Collection of Data on Race/Ethnicity and Language Proficiency of Providers | Page 4
Published Online: December 20, 2013
David R. Nerenz, PhD; Rita Carreón, BS; and German Veselovskiy, MS
The National Committee for Quality Assurance’s (NCQA’s) Multicultural Healthcare Distinction Program, which includes aspects of Culturally and Linguistically Appropriate Services, has been in place since 2010.17 Although this program is voluntary and therefore cannot enforce compliance through regular accreditation requirements, the NCQA has clearly sent a signal to plans working with it that collection of race, ethnicity, and language information on plan members, staff, and providers is an important, valued activity. It is not surprising, then, to see more plans reporting activity in this general area in 2010 than in 2008. Specific mention of race/ethnicity and language data collection in the ACA18 and in the second stage of the Health Information Technology for Economic and Clinical Health meaningful use standards for health information technology,19 although not directed explicitly to health plans, has reinforced the message from payers and accrediting bodies that such data collection is expected and essential. Such requirements will presumably encourage physicians and other providers to report this information. In their survey responses about uses of data, health plans indicated that they recognize demographic diversity among their members and are seeking to meet diverse needs. In some cases, the data are used in the design of programs (eg, wellness and disease management) and in the provision of information about benefits and other plan features in languages other than English. In other cases, information about race/ethnicity and languages spoken by providers that is shared with plan members presumably supports choices being made by members about where to seek care, which will be critical under the new health insurance exchanges that began accepting new enrollment October 1, 2013. The diverse makeup of healthcare providers and clinicians also allows plans to draw on their expertise, via advisory councils, in improving care for racial and ethnic populations and in developing tools and written/verbal messages to consumers. Through this variety of mechanisms, it appears that plans are expanding the ways in which they can provide culturally and linguistically appropriate services to members.
There is room for continued progress in expanding data collection efforts and increasing the availability of this information to consumers. As our nation’s population continues to become more diverse, the healthcare system will need to meet the increasingly complex cultural and language needs of patients. Although additional research may be needed to further understand the complexities of collecting data on provider networks’ race and ethnicity (eg, the nature of providers’ concerns, attitudes, and beliefs regarding provision of these data), there continues to be general consensus that improving the diversity of the US healthcare workforce is important for health plans and other key stakeholders to help improve access and quality for patients of all racial and ethnic backgrounds.20,21 With public programs now reinforcing the need for such data on practicing physicians and other clinicians through meaningful use requirements, physicians are seeing a concerted message on the importance of reporting such information. A broader discussion within the healthcare stakeholder community on the experiences in collecting and sharing providers’ race, ethnicity, and language data would be a critical step toward increasing patient-provider racial and language concordance.
Author Affiliations: From Henry Ford Health System (DRN), Center for Health Policy and Health Services Research, Detroit, MI; America’s Health Insurance Plans (RC, GV), Washington, DC.
Author Disclosures: Ms Carreón and Mr Veselovskiy report employment with America’s Health Insurance Plans. Dr Nerenz reports no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.
Authorship Information: Concept and design (RC, DN, GV); acquisition of data (RC, GV); analysis and interpretation of data (RC, DN, GV); drafting of the manuscript (RC, DN, GV); critical revision of the manuscript for important intellectual content (RC, DN, GV); statistical analysis (GV); obtaining funding (RC); administrative, technical, or logistic support (RC); and supervision (RC, DN).
Funding Source: Robert Wood Johnson Foundation to the America’s Health Insurance Plans Foundation (grant #62295).
Address correspondence to: Rita Carreón, BS, Director, Clinical Strategies and Healthcare Equity, America’s Health Insurance Plans, 601 Pennsylvania Ave, NW, Ste 500, South Bldg, Washington, DC 20004. E-mail: firstname.lastname@example.org.
1. Ulmer C, McFadden B, Nerenz DR, eds. Race, Ethnicity, and Language Data: Standardization for Health Care Quality Improvement.Washington, DC: National Academies Press; 2009.
2. Brach C, Fraser I, Paez K. Crossing the language chasm. Health Aff (Millwood). 2005;24(2):424-434.
3. Tang G, Lanza O, Rodriguez FM, Chang A. The Kaiser Permanente clinician cultural and linguistic assessment initiative: research and development in patient-provider language concordance. Am J Public Health. 2011;101(2):205-208.
4. Cooper LA, Roter DL, Johnson RL, Ford DE, Steinwachs DM, Powe NR. Patient-centered communication, ratings of care, and concordance of patient and physician race. Ann Intern Med. 2003;139(11):907-915.
5. Meghani SH, Brooks JM, Gipson-Jones T, et al. Patient-provider race-concordance: does it matter in improving minority patients’ health outcomes? Ethnicity Health. 2009;14(1):107-130.
6. Traylor AH, Schmittdiel JA, Uratsu CS, Mangione CM, Subramanian U. Adherence to cardiovascular disease medications: does patientprovider race/ethnicity and language concordance matter? J Gen Intern Med. 2010;25(11):1172-1177.
7. Nunez-Smith M, Pilgrim N, Wynia M, et al. Race/ethnicity and workplace discrimination: results of a national survey of physicians. J Gen Intern Med. 2009;24(11):1198-1204.
8. Williams DR, Rucker TD. Understanding and addressing racial disparities in health care. Health Care Financing Review. 2000;21(4):75-90.
9. Diamond LC, Luft HS, Chung S, Jacobs EA. “Does this doctor speak my language?” improving the characterization of physician non-English language skills. Health Serv Res. 2012;47(1, pt 2):556-569.
10. Kaplan JB, Bennett T. Use of race and ethnicity in biomedical publication [published correction appears in JAMA. 2004;292(9):1022]. JAMA. 2003;289(20):2709-2716.
11. Saha S, Taggart SH, Komaromy M, Bindman AB. Do patients choose physicians of their own race? Health Aff (Millwood). 2010;19(4):76-83.
12. Escarce JJ, Carreón R, Veselovskiy G, Lawson EH. Collection of race and ethnicity data by health plans has grown substantially, but opportunities remain to expand efforts. Health Aff (Millwood). 2010; 30(10):1984-1991.
13. Atlantic Information Services. AIS’s Directory of Health Plans: 2010. 7th ed. Washington, DC: Atlantic Information Services Inc; 2010.
14. Nerenz DR, Carreón R, Veselovskiy G. Race, ethnicity, and language data collection by health plans: findings from 2010 RWJF-AHIPF Survey. J Health Care Poor Underserved. 2013;24(4):1769-1783.
15. Au M, Taylor EF, Gold M. Improving Access to Language Services in Health Care: A Look at National and State Efforts. Policy Brief. Mathematica Policy Research Inc. http://www.mathematica-mpr.com/publications/PDFs/Health/LanguageServicesbr.pdf. Published April 2009. Accessed April 28, 2013.
16. Gazmararian J, Carreón, Olson N, Lardy B. Exploring health plan perspectives in collecting and using data on race, ethnicity, and language. Am J Manag Care. 2012;18(7):e254-e261.
17. National Committee for Quality Assurance. NCQA’s Multicultural Health Care Distinction Program. http://www.ncqa.org/LinkClick .aspx?fileticket=-sEvPOkSGfo%3D&tabid=61. Accessed April 28, 2013.
18. US Department of Health and Human Services. Implementation Guidance on Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status. http://aspe.hhs.gov/datacncl/standards/ACA/4302/index.shtml. Published October 2011. Accessed April 28, 2013.
19. Centers for Medicare & Medicaid Services. Medicare and Medicaid programs; Electronic Health Record Incentive Program—stage 2; proposed rule. Fed Regist. 2012;77(45):13697-13829.
20. The Sullivan Commission. Missing Persons: Minorities in the Health Professions: a report of the Sullivan Commission on diversity in the healthcare workforce. http://www.aacn.nche.edu/media-relations/sullivanreport.pdf.
21. Smedley BD, Butler AS, Bristow LR, eds. In the Nation’s Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: National Academies Press; 2004.