Amerigroup 1 - Texas Cultural Competency Strategic Plan 2015 1 The use of Amerigroup pertains to both Amerigroup Texas, Inc. and Amerigroup Insurance Company activities.
TABLE OF CONTENTS INTRODUCTION... 3 CULTURAL COMPETENCY... 5 POPULATION ANALYSIS... 6 LAWS AND REGULATIONS... 8 GUIDING PRINCIPLES... 10 PHILOSOPHY... 12 CULTURAL COMPETENCY STRATEGIC PLAN... 13 HEALTHCARE DISPARITIES WORKGROUP... 21 AUTHORITY, STRUCTURE, AND RESPONSIBILITY... 23 SUMMARY... 23 ACKNOWLEDGEMENT & APPROVAL... 24 2 P a g e
INTRODUCTION As the face of health care continues to rapidly change with the accelerated growth of minority populations, Amerigroup has a unique understanding of the health care and social needs of the members we serve, which affords us the opportunity to effectively manage current and future health care concerns. To that end, Amerigroup firmly believes that we must recognize and thoroughly understand the role that culture and ethnicity play in the lives of our members to help ensure everyone receives equitable and effective health care services. Amerigroup has developed and maintains a Cultural Competency Strategic Plan to assist in the integration of the knowledge, attitudes and skills reflective of a culturally competent organization. This document serves as the blueprint for the Amerigroup Cultural Competency Program. It reflects a comprehensive, organized and methodical approach to the strategic planning, development, implementation, and evaluation of cultural competency. It serves as a guide in the ongoing developmental process of a multicultural competent service delivery system. The plan is descriptive, organized around objectives and strategies, and designed to provide a measurable approach to ensuring the cultural competence of Amerigroup as an organization. Within this plan, cultural competency objectives and strategies were developed to run in a parallel course, each striving to meet culturally-unique needs of the population served. Amerigroup continually reevaluates our approach to meet our members needs in this evolving demographic landscape. To shed light on this multi-faceted approach, Amerigroup addresses cultural competency through the following: Provides a high-performance organizational culture of social awareness, values, cultural sensitivity and customer service that supports, attracts, and retains a diverse staff. Amerigroup recruits and retains a culturally diverse and culturally competent workforce that is similar to the STAR, STAR+PLUS and CHIP membership we serve. 3 P a g e
Develops a comprehensive training curriculum for cultural competency. Amerigroup ensures that all associates receive culturally and linguistically appropriate education and training. Ensures clinical assessment and plans of care reflect relevant cultural issues. Provides language assistance services, at no cost, to members with limited English proficiency or impaired hearing at all points of contact. Ensures member-related materials can be easily understood and are available in the member s language of preference. Develops collaborative relationships with communities to address health beliefs and needs of ethnic/cultural populations. Ensures culturally competent care is delivered to all members. Amerigroup strives to credential providers who understand and appreciate the socio-economic and cultural challenges that our members face in addition to their complex medical needs. Assures stakeholder participation in the service delivery process to identify and evaluate involvement of community resources. Additionally, Amerigroup solicits feedback from members and community-based organizations regarding the cultural appropriateness of member materials and programs. Identifies opportunities to implement culturally sensitive targeted initiatives that address disparities in health care. The Texas Healthcare Disparities Workgroup works on initiatives to address disparities in health care. One aspect of the workgroup s charge is to forward network gaps related to cultural/ethnic needs and preferences to Provider Relations if any are identified. Participation in a cross-functional work group to identify ways health care disparities can be addressed in a culturally sensitive manner is the key to implementing a focused approach to clinical improvement initiatives. Conducts a population assessment of Amerigroup membership annually, which helps identify critical conditions and health care needs that require targeted initiatives to maximize improved outcomes. Amerigroup embraces a Three R approach to delivering culturally competent services- Recognition of, Respect of, and Response to the culture, ethnicity, values, beliefs, strengths, 4 P a g e
gender identities, disabilities, and desires of our members, while preserving and elevating their dignity. Respecting our members means recognizing, understanding, and honoring the role that culture, ethnicity, and other forms of self-identification play in their lives to help ensure that everyone receives equitable and effective health care services and support. In Texas, Amerigroup has always been committed to providing access to culturally competent health care services and supports to people of all races, ethnic backgrounds, religions, and gender identities, and to those who have disabilities. We have done so in a way that recognizes, respects, and responds to the needs and preferences of each member, values each individual s worth, and protects and preserves each individual s dignity. CULTURAL COMPETENCY Cultural competence can be defined as willingness and ability of a system to value the importance of culture and to display that value in the delivery of services provided to its customers. A culturally competent system acknowledges and incorporates the following at all levels: valuing diversity; cultural self-assessment; vigilance toward the dynamics that result from cultural differences; expansion of cultural knowledge; and adaptation of services to meet culturally-unique needs.(cross, et.al., 1989) Cultural factors may influence the way individuals: Define, evaluate and communicate their problems Seek help for their problems Present their problems to service providers Respond to intervention plans Amerigroup defines cultural competency as the delivery of integrated health care services within the context of members cultural beliefs, behaviors, practices, disabilities and language preferences. Amerigroup routinely collects information on different cultural backgrounds to better understand our members. Amerigroup trains and educates associates and participating providers regarding ways to promote effective interaction with members. It promotes respect for all individuals, regardless of culture, language, age, ethnicity, race or disability. Amerigroup 5 P a g e
assesses and monitors cultural, ethnic, racial and linguistic needs of its members and adjusts the network availability. Associate and provider cultural competence is monitored as part of the Quality Improvement Process. POPULATION ANALYSIS On an annual basis, Amerigroup conducts a population assessment to evaluate the characteristics and needs of each of the member populations within each of the Service Delivery Areas (SDAs). In developing the annual Population Analysis, Amerigroup considers the cultural, ethnic, racial, and linguistic needs of the members and the providers that medically serve our members. This in-depth analysis, allows for Amerigroup to review and update clinical and service programs, processes, and resources, to address the health care needs of the members enrolled in the Texas Medicaid and CHIP managed care organizations. Racial and ethnic composition from U. S. Census Data (from 2010) was compared to Amerigroup data from CAHPS 2 member self-reported results (based on a limited sample of members responding) and member self-reported racial and ethnic composition data that Amerigroup receives from HHSC (with over 80 percent of members responding). U. S. Census Data and CAHPS self-reported data suggest our top three enrollee racial and ethnic makeup would be White Non-Hispanic/Caucasian, Hispanic and Black or African-American. However, we utilize the HHSC self-reported data as our primary indicator of the racial composition of our membership due to the high self-reported response rate. Based on the data for Amerigroup, the majority of members are: Hispanic 49.7%, Black or African-American at 24.1%, and White Non-Hispanic/Caucasian at 22.2%. Amerigroup Texas, 2 CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ) 6 P a g e
Inc. is consistently showing the majority of members are Hispanic (52.3%), Black or African- American (24.4%) and White Non-Hispanic/Caucasian (18.8%) in its SDAs. However in the Amerigroup Insurance Company s SDAs (the Medicaid Rural Service Areas), the majority of members are White Non-Hispanic/Caucasian (41.0%), then Hispanic (35.4%), and then Black or African-American (22.5%). Our enrollees are representative of the top racial and ethnic groups of the state but Hispanics are clearly more represented in our membership overall. Three sources of data were reviewed to determine the predominant languages spoken for our population. The 2010 U.S. Census data for the State of Texas indicates the predominant language spoken in the household after English was Spanish or Spanish Creole (29.6%). There is a sharp drop in the percentage of members speaking any other language based on both census and Amerigroup data (2.6% for Asian and Pacific Island languages based on census data and 1.4% for Asian and Pacific Island languages based on Amerigroup data). Data from HHSC enrollment files indicated the predominant language after English was Spanish or Spanish Creole for Amerigroup (24.4%), Amerigroup Texas, Inc. (26.7%) and Amerigroup Insurance Company (10.6%). Amerigroup utilizes Voiance Language interpreter service. Data from this source also indicated that the predominant language they provided service for was Spanish; Amerigroup (89.51%), Amerigroup Texas, Inc. (67.93%) and Amerigroup Insurance Company (83.3%). Through review of data, Amerigroup found that the majority of the population is female and primarily based in Dallas (30.5%), Houston (22.8%) and Fort Worth (21.1%) and 12 years of age or younger (58.3%). English is the primary language with Spanish as the second language most frequently spoken. 7 P a g e
LAWS AND REGULATIONS The three major federal legal standards that Amerigroup adheres to related to cultural competency are Title VI of the Civil Rights Act of 1964, Federal Executive Order 13166, and the Culturally and Linguistically Appropriate Services (CLAS) Standards. Additionally, the Texas Health and Human Services Commission (HHSC) has additional requirements relating to cultural competency. Title VI of the Civil Rights Act of 1964 Title VI of the Civil Rights Act of 1964 states that entities, such as companies or corporations, receiving federal financial assistance shall not do any of the following based on protected status: Deny an individual a service, aid, or other benefit Provide a benefit, etc. that is different or is provided in a different manner Subject an individual to segregation or separate treatment Restrict an individual in the enjoyment of benefits, privileges, etc. Treat an individual differently when determining eligibility Select sites or facility locations that exclude protected individuals Federal Executive Order 13166 Amerigroup, as a corporation that receives federal financial assistance, must comply with the following guidelines set forth by Title VI of the Civil Rights Act and Executive order 13166: Ensure that persons with limited English language skills have meaningful access to services Comply with Title VI of the Civil Rights Act The CLAS Standards Amerigroup has adopted all fifteen National Standards for Culturally and Linguistically Appropriate Services in Health Care (CLAS) as a guide to assure that all members entering the health care system receive equitable and effective treatment. Amerigroup disseminates Cultural Competency information to staff through New Hire training. This is also part of the Amerigroup annual mandatory compliance refresher training. In addition, Amerigroup offers ad-hoc trainings such as Lunch & Learn meetings aimed at increasing associate awareness around Cultural 8 P a g e
Competency topics. Amerigroup is committed to improving quality and eliminating health care disparities through the CLAS standards outlined below. Principal Standard 1) Provide effective, equitable, understandable and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy and other communication needs. Governance, Leadership and Workforce 2) Advance and sustain organizational governance and leadership that promotes CLAS and health equity through policy, practices and allocated resources. 3) Recruit, promote and support a culturally and linguistically diverse governance, leadership and workforce that are responsive to the population in the service area. 4) Educate and train governance, leadership and workforce in culturally and linguistically appropriate policies and practices on an ongoing basis. Communication and Language Assistance 5) Offer language assistance to individuals who have limited English proficiency and/or other communication needs, at no cost to them, to facilitate timely access to all health care and services. 6) Inform all individuals of the availability of language assistance services clearly and in their preferred language, verbally and in writing. 7) Ensure the competence of individuals providing language assistance, recognizing that the use of untrained individuals and/or minors as interpreters should be avoided. 8) Provide easy-to-understand print and multimedia materials and signage in the languages commonly used by the populations in the service area. Engagement, Continuous Improvement and Accountability 9) Establish culturally and linguistically appropriate goals, policies and management accountability and infuse them throughout the organization s planning and operations. 9 P a g e
10) Conduct ongoing assessments of the organization s CLAS-related activities and integrate CLAS-related measures into assessment measurement and continuous quality improvement activities. 11) Collect and maintain accurate and reliable demographic data to monitor and evaluate the impact of CLAS on health equity and outcomes and inform service delivery. 12) Conduct regular assessments of community health assets and needs and use the results to plan and implement services that respond to the cultural and linguistic diversity of populations in the service area. 13) Partner with the community to design, implement and evaluate policies, practices and services to ensure cultural and linguistic appropriateness. 14) Create conflict- and grievance-resolution processes that are culturally and linguistically appropriate to identify, prevent and resolve conflicts or complaints. 15) Communicate the organization s progress in implementing and sustaining CLAS to all stakeholders, constituents and the general public. Uniformed Managed Care Contract (UMCC) As a managed care organization(mco), Amerigroup must comply with the Texas Health and Human Services Commission (HHSC) Uniformed Managed Care Contract (UMCC) requirement to have a comprehensive Cultural Competency Plan in place that describes how culturally competent services are administered and Linguistic Access and Disability-related Access are provided. The contract also requires the Cultural Competency Plan to describe how the individuals and systems within the MCO will effectively provide services to people of all cultures, races, ethnic backgrounds, and religions, as well as those with disabilities in a manner that recognizes values, affirms and respects the worth of the individuals, and protects and preserves the dignity of each. GUIDING PRINCIPLES The Guiding Principles for cultural competency are the character and nature of Amerigroup. They are the filters through which we make our decisions. Their meaning, and sometimes expression, are expected to evolve as staff reflect and talk about the principles, and as the 10 P a g e
principles are utilized, to guide decisions and actions. It is the expectation that everyone will follow and reinforce the principles with each other, regardless of position or level. Guiding Principle: We acknowledge that a person s culture is relevant to their recovery and the services they receive. Guiding Principle: We believe that cultural, ethnic, and linguistic diversity enhances the personal and professional experiences of all stakeholders. Guiding Principle: We are committed to developing culturally sensitive practices that can help reduce barriers to effective care. Guiding Principle: We are committed to broadening access for multi-cultural participation within Amerigroup and its network. Guiding Principle: We are committed to educating our staff, Provider network, client organizations and their members, and the community in cultural competency as a right. Guiding Principle: We are committed to promoting models of communication giving voice to all cultures. Guiding Principle: We are committed to ensuring all organizational and individual activities are culturally competent. 11 P a g e
PHILOSOPHY Within the context of guiding principles is the Amerigroup philosophy regarding cultural competency. Amerigroup believes that compliance with treatment plans, preventive and restorative health care are more likely to occur when systems, services and providers are culturally competent. This includes developing attitudes and utilizing knowledge and skills reflecting a cultural competence compatible with the backgrounds of the person served, their families and communities. Within this philosophy, Amerigroup has developed the following definitions: Organizational Cultural Competency is the integration of congruent behaviors, skills, attitudes, policies and procedures, which will come together in a system to enable people to work effectively across cultures. Individual Cultural Competency is the ability to use knowledge and interactive skills to work effectively with people of different cultures. Individual cultural competence at a provider level also includes the acknowledgment and incorporation of the acceptance of various behaviors, beliefs, and values in determining the persons served physical and mental wellness/illness and incorporating those variables into the assessment and treatment of the person. In accordance with this philosophy, Amerigroup has developed a Statement of Diversity: Managing diversity is the key to the Amerigroup competitive edge. On behalf of our members and associates, we create and maintain an inclusive, respectful and equitable environment through effective leadership, policies and practices. Overall, this philosophy includes the expectation that management, staff and providers will attain the knowledge, attitudes and skills to provide effective care and services to people of different cultures and to work within that person s values and reality conditions. 12 P a g e
CULTURAL COMPETENCY STRATEGIC PLAN Amerigroup believes cultural competence impacts every aspect of care and service throughout the corporation, its health plans and provider network. From the broadest of operational perspectives, the strategic plan provides senior management the direction for corporate, health plan and network processes, policies and procedures, clinical as well as administrative, to ensure their cultural relevance. The plan also provides for the structured training of management, staff and providers in a common framework of cultural competency to assist in the integration of the knowledge, attitudes and skills reflective of a culturally competent organization. Therefore, the identified cultural competency objectives and strategies address the total organization and network. Objective 1 Provide a high-performance organizational culture of social awareness, values, cultural sensitivity and customer service that supports, attracts and retains a diverse staff. Key Strategy 1. Recruit and retain a culturally diverse and culturally competent workforce that is representative of the demographic characteristics of the service area. Amerigroup strives to hire associates from cultural backgrounds similar to those of our STAR, STAR+PLUS, and CHIP members. This gives our associates a greater understanding of members cultural norms, languages and folk beliefs, which enables them to work with members on treatment options, resulting in more positive health outcomes. We also strive to hire associates who speak languages similar to the languages spoken in the areas that we serve so that we can minimize the need for outside interpretation. Amerigroup is committed to making it easier for our members to access and receive health care services, and we are proud of our employee diversity. According to Human Resources data (January 2015), Amerigroup employed 894 employees and had 103 managers (manager level and above includes directors, managers, staff/regional VPs, VPs). Of the 894 Texas employees, 59 (58.95) percent represent minority populations and 48.54 percent of Texas managers represent minority populations. In addition, 89.26 percent of Texas 13 P a g e
employees are women and 79.61 percent of Texas managers are women. We build on this foundation for our STAR, STAR+PLUS and CHIP members. In addition to our Cultural Competency training, this diversity enables our associates to educate each other on cultural differences, which can impact our members. Objective 2 Develop a comprehensive training curriculum for cultural competency. Key Strategy 1. All associates receive education and training in culturally and linguistically appropriate service delivery. Training is designed to meeting the following goals: a. To respond to current and projected demographic changes in the United States b. To continue to improve our quality of services and health outcomes c. To meet legislative, regulatory and accreditation mandates d. To coincide with the Amerigroup diversity initiatives Amerigroup requires all associates to take Cultural Competency training during their first 90 days of service, and supervisors are required to ensure the training occurs. Learning objectives include the ability to: 1. Describe laws and regulations concerning cultural competence. 2. Identify the cultural groups served by Amerigroup 3. Assess cultural beliefs that impact a member s world view and how these beliefs impact patient care procedures 4. Explore innovative approaches to better serve our culturally diverse members 5. Identify how culture influences members approaches to patient care 6. Define approaches that promote self-awareness 7. Identify actions taken to accommodate our diverse members and their families 8. Describe techniques to overcome language barriers 14 P a g e
The training is designed to allow for regular review of items covered throughout the training course. Each year, all associates are required to complete a training course on cultural competency as part of the Amerigroup mandatory compliance refresher training. Objective 3 Clinical assessment and plans of care reflect relevant cultural issues. Key Strategies 1. Clinical assessments clearly identify relevant cultural issues of the member. 2. The Member Assessment form contains questions related to primary language preference and cultural expectations. 3. Plans of care are individualized and reflect appropriate integration and utilization of the member s culture (to include race and ethnicity as appropriate). The initial assessment examines a broad range of domains to determine the member s individual situation and risk of adverse outcomes. These domains include physical and mental health, social, economic and emotional status, capability for self-care, the members goals, and the current treatment plan. Assessments are completed via telephone interviews and/or home visits to collect and assess information from the members and/or their representatives. Case managers also obtain information from the members PCPs and specialists, from our Early Case Findings assessments. All of this information is used to determine appropriateness for care management services and to guide, develop and implement the care plan. Care plans are individualized using the industry-recognized Case Management Society of America approach. Working closely with the member and/or his or her representatives, case managers develop care plans that include long- and short-term goals and the scope, duration, and frequency of services, authorizations, and scheduled re-evaluation of services recommendations. Members needs for social, educational, therapeutic, and other non-medical services are also considered. By working closely with members and/or their representatives, case managers help ensure that members cultural needs are met in the development of their individualized care plans. 15 P a g e
Objective 4 Provide language assistance services, at no cost, to members with limited English proficiency or impaired hearing at all points of contact. Key Strategy The health plans and providers assure the availability of interpreter services through either bilingual staff or qualified interpreters. Amerigroup policies are designed to ensure members with low English proficiency or hearing impairment have meaningful access to health care services, assisting them in overcoming barriers and allowing them to fully utilize services/benefits. Language assistance options are available at no cost to the member. Oral interpretive services are available either in-office or telephonically. Members can contact our Member Services to arrange for services. Members who are hearing impaired can use TDD/TTY for telephonic interpretation. Members can also contact Member Services to arrange for in-office sign language assistance at the provider s office. Members receive information on how to obtain interpretation services in the member handbook, as well as through calls to Member Services. Providers are able to obtain interpreter services for telephonic contact and in-office visits. Information on how to obtain these services is documented in the provider manual and through other means such as the provider newsletter. Amerigroup employs many associates who are fluent in Spanish. In addition, associates receive training on how to assist members with language difficulties and access our in-house bilingual staff, as well as contracted interpreters via the Language Line, Voiance. Associates also receive training on how to access local interpreters and the TDD/TTY 711. If a member who has language difficulties/bilingual needs calls the Amerigroup Member Services phone line at 1-800- 600-4441 after-hours, they will be routed to the Nurse Helpline. The Nurse Helpline has access to Voiance to access translation services. In addition, Amerigroup can also assist members with interpreter services for doctor visits for those who do not speak English or who are hard of hearing. This service is at no cost to the member and the member must notify the health plan 24 16 P a g e
hours before the appointment. Associates are trained to offer interpretation services whenever they encounter a member who can benefit from such services and educate members about the availability of services. Objective 5 Easily understood member-related materials are available. Key Strategies 1. Vital documents are available in the member s language of preference. 2. Documents are available for members in a variety of formats, i.e., large print, audio, etc. Written materials, such as member handbooks and member notices are available in English and Spanish, Braille, large print and audio versions. Written member materials are available in other languages upon request. All member materials are written at or below a 6th grade reading level, according to the Flesch-Kincaid Grade Level scale. Information on our website is available in both English and Spanish. To ensure materials are culturally appropriate, Amerigroup has an internal team that reviews all materials available to members. The review is conducted by subject-matter experts in Health Promotion, Regulatory, Medical Management, Legal and other departments as necessary. This enables us to ensure that materials and programs meet cultural competency requirements, are understandable to members and address their health education needs. Objective 6 Develop collaborative relationships with communities. Key Strategies 1. Establish collegial relationships and utilize resources of Federally Qualified Health Centers and community-based organizations. 17 P a g e
2. Offer educational programs and other special events to communities that address health beliefs and needs of ethnic/cultural populations. Amerigroup has developed close relationships with community-based organizations and works collaboratively to improve health outcomes for members and the community at large. We establish relationships with community-based organizations, advocacy groups and industry partners to provide the broad range of services members may require outside of the scope of the managed care program. Amerigroup provides Ameritips to community-based organizations in need of bilingual health information. We also use educational materials developed by community organizations when they are of benefit to our members. We work closely with local minority health coalitions and sponsor educational seminars on minority and disability-related topics. Educational programs highlight areas of concern for members of different ethnic/cultural groups to raise awareness of attendees regarding their risk factors. Objective 7 Ensure culturally competent care is delivered to all members. Key Strategy 1. Credential providers of ethnic and racial backgrounds similar to members in order to offer members care that is compatible with their cultural health beliefs and in their preferred language. Amerigroup strives to credential providers who understand and appreciate the socio-economic and cultural challenges that our members face, in addition to their complex medical needs. Initial credentialing for facilities includes an on-site visit and a signed attestation is obtained from providers offices to determine compliance with HHSC standards for physical accessibility Provider directories contain information on the languages that are spoken in provider offices so that members can make informed decisions when selecting providers. Providers receive information from Amerigroup on how to access interpreters for members through provider orientations and provider manuals or by contacting our Provider Services department. 18 P a g e
We understand members disposition towards accessing and engaging in care and service programs can depend on the trust that comes from shared language and experience, as well as the ADA-compliant accessibility of our care and service sites. We work to recruit and retain a diverse provider network. We seek PCPs and specialists located near members residences that represent the cultural, ethnic and language preferences of our members and often have life experiences in common with our members. We utilize a local approach to network development by assessing the natural patterns of accessing health care in Texas communities - which are extremely diverse across the state - to identify providers who already serve the population, and we target these providers for inclusion in our network. In addition to evaluating the ethnic and racial composition of our members, Amerigroup also reviews the self-reported race/ethnicity of our provider network and their languages spoken. Amerigroup found that the primary race/ethnicity for the provider network was White, Non- Hispanic/Caucasian (67.78%), followed by Asian or Pacific Islander/Pacific Islander/Asian Pacific American (13.52%), Hispanic (10.59%), and Black or African American/Black Non-Hispanic (7.26%). The primary languages spoken, other than English, were Spanish, Hindi, Vietnamese, and Chinese. In order to gather additional information about how well our provider network is meeting our members needs, Amerigroup added a supplemental question to the 2014 Adult and Child CAHPS surveys. The question was, How would you rate Amerigroup in providing doctors who represent your cultural and language needs? Ninety percent of respondents on the Adult and 96 percent of respondents on the Child CAHPS survey indicated Amerigroup was Excellent, Very Good or Good in providing doctors who represent their cultural and language needs. Amerigroup works to ensure that its provider network is able to meet the cultural, racial and ethnic needs and preferences of its membership. Therefore, we have incorporated in our network practitioners in the communities in which our members live that are more aligned with the racial and ethnic makeup of our membership. We have Provider Relations representatives who match the demographics of our membership and who work with practitioners in our 19 P a g e
communities. For example, we have some Vietnamese Provider Relations representatives working primarily with Vietnamese practices as well as Spanish-speaking Provider Relations representatives who work primarily with Spanish-speaking practices. This enables us to develop strong relationships with our provider community to keep them in our network. We also monitor access and availability to ensure our network meets the needs of our membership. Cultural Competency Training is also available on our provider website and we recommend that all of our providers participate in the training. Objective 8 Assure stakeholder participation in the service delivery process. Key Strategies 1. Conduct Member Advisory Group meetings to represent and advocate for all the diverse people, families, and communities we serve. In addition, the Member Advisory Group meetings identify and evaluate involvement of community resources. 2. Ensure member feedback in the development of the care plan. 3. Ensure the Health Plan Member Advocate/Liaison role includes assisting ethnic/cultural populations. As previously addressed, the Member Advisory Group solicits feedback from members and community-based organizations regarding the cultural appropriateness of member materials and programs. Care plans are developed with the member and/or the member s representative. Member Advocates/Liaisons represent the interests of all members. Their responsibilities include handling complaints, ensuring members are informed of their rights and responsibilities and helping them understand their benefits. They serve as ombudsmen and interact with members at events and telephonically. 20 P a g e
Objective 9 Identify opportunities to implement culturally sensitive targeted initiatives that address disparities in health care. Key Strategies 1. Through participation in a corporate and health plan Healthcare Disparities Workgroup, expand programs for diverse members in Texas. 2. Offer culturally sensitive education and services to African American and Hispanic members. Participation in a cross-functional work group to identify ways health care disparities can be addressed in a culturally sensitive manner is key to implementing a focused approach to clinical improvement initiatives. Additionally, a Population Assessment of Amerigroup membership enables identification of critical conditions and health care needs that require targeted initiatives to maximize improved outcomes. HEALTHCARE DISPARITIES WORKGROUP Amerigroup is committed to identifying and addressing health care disparities among our members and within their communities. We endorse HHSC s definition of disparity as the unequal or different treatment or services provided to one group as compared to another group, and we understand that it can refer to how one is treated or the types, quantity, or quality of services made available. Amerigroup built the Healthcare Disparities Program with the sole purpose of reducing health care disparities, which disproportionately affect our members. A multi-departmental Healthcare Disparities (HCD) Workgroup was assembled to further our commitment to reduce disparities in Texas. The HCD workgroup has focused on aligning the components of our Cultural Competency Plan with industry standards. The HCD Workgroup developed a solid program to include: Mission and Vision statements; Objectives; and S.M.A.R.T goals. Mission: To improve the overall health of Texas Amerigroup members in a culturally sensitive manner by reducing health care disparities. 21 P a g e
Vision: A healthier Texas in which all members have an equal opportunity to health care through anchoring partnerships in communities, promoting health education and advocacy in order to live healthy and active lives. HCD Objectives: 1. Provide education and tools to help providers address health care disparities, thus improving health outcomes for our members. 2. Maintain ongoing communication with minority, ethnic and other populations, including the underserved, who experience healthcare disparities. 3. Develop effective strategies that have an impact on minority groups and their health outcomes. 4. Foster existing relationships and develop new relationships with community partners in Texas. 5. Increase cultural competency awareness amongst Amerigroup associates to decrease health care disparities. The Healthcare Disparities Workgroup works to develop specific, measureable, action-oriented, realistic and time-bound (S.M.A.R.T) goals to enhance training materials and make them more visible to our Texas associates and provider network. Another program goal is to develop a multicultural health program aimed to reduce health care disparities. The Healthcare Disparities Workgroup recognizes that the decisions and interventions we make can have a profound, immediate and lasting impact on our members lives. For this reason, we are committed to fostering partnerships with our provider network, augmenting Cultural Competency Awareness amongst the staff, and developing replicable models to reduce healthcare disparities through identifying members of various racial and ethnic groups to develop strategies to improve health outcomes. 22 P a g e
AUTHORITY, STRUCTURE, AND RESPONSIBILITY The cornerstone of the foundation for the Amerigroup Cultural Competency Program is the top down and pervasive commitment in our organization. It begins with senior management and extends to frontline employees who have direct contact with members. All commit to the philosophy, objectives and goals of the Cultural Competency Plan. At the Texas health plans, the Quality Management Committee (QMC) oversees and monitors the implementation of the strategic plan to ensure the provision of health education and outreach services to members and potential members to meet community cultural, linguistic and social needs. SUMMARY In summary, Amerigroup is committed to being culturally competent to allow us to better serve our members. We do this by recognizing members unique needs and knowing how to successfully communicate vital information about their health care. 23 P a g e
ACKNOWLEDGEMENT & APPROVAL Amerigroup 2015 Texas Cultural Competency Plan has been received and approved. LeAnn Behrens President, Amerigroup Medicaid Health Plans - Texas & QMC Chair (print) February 3, 2015 President, Amerigroup Medicaid Health Plans - Texas & QMC Chair (signature) Date 24 P a g e