Translating Patient Communications: How Cultural Competence Impacts Health, Utilization

Alan Vernon, vice president of health care solutions, CQ Fluency, reviews how many people in the United States do not speak English as their primary language and offers advice for payers and providers to keep patients engaged in their care.

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Welcome back to PopHealth Perspectives, a conversation with the Population Health Learning Network where we combine expert commentary and exclusive insight into key issues in population health management and more.

In this episode, Alan Vernon discusses how culturally competent communication by payers and providers can support patient health.

My name is Alan Vernon with CQ fluency. I'm the vice president of health care. I manage the health insurance division. I've been with the company for 12 years. I'm the most tenured employee.

My focus is day-to-day operations of health insurance providers and the ancillary service providers to health insurance companies, such as pharmacy benefit managers, provider groups, and third party administrators.

How many people in the United States speak a primary language other than English?

There is a lot of information we could dive into. Spanish is the primary language. Twenty-one percent of United States residents aged 5 and up—that's approximately 66 million people—designated on the census that they speak a language other than English as the primary language of their household. Of those 66 million people, 39%, or approximately 25 million, are limited English proficient, meaning that they speak English less than well.

And what are the language-related challenges that health care stakeholders specifically face?

Communicating in a culturally relevant manner to members and patients that speak a language other than English is always a challenge that stakeholders face.

Many cultures don't understand the concept of some of the health care processes that we have in the United States, such as wellness visits or health screenings like cancer, blood pressure, and diabetes screenings. Some of these things are very foreign to many cultures. They don't understand why you would go to the doctor if you're not sick. Going to the doctor when you feel well is not a concept that they're familiar with.

Communicating to those members in a culturally relevant manner will help them understand the information that they're receiving, process it culturally, and then hopefully act on that information, such as having that wellness visit or getting that cancer screening. For the provider and health plan, it doesn't eliminate, but does cut down on emergency room visits. If folks are not having a wellness visit, they will wait until they're very sick or very injured, and then go to the emergency room or go to an urgent care visit. We know that that's not as cost effective as seeing your primary care doctor for a wellness visit or a cancer screening.

By communicating with patients in a culturally relevant manner, then perhaps you can get them to perform that action, which is having that wellness visit or having that health screening.

Thank you, Alan. And you already just mentioned emergency visits as an example, but what are some other impacts of translating paperwork?

It's great for everybody to understand their health care benefits, especially when it comes to denying coverage. This includes coverage determinations, which could be a denial notice of a much-needed drug, medical device, or some sort of service. If the person doesn't understand what's happened, then they may not understand that a drug has been denied and they may need to seek alternative treatments.

Or health insurance companies could authorize services or drugs which weren't in their plan, but because of a mistranslation, the service wasn't identified as something that's not covered. So elective surgeries could be covered, for instance.

There are many cases where folks that don’t speak English may not utilize their benefits if the coverage or benefits aren't understood. They may not understand their health care. They may be sick when they shouldn't be. They may not be taking care of themselves well. So it's really important, especially at CQ.

Our mission is to improve lives, so it's important for us to be able to convey information to members and patients in a culturally relevant manner so that they understand how their benefits work, how the health care system works, and how they can see their doctors and get the care that they need.

When stakeholders are deciding to partner with an organization or a vendor to facilitate this translation, what should they keep in mind?

I could go on and on about many things that they should keep in mind. But specifically, when it comes to coverage determinations, it's imperative that you have a vendor that can produce accurate translations. We just spoke about how important it is for people to understand the information that's being conveyed to them, so they need to have accurate information. And then payers and providers need to be able to deliver it within federal or state guidelines, which may dictate when a document needs to be delivered to that member.

It is important to ensure the information is accurate, delivered in a timely manner, and helpful in understanding what the benefits are. Then, the doctors and the health plans are staying in compliance with any federal or state agencies that are regulating them in terms of delivering these documents to members and patients in a timely manner.

Is there anything else that we haven't mentioned that you want to add?

We developed automated processes, which removes the need for human intervention. This allows our clients’ employees to focus on other tasks rather than managing translations. Working with translation vendors really removes a need for human intervention, eliminates the risk of human error, and lowers costs. So working with a company like CQ Fluency, which has automated workflows, brings a huge benefit to the provider and to the health plan.

Thanks for tuning in to another episode of PopHealth Perspectives. For similar content or to join our mailing list, visit populationhealthnet.com.

This transcript has been edited for clarity.