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Value Base Care: The New Cultural Competence Paradigm

Value Based Care – The New Cultural Competence Paradigm

Language and cultural diversity manifest themselves in many ways – use of qualified interpreters and translators, cultural competent education and training, and diverse work forces and organizational leadership. Such diversity, of course, is more than just for the sake of appearances. Study after study demonstrate the real world, tangible benefits of cultural competence and language access – such as a more productive workforce, more profitable companies, investing in outreach to new customers through cultural and language affinities.

Cultural competence and language access serendipitously dovetail with one of the biggest current trends in health care – value-based care and increased patient engagement.  It is axiomatic that for patients to be engaged and to participate in their care, they must understand what is being offered and communicated to them, through culturally and linguistically proficient care.

The Switch to Value-Based Care

According to the March 21st edition of Modern Healthcare:

“For the move to value-based care to succeed, the healthcare industry must give patients more agency CMS [Center for Medicare and Medicaid Services] representatives told members of Congress…

“As hard as it is to put patients in the driver’s seat, at the end of the day, it’s really the only solution,” Demetrios Kouzoukas, principal deputy administrator for CMS, told the U.S. House of Representatives Ways and Means Committee’s health subcommittee [on March 21]. “The patient is the one experiencing sickness and making choices about their care.”

Many health care organizations have taken notice – reexamining cultural and language proficiency and culturally specific messaging as effective ways to engage patients, bring in new customers and keep their loyalty through respect for their language and cultural preferences.  Baylor Scott & White Health in Dallas is one of the more prominent, recent examples of this trend with the 2018 opening of its Baylor Hispanic Kidney Transplant Center.

The Transplant Center features appropriate language assistance for the Center’s large Spanish speaking clientele. In addition, the Center provides education that is directed to alleviating and resolving misunderstandings in the Spanish-speaking community about the kidney transplant program.

As Baylor explains:

“… At the Hispanic Kidney Transplant Center at Baylor Dallas, we offer more than just an interpreter- we create a supportive environment for you and your family. We offer comprehensive culturally-competent services including individual education by the bilingual transplant surgeon as well as bilingual group education sessions for family members.  We customize patient care not only for specific medical treatments, but also to recognize the cultural differences that affect each patient individually.”

According to a report by NBCTV-DFW:

“The Hispanic kidney transplant program is the first kidney transplant program of its kind in the Southwest tailored for the Hispanic and Latino communities. The program involves education courses in Spanish by a bilingual transplant surgeon as well as bilingual group education sessions for family members.

Dr. Richard Ruiz heads the program designed to increase the number of living kidney donors among the Hispanic population. Hispanics comprise 40 percent of patients on the kidney transplant wait list, but the number of living donors is very low when you compare it to the white population,” Diaz said.

Juan Bautista is one of the first kidney transplant recipients to go through the program. “I have two cousins. One of them died because of kidney failure. The other one, her mom gave her a kidney, but they’re back in my country and I’m here, so we didn’t know much about it,” Bautista said. “Our people, Spanish people, they’d rather go to work then spend one day going to the doctors,” he said.

Ruiz sees cultural barriers in his patients. “They tend to think it’s experimental. One of the information pieces I give is there are 6,000 transplants a year. That’s about 100 a week, so they need to know this is a common operation,” he said…

Johns Hopkins University researchers found that despite efforts over the past two decades to increase the number of black and Hispanic patients receiving kidney transplants from related or unrelated living donors, these racial-ethnic minority patients are still much less likely to undergo such transplants than white patients. In fact, the investigators say, the disparities have worsened in the last 20 years.”

Implementing Cultural Competent Patient Care

Baylor’s new program is one of a growing number of culturally and linguistically oriented health care initiatives to foster patient engagement. Such programs highlight both appropriate language assistance through qualified interpreters and translators but also educational components that appeal to the diverse groups that are being targeted as new patients and customers. These innovations effectively take cultural competence and language access to a new level, one that connects diversity and cultural awareness to new business opportunities while also seeking to alleviate issues of healthcare equity and disparity.

For example, according to the America Hospital Association:

“To further advance the health care and well-being of the region’s adult Latino community, the Centro de Salud LatinoAmericano program was created to serve as a bilingual and bicultural physician practice in internal medicine. … [A]dvanced practice clinicians and staff members provide educational and outreach activities to empower community members to increase their self-confidence and skills in managing and preventing chronic illness.

Meridian [Health] has developed a program with cultural ambassadors—nurses who champion cultural best practices and protocols. This program is designed to build positive relationships between nurses and patients, and to increase sensitivity and awareness of cultural nuances associated with the decision-making process and health care preferences of patients. Cultural ambassadors serve as “go-to” staff for each Meridian nursing unit…”

NYU Lutheran Hospital leadership embarked on a program to increase its imprint with the Arabic and Chinese speaking communities within the hospital’s New York City market. Leadership settled on a program of cultural and linguistic diversity to help the hospital’s involvement with these communities.  As the American Hospital Association notes, the hospital’s effort has succeeded:

“At NYU Lutheran, 39 percent of patients prefer not to speak English when receiving medical care. Leadership also ensures that all shifts at each health center include culturally and linguistically diverse staff members. These efforts have resulted in an increase in the number of patients from these various communities who use the hospital. In the 10-year period from 2004 to 2014, Hispanic patients have increased from 15 percent to 21 percent of all patients, Arabic-speaking patients have increased from 1 percent to 2 percent, and Chinese-speaking patients have increased from 4 percent to 6 percent of all patients at the hospital. The Chinese unit was expanded to the entire hospital, and Chinese staffing has increased throughout the hospital.”

Final Thoughts

Cultural and linguistic diversity and awareness programs, such as those at Baylor, NYU, and other healthcare providers are here to stay. These programs not only attract and keep new customers, they also are critically important for improved patient communication and outcomes.  This new paradigm can thus be seen as a clear win-win, having several advantages – improving patient health, engagement, cultural competence and language access, and care options while securing new revenues for health care providers, revenues that more than pay for the cost of ensuring patient safety and well-being by speaking in ways that patients understand and appreciate.

**Read some of  Bruce Adelson’s other blog posts to learn about more developments in language access law, and be sure to contact us if you’re interested in a consultation about your own organization’s compliance with federal language access law.

© Bruce L. Adelson 2018, special for Bromberg, All Rights Reserved The material herein is educational and informational only.  No legal advice is intended or conveyed.

Bruce L. Adelson, Esq, CEO of Federal Compliance Consulting LLC is nationally recognized for his compliance expertise concerning many federal laws.  Mr. Adelson is a former U.S Department of Justice Civil Rights Division Senior Trial Attorney.

Mr. Adelson teaches cultural and civil rights awareness at Georgetown University School of Medicine in Washington, D.C.

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