Enhanced Bilingual Service and Member Access
UnitedHealthcare Latino Health Solutions^SM

NCQA’s 2008 Recognizing Innovation in Multicultural Health Care Award Winner

Understanding the roblem

The Hispanic population residing in the United States has doubled since 1980, and is expected to eclipse current numbers as Hispanics are predicted to continue as the largest minority in the United
States and to consist of 30% of the U.S. population in 2050. The rate of growth for the Hispanic population is expected to increase to approximately 1.7 million Hispanics a year, according to census
estimates.* For Hispanics, access to their health care benefits depends on their carrier’s language competency, and a fully thoughtthrough service strategy, supporting Limited English Proficiency (LEP) members at every touchpoint where they interact with the carrier.

This requires a new paradigm in customer service delivery for bilingual (Spanish-English) and Spanish-preference members.

• In January 2008, UnitedHealthcare had over 2 million Hispanic members.
• Hispanic households are varied and range from those that speak completely Spanish, to those that speak a combination of Spanish and English (Spanglish), to those that speak only English. According to American Factfinder, there are at least 31 million Hispanics who speak at least some Spanish at home.**
• We estimate that between 1 million and 1.5 million members may use our bilingual services at some time during their membership tenure.

Ethnic diversity and the need for support in other languages also continue to grow in the UnitedHealthcare member population.

Goals and Rationale

The purpose of this initiative is to identify service disparity between our core English-speaking population and our Spanish-preference membership, and then take action to ensure that our Spanish-preference member population receives the same quality service experience as English-speaking members. Also critical to the success of this initiative is how we measure the results of these actions, identify tactical successes and affirm strategic direction.

The goal is to provide our Spanish-preference members an enhanced service experience and access to resources on par with our service to English-speaking members, which had not been a priority in the past.

Goals include:

• Develop a trusted “voice of the company” for Spanish-preference members
• Improve members’ ability to select and access provider offices that have the members’ required language capabilities
• Support members with trusted in-language customer care professionals (CCPs) who can guide them on how to best utilize their benefits, that is, how to “navigate” their health plan and the health care system

Prior to this initiative, support of our non-English-speaking member population had traditionally been delivered through language options offered within English-enabled telephone lines and applications.

• Service for non-English-speaking members was supported in large part through external vendor interpreter services, which did not always meet our quality or responsiveness standards, and also
  added a significant cost to providing member services.
• The efforts of this new initiative have focused on delivering an enhanced service experience, utilizing CCPs that are certified in their ability to effectively communicate in Spanish, and leveraging cost savings by decreasing the use of external language interpreter services for our highest-use foreign language, which is Spanish.

Intervention and implementation

Phone routing and in-language messaging was developed to accurately route Spanish-preference members to a certified team of CCPs. This team received additional training regarding “How to interact with a Spanish-speaking caller”. Online resources were created to assist the CCPs with call handling. Certified Spanish-language Quality Auditing was instituted to audit member interactions and improve service.

The project focused on four key areas:

Access:

• Voice Portal
• Web Portal

Support:

• In-Language LHS Staff Training
• In-Language Quality Review/Audit
• Hispanic-specific – Customer Care Resources
• In-Language Member Materials
• In-Language Employer, Broker and Member Portals

Resources:

• Certified bilingual customer care professionals
• Certified Quality Auditors
• Certified Trainers

Data/Reporting:

• Spanish-language specific call trends
• Internal Quality Scores
• Customer Satisfaction Surveys and Trends

Methods of Evaluation

To evaluate the improvement or decreased number of abandoned calls (calls in which the caller hangs up while waiting on the line before getting to a customer care professional), we tracked the abandoned
calls before and after this initiative. In July 2006, 20% of callers who selected the menu option for Spanish service were abandoning the call before speaking with a CCP. We attributed this high rate of abandoned calls to:

• Lack of a unique, dedicated toll-free number for Spanish-language service
• Greetings and on-hold messages only in English, leading to a lack of caller/member confidence that their call would be handled in Spanish
• Limited number of Spanish-certified CCPs, with coverage limited to business hours (English-only coverage after business hours)
• Low satisfaction rates of Spanish-preference callers/members whose calls were handled by an English-speaking CCP working through an external Spanish interpreter

As we developed the Enhanced Bilingual Service and Member Access Initiative, all of the foregoing issues were corrected, and the number of abandoned calls was reduced significantly.

• By July 2008, the rate of abandoned calls had stabilized in the 3% to 5% range, as the number of Spanish-certified CCPs increased, and the existence of the unique, dedicated Spanish-service line was made known to employers with a large Hispanic workforce.

Due to this initiative, we have accomplished several improvements in our metrics, which are measurements of our teams’ efficiency and translate directly to improved access for our members to their health benefits.

Impact of the Initiative

How has this project had an impact on your organization?

We have increased service levels to Spanish-preference members and member satisfaction, and further delivered on our commitment to provide superior in-language service to our customers. We are using the information we collect continuously to drive new strategies and refine our execution and delivery.

• Access to Customer Care through dedicated Spanish-language 800 number increased over 60% from February 2007 to February 2008
• Member-reported satisfaction improved from 65% overall satisfaction when supported through interpreter services to approximately 90% when serviced in-language by certified bilingual customer care professionals.
• Auditing of Spanish-language calls: outstanding average quality score of 97.76
• Significant reduction in interpreter service use: on average, time spent per call communicating through an interpreter was 3 times longer than in-language support.
• Significant annualized cost savings as a result of reduced interpreter service use. Through the inception of the program, we have realized over $120,000 in annualized savings, without a corresponding increase in customer care professionals.

Sustainability and transferability

Will this initiative be continued or expanded within your health plan? Yes. Currently deployed to support Spanish-preference members on PacifiCare HMO/PPO and UnitedHealthcare PPO products, this service model is scheduled for deployment to additional product lines (now serving major Public Sector clients). We are now receiving requests from large public sector clients to route their Spanish-preference members to this specialized team to better serve their members and give them better access.

What resource constraints will affect sustainability? We expect that funding will continue to be in place due to the success of this enhanced service – any funding limit would be a resource constraint. Savings we have achieved by reducing the use of external interpreters have been reinvested. Human factor: Ability to develop and sustain a pipeline of certified professionals. That is why we have located this specialized team in San Antonio where there is an ample pool of bilingually-educated people.

How does this relate to other organizations? We believe that Latino Health Solutions has leadership in the creation of this enhanced service capability and that it is not duplicated by other
competing organizations at this time.

How can other health plans learn from the initiative? We have proven that this is a valuable initiative that serves our members and their employers. Other health plans will be able to implement similar initiatives in Spanish or other languages as long as the size of their language-preference membership justifies making the investment. This initiative not only improves multicultural health care access and may help in eliminating health care disparities, but it is also a model for replication and can be used by NCQA in the development of voluntary accreditation standards as health plans strive to better implement CLAS and address disparities.

Are the interventions and components likely to work in other settings? Which ones? We believe that many of the key lessons will be applicable to other UnitedHealthcare companies and to other languages. At this time, we are sharing best practices with our Chinese language call center in New York City, and with our Spanish-language call center for Neighborhood Health Partnership
in Miami, Florida.

Sources:
2007 U.S. Census Bureau*
2008 American FactFinder, U.S. Census Bureau**
Insurance coverage provided by or through United HealthCare Insurance Company or its
affiliates. Administrative services provided by United HealthCare Insurance Company, United
HealthCare Services, Inc. or their affiliates.