In the United States, 67.8 million people speak a language other than English, and for healthcare organizations, ensuring language access and health equity are critical for improving access to care and achieving optimal health outcomes.
In fact, 44% of Hispanic Americans say that communication problems from language and cultural differences are a major reason they have worse health outcomes than other adults, a recent Pew Research Center survey found.
Suboptimal language access can also affect healthcare coverage. A study in the Journal of Immigrant and Minority Health found individuals with Limited English Proficiency (LEP) are more than 5 times as likely to lose their Medicaid benefits after the redetermination process compared to those who are English proficient.
Ensuring meaningful language access and health equity, however, is an ongoing challenge.
Organizations are up against new and ever-changing compliance demands and must ensure they meet the regulations—and within the timeframes set forth.
While compliance is an imperative, organizations must move beyond compliance alone and prioritize a strategy and implementation plan that combines language, cultural competency, and accessibility to encourage patients and members to engage in their health while also moving the needle on health equity.
New Proposed Rules to Improve Language Access
As new proposed rules continue to be released, healthcare organizations will be grappling with increased and expanded requirements that are designed to ensure language access equity.
One such change is the Department of Health and Human Services (HHS)’s proposed rule to revise Section 1557 of the Affordable Care Act (ACA).
The new rule titled, “Nondiscrimination in Health Programs and Activities,” is designed to ensure that individuals with LEP have meaningful access to healthcare, without language or ability preventing optimal health outcomes.
Among the key updates to the proposed rule include creating and utilizing effective language access procedures that support meaningful access and compliance.
Although qualified translation and interpretation services are an important part of any language access procedure, they’re only a start.
Meaningful access that addresses health equity and improves outcomes requires an understanding of individuals including their:
- Cultural considerations
- Preferred methods of communication
- Health literacy levels
For certain populations, interpreters may also need soft skills and emotional intelligence to engage multicultural members in their healthcare.
Recently, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would revise regulations for Medicare Advantage (MA or Part C), the Medicare Prescription Drug Benefit (Part D), Medicare cost plans, and Programs of All-Inclusive Care for the Elderly (PACE).
Although Medicare Advantage plans must already provide culturally-competent care, the proposal would expand the current CMS requirement for providing culturally competent care and increase the list of populations to include linguistically and culturally diverse populations as well as those:
- With disabilities
- With diverse sexual orientations and gender identities
- Who live in rural areas
- Who are affected by persistent poverty or inequality
How to Ensure Meaningful Language Access
As populations continue to grow more diverse, implementing a strategy to ensure meaningful language access will prove vital for organizations looking to better educate and engage consumers, improve health outcomes, and achieve their business objectives. Here’s how to get started.
Create a language access plan
With a language access plan in place, individuals with limited English proficiency have the tools necessary to access the health information they need in their care, as well as effectively communicate with medical and administrative staff.
The language access plan is a codified organizational policy that describes, in detail, how an organization provides communication assistance services.
The plan empowers healthcare organizations to address the physical, mental, and emotional well-being of the populations they serve.
Additionally, the plan reduces avoidable hospital readmissions and prevents the risk of misdiagnosis, mortality, low satisfaction and retention rates, and poor health outcomes.
The first step to developing a language access plan requires a healthcare organization to understand the demographics of the communities they serve including their needs and preferences.
For example, an organization can offer language translation and interpretation services, but expertise and cultural awareness are critical to ensure they are meeting the consumers’ needs and providing meaningful language access.
A language access plan should be customized for your organization, but CMS outlines 5 proposed sections that might be included:
Needs assessment: an understanding of the demographics of the population including the number of individuals with LEP, as well as places and ways in which they interact with your organization.
Language services: a description of the services that will be provided such as video remote interpreting (VRI).
Notices: a description of how you will make your patients and members aware of the services you offer.
Training: a description of how you will provide training for staff on policies and procedures for services.
Evaluation: a plan for how you will monitor and update the language access plan, policies, and procedures.
Keep in mind that the language access plan should be updated over time as your organization or the population that you serve changes.
Offer alternative formatting
Health plans, in particular, must accommodate language access as well as alternate format requests to ensure their members are informed and are in compliance with applicable laws.
Language access ensures consumers with limited English Proficiency (LEP) are provided the information they need in the languages of their choice. This might include written translation and over-the-phone interpreting (OPI), for example.
Alternative formatting, on the other hand, allows those with disabilities to access a variety of written documents in the version(s) of their choice. These may include:
- Large print
- Digital accessibility
Keep in mind, however, that alternative formatting is not a one-size fits all approach, so it’s important to accommodate the range of formats that are appropriate for the population or communities you serve.
Ensure communications are in preferred languages
Individuals with low healthcare literacy are more likely to have poor outcomes including hospital stays and increased emergency room utilization.
LEP individuals, in particular, may have limited health literacy in English as well as their native language, which makes communication that much more challenging.
It’s important, therefore, to make healthcare education communications available in the preferred languages of your populations and ensure they’re written in a clear, simple way and on a 5th grade reading level.
Bilingual care liaisons can be helpful in educating, connecting with individuals at the local level, and helping to support the social determinants of health that impact access.
Prioritize culturally-relevant communications
Although translation and interpretation are important, cultural competence is necessary to address the differences that exist among multicultural populations.
Yet individual barriers to achieving cultural competency exist.
For example, some individuals may have cultural backgrounds in which asking questions about care is discouraged. For others, distrust of prescription medications or treatment for mental illness can be a barrier to care.
Healthcare organizations should first recognize that if a culturally-diverse patient or member seems to be disengaged in their care doesn’t mean that they are.
Instead, bridging cultural gaps and engaging with them in ways that build trust is key.
One way to overcome the most common cultural barriers is to culturally-adapt communications and outreach such as:
- Patient education
- Condition management
- Health plan & benefit materials
- Preventative health information
The Path to Meaningful Language Access
Before implementing any organizational strategy, it’s important to have a plan in place to evaluate and improve your current language access plans and services.
United Language Group’s language access acceleration roadmap is a free resource to help you assess your current language access plan and make changes according to your evolving business needs so you can achieve an optimal ROI.