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| Workshop C-4: measuring the costs and benefits of language servicesBuilding the business case for language services - Molina Healthcare of California About Molina Molina as a Demonstration Site The Intervention Market About Juan José Orellana
Cost and Benefit Measures for Language ServicesOur country’s rapidly expanding Latino population faces frequent health care access and quality issues due to language barriers. While legal and regulatory requirements dictate the provision of language services to all patients with limited English proficiency, provider efforts have been constrained by financial and operational challenges. Thus, poor patient-provider communication continues to be a daily fact of life for many of the 14 million Latinos with limited English skills. Temple University Hospital is part of the Temple University Health System, which is the major health provider for Philadelphia’s growing Latino population. Many Latinos in the TUH primary service area speak little English and have low health literacy. The Health System’s mission to serve the region’s underserved populations has resulted in a commitment to improve access and quality for Latinos by improving its language services. Assisted by the expertise available through the Robert Wood Johnson Foundation’s Hablamos Juntos program, TUH has designed and is implementing improved language services and measuring their impact. During this workshop, Temple University Hospital’s initial experiences in developing and implementing improved language services will be presented. The Temple-Hablamos Juntos program has focused on two important clinical areas: maternity and emergency services. As a large, academic medical center starting with few formalized language services, the widespread adoption of new procedures and services by clinicians and administrators can require significant attention. TUH efforts to reduce language, cultural and informational barriers have included hiring and training four dedicated medical interpreters; improving access to quality telephone-based interpreters; developing policies and procedures for training and credentialing bilingual staff to conduct occasional medical interpreting; changing provider behavior to increase their utilization of appropriate language services; and improved policies and procedures to create more effective patient education materials. These initiatives are being evaluated through measurement of patient and clinician satisfaction, patient adherence, clinical outcomes and financial impact. The recent implementation of the program has initially improved language services for patients and clinicians but has not gone smoothly. Unforeseen complications have emerged in interpreter training and testing, clinician acceptance and operational design. The result has been a significant expansion of quality language services, but accompanied by underutilization that compromises program efficiency and interpreter morale. A formal evaluation was conducted to identify causes and solutions and has precipitated several initiatives to address these initial problems. Other providers, especially larger organizations with few existing language services, may benefit from reviewing the TUH experience to date in preparation for their own language services program implementation or expansion. In addition, TUH’s expectations regarding the financial impact of its language services will be outlined, including the evaluation model developed by its finance department. Our lessons learned have included the need for better training of interpreter candidates, more attention focused on changing the language service procedures of clinical and support staff, the need to better familiarize staff with the new professional medical interpreters’ qualifications, training and credentials, and more operational expertise in the design and implementation of the professional medical interpreter deployment. Our operational plan, credentialing standards (training and testing requirements for professional, telephone-based, contracted and dual role interpreters) and language service and translation policies will be shared. Charles Soltoff is Associate Vice President for Marketing at Temple University Health System, a five-hospital network in Philadelphia, Pa. Temple University Health System’s participation in Hablamos Juntos grew out of a Latino market development plan that Mr. Soltoff created to make TUHS more accessible and responsive to the rapidly growing Latino population in the Philadelphia region. Mr. Soltoff has been involved in numerous public health related initiatives including federal and state supported clinical trials where he has developed and managed recruitment and retention efforts with an emphasis on minority enrollment. Mr. Soltoff is currently involved in the development of a health disparities center at TUHS.
Building the Business Case for Language ServicesLanguage barriers have become a critical issue in health care. Communication is vital to a patient-doctor relationship, and many providers are concerned on how to provide care to patients who are limited English proficient. Studies have shown that patients who speak little or no English often have trouble conveying their health concerns to their health care provider. From all non-English proficient (NEP) and limited English proficient (LEP) populations, Latinos are the largest minority and ethnic group at both the state and national level. In Providence, the Latino population has more than doubled over the last ten years, increasing from 24,982 to 52,146 people, becoming 30% of the city’s inhabitants.
In recent years, focus has shifted to how reducing language barriers can produce a positive financial impact for health care organizations. In this session, we will describe our experience thus far as a Medicaid Managed Care Plan working with local provider partners to implement interventions that have already begun to demonstrate the positive outcomes of providing linguistic and culturally competent care to NEP and LEP patients. We will discuss why we targeted high volume high cost focus areas throughout our partner sites in the development of our continuum of care, how we have increased the availability and quality of interpretation services for NEP and LEP patients who speak little English at specific focus areas within our partner organizations, and how we have begun to pilot a claims reimbursement system for interpreter services, making interpreter services billable at the designated areas within our partner sites when provided as part of a medical or clinical encounter. There have been successes and challenges since we have begun implementation of the Su Salud project in October of 2003. We have had success in bringing together major health care providers in our state, state agencies, and community leaders to be attentive to the issue of language access in our state. Each of our project partners have made commitments on new hires, making all levels of staff available for training, and providing the time and opportunity for dual role and dedicated interpreter staff to participate in the Language & Interpreter Skills Assessment (L&ISA) and training. Along with that commitment are challenges as we continually strive to shift the culture within partner sites, and make language access a priority throughout the Su Salud project organizations. We have had successes and challenges in the implementation of a qualification and reimbursement system for interpreter services. Working with four very different provider sites and their unique billing processes along with our own internal configuration systems has been challenging, but we have been able to start our claims reimbursement pilot for interpreter service, a service that up until this point has not been considered reimbursable through a claims system. Lessons learned have been that in order to make an impact on how health care organizations provide language services a top down approach must be taken. All levels of staff from leadership to the interpreters need to have the same investment in making language access a priority. Dual role and dedicated interpreters need to be recognized for the services they provide. Both quantitative and qualitative data methods must be incorporated into an evaluation component that will produce the needed information demonstrating how investment in language services is smart for business because it produces cost saving, increases market share, and most of all increases the quality of care that our NEP and LEP member receives ultimately making an impact on health outcomes. Brenda Seagrave-Whittle is the Senior Director of Member Development at Neighborhood Health Plan of RI. Ms. Whittle is responsible for leading the marketing, communications and member services teams at NHPRI. As the Principal Investor of Hablamos Juntos her role is to oversee the operational management of the Su Salud Project. NHPRI is a 73,000 member HMO founded in 1993 by Rhode Island’s Community Health Centers primarily serving enrollees in RIte Care, the state’s managed-care program for uninsured families. Previous to her work at NHPRI she served as the Coordinator for the Covering Kids project in Providence, RI. She also served as the Director of Social Services at Thundermist Community Health Center where she provided mental health services to thousand of families in Rhode Island.
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| Fourth
National Conference is presented by State University of New York Downstate Medical Center, Resources for Cross Cultural Health Care, Arthur Ashe Institute for Urban Health, US Department of Health and Human Services, Joint Commission on Accreditation of Healthcare Organizations |
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| As with the rest of Diversity Rx, this section
is a work in progress and we welcome information on other efforts, programs,
and reports that will expand upon the information offered here. Please
let us know if you have other examples to include here. |
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 Resources for Cross Cultural Health Care |
 Henry J. Kaiser Family Foundation |
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TeleSalud™
is being formed as a separate department within Molina Healthcare of California
offering medical interpreting services to address the health and language
needs of the underserved Limited English Proficiency (LEP) Latino population.
TeleSalud will offer a fully-bilingual Spanish 24-hour telephonic service
line providing nurse advice, member services, and nurse interpretation.
TeleSalud will offer these services through the use of bilingual and culturally
trained California licensed nurses. These services will be offered throughout
the continuum in which a member may seek care, including: hospitals, community
clinics and public health delivery systems. TeleSalud will offer four
primary services; member services, nurse advice, medical interpretation,
and access to a low literacy print media clearinghouse. To accomplish
this, TeleSalud will maintain a 24-hour contact center to address a user’s
health and interpreter needs at all times.
Juan José
Orellana is Director of Strategic Planning for Molina Healthcare, Inc.
In this role, Mr. Orellana is responsible for long-term strategic planning
initiatives that contribute to the firm’s achievement of its corporate
goals and objectives. He provides corporate-level leadership to the firm
in the evaluation, design and implementation of a variety of business
development and patient driven programs that enhance the delivery of services
Mr. Orellana currently serves as program co-director for Hablamos Juntos,
a grant awarded in 2002 by The Robert Wood Johnson Foundation to study
and improve access to healthcare for the Latino population. Before joining
Molina, Mr. Orellana was Vice President of Corporate Business Development
for Latinocare Management Corporation, a managed care firm focused on
serving the health needs of the Latino population in the United States.
Prior to Latinocare, he was responsible for market development activities
for Lucent Technologies' optical networking group focusing on the Caribbean
and Latin American markets. Mr. Orellana also served in several marketing
and international finance roles at AT&T and AT&T Wireless Services.
He holds a Bachelor in Business Administration from the University of
California at Berkeley and an MBA from the Kellogg School of Management
at Northwestern University.