Health plans efforts to improve health care access to patients facing language barrier recognized by NCQA

The National Committee for Quality Assurance (NCQA), with support from The California Endowment, has recognized five managed care plans for their innovative efforts to improve health care access and quality for consumers facing language and cultural barriers that frequently impede their access to life-prolonging care.

Recipients of NCQA's 2009 "Recognizing Innovation in Multicultural Health Care Award" improved access to care for their culturally and linguistically diverse members by creating tools to improve communication, enhance culturally sensitive care environments and partner with ethnically diverse community organizations for outreach to targeted populations. The plans used objective data, such as NCQA's Healthcare Effectiveness Data and Information Set (HEDIS®), to demonstrate the effectiveness of their efforts.

"One in five Americans speaks a language other than English at home. Racial and ethnic differences result in substantial health disparities for millions," said NCQA President Margaret E. O'Kane. "It's imperative that health care reform efforts address the impact of disparities on the quality and cost of U.S. health care. These health plans are models for the nation, and NCQA is proud to recognize their innovations in multicultural health care."

According to the Institute of Medicine, racial and ethnic minorities tend to receive a lower quality of health care than non-minorities, even when access-related factors -- such as patients' insurance status and income -- are controlled.

"We see better health outcomes when providers respond to the needs of diverse individuals, which include improving access to services through the provision of interpreters and culturally sensitive care," said Robert K. Ross, M.D., president and CEO of The California Endowment. "These awardees demonstrate that it is possible for health plans to effectively and compassionately address race, ethnicity and language proficiency in the delivery of quality, cost-effective services."

The winners:

Kaiser Foundation Health Plan, Inc. (Kaiser Permanente) Clinician Cultural and Linguistic Assessment

To address the lack of validated testing standards, measures and tools for patient-provider language concordance -- a critical component of language access in health care delivery -- Kaiser Permanente led research and development of an overarching strategy in language concordance. With funding from The California Endowment, and in collaboration with The Alameda Alliance for Health, Kaiser Permanente created standards and tools for assessing provider linguistic proficiency. Subsequently, the collaboration pioneered the development of a new tool, the Clinician Cultural and Linguistic Assessment (CCLA). The CCLA is the first and only validated and reliable language assessment tool specifically tailored to assess clinicians who self-report they speak a language other than English. The tool establishes a standard level in which clinicians can communicate effectively independent of an interpreter. The CCLA tool is available in 14 languages and two additional languages are in development. So far, more than 1,000 assessments have been completed inside and outside of Kaiser Permanente. (Contact: [email protected])

Kaiser Foundation Health Plan, Inc., Southern California Region, Primary Care Language Concordance Program

In Southern California a diverse array of languages is spoken. To match patients with physicians who are fluent in their preferred language, the Southern California Permanente Medical Group organized a task force of bilingual physicians, regional leaders and administrative representatives to research this issue and create a Language Concordance Program. The program aims to improve patient-physician language concordance and to foster a culture that values and encourages multilingual skills.

Through this program, medical centers can match members and patients with physicians who speak their language, including Arabic, Armenian, Cambodian (Khmer), Cantonese, Farsi, Korean, Mandarin, Russian, Spanish, Tagalong, and Vietnamese. The benefits of the program include improved patient satisfaction, quality, bonding rates and resource stewardship. The language concordance visit rate in primary care also increased dramatically, resulting in approximately 93,000 more linguistically-matched appointments in 2008. (Contact: [email protected])

L.A. Care Health Plan, Health Disparities Improvement Project

Following a review of HEDIS® and focus group data, L.A. Care Health Plan, serving nearly 800,000 L.A. County residents through free or low-cost health coverage programs, sought to improve use of women's health services among ethnic and racial minorities. The effort combines L.A. Care's Health Promoters Program, Family Resource Centers and a network of Regional Community Advisory Committees (RCACs) to provide health education resources through community engagement and empowerment.

L.A. Care's Health Promoters Program, in partnership with community-based organizations, educates and trains RCAC members in peer-to-peer community outreach, preventive health, healthy lifestyles, communication skills and cultural sensitivity, as well as in health plan benefits and navigation. "Promoters" also provide individuals with health education in their own communities to help them access preventive care. Participants use awareness kits, a community resources directory and health education brochures. Other efforts include free mobile mammograms and health education classes at L.A. Care's Family Resource Centers and culturally sensitive posters promoting perinatal care. 2009 HEDIS® data show these efforts are paying off with significant improvement in the overall breast cancer screening measure and other women's health measures (Contact: Marissa, [email protected])

Midwest Health Plan, Caring for Culture - Caring for Women

Midwest Health Plan, a Dearborn, Michigan-based Medicaid HMO, sought to improve use of preventive health screening measures -- pap smears, mammograms, and chlamydia screening, as well as pre- and post-natal care services -- among its Spanish-speaking, African-American and Arabic (comprising 75% of service-area members) minority populations in Dearborn and Detroit. A concerted effort over two years led to increases from 13% to 42% in members' timely use of these important preventive health services.

The program's results were largely due to efforts that created a more culturally sensitive environment at medical offices, removed Spanish and Arabic language barriers and provided culturally sensitive outreach to pregnant women. By partnering with community organizations -- such as the Arab Community Center for Economic and Social Services -- the program provided incentives for offering and using women's preventive health care services. Incentives included financial rewards (pay-for-performance) to physicians and gift cards for health plan members. (Contact: June West, [email protected])

Independence Blue Cross, Colorectal Cancer Screening Among Vietnamese Members

Independence Blue Cross, based in southeastern Pennsylvania and serving 3.3 million people, sought to increase the rate of colorectal cancer screening among Vietnamese HMO members in Philadelphia who had not had a test done in the past five years. Colorectal cancer is the third-leading cause of cancer-related death in the U.S., but one of the most preventable when detected early.

In cooperation with the University of Pennsylvania's Department of Family Medicine and Community Health, Vietnamese members were identified through a surname analysis. For the study, members were divided into groups with each receiving differing levels of communication -- ranging from only a single letter to a letter with up to two automated-reminder telephone calls. The letter included information on the importance of screening and the availability of a translator. A control group did not receive special communication. During the study period, August 2008 to February 2009, colorectal cancer screening compliance rates increased among all Vietnamese members, including the control group. (Contact: [email protected])

More information is available on each of these programs at: www.ncqa.org/clas.aspx

Health plans will receive their awards at a dinner on Thursday, October 15, in Washington, D.C. The keynote speaker is Garth N. Graham, M.D., M.P.H., Deputy Assistant Secretary for Minority Health in the Office of Minority Health at the Department of Health and Human Services. The event is sponsored by Eli Lilly, with additional support from Bristol-Myers Squibb, CryerHealth and Novartis Pharmaceuticals Corporation. Health plans will also showcase their award-winning initiatives at a poster session and reception preceding the award ceremony.

NCQA's "Recognizing Innovation in Multicultural Health Care Award" program, also supported by The Office of Minority Health, brings together health plans, employers, physicians, policy makers and others to recognize innovative practices and breakthroughs in reducing health care disparities. The program:

-- Identifies and recognizes innovative practices in health plans -- Highlights transferable examples for adoption and dissemination -- Adds to the growing evidence base on effective methods -- Advances efforts to improve multicultural health care and eliminate health care disparities -- Supports development of voluntary standards for multicultural health care