Ethnic Marketing

Attracting a Diverse Health Plan Membership Through Culturally and Linguistically Appropriate Care

by Patricia Marine Barrett

In California, health plans are discovering that they can satisfy members and attract new clients by offering culturally and linguistically appropriate services. It’s clear that, in order to grow their market share, health plans must attract racial and ethnic minorities and the businesses that employ them. California is among the nation’s most diverse states. Latinos comprise over 36% of the population and Asians comprise 12.5%. According to the UCLA Center for Health Policy Research, 3.4 million of California’s adult HMO enrollees speak a language other than English at home.

There are approximately 50,000 Latino-owned businesses with paid employees in California, most of which do not offer health insurance, according to a study funded by the California HealthCare Foundation. Many of these employers would consider offering insurance if they had information presented simply, concisely, and bilingually. The study also found that Latino employers do not interact frequently with brokers and don’t think of brokers as good sources of information. They are concerned about whether buying through a broker costs more, whether brokers provide unbiased information, and whether they can establish trust with a broker.

As the U.S. population becomes more diverse, medical providers and others in healthcare delivery are interacting with patients from many cultural and linguistic backgrounds. Providing culturally and linguistically appropriate services (CLAS) can improve access to care; improve the quality of care; and improve health outcomes since culture and language are vital factors in how healthcare services are delivered and received. The Office of Minority Health (OMH) has developed national standards to provide a much-needed alternative to the patchwork of independently developed definitions, practices, and requirements concerning CLAS.

Going Beyond State-Mandated Requirements

As of January 1, 2009, health plans must comply with Senate Bill 853, the California Language Assistance Program (CALAP). The bill requires plans to assess the language needs of its members; arrange for language assistance services; train staff; and monitor compliance with the legislation. Cindy Ehnes, director of the Department of Managed Health Care said the bill will ensure that California health plan members get healthcare services in a language that they can speak and understand.

Several health plans have gained national recognition through the National Committee for Quality Assurance’s (NCQA) annual award program, “Innovations in Multi-Cultural Healthcare,” sponsored by The California Endowment. But, as the NCQA awards underscore, some health plans are going well beyond minimum mandated requirements in an effort to dramatically improve access to care and reduce health disparities among health plan members.

California health plans are developing innovative programs to serve Latino, Asian, and African-American members. Since 2007, Kaiser Permanente, United Healthcare, Aetna, Wellpoint, L.A. Care Health Plan, and Chinese Community Health Plan have been among the dozens of plans from around the nation recognized for efforts ranging from reducing disparities in cancer screening and diabetes care, to providing in-language physician directories and improved service through cultural competency language certification. Here is a highlight of some of the efforts:

• In 2008, Kaiser Permanente was recognized for its Primary Care Language Concordance Program, which matches patients with physicians who are fluent in a patient’s preferred language. The program improved language matching and helped foster a culture that encourages multilingual skills. In 2008, the program resulted in approximately 93,000 more linguistically matched appointments.
• L.A. Care Health Plan serves nearly 800,000 county residents through free or low-cost programs. It sought to work with community resources to improve women’s health services among ethnic and racial minorities. The program is paying off with improvement in women’s health measures, such as the HEDIS breast cancer screening measure. More than 90% of health plans use HEDIS (developed by NCQA) to measure performance on important dimensions of care and service.
• United Healthcare’s Latino Solutions program tackles the challenge of ensuring that 2 million Hispanic members, nationwide, have effective interactions with the plan. United has used customer service professionals who are trained and certified to communicate with Spanish-speaking members and found that satisfaction among members increased from 65% to 90%.
• Blue Cross of California sought to reduce disparities in asthma management through long-term controller medications among low-income families. These families have a higher prevalence of asthma. The initiative focused on assistance from local pharmacists who were encouraged to provide consultations when qualifying members filled asthma prescriptions.
As these efforts improve satisfaction among members, health plans have a growing potential for increased membership and recognition in targeted ethnic markets, creating a platform on which to grow new business. These and other innovative programs addressing cultural and language issues are featured in detailed reports available from NCQA (www.NCQA.org/clas.aspx).

Earning Distinction in the Marketplace

California health plans will soon have the opportunity to differentiate themselves even further in targeted ethnic markets if they apply for the NCQA “Distinction,” which launches in 2010. Plans have to meet several requirements to earn “Distinction” for their cultural and linguistic efforts including the following:

• Having voluntary data collection that enables health plans to understand the language and cultural diversity of its members.
• Providing materials and services in the members’ languages, particularly in critical patient and member service departments, such as claims, case management, complaints, etc.
• Offering interpretation services for anyone who needs these services and supporting practitioners to offer these services during healthcare delivery.
• Maintaining a practitioner network that meets members’ cultural and linguistic needs.
• Integrating improvements in cultural and linguistic responsiveness and improvements in reducing disparities among members into ongoing quality improvement processes.
• Using information to focus quality improvement efforts on decreasing healthcare disparities for conditions such as asthma, diabetes, heart disease, hypertension, prenatal care, immunization, and cancer screening.

Jessica Briefer French, NCQA senior consultant says, “Earning the mark of ‘Distinction for Multicultural Health Care’ will be a logical next step for many plans that already comply with S.B 853 and want to take serious efforts to provide culturally and linguistically sensitive care. Applying for Distinction makes sense for plans that want to appeal to a wide demographic, not only for marketing, but also for improving patient safety and quality of care.”

Reducing healthcare disparities is an issue that gained wider understanding and attention following the 2003 release of the Institute of Medicine report, “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care.” Reducing disparities is a top policy goal for the Dept. of Health and Human Services (HHS). This goal is also included in national health reform proposals. For health plans and brokers, excelling at culturally and linguistically effective services is a straight path to differentiation in the marketplace and enhanced marketing efforts to ethnic minorities.
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Patricia Marine Barrett is NCQA vice president of Product Development. She is responsible for exploring new product concepts and evolving existing products to meet the needs of a changing healthcare environment. Previously, she was Health Alliance Plan Associate vice president and program director for the HAP/GM Managed Care Consulting Team. During her 14 years with HAP she served in a variety of roles including manager of Research, Analysis and Program Development, Acting Director of Managed Care Information and director of Quality Management. Ms. Barrett attended the University of Michigan receiving her Bachelors degree in Sociology and a Masters Degree in Health Services Administration from the School of Public Health. For more information, visit http://www.ncqa.org.