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hospital’s culturally diverse patient populations. This realization and commitment to culturalcompetency led to the development of a master facility plan that called for 68 privatematernity suites to serve a diverse population of women and their families. However, whatwas targeted to promote culturally competent care for minority populations was also anattractive option for the full range of patients who give birth at Holy Cross. Growth inobstetrics volume among all patients who come to Holy Cross led to overall volume growthand improved financial performance for the hospital.• Language Access ServicesLanguage services are the front line of CLAS. Language barriers, in the absence of adequateinterpretation and lack of translated patient information and materials, preclude the provisionof equitable, quality health care. Language interpretation errors between health careproviders and LEP patients have resulted in dangerous and costly consequences. CLASStandards 4 through 7 outlines the linguistically appropriate services for health careorganizations serving patients with limited English proficiency.As is the case nationally, the CLAS projects included in this report use a variety ofapproaches to assure adequate language services. Perhaps because there are many morelanguage services initiatives from which to choose, it was easier to find these cases, describethem, and present more robust documentation about their successes. Finding ways to provideappropriate and thorough language services while simultaneously managing the costs ofthose services is a common theme. The business cases for Contra Costa (Remote Video/VoiceMedical Interpretation Project), Holy Cross Hospital (Volunteer Interpretation Project andGroup Discharge Classes in Spanish), L.A. Care Health Plan (Health Care InterpretationProject), and The Young Children’s Health Center (Bilingual Employee Incentive Program)all provide examples of how the implementation of language access services resulted inquantitative and qualitative business benefits and outcomes.Contra Costa Health Services (Martinez, CA)Before 2005, Contra Costa Health Services relied on 16 full-time bilingual employees andone full-time supervisor to provide language interpretation services throughout its health caresystem. To meet the language interpretation needs of the service population, Contra CostaHealth Services also contracted with two major language services agencies at an annual costof over $200,000 and rising. In an attempt to manage these language costs better and toassure culturally competent care for the limited English proficient (LEP) population atmultiple sites on a 24 hour basis, Contra Costa Health Services partnered with three NorthernCalifornia county hospitals (Contra Costa, San Mateo, and San Joaquin) in the creation of theHealth Care Interpreter Network (HCIN). The network developed the remote video/voicemedical interpretation (RVVMI) project to provide language translation services to patientsat their bedside. The RVVMI is a model of shared interpreter services utilizing the mostadvanced video and voice-over internet protocol (IP) technologies to complement in-personinterpretation. Contra Costa Health Services sought to integrate the remote video/voice callcenter systems throughout its organization and to provide the lowest-cost, highest qualityinterpretation services at all Contra Costa Health Services care venues.The project’s initial price for the exchange of language service among the tri-partnership was$.75 cents per minute as compared to Contra Costa’s previous pricing for contractinterpretation services at a rate of $1.55 per minute (cost savings of $0.80 per minute). In14
early 2006, Contra Costa assessed the cost value of RVVMI and launched a 10-week pilottest for Spanish speaking patients that achieved an immediate cost savings in contractedinterpretation services of over $25,000. The RVVMI project has increased the number ofinterpretations per day from the previous 10-15 in-person interpretations to as many as 30remote interpretations per day.Holy Cross Hospital (Silver Spring, MD)In 2001, Holy Cross Hospital established the Volunteer Interpretation Project whichcoordinates hospital interpretation services by 175 staff volunteers who speak more than 60languages. These staff volunteers report 10,000-12,000 in-person interpretations annually,ten times the number of telephone interpretations purchased from an outside vendor. Thestaff interpretations are typically twice as long as telephone interpretations purchased fromthe vendor. Without the staff volunteers, all interpretation interactions would becomecontracted telephone interpretation services which now average 20 minutes in length, and thecost to the hospital would be $320,000; if the same calls were kept to the average 12-minutesin length (for the previous telephonic tool used), the cost for contracted telephoneinterpretations would be $190,000.L.A. Care Health Plan (Los Angeles, CA)L.A. Care Health Plan has also undertaken a number of initiatives that center aroundlanguage translation, one of which is the Traditional Safety Net Telephonic InterpretationProject—a technology “toolbox” to eliminate language barriers and assist providers incommunicating face-to-face with patients who have limited English proficiency, using anover-the-phone interpreter and a dual head set. The pilot project received high marks fromboth patients and their doctors. The cost to L.A. Care for the interpretation services duringthe three month pilot test was $939—for the use of telephonic interpretation services used bythe three (3) pilot sites participating in the study. The immediate availability of telephonicinterpretation services provides a necessary resource for patients who need services inlanguages that bilingual staff are not available to support. In the cases where on-siteinterpretation is not available, telephonic interpretation services provides one solution toimmediately address a need. In addition, the ease of implementation and the effectiveness ofthe process have resulted in an increase in use of interpreter services by providers.L.A. Care also implemented the Health Care Interpretation Project and trainedapproximately 246 health care providers in 2004 and 270 in 2005. With the hiring of one-FTE ($74,480.00) to provide interpretation training of staff in 2004-2005, L.A. Careproduced an annual cost savings of $183,500 (the average yearly expenditure prior to hiringthe FTE was $258,000.)Molina Healthcare, Inc. (Long Beach, CA)The TeleSalud project was established in 2004 as a separate department within MolinaHealthcare of California offering direct accessibility for medical interpretation services toaddress the health and language needs of the underserved limited English proficient (LEP)Latino population living in the Inland Empire region of Southern California. The project wasconceived to provide Molina’s members with service in their declared language of preferencewith 24-hour live and direct access to a Registered Nurse for nurse advice and interpretationassistance. Molina Healthcare implemented the TeleSalud project using a two-tiered modelwith non-clinical staff receiving the intake calls and registered nurses receiving calls15
Page 1 and 2: MAKING THE BUSINESS CASE FORCULTURA
Page 4 and 5: PREFACEToday there are more than 30
Page 7 and 8: Major Themes• Minority and LEP Co
Page 9 and 10: INTRODUCTIONHighlights:• Overview
Page 12 and 13: NATIONAL STANDARDS FORCULTURALLY AN
Page 16: equiring interpretation, clinical a
Page 19 and 20: CLAS BUSINESS CASE PROJECTS AND RES
Page 22 and 23: ProjectOrganizational SettingCLAS A
Page 24 and 25: BUSINESS CASE THEMES,KEY FINDINGS A
Page 26 and 27: specific purpose can result in larg
Page 28 and 29: CONCLUSIONS AND RECOMMENDATIONSThe
Page 30 and 31: APPENDICESAppendix A: Bilingual Emp
Page 32 and 33: continues to provide linguistically
Page 34 and 35: start for the children at YCHC. The
Page 36 and 37: patients. This has become an attrac
Page 38 and 39: information exchange. For example,
Page 40 and 41: • Technology: A dedicated web sit
Page 42 and 43: APPENDIX FMultilingual Health Resou
Page 44 and 45: WHO TO CONTACT. For more informatio
Page 46 and 47: its internal expertise to meet the
Page 48 and 49: Remote Video/Voice MedicalInterpret
Page 50 and 51: APPENDIX IStaff Volunteer Interpret
Page 52 and 53: APPENDIX JTeleSaludMolina Healthcar
Page 54 and 55: APPENDIX KTraditional Safety Net Te
Page 56 and 57: Training for Interpreters in aHealt
Page 58 and 59: and training purposes. From 2001 th
Page 60 and 61: linguistically appropriate services
Page 62 and 63: APPENDIX O- Project MethodologyThe
Page 64:
A Family Physician's Practical Guid
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