The U.S. spends more on healthcare than any other country. Yet we struggle with healthcare access and quality, and our overall population is less healthy than other developed nations. One possible solution to this problem is value-based care. This article provides an overview of value-based care models and shows how cultural competency training is essential for doctors and healthcare organizations to provide high-value care for patients.
This content was originally presented as part of our live learning event, "Expanding the Role of Interpreters in a Value-Based System," by Dr. Alexander Green. View the recorded event here.
As a primary care physician, I take care of a large Spanish-speaking population, among other culturally and socioeconomically diverse patients. I’m fluent in medical Spanish and communicate directly with my Spanish-speaking patients. But regardless of whether I’m speaking Spanish or working with a medical interpreter, visits with limited English proficiency (LEP) patients always leave me with a worried feeling in the pit of my stomach. I’m keenly aware that most healthcare takes place outside of the doctor’s office, and this is where LEP patients fall through the cracks. I wonder, “Did Mrs. Ramirez really understand how to prep for her colonoscopy next week?” or “Was Mr. Luan actually convinced that he needs to take the medication I prescribed for his diabetes?”
After more than a year of in-depth reporting in Baltimore, The Atlantic has published a long read that explores why, as a group, black Americans are significantly less healthy than white Americans. The piece follows a woman named Kairra, who is 27, black, very overweight, and suffers from a host of health problems that are usually associated with people three times her age. In Baltimore, as well as other segregated cities like Chicago and Philadelphia, the low-income, mostly black neighborhoods have a life expectancy that is 20 years lower than more affluent, whiter neighborhoods. The gap can be attributed to several factors, including violence, diet, environmental hazards, substance abuse, and stress.
If you’re a healthcare provider who works with some of the 25 million limited English proficient (LEP) patients in the U.S., you know how important interpretation is to successful patient outcomes. Poor communication increases the chance of medical errors with any patient, and LEP individuals are especially vulnerable in this regard.
An in-depth piece from Politico Magazine explores how a small, rural hospital in Kansas has become an economic powerhouse by serving the local refugee/immigrant population and specializing in labor and delivery. Ben Anderson, the hospital's CEO, relies on community partnerships, infrastructure grants, and targeted recruiting. His recruiting model is especially interesting: He attracts young physicians who are interested in helping Third World populations. "You can do that work right here in Kansas," he says. Having a staff that actively seeks to work with diverse populations improves patient experience and outcomes.
The Congressional Tri-Caucus, made up of the Congressional Asian Pacific American Caucus, Congressional Black Caucus, and Congressional Hispanic Caucus, has introduced the Health Equity and Accountability Act of 2018 (HEAA), a bill that attempts to address health disparities based on race and ethnicity. The authors note several reasons for these disparities, including language and cultural barriers to care.
To date, 1,656 organizations, 51 state hospital associations, and 11 municipal hospital associations have signed onto the American Hospital Association's (AHA) #123forEquity Pledge to eliminate healthcare disparities. That means every state, and nearly 30% of our nation's hospitals, are represented in the movement to improve health equity. But the road between pledging good intention and effecting actionable change can be poorly marked, and dotted with unseen obstacles. In this post we'll review the key tenets of the AHA's Equity of Care Campaign, rationale for participation, and key actions hospitals and health systems can start to focus on today.
Unconscious (or implicit) bias training is in the spotlight. From the #MeToo movement to the chorus of outrage over the unwarranted arrests of two black men at a Starbucks, companies are facing increasing public pressure to address the roots of discriminatory treatment. But questions remain over whether bias training is an effective course of action, versus a perfunctory act taken to avoid bad press.
The maternal mortality rates in the U.S. are grim, but the number of women who suffer postpartum complications that nearly cause death are even worse. For every woman who dies after childbirth, at least 70 come close. Some estimates put the number of women who suffer "severe maternal morbidity" at around 80,000 per year. A report by NPR/ProPublica finds that many of these complications are preventable, and there's a common theme that postpartum mothers don't feel their concerns are taken seriously by healthcare providers.
We've reported extensively on the dismal maternal mortality rates in the U.S., and the crisis in black maternal mortality in particular. A new piece by NBC News follows the stories of two black mothers who experienced serious complications with their deliveries. Both women felt their medical teams were dismissive and brusque, and that their health problems may have been avoided with better communication. They are among the 32% of black women who feel they’ve been discriminated against in physicians’ offices. Unconscious (or implicit) bias on the part of healthcare providers has very real consequences for patient outcomes. Bias training may not be the complete solution, but it is part of the solution, and should become a standard practice in all medical schools and healthcare organizations.
