Aetna
Voluntary Race/Ethnicity and Language Data Collection Program
Aetna was among the first health plans to capture self-reported race/ethnicity and language preference data. Beginning in the fall of 2002, the company launched an on-going strategy to collect this data on a voluntary, self-identification basis. This initiative included both creating mechanisms for members to submit the information and safeguards to protect it. Aetna puts this information to work in combination with other member health data to develop and deliver targeted initiatives and outreach programs to address health issues prevalent among racial/ethnic minorities. The collection of this data also has enabled Aetna to demonstrate and address differences in quality of care measures across racial/ethnic groups and, importantly, to debunk the myths that legal impediments or negative public reaction will occur when plans collect this information. As of August 2006, nearly 3.8 million members have volunteered their race/ethnicity information.
Blue Cross of California State Sponsored Business
Asthma and Ethnic Disparities Program: Pharmacists Help Close the Gap
Research has shown that children of families below the poverty threshold report higher asthma prevalence, yet control of symptoms via long-term controller medications remains low despite the release of National Asthma Education Program treatment guidelines. Thus, Blue Cross of California State Sponsored Business (BCC) sought to improve member asthma controller compliance with the assistance of the local pharmacist. This initiative uses a point-of-service asthma pharmacy consultation in which the pharmacist is prompted by a “pop-up” screen when a qualifying member fills an asthma prescription. The prompt appears to the pharmacist if the real-time claims review system notices a potential over-reliance on relief medications and directs the pharmacist to conduct an extensive asthma consultation. BCC pharmacists were also compensated for providing these consults. When BCC analyses revealed that not all ethnic groups were utilizing the consult opportunity, BCC chose to address this ethnic disparity. Interventions included both broad dissemination as well as targeted personal contact with pharmacists to disseminate disparity findings. Recent results indicate an increase in the consult rate and a reduction in the disparity.
CareFirst BlueCross BlueShield
Closing the Gaps
CareFirst BlueCross BlueShield (CareFirst) collaborated with several organizations to implement its Closing the Gaps program, with outreach and clinical interventions targeted to high disease prevalence of diabetes in Latinos, cervical cancer among Vietnamese women, and cardiovascular disease among African Americans. Diabetes Education and Treatment Initiative is a three-year diabetes education program to support evidence-based approaches to improve Latino health status in a clinic setting. Health providers using the Chronic Care Model track client services for ongoing evaluation of interventions. Culturally-competent health educators provide case management and trained peer counselors or “promotores” make home visits to enhance self-management strategies. The Health Awareness Program for Immigrants – Cervical Cancer (HAPI-CC) is a three-year partnership with the Boat People SOS, a Vietnamese organization in which education, early detection and treatment of cervical cancer is promoted. A mass media campaign targets a local and national audience, and trained bilingual health advocates and volunteers provide on-going education, support and home visits. Hair, Heart and Health is a partnership with University of Maryland School of Medicine to promote cardiovascular health among African Americans. A community grassroots organization trains outreach workers, barbers and hair stylists to provide health education and blood pressure screenings in barbershops and hair salons. In addition, CareFirst undertook mandatory cross-cultural training of all internal clinicians to increase awareness and sensitivity to ethnic and cultural issues that impact the health of minorities.
Chinese Community Health Plan
Bilingual Health Web site
Scarcity of language- and culture-appropriate education materials has been a barrier in delivering health education to Chinese Americans with limited English proficiency. Thus, the Chinese Community Health Plan (CCHP) created a comprehensive, bilingual health website to better equip providers in providing reliable bilingual health education materials to clients and to allow monolingual Chinese consumers to access up-to-date education materials. The CCHP website is an E-health venture, which presents bilingual health educational materials developed specifically for the Chinese population, not merely direct translations of English materials. This comprehensive bilingual health website provides user-friendly access to over 100 bilingual articles on various health topics and direct links to over 40 websites, many containing Chinese health education materials. This website enables users to conduct a topic search in English and print the Chinese version. This feature is an invaluable and timesaving tool for those who do not read Chinese, particularly healthcare providers in search of Chinese health education materials. Chinese users with limited English proficiency and basic Internet navigation skills can visit this website with ease and confidence as the website can be viewed in either Chinese or English. Currently, the website records approximately 56,000 visits per year, and CCHP has received numerous positive feedback from clients and providers from across the country.
Health Net
Salúd con Health Net Initiative
Health Net launched the Salúd con Health Net initiative (SCHN) in 2000 to provide the Latino community with health care that is culturally sensitive and linguistically sound. This innovative approach was the first time health care coverage was created through a partnership with a commercial health care company and a culturally distinct community. Health Net worked with community-based organizations and Latino health advocates to develop health care that meets the Culturally and Linguistically Appropriate Services (CLAS) Standards established by the Office of Minority Health. This diligence resulted in the development of a cross-border health plan that can be accessed in the U.S. and Mexico. Care in Mexico is provided by the only Mexican health plan licensed by the California State Department of Managed Care. This license ensures that Californians seeking care in Mexico receive the same quality they would receive in California. This initiative serves as a model to meet the needs of other cultural populations in California. The core aspects of the initiative involve the community, identifying culturally appropriate health care providers and networks and providing linguistically and culturally acceptable health care options. By adopting the core aspects of this model, health care coverage could be made available to communities that have limited access to health care and/or are experiencing poor health outcomes and health disparities. The Salúd con Health Net initiative has been well received by the Latino community, Business Associations, and the Mexican Consulate. Recognition by these groups validates the Salúd initiative as a health care model that can be both culturally and linguistically acceptable.
HealthPartners
Language Assistance Plan
Language access is critical for minority individuals who have limited English proficiency. Research shows that language barriers have a negative impact on health care utilization, patient satisfaction, and possibly adherence to treatment regimens. In 2005, HealthPartners conducted a comprehensive organizational assessment of the language needs of its members, and based on its findings invested $5 million in interpreter service in order to provide on-site, in-person interpretive services in all key languages spoken by its members and patients (Cambodian, Lao, Thai, Oromo, Amharic, Spanish, Somali, Hmong, Vietnamese, Russian and American Sign Language). Providers also have telephone access to interpreter services for more than 150 languages. HealthPartners also has programs designed to address the needs of hearing or sight impaired members and patients. Also in 2005, HealthPartners developed a language assistance plan for spoken and sign language services to formalize best practices in interpreter services for its health plan, medical group, clinics and hospital. The plan features a user’s guide, which includes information on HealthPartners’ services, how to arrange services, how to use the language line, how bilingual staff can best assist patients who require language assistance, how to respond if patients want to use a family member or friend to interpret, and where to get information. The plan also includes a provider manual that defines quality and performance expectations for interpreter service vendors, an oversight and delivery model for interpreter services, a provider satisfaction survey to measure interpreter performance, procedures for appropriate, third-party payer reimbursement of state public, and program interpreter services. The Language Assistance Plan is part of a larger effort by HealthPartners to improve cultural competence, reducing health disparities and improve cross cultural care and service.
Kaiser Permanente
Qualified Bilingual Staff (QBS) Model and Health Care Interpreter Certificate Program (HCICP)
In response to the increasing demand for linguistically and culturally appropriate services, Kaiser Permanente undertook two related efforts: the Qualified Bilingual Staff (QBS) Model and the Health Care Interpreter Certificate Program (HCICP). The goal of the Qualified Bilingual Staff (QBS) Model is to identify, qualify, educate/enhance, mobilize, and monitor an internal workforce to improve health outcomes and eliminate health care disparities. The QBS Model leverages the linguistic and cultural expertise of the Kaiser Permanente workforce and enhances bilingual communication within the staff and provider’s scope of practice. To date, this Model has been successfully replicated in the Mid-Atlantic States, Northern California and Georgia regions, a successful partnership between labor and management. The QBS standards are also incorporated into organizational policy and procedures, setting the “gold standard” in the industry. Kaiser initiated the HCICP in partnership with City College of San Francisco to address the dearth of qualified, professional health care interpreters in the community. The HCICP is designed to provide standards for health care interpreters. Kaiser Permanente designed a model HCI curriculum in 1996 and now has established multiple internship programs internally and externally, certified faculties, and disseminated the curricula across the country. This innovative model has shown that partnerships between health care organizations and accredited academic institutions are sustainable and mutually beneficial. The collaborative efforts help promote a renewable balance of supply and demand by joining the health care institutions that need professional health care interpreters with the academic institutions that train them. Kaiser Permanente continues to develop the core content materials and supports new and existing HCICP partnerships across the country. Together, the QBS and HCICP expand the availability of qualified interpreters within the health plan and the community.
Keystone Mercy Health Plan in Partnership with Healthy Hoops Coalition
Healthy Hoops Program
Keystone Mercy Health Plan and the Healthy Hoops Coalition created Healthy Hoops, an innovative, community-based, asthma education basketball program. Using basketball as a platform, Healthy Hoops teaches participants (both kids and families) how to manage asthma through appropriate medication usage, proper nutrition, monitored exercise and recreational activities. The goals of Healthy Hoops are to educate and reinforce asthma management; to provide asthma professional development to school nurses, community nurses, gym and health instructors and coaches; to expand the program components to address childhood obesity and the prevention of cardiovascular disease; and to make the Healthy Hoops a turn-key program for expansion. Over the past few years, the program has produced positive outcomes, demonstrating an increase in the use of preventive medications over rescue medications, a decrease in ER utilization, a decrease in sleep disturbances, lower hospitalization rates, and overall healthier lifestyles.
L.A. Care Health Plan
Pediatric Weight Management Patient Education Materials
L.A. Care Health Plan is a local public agency in Los Angeles County serving more than 750,000 Medi-Cal, Healthy Families, and Healthy Kids members, the majority of whom come from diverse racial and ethnic communities and speak a language other than English. Surveillance by L.A. Care found a higher prevalence of overweight and obesity among L.A. Care members than has been reported for the general population. In the summer of 2005, L.A. Care created a pediatric weight management toolkit to help clinicians address the epidemic of overweight and obesity among children and youth. The toolkit was introduced at a series of educational conferences offering health care professionals information and strategies to manage their overweight and obese patients. It contains a patient educational pamphlet, “My Easy Steps to a Healthy Weight”, in English and Spanish and available in Armenian, Korean, Vietnamese, and Khmer; exam room posters in English and Spanish; and expert policy recommendations and clinical resources, such as BMI wheels and laminated growth charts. The patient education materials focus on simple, positive changes patients can take, such as discussing healthy steps with their doctor, eating more fruits and vegetables, and exercising 30 to 60 minutes a day. These materials reflect the diverse communities L.A. Care serves in their depictions of Latino, African-American, and Asian American/Pacfic Islander children and families engaging in healthy activities. More than 3,000 of these toolkits and over 15,000 copies of the educational materials have been distributed to providers for use with their patients. L.A. Care has also translated the recently updated food pyramid produced by the U.S. Department of Agriculture into 8 additional languages and made these materials available to providers.
Molina Healthcare of Michigan
Shots for Shorties: Improving Health Care Quality for Racially and Ethnically Diverse Populations
Vaccines play an important role in protecting people from many viruses and bacteria that cause disease and death. In December 2004, Molina developed the pilot program “Shots for Shorties”. The goal was to increase African American Childhood and Adolescent Immunization rates for Combo 2 from the HEDIS 2004 rate of 38.3% and 19.0% to the 2004 NCQA 75th percentile of 67.94% and 46.23% respectively. The SE Michigan pilot ran for one year and involved 1,200 children age under 2 years, 3,200 adolescents age 12 -13 years, and 10 practitioner sites. Member and practitioner interventions in 2004 – 2005 increased the African American Childhood and Adolescent Immunization HEDIS 2006 rates to 58.4% and 51.9%. Efforts in 2006 focus on low performing areas. The program includes 4,200 children age under 2 years, 3,900 adolescents turning 12 -13 years, and 120 PCP sites. Interventions to improve immunization rates include working with the Michigan Care Improvement Registry (MCIR) and Vaccine for Children (VFC) staff in Detroit, increasing Immunization Assessments performed by the Michigan Department of Community Health (MDCH), discouraging members from seeking inappropriate care at the emergency room, offering an incentive (baby portrait) for 18-month olds if their immunizations are complete by their 2nd birthday, and follow-up with members needing only one shot to be complete.