Patients from linguistically and culturally diverse backgrounds experience health disparities and differential health outcomes compared to the overall population. By 2050, nearly one in five people living in the U.S. will be foreign born. Now, more than ever, it is time to reaffirm our commitment to reducing health disparities for patients of all linguistic and cultural backgrounds.
Achieving distinction in multicultural healthcare is a comprehensive strategy to improve an organization’s response to the health care needs of minority members and those with limited English proficiency (LEP). The National Committee for Quality Assurance (NCQA) Multicultural Healthcare (MHC) accreditation is broadly accepted as the seal of approval in healthcare. Because the evaluation process is performed by an external organization, accreditation status delivers an impartial opinion about the healthcare organization’s standard of quality.
Why Pursue Accreditation?
National Committee for Quality Assurance (NCQA) Multicultural Healthcare accreditation not only recognizes and lends credibility to organizations; it also helps them accomplish the following objectives:
- Identifying gaps in care (data, policy and practice)
- Establishing standardization
- Equitably serving all customers and communities
- Building a plan to address disparities
- Identifying opportunities for improved and enhanced patient experience
Over the last decade, the NCQA distinction scoring system has influenced the way healthcare organizations prepare for MHC accreditation. In 2020 alone, however, we’ve seen the United States and the rest of the globe reinvigorate a social justice movement as a global pandemic put a major spotlight on health disparities and inequality. With the focus on quality of care, this cultural transition means keeping up with MHC requirements is more important than ever. As you take steps to correct inequities, you will begin to see
- Improved outcomes
- Decreased costs
- Higher ratings from your members
Earning the Distinction
NCQA publicly reports quality results, ensuring a fair and consistent comparison among all applicants. In order to become accredited, organizations must demonstrate the following:
- Collection of race, ethnicity, and language data
- Identification and action on opportunities for improving culturally and linguistically appropriate services (CLAS)
- Provision of language services
- Reduction of healthcare disparities
NCQA scores equally on clinical performance, consumer experience, and a set of standards used to measure performance. Key things to keep in mind include
- Organizations must attempt to collect race and ethnicity data directly from members.
- Collected race and ethnicity data must be reported using the Office of Management and Budget (OMG) categories.
- Organizations must have a documented process for how it estimates race/ethnicity using indirect methods, e.g., geo coding and surname analysis.
- Organizations must maintain an electronic database that can receive, store, and retrieve race and ethnicity information at the individual member level.
- Organizations must report the HEDIS Race/Ethnicity Diversity of Membership Measures
The Role of Language
Studies and data collected for some time shows there are indeed disparities in healthcare, and members with limited English proficiency (LEP) suffer the consequences. Research indicates that emergency department (ED) patients with LEP are 24% more likely to have an unplanned ED revisit within 72 hours. Additionally, hospital stays are 50% longer for individuals with LEP than those of English-speaking patients with similar conditions. Plus healthcare costs -- including pharmacy costs -- are twice as much for those with limited English proficiency. Requirements for NCQA MHC accreditation directly play a role in closing the gap in health equity. Accredited organizations must
- Collect language data directly from members using the Institute of Medicine (IOM) method or another method
- Maintain an electronic database that can relieve, store, and retrieve information on language needs at the individual member level
- Every three years, use state or community-level data to determine the languages spoken in their service areas, both for translation purposes and to anticipate and plan for changes in language services provided
- Report up to 15 “threshold languages”—those spoken by 1% of the population or 200 eligible individuals, whichever is less
- Report the HEDIS Race/Ethnicity Diversity of Membership measure
To be successful, organizations should
- Share data with practitioners about the language needs of individual members and populations
- Provide language assistance resources to practitioners
- Make training available to practitioners
- Distribute a written notice in English and the threshold languages that free language services are available, including information on how to access them.
Evolution of the Process
As mentioned above, growing awareness of widespread health disparities during the Covid-19 pandemic has led healthcare organizations to strengthen their existing health equity efforts and initiatives. This is, however, a complex and ever-changing process. Some of the criteria that have changed in recent years include
- The look-back period for renewal surveys prior to July 1, 2021 is 12 months and 24 months after July 1, 2022. (The current look-back period is six months.)
- Updated scope of review sections address evidence required for initial surveys and renewal surveys.
Organizations are expected to monitor and assess their program annually through data and information captured via staff and member/patient experience. Every three years, they must analyze and enhance network responsiveness by
- Analyzing their network’s capacity to meet the language needs of members
- Analyzing the cultural responsiveness of their networks
- Developing plans and implementing steps to address network gaps in the availability of languages and/or cultural responsiveness
Guidance for Language Services, MHC accreditation and Beyond
If all the requirements have your team scrambling, ULG can help. From a new accreditation, renewal, or training, our experts are ready to guide your team through the entire accreditation process. For more information about meeting the language needs of diverse populations