Emerging America: Engaging Hispanics in the U. S. Healthcare System
How are healthcare organizations addressing both the challenges and rewards of engaging Hispanic consumers in their markets? Six experienced executives representing different parts of the healthcare industry gathered in Los Angeles to discuss the results
In just under 15 years, the U.S. Hispanic population has grown from a group of 35.7 million to 55.4 million people. Under the Affordable Care Act, more than 10 million Hispanic-Americans are eligible to gain health insurance coverage. For healthcare organizations across the country, understanding the Hispanic population represents a huge opportunity to improve community engagement, population health management and more—an opportunity that is largely being untapped.
As the national leader for North Highland’s healthcare consulting division, I am proud to be part of a group that is helping healthcare organizations recognize and realize these unique opportunities. We are bringing to healthcare what we’ve learned through successful partnerships in other industries, and are pleased to present with Modern Healthcare Custom Media new research, information and insights about how organizations are taking on the challenges and rewards of engaging Hispanic consumers in their markets. I invite you to learn more, and join our conversation, at ModernHealthcare.com/EmergingAmerica, and Info.NorthHighland.com/EmergingAmerica.
Fletcher Lance, Managing Director and National Healthcare Lead, North Highland
How do Latinos view the U.S. healthcare system?
Dr. Santana: It is seen as something that does not always meet their needs, and is a little bit foreign and intimidating. That happens by way of language, and by way of access—whether that’s geographic, transportation-based or financial.
Dr. Mulligan: The health system is bewildering for many of us, but especially for this population. Many Hispanics are used to getting their health information from the local botanica or pharmacy—because that’s the way healthcare is provided in many countries outside the United States.
Dr. Martinez: It’s true that a lot of healthcare institutions sit back and receive, and they don’t really reach out into the community, which is a focal point for the Hispanic population. Other industries not only recognize the growing power of the Hispanic community, but actively compete for it. Healthcare has the same opportunity.
A recent survey of healthcare executives shows that language is the No. 1 barrier to delivering quality healthcare to Hispanic patients. Why is that?
Mr. Gil: Two years ago I spoke to our board of 12 physicians and issued the challenge, how can you have 12 patient populations that are 60% Hispanic and not have taken the medical Spanish course? After that, 10 of the 12 have taken it. The feedback I received is they’re closer to the patient. They can actually laugh with the patient, and there’s not that delayed smile because somebody translated something funny and endearing the patient said three minutes ago. That creates better understanding, better trust and better healthcare.
Ms. Mallory: When I worked at Johnson & Johnson, we conceived for Blue Cross and Blue Shield of Texas the most basic, simple thing: laminated pages in a binder that listed terms in English, along with translations into Spanish. Case managers working the phones thought they had “died and gone to heaven,” because when they’re talking about even the most basic terms, there are different words that may mean different things. And they may or may not be fluent in Spanish, but in either case, you can’t have people translating such precise information on the fly if you want to develop coherent, continuous health education.
What other barriers exist?
Mr. Gil: The idea of visiting hours and other “typical” hospital rules run counter to the Hispanic culture. It takes volume and critical mass for the American health system to adjust to those cultural differences. That said, it would be a mistake to say Latinos are having trouble coming into our orderly system, because there is nothing orderly about American healthcare. They are coming into something that is, in my opinion, broken and fragmented.
Dr. Martinez: We must remember that healthcare is in a period of change, but so are our patients. We’re being asked to redesign the system to provide proactive care, to be able to manage populations and manage risk, and the Hispanic community provides that opportunity. It’s just not being viewed that way.
What are some ways providers can engage?
Mr. Gil: I wish we had more than 5% Latino doctors, but that’s not going to happen in my lifetime. The biggest improvement we can make now is the promotoras, the navigators, who help build a support system that takes the mystery out of access and makes healthcare accessible and understandable.
Dr. Mulligan: Organizations can engage patients, especially Latino populations, through telemedicine. MDLIVE has a pilot in New Mexico, where 47% of the population is Spanish speaking, to help a large insurer there deliver behavioral health benefits. In the Hispanic culture, behavioral health can be considered taboo, but with telemedicine you can quietly make your appointments and talk to someone without anyone knowing.
Dr. Santana: Another benefit of telemedicine is connecting clinics and primary care to multispecialty groups. Accountable care organizations are exploring those opportunities because as payment models are changing, we do not have enough man or woman power to access the care the patient may need.
What is the importance of “cultural competence”?
Mr. Luna: Cultural competence, to me, begins with being willing to inquire and discover the actual needs and preferences of the patient in a clinical setting, and of the populations that you have in your overall patient population. And right now there’s still too little willingness to inquire, to discover.
Mr. Gil: I agree. Hospital executives are used to deciding what food to serve, how many people to allow in a hospital room, and so forth, instead of culturally engaging. Healthcare management needs to do more listening instead of issuing directives.
How do the goals of achieving the Triple Aim—better experiences and better outcomes at a lower cost per capita—intersect with improved access and outcomes for Hispanics?
Dr. Martinez: There is a huge opportunity here to move from standing still as a health system, and moving out into the community. That leads to better patient engagement, better outcomes, and early intervention. The Hispanic community provides an opportunity to create new capabilities and innovate, allowing you to achieve the Triple Aim and helping you drive long-term success in the new environment.