QUEST Integration – Cultural Competency Plan

Original Effective Date:

04/01/1999

Current Effective Date:

01/01/2015

Cultural background and values shape the world view of each individual. Encouraging HMSA QUEST Integration staff and participating providers to acknowledge that their attitudes, behaviors and beliefs are shaped by their environment leads to more culturally competent professionals. Understanding the impact cultural differences have on successful health care delivery is essential.

3 Key Cultural Competency Messages

The HMSA QUEST Integration cultural competency approach is based on the following:

• QUEST Integration members are multicultural with diverse beliefs, values, health practices and socioeconomic needs.
• QUEST Integration members have the right to receive medical services and to be treated with courtesy, consideration and respect.
• HMSA QUEST Integration staff and participating providers should respect this diversity and realize that biases and preconceptions about public assistance recipients, including those with disabilities, can be barriers to successfully delivering health care services.

Member Communication

The HMSA Plan for QUEST Integration Members Member Handbook

Communicating with our members in a culturally aware and appropriate way is a critical part of HMSA’s cultural competency efforts. The member handbook lists important member rights and responsibilities. Member rights are defined so that all members have a clear understanding of their rights under HMSA’s QUEST Integration plan. Specific information is given about member rights and responsibilities in the following areas:

• Information Disclosure
• Accessibility of Services and Providers
• Participation in Treatment Decisions
• Respect and Nondiscrimination
• Confidentiality of Health Information
• Complaints and Appeals
• Plan Information and Benefits
• How to Obtain Language Interpretation Free of Charge

Importantly, the member handbook states the following:

“You have rights under this plan. Exercising your rights will not affect in a negative way how we or network providers treat you. This is true regardless of race, physical or mental disability, ethnicity, gender, sexual orientation, creed, age, religion, national origin, cultural or educational background, economic or health status, English proficiency, reading skills, or the source of the payment for your care.”

In addition to English, the QUEST Integration member handbook is available in Ilocano, Korean, Chinese (Traditional), and Vietnamese.

Member Newsletter

A newsletter for HMSA QUEST Integration Members is regularly published and distributed to update and keep members informed about their plan. The newsletter explains important health plan benefits, procedures, programs and other important information in a culturally sensitive, clear, concise and easily understandable manner.

Other Member Communication

Communications produced by HMSA for QUEST Integration members will include a language block translated in Ilocano, Korean, Chinese (Traditional), and Vietnamese stating that the document contains important information and directs the member to call HMSA to request the document in an alternative language or to have it orally translated. There is no charge to QUEST Integration members for translation services.

Participating Provider Directory

The HMSA QUEST Integration participating provider directory is distributed to members and provides information about the foreign languages spoken by providers. This allows members to use a physician’s language abilities as a basis for selecting a physician with whom they will be most comfortable.

Service Coordination

Through training and this cultural competency plan, HMSA’s service coordination system allows HMSA to meet the diverse needs of QUEST Integration members in a culturally appropriate manner. The program focuses on ensuring timely access and delivery of quality, cost-effective health care. Continuity of care is provided through coordination and integration of services. Specifically, HMSA QUEST Integration service coordination focuses on serving members with Special Health Care Needs (SHCN) and those receiving long term services and supports (LTSS).These members have exceptional and special health care needs, chronic or high health risk conditions and/or need a spectrum of medical and non-medical services. Each member requiring this level of care has a service coordinator or service manager committed to designing and implementing an appropriate plan of care to meet his/her needs.

“HMSA recognizes that Hawaii QUEST Integration members are a multicultural population with diverse beliefs, values, health practices, and socioeconomic needs. As a health plan, cultural sensitivity means respecting such diversity and realizing that biases and preconceptions about recipients, including those with disabilities and those on public assistance, are barriers to accessing quality health care. The service coordination staff will conduct themselves in a non-discriminatory and inoffensive manner at all times.”

Outreach Programs

HMSA QUEST Integration offers outreach programs and services that address cultural and language barriers and effectively deliver appropriate and necessary health services. One example of these types of outreach programs developed by HMSA attempted to increase the mammography screening rates of Filipina women by partnering with the Catholic Church of Hawaii. The goal of the program was to increase breast cancer awareness through the use of culturally appropriate means. The Pastors at St. Philomena’s Parish delivered this message as trusted community leaders. An educational tour of St. Francis Cancer Screening and Education Program was scheduled so women could gain a better understanding of the exam itself by visiting the mammography facilities. The small group format also allowed participants an opportunity to share their experiences. HMSA hopes to be able to use this program as a model with other populations.

Health Plan and Provider Monitoring

To ensure that HMSA provides services to people of all cultures, races, ethnic backgrounds and religions in a manner that respects the worth of the individual members and to ensure that providers comply with all applicable federal and state laws and regulations, HMSA’s grievance resolution processes are culturally and linguistically sensitive and capable of identifying, preventing, and resolving cross-cultural conflicts or grievances by members about health care services. HMSA conducts an annual training and self-assessment. This means providing cultural competence training to staff who handle grievances; providing members information on their right to file a grievance in an easy and understandable language; how to obtain grievance procedures translated into another languages; and providing the contact name and toll-free phone number of the HMSA QUEST Integration grievance coordinator.

HMSA oversees and monitors these culturally or linguistically related grievances. Such grievances are trended, analyzed and, when issues are identified, acted on in a timely manner. HMSA, however, does not assume that a lack of grievances from members means that cross-cultural conflict or discrimination is not occurring and recognizes members may not recognize that they are being treated inappropriately, or they may have fears or cultural beliefs that inhibit complaining, or may not know that they have the right to complain.

In addition, ethnic data from the Department of Human Services, Med-QUEST Division enrollment file, disease burden, utilization, gender and age are reviewed to identify the needs of the population so clinical and preventive programs can be developed to address those needs.

Member Services

HMSA is prepared to address the diverse language and cultural needs of QUEST Integration members. Members are informed in their preferred language both verbally and in written notices of their right to receive language assistance services at no charge. The Government Programs, QUEST Integration Operations Unit handles customer service calls from QUEST Integration members. HMSA offers and provides language assistance services, including bilingual staff and interpreter services, at no cost to each member with limited English proficiency at all points of contact, in a timely manner during all hours of operation. HMSA trains its bilingual staff initially upon assignment to operate in a bilingual capacity and annually thereafter or uses contracted, certified interpreters to assure the competence of language assistance provided to limited English proficient members. Unless authorized by the member, HMSA does not use the member’s family and friends to provide interpretation services.

Additionally, HMSA QUEST Integration is able to assist hearing impaired members through the use of a Telephone Display Device.

Provider Communication

HMSA recognizes that identifying the health practices and behaviors of QUEST Integration members will enable providers to gain a better understanding of this population and how to most appropriately provide quality health care services. In order to increase provider awareness of the QUEST Integration population’s diversity and encourage providers to address QUEST Integration patients’ needs appropriately, the three key cultural competency messages are included in the HMSA Quest Integration Participating Provider Handbook.

The Provider Handbook and Provider Bulletins are used as tools to increase provider understanding of QUEST Integration members. Both resources can be viewed in the HMSA Provider Resource Center. Each year, HMSA published six scheduled updates to the Provider Handbook in February, April, June, August, October, and December. These updates are included in Provider Bulletins. Provider Handbook updates can also be published in other months when necessary.

Past articles have included a “how-to” for providers on ways to customize their services for patients from other cultures. Steps include printing or obtaining from community organizations brochures and patient forms in the major languages of their patients, having bilingual staff or making accommodations for friends or family to accompany the patient for translation purposes, and being sensitive to issues of privacy, confidentiality of personal data, restrictions on male/female interaction and other cultural concerns that may impact healthcare.

The following are myths about public assistance recipients and the facts related to those myths. This material is updated annually to include other myths based on culture, ethnicity and their socioeconomic status.

Myth #1

QUEST patients miss appointments and fail to follow doctor’s orders because they don’t care about their health or their doctor.

Fact: Some QUEST Integration patients have valid reasons for appearing non-compliant. Some may be coping with economic hardships forcing them to focus their efforts at meeting only basic life needs. Others may not seek medical care due to dysfunctional relationships, unresolved behavioral health needs and/or a crisis at home. They may feel uneasy discussing these things with their doctor and often may not offer explanations.

Myth #2

Providers have to make all the healthcare decisions for QUEST Integration patients.

Fact: The patient is the primary decision maker when it comes to his/her own medical care and should be given full facts about a recommended treatment plan. An individual’s economic status and/or disability would not negate a person’s right to make healthcare decisions for him or herself.

Myth #3

Patients with disabilities who bring companions to medical appointments are incapable of discussing their health or medical needs. Providers should address the companion.

Fact: People with disabilities may have different communication styles and abilities but still can articulate information about their health and medical status. It’s important to address these individuals directly and recognize that a person with developmental delays may be capable of comprehending or explaining his or her needs.

Myth #4

Patients from other cultures have superstitions and beliefs that are incomprehensible to Americans.

Fact: We must remember that all cultures have beliefs and customs that seem strange to those in other cultures. People in the United States have beliefs that baffle outsiders, such as our fears of black cats crossing our paths, walking under ladders, and the number thirteen. Many cultural beliefs have direct or indirect implications for healthcare.

The manner in which services are packaged and promoted or the terms used in promotional materials may create problems in cross-cultural communication. For example, many Asians believe that the number four is unlucky because when pronounced in Japanese or Chinese it sounds very similar to those cultures’ word for “death”. Thus, items arranged in groups of four, such as pills or syringes can symbolize bad luck for those people who believe in numerology. Just as there are very few hospitals or hotels in America with a thirteenth floor, the same is true for buildings in Asia where they avoid numbering the fourth floor.

Myth #5

People don’t want to talk about their culture – they just want to be treated like everyone else.

Fact: Minorities know they are different and this difference will always stand as a barrier to building true rapport unless culture is mentioned early in the doctor/patient relationship. When a sincere interest in the patient’s culture is shown, people will usually be more than happy to talk about their language, food, and even beliefs; beliefs that could affect health outcomes due to misunderstandings. For example, a patient who feels that Western medicine is ‘too strong’ may take only a portion of prescribed medications. Those who believe all doctors wear white coats may not believe you are a doctor if you don’t wear one during a visit. And some may believe that a doctor who smiles often may not be taking them seriously. Knowing these beliefs and addressing them can significantly improve health outcomes.

Also included in the HMSA QUEST Integration participating provider contract is language attesting to the fact that providers adhere to Title VI of the Civil Rights Act of 1964.

Revision History