Medicaid Managed Care - U.S. Senate Special Committee on Aging

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Communicating With Vulnerable Populations: <strong>Medicaid</strong> 167
June through November of 1992, more than 2,000 people, including <strong>Medicaid</strong> recipients
and key people in the community who work with public-secror clients, were surveyed. To
ensure detailed and accurate responses, three different questioning formats were usedmail,
telephone, and face-to-face interviews. The survey presented a complex communication
challenge, for the questions not only had to be translated into many different languages,
they also had to be carefully constructed to ensure their meaning would be effectively understood
across all cultures.
The study drew many conclusions, but two stand out. The first was that health-care
coverage provided by managed care plans must reflect the great diversity of the <strong>Medicaid</strong>
population. <strong>Medicaid</strong> recipients represent a wide cross-section of society with many subgroups
that have unique needs and challenges. To serve all these varied needs, the study concluded,
a health plan must take a specialized approach when developing programs for its
<strong>Medicaid</strong> members. A "one-size-fits-all" approach simply will not work.
The second major conclusion of the study was that a successful managed care program
for <strong>Medicaid</strong> members must integrate social services with traditional medical services.
<strong>Medicaid</strong> recipients include many members of a highly vulnerable population with a wide
range of social problems that invariably affect their health care-things like being evicted
from an apartment, not having telephone service, or not having an affordable means of
transportation to the doctor's office. A health plan cannot help its members receive quality
care without helping them resolve these problems as well.
As a direct result of the study, Medica Health Plans decided it needed to look inward
and reevaluate the structure of its <strong>Medicaid</strong> program and its overall approach to its members.
In May of 1993, the company hired a fulltime director for its <strong>Medicaid</strong> Department.
The director began to assemble a staff with expertise in managing the complex health and
social needs of low-income people. The first goal: to find ways to eliminate the barriers that
were preventing Medica Health Plans' <strong>Medicaid</strong> recipients from receiving appropriate
health care. They decided to begin by tearing down the two biggest barriers: language and
transportation. It soon became clear that the success of these efforts would require some
innovative forms of communication.
OVERCOMING THE LANGUAGE BARRIER
When asked in the 1992 survey, "Do you need an interpreter when going to a medical
doctor?" four distinct subgroups of <strong>Medicaid</strong> recipients overwhelmingly responded "yes."
All Laotian respondents (100 percent) and a large majority of Hmong and Viqtnamese
respondents (96 and 89 percent, respectively) said they needed an interpreter in order to
communicate with their physician. A smaller, but still significant, majority of Russian
respondents (67 percent) also said they needed an interpreter in order to understand their
doctor's diagnoses and instructions.
Nor are these the only groups of <strong>Medicaid</strong> enrollees with members who need an
interpreter to talk with their doctors. Medica Health Plans has had requests for interpreters
representing more than 100 languages, ranging from Finnish to Nuer, a Sudanese dialect.
To better communicate with and serve this diverse clientele, Medica Health Plans has
hired multilingual access representatives for its Medica Choice <strong>Care</strong> members and initiated
a program called Interpreter Services. As their job title suggests, the access representatives
are responsible for helping Medica Choice <strong>Care</strong> members access their health care providers.
The representatives provide a variety of services, from helping a member set up an
appointment with a health care provider to arranging for a taxi or van to pick up and take
the member to the provider's office.
These access representatives should not be confused with customer service
representatives, who answer members' questions about their plan's benefits and coverage.