As a company dedicated to providing all of its
public and private sector clients with superior service, Avesis
fully recognizes the importance of serving members in a culturally
and linguistically appropriate manner. We know from direct experience
and the experiences of our client groups that:
- Some members have limited proficiency with the English language
including some members whose native language is English but who
are not fully literate.
- Some members have disabilities and/or cognitive impairments
that impede their communicating with us and using health care
services.
- Some members come from other cultures that view health-related
behaviors and health care differently than the dominant culture.
Avesis is committed to ensuring that its staff and its participating
providers, as well as its policies and infrastructure, are attuned
to meeting the diverse needs of all members, especially those who
face these challenges.
Cultural competency is a key component of Avesis’ continuous
quality improvement efforts. We expect to realize tangible gains
in member satisfaction resulting from the measures set forth in
this plan.
The Cultural Competency program aims to ensure that:
- Avesis meets the unique diverse needs of all members in the
populations that we service
- The staff of Avesis value diversity within the organization
and for the members that we serve
- Members with limited English proficiency have their communication
needs met
- Our participating providers fully recognize and are sensitive
to the cultural and linguistic differences of the Avesis members
they serve.
The objectives of the Cultural Competency program are to:
- Work with our clients so that once members are identified that
may have cultural or linguistic barriers alternative communication
methods can be made available
- Utilize culturally sensitive and appropriate educational materials
based on the member’s race, ethnicity and primary language
spoken
- Ensure that resources are available to overcome the language
barriers and communication barriers that exist in the member population
- Make certain that providers care for and recognize the culturally
diverse needs of the population
- Teach staff to value the diversity of both their co-workers
inside the organization and the population served, and to behave
accordingly.
Cultural competence in health care describes the ability of systems
to provide care to patients with diverse values, beliefs and behaviors,
including tailoring delivery to meet patients’ social, cultural,
and linguistic needs. It is both a vehicle to increase access to
quality care for all patient populations and a business strategy
to attract new patients and market share.
Culturally and linguistically appropriate services (CLAS): Health
care services that are respectful of, and responsive to, cultural
and linguistic needs. The U.S. Department of Health and Human Services,
Office of Minority Health, has issued national CLAS standards. Avesis
is committed to a continuous effort to perform according to those
standards.
The delivery of culturally competent services requires providers
and/or employees to possess a set of attitudes, skills, behaviors,
and policies which enable the organization and staff to work effectively
in cross-cultural situations. It reflects an understanding of the
importance of acquiring and using knowledge of the unique health-related
beliefs, attitudes, practices, and communication patterns of beneficiaries
and their families to improve services, strengthen programs, increase
community participation, and eliminate disparities in health status
among diverse population groups.
Performing in a culturally competent manner is not just good for
our members, it is good for business. Avesis endorses the view,
promulgated by the federal government, that achieving cultural competence
will help us to:
- Improve services and care for current members (improved understanding
leads to better satisfaction)
- Increase market penetration by appealing to potential culturally
and linguistically diverse members
- Enhance the cost-effectiveness of service provision
- Reduce potential liability from medical errors and Title VI
(Civil Rights Act) violations.
Achieving cultural competency is an on-going process, not a single
act. With that knowledge, this document sets forth Avesis’
approach toward becoming a more culturally competent organization.
Betancourt, Green and Carillo, Cultural Competence
in Health Care: Emerging Frameworks and Practical Approaches, The
Commonwealth Fund, October 2002.
National Standards for Culturally and Linguistically Appropriate
Services in Health Care, U.S. Department of Health and Human Services,
Office of Minority Health, December 2000.
Centers for Medicare and Medicaid Services (precise source document
uncertain).
Planning Culturally and Linguistically Appropriate Services: A Guide
for Managed Care Plans, Centers for Medicare and Medicaid Services
and Agency for Health Care Research and Quality, 2003.
Title VI of the Civil Rights Act specifically requires that managed
care organizations provide assistance to persons with limited English
proficiency, where a significant number of the eligible population
is affected. Department of Justice regulations (28 CFR Section 42.405(d)(1))
state: “Where a significant number or proportion of the population
eligible to be served or likely to be directly affected by a federally
assisted program … needs service or information in a language
other than English in order effectively to be informed of or to
participate in the program, the recipient shall take reasonable
steps, considering the scope of the program and the size and concentration
of such population, to provide information in appropriate languages
to such persons. This requirement applies with regard to written
material of the type which is ordinarily distributed to the public.”
The main components of Avesis’ Cultural Competency program
are:
- Needs Assessment – Activities we conduct to identify the
cultural and linguistic needs of the communities and members we
serve, as well as health disparities present in the enrolled population
and the community at large.
- Organizational Readiness – Steps Avesis takes to make
certain that we have the platforms, systems, and people skills
needed to operate in a culturally competent manner.
- Program Development – The implementation of programs to
link Avesis to community resources, to enhance the cultural and
linguistic capabilities of our participating providers and to
educate members so that their experience with Avesis and our providers
is more positive and their outcomes are more favorable.
- Performance Improvement – Ongoing identification of opportunities
to improve the operation of the Cultural Competency Program or
to improve outcomes through new responses to cultural and linguistic
needs of members.
Data Analysis
When provided with information from our clients regarding the cultural
and linguistic needs of their populations, Avesis will review the
data provided and will:
- Compare the data with information available regarding the cultural
and linguistic composition of our network
- Assess the customer service center to ensure that assistance
with members’ requests for information or complaints and
grievances are handled with the utmost regard to cultural and
linguistic diversities
Whenever possible, we will team up with public health entities and
private groups having a similar charter, to share information that
will guide all health service organizations in each region and community
in directing resources where they will yield the most benefit.
Community-based
Support
Our success requires linking with other groups having the same goals.
Avesis reaches out to community-based organizations that support
racial and ethnic minorities and the disabled to be sure that the
community’s existing resources for members having special
needs are utilized to their full potential. The goal is to coordinate
the deployment of resources, as well as to take full advantage of
the bonds that may exist between the community-based entities and
the covered population.
Management Accountability for Cultural Competency
The Board of Directors maintains ultimate responsibility for the
activities related to cultural competency. The Chief Executive Officer
is a member of the Board and is responsible for ensuring implementation
of Avesis’ Cultural Competency program. The Chief Operating
Officer (COO) is a member of the Quality Improvement Committee,
which oversees the day-to-day operations of the quality program
including the Cultural Competency program.
Avesis’ Director of Quality Improvement is the principal executive
in charge of the company’s efforts to meet its internal cultural
competency objectives and any externally set rules and guidelines
on the subject. The Director of Quality Improvement collaborates
with the heads of all Avesis functional units in making certain
that the Cultural Competency program plan is fully and properly
executed.
The Senior Management Team, comprised of the unit leaders of all
departments of Avesis is responsible for ensuring that culturally
sensitive training occurs in their respective areas.
In 2006-2007, beginning with our new Georgia program, Avesis will
review client-provided needs assessments and, where possible, work
with community-based organizations to ensure that Avesis services
the entire population in accordance with cultural competency objectives.
A report will be presented to the Chief Operating Officer, who will
be accountable for the results of cultural competency efforts in
the state.
Diversity
and Language Abilities of Staff
Avesis recruits diverse talented staff to work in all levels of
the organization. We do not discriminate with regard to race, religion
or ethnic background when hiring staff.
Avesis ensures that bilingual staff is hired for functional units
that have direct contact with members to meet the needs identified.
Spanish is the most common translation required. Whenever possible,
we will distinguish place of origin of our Spanish-speaking staff,
so as to be sensitive to differences in cultural backgrounds, language
idioms, and accents. For example, in Georgia, approximately two-thirds
of the Hispanic population is of Mexican origin.
Where we enroll significant numbers of members who speak languages
other than English or Spanish, Avesis will either recruit staff
bilingual in English plus one of those other languages or establish
communication with a language line vendor, as needed.
Diversity
and Suitability of Provider Network
Avesis recruits providers to ensure that the network includes a
diverse array of providers to care for the population served. By
building our network for the Medicaid programs around “significant
traditional providers,” we intend to have providers and supportive
services that value diversity and are committed to serving people
of racial and ethnic minorities. Though it is unlikely that the
make-up of the provider network will reflect the composition of
the enrolled population exactly, Avesis strives to achieve the best
match possible in each community.
Avesis captures information from providers regarding their own and
their staff’s language abilities. This information is maintained
on the website so that members can choose providers that speak the
languages that they do.
Education
on Cultural Responsiveness
All new Avesis staff must attend cultural competency training within
three (3) months of the date of hire. Major elements of the training
include:
- The rationale and need for providing culturally and linguistically
competent services
- Effective approaches to communicating information to Medicaid
beneficiaries.
- Gauging members’ perception (i.e., fearful versus trustful)
of providers and their staff
Avesis also incorporates diversity exercises into staff meetings
to ensure that staff respects diversity within the organization
and among the enrolled population.
At each performance appraisal period, Avesis staff is evaluated
on their respect for diverse backgrounds as a core value that Avesis
measures. Staff will be assessed for their cultural competency through
testing, direct observation, and monitoring of patient/consumer
satisfaction with individual Customer Service Representative encounters.
Linguistic
Services
Preparation of Materials
Readability – Materials that are used for member
marketing, enrollment, education, etc. are tested for readability
and must be scored at the 5th grade level or lower.
Language other than English – Materials are
routinely prepared in full in both English and Spanish. Upon request,
Avesis will prepare materials in any other languages spoken by five
percent or more of the client’s member population, if requested.
Whenever we learn that a segment of the population that is under
five percent, but not negligible, speaks a language other than English
or Spanish, we will explain how the prospective member or active
member can contact a translation service to assist with interpretation.
Materials for persons with cognitive impairments
– Materials will be specially prepared in large-print versions
for people who can see but not read normal size print, or in Braille
or audiotape for people who are legally blind.
Foreign Language Translation Services
Communication with Avesis – There is a Spanish language
queue set up in Customer Service that members can access as they
call into Customer Service. Avesis employs customer service representatives
who speak Spanish. In addition, Avesis uses Language Line for interpreter
services as needed to communicate with members who have limited
English proficiency. Avesis pays all costs of commercial language
services required by its members.
Special Services for Persons with Hearing Impairments
– Avesis’ members who are deaf or hard of hearing may
require devices or services to aid them in communicating effectively
with their providers. Customer Service Representatives ask members
who are hearing impaired if they would like a certified interpreter—such
as a computer assisted real-time reporter, oral interpreter, cued
speech interpreter, or sign-language interpreter—to be present
during a visit to the provider. Customer Service maintains a list
of phone numbers and locations of interpreter services, by county.
If the use of an interpreter is not appropriate, Customer Service
will offer the member the chance to specify what other type of auxiliary
aid or service they prefer.
Also, Provider Services and Provider Relations staff will educate
providers on what they can do to make facilities more accessible
for individuals with hearing impairments, such as the following:
- Ensure a quiet background for the patient
- Reduce echoes to enhance sound quality
- Add lighting to enhance visibility
- Install flashing lights that work in conjunction with auditory
safety alarms
- Clearly identify all buildings, floors, offices and room numbers
- Include a TTY (teletypewriter) or TDD (telecommunications devices
for deaf persons) in the office.
Functional Illiteracy – Often hidden from
view is the fact that many members who speak English as their native
language cannot read at a level that allows them to perform basic
tasks such as filling out forms used in everyday transactions. Fearing
embarrassment, seldom do such members identify themselves to staff
or to network providers. Nevertheless, we are committed to making
best efforts to help these individuals so that they can get the
most out of their health care plan.
We begin by encouraging our staff and providers’ office staffs
to look for telltale signs of literacy problems. These personnel
then attempt, with sensitivity and discretion, to help the member
with the immediate need, such as completing a form. We will also
try to guide the member to appropriate community resources that
can help the member improve his or her literacy skills.
Website adaptations – Avesis’ website
has been updated to improve the content and interactive capabilities
available to members and prospective members. We are also working
on translating key pages of the website into Spanish.
Linkage to Community
Avesis is dedicated to partnering with community organizations to
promote cultural understanding and to meet the needs of the diverse
population. Wherever possible, Avesis will pursue linkages with
national, state-level and local organizations dedicated to advancing
both the broad interests and the health interests of groups having
needs for culturally-based supports.
To reinforce community ties, Avesis will focus on recruiting staff
that have roots in the community. We will make it known to our member
population when there are openings, in the hope that some of our
own members might become Avesis staff.
Provider
Education
Avesis educates providers regarding the Cultural Competency program
through the Provider Handbook, the Provider Portal of the Avesis
website, and as part of routine encounters with Provider Services
staff. The topic will be covered regularly in Avesis’ provider
newsletter. We will distribute appropriate reference materials to
providers as well—for example, the national CLAS standards.
All Providers receive a Cultural Competency Checklist, approved
by the federal Centers for Medicare and Medicaid Services, to assess
their cultural competency in their offices. (See Appendix.) Use
of the tool is voluntary for providers at the present time. Avesis
will arrange for appropriate follow-up assistance to providers who,
after using it, report a need for help in becoming more culturally
competent.
Avesis is committed to conducting performance improvement projects
both pertaining to culturally and linguistically appropriate services
and related to health care disparities identified in the population
served.
Provider Performance Monitoring
In the event that members file complaints or grievances with Avesis
concerning a provider that behaves in a manner inconsistent with
standards for culturally and linguistically appropriate services,
Avesis will investigate the matter with the same degree of concern
applied to any other complaint or grievance. Offending providers
will be expected to take corrective measures, and Avesis will follow
up to make certain that such action indeed was taken.
If we observe patterns in complaint and grievance information that
suggest there are systemic deficiencies in providers’ conformance
to cultural competency aims, we will investigate the causes and
define broad performance improvement projects to eliminate the weakness.
Ongoing
Self-Assessment
Process and Tools
Avesis will continually assess the cultural competency of the company
to ensure that we are meeting the diverse needs of our members,
providers, and staff. A component of the assessment will be focus
groups of members, providers, and staff to explore the needs of
all Avesis constituent groups and to listen to suggestions for improving
our Cultural Competency program.
Annually the Cultural Competency program will be reviewed, revised,
and presented to the Quality Improvement Committee and the Board
of Directors to ensure compliance with the program objectives.
Reporting
All measures will be reported to the Quality Improvement Committee
and Board of Directors for recommendations, interventions, and approval.
Determination
of Performance Improvement Projects
Benchmarking Against Best Practices
The Quality Improvement Department will review the literature on
innovations and best practices in cultural competency at least once
yearly. The results of this review will be compared to the findings
of the assessment (above) to identify gaps between Avesis’
Cultural Competency program and the state of the art.
Setting Priorities and Assignments
Avesis, at least annually, presents member demographics and provider
demographics to the Quality Improvement Committee. The QI Committee
is responsible for setting priorities and assigning owners for quality
improvement activities and ensuring that continuous quality improvement
is incorporated throughout the organization.
Linking
Cultural Competency/CLAS with Other Quality Improvement Efforts
Avesis’ Quality Improvement Committee is charged with ensuring
that there is an active feedback loop between the cultural competency
activities and other quality improvement efforts. When opportunities
for improvement are identified in either of the two domains, the
department staff and the committee are expected to explore ways
to introduce that improvement opportunity into the other realm.
Promoting Cultural and Linguistic Competency:
Self-Assessment Checklist for Personnel
Developed by: Tawara Goode, National Center for Cultural Competence,
Georgetown University
Target Group
Healthcare workers
Purpose
- To increase individual awareness of practices, beliefs, attitudes
and values that promotes and hinders cultural and linguistic competence
in the delivery of health care.
- To identify training needs.
Length of Survey
30-item list
Distinguishing Characteristics
Divided into 3 categories:
- Physical Environment, Materials, and Resources.
- Communication Styles
- Values and Attitudes
Each item is rated on a 3-point scale
Georgetown University Child Development Center-National Center
for Cultural Competence
This checklist is intended to heighten the awareness and sensitivity
of personnel to the importance of cultural and linguistic cultural
competence in health and human service settings. It provides concrete
examples of the kinds of beliefs, attitudes, values and practices,
which foster cultural and linguistic competence at the individual
or practitioner level.
DIRECTIONS: Select A, B, or C for each item listed below.
A = Things I do frequently
B = Things I do occasionally
C = Things I do rarely or never
—— |
 |
1. I display pictures, posters,
artwork and other décor that reflect the cultures and
ethnic backgrounds of clients served by my program or agency.
|
—— |
|
2. I insure that magazines, brochures,
and other printed materials in reception areas are of interest
to and reflect the different cultures of individuals and families
served by my program or agency. |
|
—— |
|
3. When using videos, films or
other media resources for health education, treatment or other
interventions, I insure that they reflect the cultures and ethnic
background of individuals and families served by my program
or agency. |
—— |
|
4. I insure that printed information
disseminated by my agency or program takes into account the
average literacy levels of individuals and families receiving
services. |
—— |
|
5. When interacting with individuals
and families who have limited English proficiency I always keep
in mind that: |
—— |
|
• limitations in English
proficiency is in no way a reflection of their level of intellectual
functioning. |
—— |
|
• their limited ability to
speak the language of the dominant culture has no bearing on
their ability to communicate effectively in their language of
origin |
—— |
|
• they may or may not be
literate in their language of origin or English. |
—— |
|
6. I use bilingual-bicultural staff
and/or personnel and volunteers skilled or certified in the
provision of medical interpretation during treatment, interventions,
meetings or other events for individuals and families who need
or prefer this level of assistance. |
—— |
|
7. For individuals and families
who speak languages or dialects other than English, I attempt
to learn and use key words in their language so that I am better
able to communicate with them during assessment, treatment or
other interventions. |
—— |
|
8. I attempt to determine any familial
colloquialisms used by individuals or families that may impact
on assessment, treatment or other interventions. |
—— |
|
9. When possible, I insure that
all notices and communiqués to individuals and families
are written in their language of origin. |
—— |
|
10. I understand that it may be
necessary to use alternatives to written communications for
some individuals and families, as word of mouth may be a preferred
method. |
—— |
|
11. I avoid imposing values which
may conflict or be inconsistent with those of cultures or ethnic
groups other than my own. |
—— |
|
12. I screen books, movies, and
other media resources for negative cultural, ethnic, or racial
stereotypes before sharing them with individuals and families
served by my program or agency. |
—— |
|
13. I intervene in an appropriate
manner when I observe other staff or clients within my program
or agency engaging in behaviors which show cultural insensitivity,
racial biases and prejudice. |
—— |
|
14. I recognize and accept that
individuals from culturally diverse backgrounds may desire varying
degrees of acculturation into the dominant culture. |
—— |
|
15. I understand and accept that
family is defined differently by different cultures (e.g. extended
family members, fictive kin, godparents). |
—— |
|
16. I accept and respect that male-female
roles may vary significantly among different cultures and ethic
groups (e.g. who makes major decisions for the family). |
—— |
|
17. I understand that age and life
cycle factors must be considered in interactions with individuals
and families (e.g. high value placed on the decision of elders,
the role of eldest male or female in families, or roles and
expectation of children within the family). |
—— |
|
18. Even though my professional
or moral viewpoints may differ, I accept individuals and families
as the ultimate decision makers for services and supports impacting
their lives. |
—— |
|
19. I recognize that the meaning
or value of medical treatment and health education may vary
greatly among cultures. |
—— |
|
20. I accept that religion and
other beliefs may influence how individuals and families respond
to illnesses, disease, and death. |
—— |
|
21. I understand that the perception
of health, wellness and preventive health services have different
meanings to different cultural or ethnic groups. |
—— |
|
22. I recognize and accept that
folk and religious beliefs may influence an individual’s
or family’s reaction and approach to a child born with
a disability, or later diagnosed with a disability, genetic
disorder, or special health care needs. |
—— |
|
23. I understand that grief and
bereavement are influenced by culture |
—— |
|
24. I seek information from individuals,
families or other key community informants that will assist
in service adaptation to respond to the needs and preferences
of culturally and ethnically diverse groups served by my program
or agency. |
—— |
|
25. Before visiting or providing
services in the home setting, I seek information on acceptable
behaviors, courtesies, customs, and expectations that are unique
to the culturally and ethnically diverse groups served by my
program or agency. |
—— |
|
26. I keep abreast of the major
health concerns and issues for ethnically and racially diverse
client populations residing in the geographic locale served
by my program or agency. |
—— |
|
27. I am aware of the socio-economic
and environmental risk factors that contribute to the major
health problems of culturally, ethnically and racially diverse
populations served by my program or agency. |
—— |
|
28. I am well versed in the most
current and proven practices, treatments and interventions for
major health problems among ethnically and racially diverse
groups within the geographic locale served by my agency or program.
|
—— |
|
29. I avail myself to professional
development and training to enhance my knowledge and skills
in the provision of services and supports to culturally, ethnically,
racially and linguistically diverse groups. |
—— |
|
30. I advocate for the review of
my program’s or agency’s mission statement, goals,
policies, and procedures to insure that they incorporate principles
and practices that promote cultural and linguistic competence.
|
There is no answer key with correct responses. However, if you
frequently responded “C”, you may not necessarily demonstrate
beliefs, attitudes, values and practices that promote cultural and
linguistic competence within health care delivery programs.
National Center for Cultural Competence * 3307 M
Street, NW, Suite 401, Washington, DC 20007-3935
Voice: 800-788-2066 or 202-687-5387 * Fax: 202-687-8899 * e-mail:
Cultural@Gunet.Georgetown.Edu
|
