Top ways to attract, manage diverse patient populations

Finding meaningful ways to connect with patients of diverse backgrounds is a struggle for health plans for various reasons. Language barriers, lack of education on healthcare, and ineffective communication efforts leave many minorities underserved.

“There’s a lot of work that needs to be done to get plugged into targeted communities using novel, unique, innovative strategies and technology,” says Silas Buchanan, CEO of the Institute for eHealthy Equity. “As we transition into accountable care organizations, plans have to think about reaching out to the patient as a consumer.”

Success in value-based models like accountable organizations also requires higher patient engagement, as people who are more engaged use fewer health services, which in turn lowers healthcare costs, according to research by the American Health Information Management Association.

For that reason, plans and providers must make timely, accurate and culturally appropriate health information a priority in their business strategy. Understanding how underserved communities interact with healthcare systems is key, Buchanan says.

“Payers can keep track of patients when they are in care, but most healthcare happens in the community or the home. A relatively healthy person of faith may spend only 15 minutes per year in a doctor’s office, but more than 70 hours per year at church. So I would have to ask, does a doctor or a preacher have a greater chance of influencing that person’s health behaviors, particularly when it comes to the critically important everyday activities (eating, moving, socializing) that contribute to at least 40% of overall wellness?" Buchanan says.

Specialized skills needed

Though the Affordable Care Act (ACA) has helped millions of Americans gain insurance, there are still millions of uninsured in minority population groups. More than 25% of Hispanics younger than age 65 and nearly 14% of African Americans younger than age 65 lack insurance, as of April 2016, according to the CDC National Center for Health Statistics.

And of those millions of newly insured patients in the healthcare system, many African Americans, Hispanics, and others from large immigrant populations, still need to be educated and encouraged to properly use their new services, say experts.

Some health plans are hiring or consulting with specialists who can help them connect with targeted populations in order to build meaningful relationships, says Liz Reyer, vice president of consulting at GfK Custom Research North America. People who have a deep understanding of health plans, and can also speak in several languages, or specialize in target marketing are hard to find, but necessary, she says. These skills are important for clinical staff, as well as sales, customer service, and administrative staff who spend a lot of time explaining services and benefits to consumers.

Next: Cultural differences to consider

Family matters

“There are fundamental things about minority communities that health plans need to tap into in order to increase patient engagement in these populations, Reyer says, adding that there are often cultural differences that health organizations need to consider when interacting with people from different backgrounds.

“I don’t think mainstream organizations do a good job of recognizing the importance of family. Health plans can accomplish so much more when leaders from within the community can talk about the ACA instead of an outsider,” Reyer says.

Reyer has worked to bring healthcare messages to people in the Hispanic, Somali and Hmong communities in the Minneapolis, Minnesota area. She says that often, younger adults or children must interpret healthcare messages for adults, which causes awkwardness and a shift in the family power structure.

“It is especially hard for older refugees when their kids are the linguistic buffer,” Reyer says. “That’s why hiring neutral interpreters has been an area of focus. When a child has to be in the middle of very detailed and intimate healthcare information, it can cause patients who don’t speak English to not be truthful or be withdrawn from the process.”

Next: Community collaborators

Community collaborations

It is important that trusted leaders within minority communities help craft and deliver healthcare messages in order for them to be effective, Buchanan says.

“Working through organizations that are known, loved and trusted effects how messages are received in the community. It’s important to note, that not everyone can reach people. The messenger means quite a lot more than the message at times,” says Buchanan, who helps healthcare organizations connect with African American organizations through authentic messages.

Buchanan says that establishing trust in the African American community is essential in increasing engagement. A 2010 report by the Journal of General Internal Medicine suggests that African American men have a higher mistrust of the healthcare system than white men, and this can lead to delays in preventive health services.

"Many times people on the ground in these underserved communities are not engaged in the planning and program development of healthcare initiatives. Often there is no funding made available to community organizations to implement these initiatives. And they aren't comprehensive, meaning they don't serve interest of the community in ways that have been defined by community leaders,” Buchanan says. “What we do is have very forthright and transparent conversations with health organizations about the history of marginalization in African American communities. This makes the message from the health plan better received because we have the relationships from known, liked and trusted members of the community.”

Reyer agrees that many immigrants may distrust the U.S. healthcare process because it is very different from how healthcare operates in other countries.

“There’s a lot of suspicion, and it’s justifiable. In the U.S., we think ours is the dominant insurance model, but in other countries healthcare is so different. A lot of learning has to happen,” Reyer says.

Next: How technology can help

Technicalities

As more consumers receive messages through mobile devices, it is important that health plans work to adapt their messages to be both culturally and technologically appropriate.

According to a Pew Research Center Report, 12% of African Americans and 13% of Hispanics are “smartphone-dependent” and are less likely to have home internet service, compared with 4% of whites.

In 2014, the Institute for eHealthy Equity’s Text4Wellness e-health initiative was tested in African American churches in Atlanta and in Cleveland and Columbus, Ohio, for nine months and received 2,500 participants to opt-in. The text message program, which received a $100,000 grant from Aetna, included wellness and fitness information, says Buchanan. In July, the institute is partnering with the African Methodist Episcopal Church for the organization’s general conference, to connect with the church’s health ministers.

The church has 2 million African American members, and 40% of its church members will be given timely health information crafted from the institute’s relationships with health plans.

“We listened to African Americans in faith-based communities, and worked through known and loved organizations, and that was effective,” Buchanan says. “Our approach was culturally appropriate, but also linguistically accurate and ‘sticky’ for consumerism.”

Though using technology to reach diverse patients seems to be an easy solution, it should be used as one part of a larger, targeted- outreach strategy.

“It’s a real mistake to think technology will solve all of your marketing problems,” Reyer says. “Data shows that it is just one important aspect of overall effective human connection. Being able to have a personal connection, along with some digital tools and clear information, makes for long-term relationship building.”

Donna Marbury is a writer in Columbus, Ohio.