Alan Vernon of CQ fluency: Addressing Health Disparities Among People With Limited English Proficiency

For people with limited English proficiency (LEP), it is vital and required by law that their health insurance benefits are comprehensively explained in their preferred language within defined time parameters, including the specific reasons for a denial or delay of services (CDAG letters – Coverage Determinations, Appeals and Grievances). Medicare and health insurance plans cannot delay, defer, or ignore the LEP population or they risk fines and sanctions.

Urban Health Today spoke with Alan Vernon, Vice President, Healthcare, CQ fluency, a company dedicated to removing cultural barriers, about addressing health disparities related to the LEP population.

Urban Health Today: Tell us about yourself, and the company, CQ fluency?

Alan Vernon: Absolutely. I am the Vice President of Healthcare with CQ fluency. We are a language services company specializing in healthcare and life sciences. I’ve been with the company for 12 years. My focus is the health insurance industry. So working with health insurance providers, or I’m sorry, health insurance payers and the third party providers to health insurance companies, such as pharmacy benefit managers and provider groups. We work with lots and lots of preferred provider networks that are associated with the health insurance organizations that we work with.

What challenges do people with limited English proficiency face with respect to the explanation of their health insurance benefits, and what is required by law to help this population?

That’s a great question, Rob, and it’s something that’s very top of mind for CQ fluency. Our mission is to improve lives. And we know that if people can understand the health benefits that they have that they’re entitled to and whatever plan that they’re using, then that would improve their lives. Because not understanding how the benefit works, what’s your benefits are what the costs are, what’s being covered. What’s not being covered all could be extremely confusing to somebody who may not speak English.

English may be their second language. They may be limited English proficient and not understanding how the healthcare system works in the United States, and then not understanding their benefits may prevent them from seeking out like health screenings or other wellness visits, things like that. And then they may instead of seeking those screenings or those as health visits out, they may end up going to the emergency room or some sort of urgent care, which is an unnecessary cost for them and for the health plan. And it’s not really a good way to manage your health. You want to be more proactive in your health, take the screenings. Like I know it’s time for me to get my colorectal cancer screening.

So having those types of screenings are really important in somebody that wants to be proactive in their health. But if you don’t understand what benefits you have, then very unlikely that you’ll take that proactive role. Now, in terms of the law, there is a requirement. It’s a Medicare Advantage Plan. If the plan is located in a service area or in an area where 5% of the population has selected that they speak another language other than English in their home as their primary language, 5% of the people check that box on the census then the plan is obligated to those documents translated and also to provide interpretation services.

What are the dangers of misunderstood communication with limited English proficiency patients?

That’s a great question and one that I could go on at length about because there’s a lot of dangers. Well, there’s dangers involved for everybody for the member or the patient, the doctor, and for the health insurance plan. For the health insurance plan, they may be covering things that if documents aren’t understood then they may be covering things that aren’t covered in that plan for the LEP not understanding a communication, a critical communication that comes across such as the results of the tests. If they had a cancer screening or some other screening and they don’t understand the results or they misinterpret the results, it could cause them undue stress. They maybe think that they’re positive for something or negative for something when the opposite may be the results.

So just not having an understanding of the documents that you’re reading if they’re ambiguous or the terms aren’t understood or if their medical terms aren’t at their reading level, then it could create all kinds of confusion and probably will cause the person to, again, not take that proactive role in their healthcare and may lead to their health deteriorating. And then they have other comorbidities that may happen. So having a good understanding of the documentation that’s being presented to them in terms of test results or notices from their doctor, extremely important that those are understood and acted upon.

How can CQ fluency help improve these health disparities?

Well, there’s a number of ways that we work with our clients to translate documents that are culturally relevant and that are tailored to that person’s culture. Because many cultures outside of the United States, they don’t treat their healthcare systems the way that we do. If the documents are in language, that’s great, that’s the first step. But if they’re also culturally adapted to that particular culture and then we’re looking at tone and images and gender, colors, humor, things like that. If those don’t resonate with the person, then they’re probably not going to respond favorably to that communication.

So what we do is we take those communications, letters, benefit documents and we culturally adapt them to the target culture. So that means looking at what are acronyms? Are is there any jargon or slang? Are there any confusing medical terms? Is everything in the correct context? And we have a cultural red flag checklist that we go through, that the linguist goes through, checks everything, to make sure that, “Hey, this communication is translated into the language.” And it’s also been culturally adapted so that it resonate with that person on a cultural level.

And we know that if it resonates with you culturally, then you’re much more likely to take that action. Even though your culture may not understand a wellness visit, like why would I go to the doctor if I’m well and I’m not sick? But it’s really an important visit to get an annual checkup, to make sure that you’re taking care of your health, you’re being proactive in your health. So what CQ does is really to make sure that those communications are received and understood on a cultural level.

What are some key takeaways you would like to leave our audience with today?

Well, Rob, thank you very much for that. A long list, but I don’t want to talk at length. But what CQ has been able to do is a number of things. We’re culturally adapting these types of communications to make sure that they are understood. We’ve also developed an automated process for health plans or doctors are sending out notices, approval notices, denial notices, coverage determination notices. Most of those letters come with some sort of regulation in terms of when it must be delivered to the member because it contains critical information. Especially if it’s a denial notice, if a drug or a service has been denied and another drug or service has offered then the member needs to know about that information and they need to be able to understand it.

So what CQ has done has been able to create an automated process that removes the need for human intervention on the client side. They don’t have to have a lot of resources that are managing these documents to make sure they’re translated and delivered back. CQ takes care of all that. We put an automated process in place, we translate it. We send it back to the member, or I’m sorry, to the provider or to the health plan and then they can deliver it to the member within those SLAs; the service level agreements that they’ve agreed to with whoever may be regulating that notice, state or fed government. So culturally adapted communications and automated processes that deliver these documents within a matter of hours.