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Improving health care for immigrant and minority populations in the US

Improving health care for immigrant and minority populations in the US



Using practice, policy, and strategic alliances to improve access to and quality of care for diverse populations

Using practice, policy, and strategic alliances to improve access to and quality of care for diverse populations



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  • Julia Puebla Fortier Director Resources for Cross Cultural Health Care 420 rue des Ouches 01210 Versonnex FRANCE [email_address] www.diversityRx.org
  • References for selected projects/publications: CLAS standards http://www.omhrc.gov/templates/browse.aspx?lvl=2&lvlID=15 Research agenda on CLAS: Report highlights (without the literature abstracts and full research agendas): http:// www.ahrq.gov/research/cultural.htm Full report (online and PDF download) http:// www.omhrc.gov/templates/content.aspx?ID =86 Biennial conference series: www.diversityRxconference.org CLAS-talk listserv: http://www.diversityrx.org/HTML/NESIGN.htm Your Voice project: www.diversityRxconference.org/YourVoice
  • US DHHS Office of Refugee Resettlement http://www.acf.hhs.gov/programs/orr/index.html
  • Community health centers: http://www.hrsa.gov/culturalcompetence/ Public hospitals: Serving Diverse Communities in Hospitals and Health Systems www.naph.org, search publications
  • Cross Cultural Health Care Program www.xculture.org Community Health Services Program http:// www.diversityrx.org/html/MOBISA.htm Asian Health Services www.asianhealthservices.org / National Council on Interpretation in Health Care www.ncihc.org
  • Title VI (this is the Federal requirement for offering language access services): http:// www.usdoj.gov/crt/cor/lep/hhsrevisedlepguidance.php http://www.hhs.gov/ocr/civilrights/activities/examples/LEP/complaintcompliance.html http://www.hhs.gov/ocr/civilrights/resources/specialtopics/hospitalcommunication/index.html State activity: http://www.healthlaw.org/library/item.174993
  • US Department of Health and Human Services Office of Minority Health www.omhrc.org
  • CLAS Standards: http:// www.omhrc.gov/templates/browse.aspx?lvl =2&lvlID=15
  • IOM report: “Unequal Treatment” http:// www.iom.edu /?id=16740 (you can read it online without charge)
  • Joint Commission http:// www.jointcommission.org/PatientSafety/HLC / National Committee for Quality Assurance NCQA awards program, best practices and toolkit: http://www.ncqa.org/tabid/451/Default.aspx Proposed CLAS standards within their overall standards framework: http://www.ncqa.org/Portals/0/PublicComment/2010_Products_Update/Appendix_3_Creation_of_CLAS_Standard.pdf http://www.ncqa.org/Portals/0/PublicComment/2010_Products_Update/Appendix_2_Incorporating_Aspects_of_CLAS.pdf National Quality Forum Project summary: http:// www.qualityforum.org /projects/ongoing/cultural-comp/ Framework summary: http://www.qualityforum.org/pdf/projects/cultural-comp/txReportDraft%2002-25-09PREPUB.pdf
  • The California Endowment: www.Calendow.org , click on: Publications -> Program Areas -> Cultural Competent Health Systems The Robert Wood Johnson Foundation www.rwjf.org Search cultural competence and interpretation for a full list of publications and projects The Commonwealth Fund: http://www.commonwealthfund.org/Grants-and-Programs/Browse-Grants.aspx?program = Health+Care+Disparities Also search cultural competence and interpretation for a full list of publications and projects The WFF Kellogg Foundation www.wkkf.org

Improving health care for immigrant and minority populations in the US Improving health care for immigrant and minority populations in the US Presentation Transcript

  • Improving health care for immigrant and minority populations in the United States Using practice, policy, and strategic alliances to drive change Julia Puebla Fortier Resources for Cross Cultural Health Care
  • Resources for Cross Cultural Health Care
    • Policy development
      • National CLAS Standards
    • Research
      • Research agenda on cultural and linguistic competence
    • Education
      • Biennial conference series
    • Information dissemination
      • Newsletter and DiversityRx website
    • Professional networking and support
      • CLAS-talk listserv and ‘Your Voice’ project
  • Outline
    • Financing and access to health services in the U.S.
    • Key forces and players
    • Role of service delivery innovation
    • Research on disparities and barriers to care
    • Policy structures and models
    • Non-profit and for-profit sector contributions
    • Role of strategic alliances
  • Health care insurance in the U.S.
    • (Employment-based) private insurance
      • Through networks of government and private providers
    • Government insurance
      • Medicare (elderly, disabled)
      • Medicaid (low-income)
      • Through participating providers
  • No insurance
    • Government/NGO clinics and hospitals
      • Sliding scale fees
      • ‘ Charity’ care as part of mission
    • Private providers
      • Self-pay
      • Unreimbursed care (loss)
  • Refugees and health/social services
    • Government-funded resettlement program
      • Local/regional health departments
      • Voluntary Agencies
      • Mutual Assistance Agencies
    • Community clinics/hospitals
    • Private practitioners
  • Immigrants and health/social services
    • May have employment-based health insurance
    • Sometimes have Medicaid
    • Use of community clinics, hospitals
    • Often self-pay
    • Immigration status
      • Legal – government program eligibility
      • Undocumented – neither public nor private insurance
  • Key forces in improving access and quality of care for immigrants and minorities
    • Minority health and civil rights
    • Cultural and linguistic competence
    • Health disparities reduction
    • Quality improvement
    • The ever-elusive goal of cost-effectiveness
  • Key players
    • Minority and civil rights leaders
    • State and local health departments
    • Front-line providers in diverse communities
    • Health services researchers
    • State and national policy leaders
      • Federal government
      • National health professional and quality organizations
    • Private foundations
  • Service innovation: Community oriented providers
    • Community health centers
    • Public hospitals
    • Public health departments
    • Health education programs run by community based organizations
  • Service innovations for diverse populations
    • Medical interpretation and translation services—on-site and telephone
    • Cultural competence training
    • Use of cultural mediators/community health workers
    • Patient/community involvement in governance and planning
    • Technical assistance to other health care organizations on health/social/cultural/linguistic issues specific to ethnic minority populations
  • Power of service innovations
    • Community-oriented providers had legal mandates to be responsive to the needs of underserved populations  
    • They inspired and raised the performance bar for other providers
    • They drove the development of policy: gov’t requirements/programs need models and a track record of success
  • Policy framework
    • Minority health agenda (programmatic)
    • Refugee resettlement programs
    • Civil rights laws
    • State laws and regulations
    • National CLAS Standards
    • Minority health disparities reduction
    • Quality improvement agenda
  • Offices of Minority Health
    • Legislation to strengthen and expand the scope of the federal Office of Minority Health and related programs (1990-)
      • Additional funding
      • More specificity about language and cultural issues
      • Increase number of minority health professionals
      • Support for state Offices of Minority Health
  • Development of National CLAS Standards
    • CLAS: Culturally and Linguistically Appropriate Services in Health Care
    • Research on model programs and policies
    • Identification of common elements
    • Draft standards—aimed at health care organizations
    • National public comment period
    • Publication in the Federal Register
  • CLAS Standards: Categories of interventions
    • Culturally Sensitive Interventions
      • Cultural competence education
      • Race, ethnic and linguistic concordance
      • Cultural mediators, community health workers and culturally competent health promotion
    • Language Assistance
      • Bilingual services, oral interpretation, translated written materials
  • CLAS Standards: Categories of interventions
    • Organizational Supports for Cultural Competence
      • Management and policy strategies
      • Community engagement
      • Information and data for planning and evaluation
      • Appropriate ethics and conflict resolution processes
  • Unexpected impact
    • Highly symbolic impact
    • Raised profile of the issue
    • Spurred discussion, controversy, refinements
    • Offered an organizing framework
    • Prompted action
  • NGOs and research, policy development, and advocacy
    • Research and tool development to enhance knowledge and good practice
    • Consensus-building to advance key issues
    • State and federal policy analysis and policy formulation
    • Awareness-raising and advocacy to improve practices and policy structures
  • Research on disparities and barriers to care
    • Government and foundation funding for research on minority/immigrant populations
      • Barriers to care
      • Comparative health status
      • Effectiveness of targeted interventions
    • Institute of Medicine Report: “Unequal Treatment”
    • New government initiatives to address health disparities
  • Role of Strategic Alliances
    • Decision to reach beyond traditional ‘advocates’ to mainstream health stakeholders
    • Key role of money and convening power of foundations and government health agencies
    • Demonstrate the relationship between emerging national health agendas and this population
  • Synergy and support
    • Identify who has the power in health policy making
    • Bring them to the table
    • Show how their agenda can’t succeed unless these concerns are integrated
    • In time, they become your allies
  • State and Federal policy level
    • States: coalitions of community clinics, ethnic community organizations, civil rights advocates working with sympathetic health department officials and elected representatives
    • National: data from state and local programs, combined with national ethnic organizations, elected representatives and their staff. Federal health agencies not so sympathetic at first, except at Office of Civil Rights
  • Examples: language access
    • 1995 briefing on language access –first time non-traditional stakeholders to the table
    • NHeLP language access coalition – informational at first, now working together for policy points in health care reform
  • Key issues and stakeholders
    • Patient centered care: medical societies
    • Quality of care: accreditation agencies, hospital associations
    • Patient safety/medical errors: risk managers/legal departments
    • Disparities reduction: NIH, AHRQ
    • Effectiveness/cost containment: public and private insurance agencies
  • Influence of quasi-regulatory agencies
    • Initiatives from key health care quality and accreditation organizations:
      • The Joint Commission
      • National Committee for Quality Assurance
      • The National Quality Forum
  • Role of for-profit sector
    • Service provider
      • financial support for language and cultural services
      • Uncompensated care
    • Companies that provide interpretation and translation services
    • Consultants who do training and program support
  • Foundations
    • Major players
      • The Robert Wood Johnson Foundation
      • The Commonwealth Fund
      • The WFF Kellogg Foundation
      • The California Endowment
      • Regional and community foundations
  • Final thoughts
    • Policy statements are not enough
      • Funding for demonstrations, evaluations, research, technical assistance
      • Impact of success
      • Awareness raising and advocacy to a broad and influential audience
      • Integration of the needs of diverse populations into broader health priorities
  • For more information
    • Julia Puebla Fortier, Director Resources for Cross Cultural Health Care
    • [email_address]
    • www.diversityRx.org