All materials © 2015, National Committee for Quality Assurance

October 19, 2015Jessica Briefer French, Senior Research Scientist

Integrating Health Literacy, Cultural Competency and Language Access

Services

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NCQA

MissionTo improve the quality of health care.

VisionTo transform health care through quality measurement, transparency, and accountability.

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Relevant NCQA Evaluation Programs

• Accreditation programs for health plans and other entities (n=1522)– Multicultural Healthcare Distinction

(n=16)• Healthcare Effectiveness Data &

Information Set (HEDIS) (n=1,171)• Recognition programs for Patient-

Centered Medical Home (n=11,296) and specialty Practice (n=101)

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Health Plan Accreditation vs. Multicultural Healthcare Distinction

Health Plan Accreditation• Standards in many

categories• Fewer CLAS

standards• Health literacy

addressed throughout (requirements to provide information in understandable language)

MHC Distinction• Focus on CLAS and

Disparities• Standards address

CLAS and disparities

• Health literacy not addressed

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Strategic Focus Differs

Health Plan AccreditationProgram description specifies objectives for serving a culturally diverse membership (and 8 other objectives)

MHC DistinctionProgram description for improving CLAS includes objectives for serving a culturally diverse membership, a process to involve members of the diverse community, a list of measureable goals for improving CLAS.

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Cultural Competence of the Network

Health Plan AccreditationNetwork cultural and linguistic competence requires assessment of cultural, racial and linguistic needs of members and adjustment of the availability of practitioners.

MHC DistinctionEnhancing network responsiveness is comparable.Assessment & Availability of Information also requires collection and publication of information about practitioner languages and language services

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Language Services

Health Plan AccreditationRequires:• Provision of

language services for complaints and appeals processes and member services

• Provision of information on how to obtain language assistance

MHC DistinctionRequires:• Translation of vital

docs • Provision of

competent interpreter or bilingual services

• Supporting practitioners in providing language services

• Notice of the availability of language services

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Focus on Improvement

Health Plan AccreditationRequires:• Improvement, but

not focused on CLAS

MHC DistinctionRequires:• Assessment of the use

of, and experience with language services

• Improvement of CLAS• Evaluation of the

effectiveness of interventions to improve CLAS

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Data Collection for CLAS

Health Plan AccreditationRequires:• Reporting of

selected HEDIS measures

MHC DistinctionRequires:• Collection of data on

race/ethnicity• Collection of data on

language needs• Reporting HEDIS

Diversity of Membership measures

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HEDIS• Language Diversity of Membership

– An unduplicated count and percentage of members enrolled at any time during the measurement year by spoken language preferred for health care and preferred language for written materials.

• Race/Ethnicity Diversity of Membership– An unduplicated count and percentage of members

enrolled any time during the measurement year, by race and ethnicity.

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2014 HEDIS Diversity of Membership Measures:

Race, Ethnicity, Language Needs

Availability of health plan data on race, ethnicity and language needs varied by type of plan, but remained largely incomplete

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Patient-Centered Medical Home Recognition

Practices must:• Understand and meet the cultural and

linguistic needs of its patients/families by:

– Assessing the diversity of its population– Assessing the language needs of its population– Providing interpretation or bilingual services to meet the

language needs of its population– Providing printed materials in the languages of its population

• Use an electronic system to record patient information as structured data on … race, ethnicity, preferred language

• Collect and regularly update health assessment including assessment of health literacy.

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Recognized Practice ResultsFunctional requirement

Patient-Centered

Medical Home (N-420)

Patient-Centered Specialty Practice (N=95)

Assessing the racial and ethnic diversity of its population. 96.7% 87.9%Assessing the language needs of its population. 98.3% 80.2%Providing interpretation or bilingual services to meet the language needs of its population.

98.6% 94.5%

Providing printed materials in the languages of its population. 77.1% 63.7%

Assessing health literacy 58.3% NA

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Discussion• Standards and measures of CLAS and

health literacy are available• Purchaser and regulatory incentives

make a difference– Alignment with Meaningful Use incentives helps– Covered California is considering requiring

Multicultural Healthcare Distinction• More leverage and incentives are

needed– Combat delivery system reform fatigue– Align and focus efforts on priority areas