Cultural competency as it intersects with racial/ethnic, linguistic, and class disparities in managed healthcare organizations.

Culture in and of itself is not the most central variable in the patient-provider encounter. The effect of culture is most pronounced when it intersects with low education, low literacy skills, limited proficiency in English, culture-specific values regarding the authority of the physician, and poor assertiveness skills. These dimensions require attention in Medicaid managed care settings. However, the promise of better-coordinated and higher quality care for low-income and working-poor racial/ethnic populations--at a lower cost to government--has yet to be fully realized. This paper identifies strategies to reduce disparities in access to healthcare that call for partnerships across government agencies and between federal and state governments, provider institutions, and community organizations. Lessons learned from successful precedents must drive the development of new programs in Medicaid managed care organizations (MCOs) to reduce disparities. Collection of population-based data and analyses by race, ethnicity, education level, and patient's primary language are critical steps for MCOs to better understand their patients' healthcare status and improve their care. Research and experience have shown that by acknowledging the unique healthcare conditions of low-income racial and ethnic minority populations and by recruiting and hiring primary care providers who have a commitment to treat underserved populations, costs are reduced and patients are more satisfied with the quality of care

Physician Clinical Alignment and Integration: A Community Academic Hospital Approach

An overwhelming need for change in the U.S. healthcare delivery system, coupled with the need to improve clinical and financial outcomes, has prompted hospitals to direct renewed efforts toward achieving high quality and cost-effectiveness. Additionally, with the dawn of accountable care organizations and increasing focus on patient expectations, hospitals have begun to seek physician partners through clinical alignment. Contrary to the unsuccessful alignment strategies of the 1990s, today\u27s efforts are more mutually beneficial, driven by the need to achieve better care coordination, increased access to infrastructure, improved quality, and lower costs. In this article, we describe a large, academic, tertiary care hospital\u27s approach to developing and implementing alignment and integration models with its collaboration-ready physicians and physician groups. We developed four models--short of physicians\u27 employment with the organization--tailored to meet the needs of both the physician group and the hospital: (1) medical directorship (group physicians are appointed to serve as medical directors of a clinical area), (2) professional services agreement (specific clinical services, such as overnight admissions help, are contracted), (3) co-management services agreement (one specialty group co-manages all services within the specialty service lines), and (4) lease arrangement (closest in scope to employment, in which the hospital pays all expenses and receives all revenue). Successful hospital-physician alignment requires careful planning and the early engagement of legal counsel to ensure compliance with federal statutes. Establishing an integrated system with mutually identified goals better positions hospitals to deliver cost-effective and high-quality care under the new paradigm of healthcare reform

Understanding breast-cancer patients’ perceptions: Health information-seeking behaviour and passive information receipt

It is critical to understand patients’ information use from the patient perspective, especially when patients are from different cultures and levels of health literacy. A cross-sectional survey supplemented with interviews of breast cancer survivors including both Latina and non- Latina women was undertaken. Subjects were classified as active information seekers, passive information receivers, and/or users of information. Subjects were further classified by stage of information use, progressing from unawareness or awareness of available information to use or non-use of information to make health decisions. Information sources used and use patterns were examined. Most were active information seekers; many were also passive receivers. Healthcare providers remain the primary information source. Interpersonal communication was far more often cited than either the internet or traditional print and broadcast media. Important cross-cultural differences were found. This study provides insight into how patients use actively sought and passively received information. Despite dramatic growth of the internet and other new media, healthcare providers currently remain keys to health information. Findings may help develop more successful communication strategies when viewed in light of the National Cancer Institute’s ‘Making Health Communication Programs Work’ and the four stages it proposes. It is hoped that future work will focus on evidence-based methods to improve health communication, especially for vulnerable populations. A major lesson learned is the importance of understanding where patients decided to seek information outside the traditional provideroriented approach taken in many health education programmes