As seen in Medical Economics
In 2024, health care organizations will need to intensify their efforts to reduce disparities and advance equity for the diverse populations they serve. It’s not only the right thing to do, it’s required for compliance with federal regulations and it makes great business sense, too.
Because 68 million Americans speak a language other than English at home, interpretation and translation services are essential to expand access, boost engagement, improve outcomes and elevate the patient experience.
As a language services professional who works with health care organizations nationwide, I’d like to offer some considerations for health equity, language services and marketing leaders to keep in mind when planning for the year ahead:
A new rule will strengthen discrimination prohibitions
The top compliance headline for 2024 is that the U.S. Department of Health and Human Services may publish its final rule strengthening Section 1557 of the Affordable Care Act. This section prohibits discrimination in hospitals, clinics, physician practices, pharmacies, nursing facilities and other health care settings.
While the final rule is still pending, organizations can prepare by taking steps to comply with the proposed rule, which was published on Aug. 4, 2022. It differs from earlier interpretations of Section 1557 in its description of the reasonable steps health care organizations must take to provide meaningful access to individuals with limited English proficiency (LEP). Among the notable updates are requirements for organizations to:
Create effective language access procedures with:
- Explanations of how the organization identifies LEP individuals.
- Instructions for workers to engage qualified translators and interpreters.
- A list of translated materials and their locations.
Note: Earlier rulings on Section 1557 required organizations to create formal language access plans. The new rule encourages, but does not require, creation of a formal plan.
- Appoint a Section 1557 coordinator to implement and oversee language access procedures.
- Train relevant staff on language access procedures.
- Provide qualified interpreters and translators for each LEP person who is served or affected by a health care service.
- Post notices about the availability of qualified interpreters, translated documents and accessible formats (such as large print, Braille or audio) in the user’s preferred language.
- Ensure, as a minimum standard, that qualified human translators review machine-translated materials whenever accuracy is essential, or the source material contains complex or technical language.
Note: The proposed rule addresses several potential use cases for machine translation. Organizations that use this technology should review those provisions closely.
It’s also important for health care organizations to be aware that the proposed rule permits a bilingual staff member or other adult who is not a qualified interpreter, or a minor child, to facilitate communication with a LEP patient only in very specific and limited situations.
Competitive pressures that drive focus on access and equity
As government payers continue to raise standards for health equity in Medicare and Medicaid, health plans are also intensely competing for increasingly diverse populations who are covered through individual insurance marketplaces and employer-sponsored plans.
For example, the Commonwealth Fund recently published research that highlights equity strategies of marketplaces for individual health insurance plans in California, Connecticut, the District of Columbia and Massachusetts. These marketplaces are collecting race and ethnicity data, requiring insurers to achieve health equity accreditation from the National Committee for Quality Assurance, designing plans to meet the needs of people of color, and pursuing strategies to ensure that enrollees can use their plans and receive equitable care.
The work that government entities and other purchasers are driving through their health plans will inevitably impact provider organizations, most likely surfacing during contract negotiations. Health plans are under pressure to improve access to in-language communications as part of the product and service experience, and to demonstrate how these efforts create a return on investment. Where the health plans go, provider organizations must be prepared to follow.
Economic forces are driving a focus on measurement and outcomes
Providing quality health care is costly and budgets often are stretched thin across numerous priorities. This is especially true in our post-pandemic world. Trying to do more with less is always a concern, but it would be shortsighted to view language services as just another expense to be trimmed. Over time, language services can elevate the patient experience while yielding cost savings. For example:
- Language access fosters trust. When patients communicate in their native language, they’re more likely to share vital details about their health and get better outcomes.
- Competent interpretation and translation contribute to accurate diagnoses and appropriate treatment plans. This helps reduce complications and costly readmissions.
- Patients who feel heard and understood are more likely to adhere to treatment plans and keep follow-up appointments.
- Feedback from LEP patients yields valuable insights for continuously improving language services and, by extension, the overall patient experience.
As organizations shift from reactive, compliance-oriented stances around language services to proactively striving for better outcomes and experiences, more sophisticated measurement strategies will naturally come to the forefront. For many, the current measure of success is timely availability of interpreter services and required document translations. Obviously, these are important, but they should be the floor rather than the ceiling.
It’s heartening to see more organizations measuring the value of language services with metrics like call center volumes, traffic to linguistically and culturally appropriate webpages, and attendance at events that are promoted and delivered in languages other than English.
Language access is critical
Language access and health equity are intrinsically connected. With the richness of linguistic and cultural diversity in our country today, the stakes have never been higher.
Compliance, competition and budgetary factors will have an impact on how health care organizations address language differences in 2024 and beyond. To achieve an equitable health care landscape, a relentless commitment to understanding, respect and inclusion is essential. Partnering with a full-service language services provider may help organizations get up to speed on the nuances faster, as well as identify and implement best practices.
Iburg is director of health care accounts at United Language Group.
