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Workshop D-6: Building the businness case for culturally and linguistically competent care and reducing health disparities: a roundtable discussionBuilding the business case for culturally and linguistically competent care and reducing health disparities: A roundtable discussionThe goal of roundtable sessions is to explore critical issues and model programs in an interactive, moderated discussion with roundtable participants and the audience. As part of launching the discussion, each invited roundtable participant will be asked to introduce themselves and their program/expertise in short, 15 minute presentations. The moderator will then pose questions to the panelists about successes and challenges in the field, what work needs to be done now and in the future, and brainstorming of recommendations for policymakers and funders. The audience will be invited to share their questions, ideas, and concerns, and ideally, a lively discussion will follow. This session will focus on different approaches to conceptualizing and making the business case for culturally and linguistically competent care and for reducing health disparities. Among the issues to be raised in this session are:
The participants in this session are: Edward L. Martinez, MPA Assistant Vice President, National Association of Public Hospitals and Health Systems (Washington, DC) Yolanda Partida, MSW, DPA Director National Program Office, Hablamos Juntos; Tomás Rivera Policy Institute, School of Policy, Planning & Development, University of Southern California (Los Angeles, California) Courtney Rees Program Associate, National Business Group on Health (Washington, DC)
Participant abstracts and bios can be found on the following pages.
NAPH Perspective on the Case for Cultural CompetenceEdward L. Martinez, M.S. Assistant Vice President, The National Association of Public Hospitals and Health Systems, Washington DC The National Association of Public Hospitals and Health Systems represents over 100 hospitals and health systems that together comprise the essential infrastructure of many of America's largest metropolitan health systems. NAPH members serve a substantial proportion of patients who are uninsured, underinsured, or covered by the Medicaid program. For fiscal year 2001, an average of 62 percent of patients discharged from NAPH hospitals were either covered by Medicaid or uninsured. During this same time period 81 NAPH members provided over $37 billion in patient services, an average of more than $462 million per member hospital system. Many of the patients cared for by NAPH hospitals and health systems are considered at risk: the elderly, low-income children and families, minorities, people with limited English proficiency, and people with chronic illnesses like HIV/AIDS, mental illness, diabetes and asthma. Individual public hospitals last year responded to as many as 130,000 requests for interpreter services. In addition, NAPH members provide essential care for all the members of their communities through emergency and trauma departments, burn care, neonatal and pediatric intensive care, and emergency psychiatric services. For major public hospitals and health systems across the country, providing health care in a culturally competent manner is crucial to quality of care, patient satisfaction, successful staff training and recruitment, and the financial viability of safety net institutions. Far from being a supplemental activity, culturally and linguistically appropriate practices are a fundamental part of the mission of these organizations. U.S. public hospitals and health systems have long been the “health care providers of first resort” for arriving immigrant groups of virtually every ethnic and language background. These institutions have been on the forefront of responses to the processes of social, economic, and demographic change. Out of necessity, programs demonstrating linguistic, clinical, educational, and administrative competencies have been developed and modified to meet the needs of diverse and vulnerable patient populations. Confronted with the issues raised by rapid change in a community, NAPH member hospitals and health systems have responded to these challenges despite operating in an environment characterized by overburdened and constrained financial reimbursement mechanisms. Lacking sufficient resources, public hospitals and health systems serve their culturally and linguistically diverse patient population with a variety of innovative practices, many developed by entrepreneurial leaders and staff. Increasingly, Public Hospitals and Health Systems have recognized the importance of effective management and leadership to better serve their culturally and linguistically diverse patient populations. The case for investment in cultural competence, including the business case, has emerged as a major concern for the institutional leadership and governing boards of these institutions. Identifying a Case for Cultural Competence Cultural competence practices refer to programs and procedures aimed at reducing health disparities by improving access, eliminating language and communication barriers, and providing culturally sensitive clinical treatment. Cultural competence practices at NAPH member hospitals and health systems can be categorized under five domains: clinical services, language services, staff training, infrastructure, and community relations. 1 Although cultural competence practices are widespread among members of the National Association of Public Hospitals and Health Systems, their adoption strains severely limited resources. For example, language services for individuals who do not speak English are required of all health care providers who receive federal funding including those who serve Medicaid, Medicare, and SCHIP enrollees. Despite the federal mandate, only ten states directly reimburse providers for language services. 2 There are a variety of incentives to reduce racial and ethnic disparities in health services. For example, moral, social or regulatory incentives may establish a compelling case to adopt cultural competence practices even when a business case cannot be made. The mission of safety net hospitals and health systems is to care for all the residents of a community regardless of their ability to pay. Because culturally competent practices enhance the quality of care to many patients at NAPH member institutions, these practices are a priority because they are consistent with the mission of the safety net institution. Establishing the business case can, however, garner institutional or financial support, for those audiences or situations where social incentives alone are insufficient. A business case is focused on the benefits, especially financial, that may accrue to an institution, if effective cultural competence practices are established. While the business case for cultural competence has important implications, the total case for cultural competence should incorporate the importance of quality and safety of and access to care. Many questions regarding the case for cultural competence remain: For example, Leatherman, et al, identify four basic questions to establish a business case, which are pertinent to considering the effectiveness of the business case in advancing cultural competence:
Additional questions include:
Edward L. Martinez has nearly thirty years of experience as an executive and manager in the public sector. Prior to joining NAPH, he was Associate Director for Programs with the American International Health Alliance in Washington DC, a USAID-supported organization that manages health care partnerships between U.S. health care systems and those in countries of the former Soviet Union and in Central and Eastern Europe. In addition, Mr. Martinez served over twenty-five years with the County of Los Angeles, where he specialized in hospital administration and human resources management. He managed one of the largest public hospitals in the U.S. as executive director of Los Angeles County+University of Southern California Medical Center and held key management positions at Harbor-UCLA and Martin Luther King, Jr.-Drew Medical Centers. In addition to earning a masters degree in public administration, Mr. Martinez completed NAPH fellowship programs in health care policy and management. Mr. Martinez has had extensive experience managing safety net institutions with highly diverse patient populations. Mr. Martinez is a member of a number of national committees and advisory groups addressing issues of cultural competence, disparities, and health care quality, such as the Technical Advisory Panel to the Joint Commission on Accreditation of Healthcare Organizations, the National Advisory Panel for the Health Research and Educational Trust project on eliminating disparities in healthcare, and Kaiser Permanente and the Care Management Institute for collaboration on chronic care management with a focus on addressing health disparities.
1 National Public Health and Hospital Institute. Serving Diverse Communities in Safety Net Hospitals and Health Systems. May 2003. 2 National Health Law Program and The Access Project 2003: Language Services Action Kit.
Hablamos Juntos: Improving Patient-Provider Communication for LatinosYolanda Partida, MSW, DPA, Director, Hablamos Juntos National Program Office Federal Legislation (Title VI Civil Rights Act of 1964, White House Executive Order 13166) mandates that language services be provided to Limited English Proficiency (LEP) members of the community by health care providers that receive federal funding. According to the U.S. Census 2000, 11.8 million persons over the age of five speak English “less than well”. Rapid growth in newly arrived populations who speak various languages are changing the practices of health providers large and small. Health care providers are unprepared to accommodate to the language needs of these new populations. Language barriers impede patient-provider communication increasing the likelihood something will be lost or resulting in patients foregoing care. Therefore, it is not surprising that language barriers are often associated with higher burden of disease and adverse health outcomes. Delays or inappropriate care have costly implications for patients, providers and communities at large. This presentation examines the business case for language services from a health provider and a community perspective. The presenter contends that the need for language services is a community problem confronting all business and social sectors and affordable solutions will require community approaches. Health organizations are using limited health care dollars to develop language services programs. The cost of developing untested approaches, unresolved ambiguity about the role of health interpreters and the absence of locally supported training programs to produce a pool of trained interpreters is being absorbed by pioneering health leaders. Rather than looking for community level solutions, health organizations and regulators take a myopic view of the problem and employ costly solutions with questionable results. This presentation reviews the cost of language barriers on patients, providers and local communities. It also discusses development and operational costs associated with language services and presents promising alternative community level solutions that leverage economies of scale. Yolanda Partida, MSW, DPA. Ms. Partida is National Program Office Director for Hablamos Juntos: Improving Patient-Provider Communication for Latinos an initiative of The Robert Wood Johnson Foundation to improve access to quality health care for Latinos with limited English proficiency (LEP). Hablamos Juntos (We Speak Together) is investing $10 million in 10 demonstration sites around the country, with new and fast-growing Latino populations, to develop affordable ways health providers can offer language services. Grantees are implementing seven program requirements in three benchmark areas: 1) Increasing the availability and quality of interpreter services, 2) developing useful health related materials in Spanish, and 3) supporting the development of symbols-base signage to help patients find their way around health care facilities. Dr. Partida has extensive experience in public teaching and private hospital administration, as well as public health administration and public policy. She is the founder and Executive Director for The Partida Group, a Latina-owned health policy, research, and management consulting firm specializing in diverse populations. Dr. Partida received her DPA from the University of Southern California, School of Policy, Planning and Development.
National Business Group on Health: Why Companies Are Making Racial/Ethnic Health Disparities Their BusinessCourtney Rees, Program Associate, National Business Group on Health, Washington, DC 20001 Employers believe that they are getting the same health care for all of their employees. In some instances, they are paying for care that is inappropriate or inadequate for their employees. They believe they are treating all employees appropriately according to medical need, but their employees and dependents may be over-served or under-served in the health care system. These disparities may exacerbate large employers’ already daunting task of ensuring quality health care while moderating increasing health care costs. Large employers drive the health care marketplace in many ways and are well poised to leverage their collective resources to bring necessary changes in the way health care services are delivered.
The Possibility of Decreased Direct Costs The Possibility of Decreased Indirect Costs Large employers have another incentive for working to reduce disparities in health and health care. The U.S. Bureau of Labor Statistics projects that over the next decade, racial and ethnic minorities will account for 41.5% of the workforce. Large employers, then, have a vested interest in ensuring that health care treatments and services, for which they are paying, are of the highest quality and deliver the greatest value. The Retention in the Workforce of Racial and Ethnic Minority Employees Courtney Rees serves as a Program Associate at the National Business Group on Health. In her position, she works on projects and resources that focus on preventative and health promotion activities in the corporate sector. Currently, Ms. Rees works on the Racial and Ethnic Health Disparities Initiative at the Business Group. It is a multi-pronged effort to: provide information to large employers about the impact of health disparities on the quality of health care among their employees; create practical strategies on how employers can purchase health care for an increasingly diverse working population; and serve as a link between the business and public health communities. Ms. Rees holds a BA with Honors and Distinction in Human Biology – with a concentration on Race/Ethnicity and Health Care Policy – from Stanford University.
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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,
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