Second National Conference on
Quality Health Care for Culturally Diverse Populations:
Strategy and Action for Communities, Providers, and a Changing Health System

1-6. Public Health Systems And Managed Care Organization Respond To Cultural Diversity

The Hennepin County Project for Multi-Cultural Service Delivery

Over the last 15 years, Minnesota's demographics have increasingly reflected the diversification of the nation's population. Each year Minnesota is the destination for over 3,000 immigrants, as well as substantial numbers of non-immigrant ethnic groups who relocate here from other states. Minnesota is now home to over 85,000 Hispanics/Latinos, 108,000 Asians and Pacific Islanders, 140,000 African Americans, 60,000 American Indians, 15,000 Africans and growing numbers of Russians and Eastern Europeans. Minnesota boasts the second largest population of Hmong refugees in the country, and the twelfth largest American Indian population. Over 80 languages are spoken in Minneapolis schools.

One of the greatest challenges these new residents in Minnesota face are the cultural and linguistic barriers to meeting their basic needs. This struggle is especially acute in areas as sensitive as health care and human services. These struggles can be overwhelming for individuals that must first attempt to adjust and adapt to a new culture, learn English, and understand values that sometimes conflict with their own. As a result, an ever-increasing number of immigrants, refugees, traditional minority groups, and new Americans enter Hennepin County's system to access services in their attempt to stabilize, transition, and ultimately, achieve self-sufficiency within our community with little or no understanding of it.

This Project attempts to help these populations by identifying and securing services of bilingual/bicultural individuals from within County departments and the community at large. It has begun to explore the ever-increasing needs and costs of service delivery in a multi-cultural environment. The Project's goal is to facilitate the design and implementation of a strategy to enhance multi-cultural service coordination across County departments and with the community.

The benefits of the Project for Hennepin County are clear:

1. Provides greater efficiency and cost-savings resulting from increased coordination and reduction of duplicated services;
2. Establishes a single point of coordination and access for staff, clients, the community and other partners;
3. Reduces long-term client dependence on County services and accelerates transition towards self-sufficiency;
4. Increases opportunities to capture external funding;
5. Facilitates collaboration with partners;
6. Demonstrates a viable leadership role for Hennepin County.

The Project Goal is to ensure that Hennepin County services are accessible and responsive to persons regardless of culture and/or language and that services are cost effective, coordinated with the community, and contribute to individual and family self-sufficiency.

The Project's Objectives include:

1. Coordinating existing services across departments and partner with the community;
2. Ensure quality interpretive services;
3. Enhance access to culturally and linguistically appropriate services;
4. Improve staff's cultural competency and expand bilingual-bicultural employment opportunities.

These objectives will be achieved through a number of programs that will help Hennepin County and the community realize the potential for a coordinated, streamlined, and enhanced approach for the delivery of services and programs. Programs include:

1. Community Outreach Liaisons;
2. Workforce Development Issues -Diversity and Cultural Competency Training;
3. Immigration Policy Specialists;
4. Community Justice Liaisons;
5. Vista Volunteers Community Capacity-Building Project;
6. Hennepin Languages;
7. Interpreter Training.

The above-mentioned programs are complementary in nature and provide a seamless approach to serving the needs of both the County departments and populations with limited English proficiency.

Advising the Project are two committees - an internal group made up of County representatives and a community advisory panel made up of community members and other jurisdictional partners.

Hennepin County, through the efforts of the Project, is stepping forward to address the existing and emerging needs of refugees and immigrants. The process of determining the appropriate approach to meeting the needs of the county, community, and client is our immediate task. Long-term, the Project will become a shared resource and a point of coordination with all community partners.

Vinodh Kutty was born in Malaysia and went to school in Singapore. He has certifications in education, English, and anthropology from the National University of Singapore, Macalester College, and the University of Minnesota.

After serving two and half years in the Singapore Armed Forces, he taught high school in Singapore before coming to the United States. After arriving in Minnesota, he has worked at the Minnesota Humanities Commission, the Center for Cross-Cultural Health, and Hennepin County Medical Center. He has had extensive experience in conducting cultural competency training and working with health, social and human service providers and educators who serve new Americans, refugees, immigrants, asylees, and traditional minority groups.

He is currently the Project Coordinator for the Hennepin County Project for Multi-Cultural Services Delivery. The Project looks to streamline and enhance services and programs that Hennepin County provides to new Americans, refugees, immigrants, asylees, and populations with limited English proficiency in a cultural and linguistically appropriate manner, while working with community based organizations and mutual assistance associations.

His current interests include writing poetry, cooking, brewing beer, painting, and hiking with his wife and two dogs. He also likes to travel to distant places and meet new peoples.

Vinodh Kutty
Project Coordinator
Hennepin County Project for Multi-Cultural Service Delivery
330 South 12^th Street, Suite 340
Minneapolis, MN 55404
Phone: (612) 348-9498
Fax: (612) 317-6115
Email: vinodh.kutty@co.hennepin.mn.us

C&L in Managed Care - Raising the Bar

The Alameda Alliance for Health (the "Alliance”) is a managed care plan originally created to serve the Medicaid beneficiaries in Alameda County, California. It has grown to a membership of 80,000 enrollees with participation in Medicaid and Healthy Families (known nationally as the "Children's Health Insurance Program” or "CHIP”). In July 2000, the Alliance initiated two new programs - Family Care (comprehensive health and dental coverage subsidized by the Alliance and directed at the uninsured) and First Care (a commercial program).

Throughout its existence, the Alliance has been committed to providing culturally and linguistically sensitive services that extend beyond the contractual and statutory requirements of the Medicaid and Healthy Families programs. In early 2000, heightened contractual requirements were introduced in Healthy Families program. Together, these became the catalysts to the Alliance's more formalized C&L program development.

This presentation will review the external and internal catalysts leading to the creation of the Alliance's C&L program; operational strategies and challenges; the overall design of the C&L program in terms of goals, staffing and role within the organization; and long-term industry-wide goals that extend beyond the Alliance itself. The presentation proposes the following:

• Promote the recordation of the language preference and ethnicity of each managed care enrollee.
• Promote separate payment to physicians for utilizing qualified health interpreters by Medicare, Medicaid and commercial payors.
• Promote the adoption of industry-wide standards and testing of language proficiency of both health interpreters and providers. Develop incentives for providers and their office staff to comply.
• Develop multi-cultural, multi-ethnic staff and provider network to match member diversity.
• Focus provider cultural trainings on behaviors and understandings to improve physician-patient relationships and health outcomes.
• From an epidemiological approach, improve measurable health outcomes by ethnic and cultural groups - even if it results in higher utilization.
• Challenge initial findings of low utilization by ethnic or cultural groups to determine whether they're due to better health status or access problems (e.g., language barriers, ethnic beliefs and behaviors).
• Identify health disparities and create interventions directed at providers, individual members and the community at large. When communicating with members from ethnic or cultural groups, build on their beliefs and behaviors rather than attempting to replace them.

• Promote innovation and coverage programs to serve the minority, the undocumented immigrant and the uninsured communities.

Kelvin P. Quan, JD, MPH is the Chief Financial Office & General Counsel of the Alameda Alliance for Health, the managed care health plan serving MediCal and other low-income, vulnerable populations throughout Alameda County in Northern California, where he has administrative responsibility for their Cultural & Linguistics program. Since 1996, Mr. Quan has been the Board President of the Asian & Pacific Islander American Health Forum, a national health advocacy and policy organization that promotes policy, program & research for APIA communities. Mr. Quan is a co-founder of the Bay Area Asian Health Alliance, a pioneering health advocacy group formed in 1980, and a co-founder of Self-Help HomeCare, a home health agency serving the monolingual Chinese elderly in San Francisco since 1981. He is the Co-Investigator and Quality Assurance Specialist for the study "Exploring Ethnic/Language Match and Cervical Cancer Screening,” which is funded by the California Cancer Research Program.

As an attorney at the law firm of Cooley Godward, Mr. Quan's law practice focused on transactional health care law. Prior to that, Mr. Quan was the Chief Financial Officer of Chinese Hospital in San Francisco. He has held senior financial and administrative positions at Peninsula Hospital and French Hospital Medical Center. He earned his JD from the University of California, Hastings College of the Law; his MPH in Corporate Healthcare Management from the University of California, Berkeley; and his undergraduate degree from Northwestern University. He is a Board member of the American Heart Association (East Bay affiliate) and Operation Access, a non-profit organization that provides outpatient surgeries to the uninsured through the voluntary efforts of surgeons, nurses and hospitals. Past board affiliations include Self-Help for the Elderly, St. Mary's Chinese Foundation, and the Oakland Chinese Community Council. He has been a member of the California State Bar since 1993.

Kelvin P. Quan, JD, MPH
Chief Financial Officer & General Counsel
Alameda Alliance for Health
1850 Fairway Drive
San Leandro, CA 94577
Email:KQuan@AlamedaAlliance.com

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