Independence Blue Cross PDF
Colorectal Cancer Screening Among Vietnamese Members
Although colorectal cancer is a leading cause of cancer morbidity among racial and ethnic minority groups, it is curable when detected early. To improve screening rates, Independence Blue Cross designed and implemented a health promotion effort to reach out to a subset of members who had not had a screening in the past five years. Lacking sufficient race and ethnicity data to identify their vulnerable minority populations, Independence Blue Cross discovered it could use surname analysis to identify its Vietnamese members, thereby creating a new and more targeted effort to address disparities. These eligible members were randomized into groups to test the effectiveness of different outreach methods against a control group, with notifications provided through phone calls and direct mailings. Outreach materials were mailed in Vietnamese and provided information about the availability of Vietnamese translators. Moreover, they included information about the importance of screening and a postage-paid reply card for members to request a free fecal immunochemical test (FIT test). Independence Blue Cross tracked administrative claims data to determine whether members received a screening and, in just the first year, saw compliance jump by nearly 25 percent in the Vietnamese population.
Kaiser Foundation Health Plan, Inc. PDF
Clinician Cultural and Linguistic Assessment
Patient-provider language concordance is a critical component of the language access equation in health care delivery and is considered the gold standard for patient communication. Due to the lack of validated testing standards, measures, and tools, National Linguistic & Cultural Programs, Kaiser Permanente National Diversity led the research and development of an overarching strategy in language concordance to ensure health care teams and delivery systems meet the cultural & linguistic needs of patients served. In 2001, Kaiser Permanente, with funding from the California Endowment, led the collaboration with The Alameda Alliance for Health, to develop standards and tools for assessing provider linguistic proficiency to serve the needs of diverse populations. Subsequently, the collaboration pioneered the development of a new tool, the Clinician Cultural and Linguistic Assessment (CCLA), which assesses physicians’ ability to communicate with patients in a primary care setting. The CCLA is both a proficiency-based and criterion-referenced evaluation procedure, and assesses a candidate’s ability in five dimensions: communicative competence, fluency, pronunciation, customer service, and cultural proficiency. Prior to the assessment, many bilingual clinicians’ were either unaware of their own proficiency level or had varying self-perceptions of their actual abilities. The CCLA is the first and only validated language assessment tool specifically tailored to assess clinicians who self-report they speak a language other than English, and establishes a standard level in which they can communicate effectively independent of an interpreter. Currently, the assessment tool is available in 14 requested languages, and two additional languages are in development. As of date, over 1000 assessments have been completed internal and external to Kaiser Permanente.
Kaiser Foundation Health Plan, Inc., Southern California Region PDF
Primary Care Language Concordance Program
The U.S. Census estimates that by 2050, nearly one-quarter of the population will be Latino. Although many health-related settings provide interpreter services for non-English speaking patients, Kaiser Permanente’s Southern California Region recognized a need for more language concordant physicians within their own network. With Spanish speaking members comprising more than 12% of their population, Kaiser Southern California established a regional Spanish Language Task Force to determine the needs of members and formulate recommendations for action. Subsequently, Kaiser Southern California developed their Primary Care Language Concordance Program, which seeks to increase the number of language concordant visits for limited English proficient (LEP) members and foster a culture where multilingual skills are valued and utilized. The Primary Care Language Concordance Program focuses on ensuring that existing patients have visits with language concordant physicians, assigning new members to appropriate primary care physicians, and allowing physicians to take language proficiency tests. Physicians who have a significant number of language concordant patients can receive award recognition, and for others, reimbursement is available for educational courses to improve their language fluency. Since the programs inception, utilization of staff interpreters and telephonic interpretation has declined, and awareness, knowledge, and skills of physicians have improved significantly. Data has shown that in just the first year, language concordance visits increased from 28.9% to 35.4%, resulting in approximately 93,000 more language concordant appointments. There has also been a 6% increase in the utilization of Spanish language concordant clinicians and an 8% increase in Spanish-language appointments.
L.A. Care Health Plan PDF
Health Disparities Improvement Project
After data analysis revealed several disparities for African-American and Latina women in their membership, L.A. Care Health Plan set out to reduce the gap. They conducted a series of member focus groups, particularly as they applied to perinatal care and screening for breast and cervical cancer. Because of their findings, L.A. Care developed their Health Disparities Improvement Project, combining both new and existing efforts focused on mobilizing community members to engage in grassroots health education efforts, and create peer-to-peer community health promotion. L.A. Care began with their existing Regional Community Advisory Committees (RCAC) and developed a new Health Promoters Program to train RCAC members in outreach and education. At the same time, L.A. Care also opened their first Family Resource Center, developed to provide community outreach and health education resources through partnerships with local community organizations. The Health Disparities Improvement Project has lead to creative partnerships with community-based organizations such as the American Diabetes Association, the creation of new resource centers in underserved areas, a series of health education presentations, and free mammograms, creating a comprehensive approach to improving health outcomes. Though the program is still young, L.A. Care has already seen notable improvements in their preliminary HEDIS rates for several women’s health measures, including breast cancer screening, prenatal and postpartum care, and cervical cancer screening. More importantly, the effects can be seen with not only L.A. Care members, but also with their family and friends and in the communities in which they live.
Midwest Health Plan PDF
Caring for Culture – Caring for Women
In 2006, Midwest Health Plan saw that their HEDIS rates for a number of female health measures were falling below national Medicaid benchmarks. Further analysis revealed a number of barriers for their population in seeking care, specifically due to a highly diverse population comprised of Arabic, Hispanic and African American women who experience both language difficulties and cultural sensitivities when seeking care. In turn, Midwest developed the Caring for Culture – Caring for Women Project, which sought to educate members on the importance of preventive healthcare for women and increase the number of women obtaining preventive screenings. Efforts focused on creating a culturally sensitive environment for female health, removing language barriers through use of translated materials and bilingual staff, providing culturally sensitive outreach and collaborating with community organizations such as the Arab Community Center for Economic and Social Services to promote community health education. Midwest Health Plan also provided incentives to both providers and members for promoting and participating in preventive healthcare services. Midwest has seen statistically significant improvement across many of their female preventative health measures.