C. Breakout Sessions

The Summit's Breakout Sessions continued the practice of prior Summits to address issues of current and strong interest to Ethnic Physician Organizations and the communities they serve. Those planning the Summit chose the following topics and recruited an outstanding group of presenters. These sessions not only provided important information to participants, but also generated spirited discussion that helped to illuminate the multiple dimensions of complex and sometimes controversial issues.

1. Working with Health Plans to Provide Care in a Multicultural Community

   Gerald Bishop, MD, Aetna
   Ed Mendoza, MPH, Office of the Patient Advocate, State of California
   Diana Carr, MS, Latino Health Programs, HealthNet
   David Pryor, MD, Medical Director, Blue Cross

   Facilitator: Lia Margolis, President & CEO, Lia Margolis and Associates

   This breakout session provided an opportunity for health plans to provide information on programs and services they provide to better serve multicultural communities. In addition, the Office of the Patient Advocate provided information on its efforts to inform the public and providers.

   Ed Mendoza, Acting Director of the Office of the Patient Advocate (OPA), described the functions and programs of OPA. The mission of OPA is:

   • To inform and educate consumers about their rights and responsibilities as HMO enrollees."

While emphasizing that OPA is not a part of the Department of Managed Health Care (the State's HMO regulator), Mr. Mendoza described the mandated services and products of OPA:

• Consumer Education
  
• HMO Quality Report Card
  
• Advice and Assistance to HMO Enrollees
  
• Recommendations to DMHC
  
• Collaboration with other organizations

Mr. Mendoza identified several key products of OPA, including:

• A variety of enrollee information publications.
  
• California's HMO Guide
  
• HMO Quality of Care Report Card

He elaborated on the language access information that is now included in the Report Card, recommending that HMOs:

• Ensure linguistic services are available to all their members who need them.
  
• Assess the language needs of their members.
  
• Standardize the process for accessing linguistic services across HMOs.
  
• Inform members of that process.
  
• Evaluate the language proficiency of staff and providers who provide bilingual services.

David P. Pryor, MD, MPH, Associate Medical Director, Blue Cross of California, described the Cultural and Linguistic Program at his health plan. Blue Cross has more than one million members in its Medicaid (Medi-Cal) and State Children's Health Insurance Program (Healthy Families) programs. About 80% are people of color and almost half speak a primary language other than English. Twelve Medi-Cal threshold languages are represented among Blue Cross's members.

Dr. Pryor described how Blue Cross addresses Medi-Cal's cultural and linguistic requirements, including translated health education materials, 24-hour toll free telephone services, and a Community Advisory Council. In addition, Blue Cross has established Community Resource Centers, provider training programs, a Cultural and Linguistics Department, and a network development initiative to identify language information for its provider directory. The Product Services and Health Promotion Department also plays a major role in promoting cultural competence throughout the Blue Cross network by translating materials, developing programs and conducting group needs assessments.

Gerald Bishop, MD of Aetna described his health plan's Pay for Performance Program, which was developed to encourage a greater emphasis on quality of care.

Overall, the presentations and ensuing discussion generated several recommendations on how the health plans could better serve diverse communities:

• Information on quality of care should be provided to all consumers in languages and at literacy levels they can understand.
• While Aetna's Pay for Performance Program is a useful step, it should be linked to consumer satisfaction as well. The program should be part of an overall plan to continually monitor and improve quality that is tied to measurable outcome such as HEDIS and national performance standards.
  
• Direct community interaction is needed to supplement written consumer information.
  
• There should be greater emphasis on patient "self-management" that provides incentives for consumers to adopt healthy behaviors and utilize health systems more effectively. Such a program should include a patient health education component that is initiated prior to instituting the self-management program.
• Health plans should develop more incentive driven programs for patients on nutrition, physical activity and other positive health behavior change.
  
• Government agencies, health plans, providers and consumers should work cooperatively to develop social marketing campaigns to promote improved health.

The discussion also generated recommendations on how health plans could be more responsive to providers:

• The treatment authorization process needs to be made less cumbersome and time consuming.
  
• Patients need to be better informed of their insurance benefits and limitations.
  
• Forms and reporting formats should be standardized across health plans since providers tend to serve patients from multiple plans.
• Health plans should provide more training implementing Culturally and Linguistically Appropriate Services (CLAS) standards to create greater cultural understanding and language access. These trainings should be offered at hours that are convenient for the providers.

This session succeeded in achieving its aim to foster a dialogue among physicians and health plans on improving care to California's diverse residents.