The Third National Conference on
Quality Health Care for Culturally Diverse Populations:
Advancing Effective Health Care through Systems Development, Data, and Measurement

October 2 - 4, 2002, Chicago, IL
Westin Chicago River North Hotel

Session B-4: Integrating cultural competence into the quality goals of the organization

Alameda Alliance for Health: A Managed Care Organization’s Commitment to System-Wide Cultural Competence

The Alameda Alliance for Health (the "Alliance") evaluates, implements, and integrates cultural and linguistic competency throughout plan operations in order to create a culturally competent organization, increase access to care, enhance quality of care and health outcomes, maximize patient satisfaction and retention, and reduce health disparities.

The Alliance has adopted a strategic vision for culturally competent health care and has implemented this across its business practices. We will discuss:

• the Virtue Matrix: Calculating the Return on Corporate Responsibility (Martin, 2002) as a conceptualization to understand how health care entities might choose to promote culturally and linguistically appropriate health care services;
• strategies for change (data needs, cultural goals, linguistic goals, epidemiology, and other) as areas that the Alliance has addressed to implement not only industry standards/regulations, but to also implement innovative programs and activities;
• choice of different organizational cultural competence assessments strategies as they relate to the type and degree of organizational commitment;
• development of a systems approach to assessing the Alliance as the only OMH national case study of an MCO’s implementation of CLAS;
• the Alliance vision for culturally competent health care and how the Alliance is working towards this with specific programs and business practices as a coherent and dynamic system;
• some of the challenges that the Alliance has encountered and how we are addressing these;
• Recommendations for a systemic and institutionalized organizational commitment to culturally competent health care in a managed care organization.

As part of its commitment to serve a diverse community, the Alliance has taken active steps to design organizational-wide and program specific cultural and linguistic infrastructures. Towards this end, the Alliance created a Cultural and Linguistic (C&L) Program with full-time dedicated staff. The C&L Program develops strategies and provides guidance in the implementation of culturally and linguistically appropriate health care services, including organizational assessment and C&L program development. Ongoing C&L services include translation of all member materials, payment for qualified medical interpreter services, payment to providers for the use of qualified medical interpreters, training for providers and Alliance staff, and internal consulting services to integrate and support C&L efforts across departments. Special initiatives include a Cultural Competency Initiative and a Linguistic Proficiency Initiative, each designed to assess and train skill-based competencies among providers, and to evaluate the effectiveness of such training on the acquisition of new skills, as well as quality of health care. In addition, the Alliance was selected to be the only MCO national site to model the implementation of the Culturally and Linguistically Appropriate Services (CLAS) in Health Care standards released by the US Department of Health and Human Services, Office of Minority Health.

Alameda Alliance for Health (The Alliance)
1240 South Loop Road
Alameda, CA 94502

Alameda Alliance for Health, is the managed care health plan serving Medi-Cal, Healthy Families (SCHIP) and other low-income, vulnerable populations throughout Alameda County in Northern California. Comprehensive medical and behavioral health services are provided through over 1,300 public and private physicians, hospitals, and community clinics. As part of the Alliance’s commitment to serve a diverse community, the Alliance has taken active steps to design organizational-wide and program specific cultural and linguistic infrastructures to best meet the needs of the communities of Alameda County.

Juanita M. Dimas, PhD
Cultural and Linguistic Program Manager
Alameda Alliance for Health
Phone: 510-747-4555, x 4040
E-mail: jdimas@alameda-alliance.com

Juanita Dimas serves as the Cultural and Linguistic (C&L) Program Manager of the Alameda Alliance for Helalth. The C&L Program develops strategies and provides guidance in the implementation of culturally and linguistically appropriate health care services, including organizational assessment and C&L program development, the Culturally Competency Initiative, the Language Proficiency Initiative, as well as ongoing C&L operations.

Dr. Dimas is a licensed clinical/community psychologist, with a specialization in working with diverse, poor and underserved populations, and in researching cultural factors related to health disparities. As a professor of psychology, she taught a variety of graduate level courses, including cultural competency. Dr. Dimas’ numerous presentations have been made to national and state health institutes, professional organizations, as well as colleges and universities; her publications focus on cultural factors and health and include book chapters, professional journal articles, and policy reports.

Dr. Dimas earned her PhD in Clinical Psychology from the University of California, Berkeley, and served her clinical internship and postdoctoral fellowship at the University of California, San Francisco, Public Service and Minority Cluster, based at San Francisco General Hospital.

Kelvin P. Quan, JD, MPH
Chief Financial Officer & General Counsel
Alameda Alliance for Health
E-mail: KQuan@AlamedaAlliance.com

Kelvin Quan, JD, MPH is the Chief Financial Office & General Counsel of the Alliance, where he has administrative responsibility for the Cultural and Linguistic program. Mr. Quan was the Board President of the Asian & Pacific Islander American Health Forum. He is the co-founder of Self-Help HomeCare, a home health agency serving monolingual Chinese elderly.

Mr. Quan is the Co-Investigator for the study "Exploring Ethnic/Language Match and Cervical Cancer Screening" and served as a member of the national Research Advisory Committee for cultural competency.

Mr. Quan practiced health care law at Cooley Godward and was CFO at Chinese Hospital. 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 BA from Northwestern University. Mr. Quan received the 2002 "Spirit of Public Health" award from the University of California, Berkeley.

Management and organizational factors affecting the effectiveness of culturally and linguistically appropriate services programs in managed care settings and the measurement of the effectiveness of such programs at the provider level

Health plans in California participating in state programs are governed by multiple regulations on CLAS. This presentation will address the challenges faced by a medium size health plan in California in complying with these regulations and providing effective CLAS. It will discuss how certain management and organizational variables affect the organization and implementation of CLAS programs at plan and provider levels. The regulators, generally, hold the health plan responsible for ensuring that CLAS at the provider level are effective. This presentation will also address the difficulties associated with organizing and implementing effective CLAS programs, measuring their effectiveness at the provider level, and possible ways of overcoming these difficulties.

At Care 1^st, the company decided to treat CLAS not as a compliance hassle but as an element in improving quality of its services. It adopted the well-known Total Quality Management (TQM) approach used by the Malcolm Baldrige National Quality Award (MBNQA). This presentation will show how key components/factors in TQM were used in formulating the CLAS program at Care 1^st. Following a strategic plan prepared on the basis of TQM principles, and a detailed work plan, Care 1^st was able to improve its CLAS programs from a "poor/fail" regulatory status to a "commendable" rating over a period of one and a half years. In addition to meeting regulatory requirements, Care 1^st was also able to establish partnerships with regulatory agencies, providers, other health plans and community based organizations ultimately improving the quality of services provided to plan members.

A major challenge faced in implementing these CLAS programs was making the programs effective at provider level - the level where it really matters. These included the lack of awareness of language assistance requirements and resources, the lack of a clear identification of plan and provider roles, the varying acceptance of, and attitudes towards, CLAS principles and programs by providers, and the measurement of effectiveness of programs at provider level.

These experiences indicate that an effective CLAS program can be established at small to medium plan levels only if three infra-structural factors exist in the organization: Leadership, Strategic planning of CLAS (within the company strategic business plan), and the proper Organization structure. The results of a CLAS effectiveness assessment conducted at 20 health care provider groups confirms this hypothesis at provider level as well. The programs were successful also because the formulation of policies and procedures indicating a clear identification of CLAS responsibilities between the plan and the provider or the provider organization (such as a medical group or an IPA) and a measurement tool to audit implementation at provider level.

Gamini Gunawardane, PhD, JD
Director
Legal & Regulatory Affairs
Care 1^st Health Plan
1000 South Fremont Avenue
Alhambra, CA 91803
Phone: 626-299-5244
Fax: 626-458-0415
E-mail: drg@care1st.com

Dr. Gamini Gunawardane holds an MBA and a PhD from the Graduate School of Business, University of Chicago and a JD from the Western State University College of Law, and is also an Attorney at Law. He has worked in the managed care industry in California for the last sixteen years as an IPA administrator, HMO board member, legal counsel, and CLAS and HIPAA project manager. He serves in the Legal Affairs and Public Policy Committees of the California Association of Health Plans and CLAS, HIPAA and State Legislation Committees of the Industry Collaboration Effort (ICE).

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