. “

So eventually, “if the insurer can’t get the information they want to qualify for the parameters that the state’s plan is requiring, at some point there’s going to be pressure on someone. The state is going to put pressure on the plan, and the plan is going to put pressure on the clinician … And I think that’s where there can be unintended consequences.” Right now, clinicians can opt out of giving that information, but “what happens when the opt-out comes out” of the law?, he said.

Klauer, whose organization has 168,000 osteopathic physicians and students nationwide, said he understood why some clinicians might be reluctant to disclose their information.

“The only person who is legitimately allowed to speak to their concern about retribution because of release of this information is that particular clinician,” he said. “So if there is a clinician who feels that ‘In my community, they may not embrace my LGBTQIA+ status’ … There’s a lot of bias, and even a lot of unfair treatment still in the world. And what if someone expresses some of that toward a clinician because they’re in a community that is less progressive?…People should be able to release information about who they are, when, and how, and if they want to.”