Fourth National Conference on
Quality Health Care for Culturally Diverse Populations:
Integrating Community Needs into the National Health Agenda

September 28-October 1, 2004, Washington, DC
Hilton Washington, Washington DC

Workshop C-7: Managed health networks meet the challenge of serving diverse populations

Culturally and Linguistically Appropriate Services (CLAS) in a Managed Care Organization (MCO); Reporting back on Office of Minority Health (OMH) Case Study at Alameda Alliance for Health

As the U.S. population becomes more diverse, health care organizations and providers are interacting more often with patients/consumers from many different cultural and linguistic backgrounds. The development of appropriate organizational and system wide approaches to better serve the health care needs of culturally and linguistically diverse populations is becoming more paramount to the health care industry. The Office of Minority Health developed national recommended standards for CLAS to assist health care organizations in providing care to racially and ethnically diverse communities. The provision of culturally and linguistically appropriate services to diverse patient populations has the potential to improve access to health care, quality of care, health outcomes and ultimately reduce health disparities.

Alameda Alliance for Health (The Alliance) is a local health plan, serving Medicaid, SCHIP, and other low-income, vulnerable populations throughout Alameda County, California. Serving over 85,000 (87% people of color or immigrants, and about half whose primary language is other than English), comprehensive medical and behavioral health services are provided through over 1,300 public and private physicians, hospitals, and community clinics. 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.

The Alliance was selected as the only health plan nationally to be the subject of a case study for the application of the CLAS standards. For eighteen months, Department of Health and Human Services (DHHS) Office of Minority Health (OMH) conducted a study of the ongoing implementation of CLAS standards at the Alameda Alliance for Health (the Alliance). This case study looked to address three primary questions:

1. What organizational inputs and processes are associated with the implementation of CLAS standards in a MCO?
2. How do the organizational inputs and processes interact to affect the MCO outputs?
3. What factors support or inhibit the implementation of CLAS standards with the MCO’s provider network.

Using a criterion rating scale, four levels of CLAS implementation were identified (Level 1-No Implementation, Level 2-Preliminary Implementation, Level 3-Intermediate Implementation, Level 4-Expanded). This rating suggests that the Alliance is operating in a way that is both consistent with as well as achieving many of the suggested goals and objectives of the CLAS Standards.

An example of an initiative rated by the case study is the Alliance’s Interpreter Services. Since 1996, the Alliance has made available on-site and telephonic interpreter services for members receiving any health service or benefit from our plan. The utilization of interpreter services has grown from 112 monthly requests during the 2nd quarter of 2002 to 1000 monthly requests during the 2nd quarter of 2004. Our top interpreter utilization languages are: Spanish (49%), Cantonese (18%), Vietnamese (17%) and Farsi (4%). Lessons learned from this program include that overcoming language barriers requires much more than simply making interpreters available and that physician incentives to utilize interpreters do not automatically work. It is crucial to support and participate in creative collaborative interventions such as the implementation of the I-Speak cards and countywide collaborative projects to address challenges, increase interpreter availability and utilization with in the health care community as a whole.

Dr. Arthur Chen currently serves as the Chief Medical Officer for the Alameda Alliance for Health, a public Medicaid Managed Care health plan serving 95,000 low income residents of Alameda County where from 1996-2001 he also served as the County’s Health Officer. Since 1983 he has practiced clinical medicine as a family physician at Asian Health Services, a community health center serving low-income, LEP Asian immigrants in Oakland, California. When he served as Medical Director and Special Programs Director he helped to pilot cultural competence trainings for physicians, nurses and other health professionals serving Asian immigrants. He also helped develop a workshop on how health professionals should work with interpreters. He also served as the Executive Director of the Chinatown Health Clinic in New York City. He currently serves as Vice-Chair of the Board of Directors of The California Endowment and he chairs the Board of Directors of the Asian and Pacific Islander American Health Forum, a national policy and advocacy organization whose mission is to improve the health status of Asian Americans and Pacific Islanders. From 2001-2003 he was appointed to the Task Force on Culturally and Linguistically Competent Physicians and Dentists for the CA Dept of Consumer Affairs.

Arthur Chen, MD
Chief Medical Officer, Alameda Alliance for Health
1240 South Loop Road, Alameda, CA 94502
510-747-4571; Fax: 510-747-4503;
AChen@alamedaalliance.com;
www.AlamedaAlliance.com

Building the Foundation for Cultural and Linguistic Competency in Healthcare:
Action Steps for Changing Attitudes and Building Compliance in a Medicaid Managed Care Organization

Passport Health Plan (PHP), the only Medicaid managed care entity in the Commonwealth of Kentucky, serves members from one urban and fifteen rural counties. A key component of the Plan’s success was, and continues to be, an emphasis on community collaborations and face-to-face interaction with members. In 1999, however, associates of the Plan began to notice and remark on the number of members and potential members with whom they were unable to effectively communicate. In most cases, the barriers was a linguistic one; these members had either little or no ability to communicate in or understand English, and therefore, little or no ability to understand or access healthcare benefits. In other cases, the barrier was defined by culture, or rather a misinterpretation (from both sides) of individual culture and its impact on verbal and nonverbal communication.

In this workshop, we will discuss how the Plan responded by appointing an existing community affairs coordinator to serve as an advocate for members facing cultural and linguistic barriers to care. We will review how what began as a small, part time role has catapulted into a full-time position – and in retrospect, became the critical intervention for the Plan. During the workshop we will examine the agenda the coordinator developed to achieve key objectives, such as interventions to promote continuity of care, and enhance provider education. We will also look at the Plan’s first conference on cultural and linguistic competency in healthcare – the planning and execution, and impact on the attendees. Lastly, we review our Provider Toolkit on Cultural and Linguistic Competency in Healthcare and discuss how it assists medical and human service practices with establishing their own foundation for cultural competency.

Lessons learned include methods for changing the attitudes of reluctant associates and providers, and gaining support from senior management. Other lessons are related to the fairly recent influx of immigrants, which was a significant phenomenon in most areas of Kentucky. Until the development of the coordinator position and a solid plan for cultural competency many of the Plan’s associates and participating providers were resistant to making accommodations for individuals with special communication needs.

Loretta Estes serves as the Coordinator of Cultural and Linguistic Services for Passport Health Plan, and has been with the organization since its inception in 1997. Prior to her role in the Public Affairs department, Ms. Estes served as a member services representative for the Plan. She has been certified as a cultural diversity trainer by the Cross Cultural Health Care Program (CCHP) in Seattle, Washington.

loretta.estes@amerihealthmercy.org
(502) 585-7932
Passport Health Plan
305 West Broadway
Louisville, KY 40202

Lucienne Ricketts currently serves as the senior manager of Public Affairs and Cultural and Linguistic Services for Passport Health Plan in Louisville, Kentucky. Since 1999, Ms. Ricketts has provided oversight to the Plan’s efforts to become compliant with federal mandates related to persons with special communication needs. Her achievements in this area include serving as a speaker at five national conferences on cultural competency in the past two years.

lucy.ricketts@amerihealthmercy.org
(502) 585-7331
305 West Broadway
Louisville, KY 40202

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