All materials © 2015, National Committee for Quality Assurance October 19, 2015 Jessica Briefer French, Senior Research Scientist Integrating Health Literacy, Cultural Competency and Language Access Services

2 NCQA Mission To improve the quality of health care. Vision To transform health care through quality measurement, transparency, and accountability.

3 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)

4 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

5 Strategic Focus Differs Health Plan Accreditation Program description specifies objectives for serving a culturally diverse membership (and 8 other objectives) MHC Distinction Program 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.

6 Cultural Competence of the Network Health Plan Accreditation Network cultural and linguistic competence requires assessment of cultural, racial and linguistic needs of members and adjustment of the availability of practitioners. MHC Distinction Enhancing network responsiveness is comparable. Assessment & Availability of Information also requires collection and publication of information about practitioner languages and language services

7 Language Services Health Plan Accreditation Requires: Provision of language services for complaints and appeals processes and member services Provision of information on how to obtain language assistance MHC Distinction Requires: Translation of vital docs Provision of competent interpreter or bilingual services Supporting practitioners in providing language services Notice of the availability of language services

8 Focus on Improvement Health Plan Accreditation Requires: Improvement, but not focused on CLAS MHC Distinction Requires: Assessment of the use of, and experience with language services Improvement of CLAS Evaluation of the effectiveness of interventions to improve CLAS

9 Data Collection for CLAS Health Plan Accreditation Requires: Reporting of selected HEDIS measures MHC Distinction Requires: Collection of data on race/ethnicity Collection of data on language needs Reporting HEDIS Diversity of Membership measures

10 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.

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

12 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.

13 Recognized Practice Results Functional 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

14 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